Shoulders

It seems that lately we've been seeing a lot more shoulders. The most intersting observation is that they seemed to be mostly related to scapular dysfunction as the problem where as their point of pain is just a symptom. How many protocols develop and emphasize the scapula in rehab either post operatively or not?

plyometrics

If you have been in fitness long enough you have heard of a plyometric or a plyo for short.  A plyo is a method used to gain muscle strength.  It utilizes the stretch-contract property of the muscle to produce greater force.  Such activities include jumping, bounding, hopping among others.  However I have recently asked the questions:
1. Is a plyometric basedon the range of motion?  In other words, is an activity a plyo if only 5 degrees of joint flexion os achieved prior to the contraction?
2. Does the strength of the contraction matter?  In other words, after the stretch, does the muscle have to fully contract in order for a plyometric effect to occur?
3. Does the movement have to be voluntary?  In other words, what if the stretch and/or the contraction is a reflex?

Just some things to consider when attempting to come up with strengthening techniques for someone who may not have full ROM.

Functional Hip Stretch

Lately it seems that I have had several hip/back issues to deal with. And in each case teh remedy has been a functional hips stretch.



Have the individual stand on the effected leg and with the other foot have them perform a toe tap in the transverse plane allowing the hip to "open and close". Think of them standing on the fact of a clock with there right leg let's say. The right foot will be placed with the toes facing 12. With the other leg they will see how far they can reach, for example, can they reach from 2 and then pivot backwards and toe touch the 6? Do not hold at either position for any length of time. This is a very effective way to lengthen the external rotators (ERs) and teh internal rotaors (IRs) of the hips while weightbearing and against gravity.



Try it and see what you think.

Shoulders

Seems like we've had a lot more shoudlers lately. The most interesting part is that the scapula seems to be the real problem despite the pain is located elsewhere. The other interesting think about the scap is that the LE feed into it and help to make it move more effectively. But how many protocols emphasize the scap in post op rehab or rehab in general?

Baby Fox

Just down from our house is a den with 3 baby foxes. I was fortunate enough to get a picture of one of them. Check it out!!

Mental Toughness Myth?

Vern Gambetta has a post on his blog today about mental toughness. His opinion is that mental toughness is a myth and a cliche'. Cliche' maybe but myth? Come-on! Mental toughness is the ability to ignore that little voice (internal or external) that says, "Ok it's time to quit. There's no need to keep going, that's good enough." Or it's the circumstance that threatens to break your spirit but you continue to press on. This character trait can and should be developed. In Vern's blog he also mentions mindfulness. There is a vast difference in my mind between bull headedness, which some would call mental toughness, and mindfulness. Mental toughness must be accompanied with a moral compass and the wisdom to know when you are being mentally tough and rightfully so or just bull headed and wrongfully so.

What is cusious to me is how Mr. Gambetta so highly relies on the facts of science in his training methods and principles but seems to be able to state his opinions as fact but appears to not have any scientific back support at all.

Is mental toughness a myth? No. Can it be developed? Yes Can it be mistaken for other less desireable character traits? Yes.

In the blog it was also suggested that one of the qualifications of mental toughness is "getting it done". I'm sorry but depending on the situation, not getting it done is not in direct coorelation to mental toughness. Someone can be extremely gifted with mental toughness but still falls short of "getting it done" whatever that means. However I would have to say that a certain amount of mental toughness is required when "getting it done" is achieved.

Feet

Right now I've got a female former DI cross country runner that still trains like she's gonna lose her scholarship. We are seeing her for a torn posterior tib. Interesting, during the eval, her arches were almost exactly the same on both feet. One side she's had multiple stress fxs, plantar fascitis multiple times, etc. The other side, she's never had an injury. However she has always had orthotics in her shoes since her early years in high school.
Oh did I mention that her navicular has migrated medially and her talus pronates extremely bad.
If the feet were the problem, and she ahd orthotics in both the left and right shoes? Then why is one side never injured while the other is frequently injured?

The Silent Predator

Here is a post to an article I wrote about the effects of deer hunting on the human heart.

http://www.ncwildlife.org/pg09_NCWildStore/sample_aug07.pdf

Don't Judge A Book By It's Cover

Once again we are reminded not to judge a book by it's cover. I've heard people say different things to define themselves such as "my work defines me" or a person is defined by what they do and not what they say. We are what our lives reflect of us both in private and in public, in speech and in action, externally and internally, and by our talents of lack thereof.
Watch the reaction of the judges and the audience before her performance.

BUT also Listen to what the woman in the middle says at the end of Susan Boyle's Performance.

http://www.youtube.com/watch?v=9lp0IWv8QZY

Pitching and external rotation.

The smell of freshly cut canvas of green, dew from the grass wetting your cleats, leather and the crack of the bat. It's that time again, Baseball season. Still we see conditioning programs focusing on the external rotators (ER) of the shoudler (supraspinatus, infraspinatus, teres minor). If you've been in baseball long enough you realize that the ERs of the shoulder do not perform external rotation of the humerus while in the acceleration phase of the pitching motion. The importance of the ERs come into play in deceleration but only a fraction of the percentage. The majority of the deceleration comes form the opposite low back, hip and leg. See Serape Effect.

There is little need to train the ERs to concentrically contract. The emphasis should be on teaching the entire body to share the responsibility of deceleration in order to protect the shoulder.

The Spine

Once again I am thinking of a statement said by Dr. Stuart McGill. He gave the anaogy that the spine is like a clothes hanger and will has a breaking point when bent too many times. However there are a decent number of people who never have to see a Dr. for their back because they don't have back problems. My own father for example is 76 years old and I asked him if he ever had back problems. His answer was "No". He worked in manual labor for the majority of his life and before that was a 3 sport athlete. We always focus on the 80-90 % who have back pain but why don't we ask the question, "Why do the 10-20% NOT have back pain?"

The second question I would like to ask is, "Why that particular vertebrae?" Why not another one? If we can find the answer to "Why this one?" I think we may be able to fix more than just the symptoms.

For a great perspective on this go to the Gray Institute's website and read this months newsletter on knees.

To brace or not to brace...the back/spine?

Here's where I get I little fuzzy on the idea of bracing.
Bracing is essentially a co-contracting of the "core" musculature correct? If that is true, in movement, especially of the spine, their must be an agonist/antogonist relationship between the contractors (shortening) and noncontractors (lengthening) muscles. In terms of athletics the spine moves. In the industrial setting where I work, we see the interspinalis muscles become (in my humble opinion) de-conditioned especially in transverse movement. As a result, we still deal with back pain even though their "core" muscles are strong as can be. I also don't know that I buy the idea that our spines only have so many
"flexes" in them before they break. The analogy used was that of a wire bending which will eventually break. Unlike a wire, the body has the potential to actually become better with use. So for me the search continues to find that balance between bracing (protecting the back) and moving (using the back) to perform functional activities in a wide variety of settings.

Rest and Recovery

I will remember the first time it hit me. The time when I realized how important rest is. Vern Gambetta pointed out that it's not during the conditioning that we get better but during the rest after the conditioning where the adaptation takes place. This truth was HUGE for me to understand.

This week I've had to address the issue of rest and recovery in 2 completely different environments. The first environment is at the industrial facility where I work my full time job providing rehab and fitness programming. the individual is being seen post op shoulder debridement. Well on their own they have managed to turn a relatively simple rehab process into a much more complicated situation than it needed to be merely because they over worked the effected shoulder on the outside of rehab. I had to explain the reason why his RC is rebelling via spasm. Now that he has listened to me, the pain and spasm has decreased. Why? because of the appropriate rest.

In the second situation the DIII coach that I've been working with asked me, "My team looks like they are tired during practice and in games. What should I do?" My response, "Rest". I've made this mistake as an athlete myself. During the seaons isn't the time to get the players into game or tournament shape. This is why the off season is crucially important in developing those basic biomotor qualities of an athlete.

Athlete vs Athleticism part 2...

In a comment the question was basically why are we trying to redefine a word that seems pretty clear by its definition. Athlete or athleticism basically refers to an individual who participates in a game or sport requiring physical components of strength, stamina, etc. The comment was correct in pointing out that the word needs no new definition.

However what wasn't asked is why was the topic presented in this manner to begin with?

The reason I asked the question for a definition of athleticism was to break up the confines of rehabilitation and therapy. Too often we see an individual in our clinic or ATR and we immediately go to work on the area in question. The mantra train movements not muscles comes to mind (Gary Gray). So is the idea that we should train/rehab the whole person not just the 1 muscle that may have tendonitis. In the industrial setting where I work the production workers could all benefit from improved physical function as to prevent injury during their jobs. If I only rehab their 1 joint or muscle that has pain I've really not done my job. However if I can improve there overall function then I may have prevented them from becoming the next recordable. Perhaps I can even convince them to become the next fitness user at our facility.

So instead of looking at your next patient in terms of Range of motion, goniometer measurements, and 4+/5 during a manual muscle test try seeing them in terms of agility, balance, coordination, functional strength, functional endurance, functional reaction time.

Do we need to drop the swelling measurements? Maybe not but look and rehab the next patient as a whole and not as an injury.

Coaching, Teaching, Mentoring

No doubt I could find countless blogs about how to play this sport or that sport. And no doubt that I could hire someone to train me to become as good as i can in one of those sports. Personally my sport was baseball. Then one day when I was coaching a little league 13 year old team my perspective on coaching/teaching/mentoring changed.

One day during practice a 13 year old boy came up to me and told me what his father had said to him. His father told him that he threw like a girl and he would never be able to throw. The way the boy said this to me was not what you would expect. He said it so matter of fact, as if he actually believed his dad. Why wouldn't he, after all he was his father? So it was my mission to teach this 13 yo boy how to throw. I didn't want to teach him to be the best on thea team or to be the next Nolan Ryan. I wanted to teach him how to throw to prove the dad wrong. His father never came to the games by the way.

As the season went on the boy kept getting better and better. Then one day it happened. His dad actually came to a game. His son was playing right field when a sharp ball was hit in the gap all the way to the fence just under the 360 ft sign. His son picked up the ball and threw it on a line drive all the way to second base. No he didn't throw anyone out, or help us get out of the inning. But with that throw a relationship was restored, improved or whatever you want to call it. From that day on his dad didn't miss a game.

The kid learned from me only how to throw a baseball. I leanred from the kid that sports are a great avenue to reach someone deep in their soul. That day a boy began to walk with confidence, and a father was proud of his son and I walked away able to see the bigger picture.

Volleyball wrist snap and other myths...

Below is a link to Vern Gambetta's blog. Today he talks about the imprtance of coaching as well as some VB myths. Interstingly enough the VB coach at SUNY Potsdam was telling about the same myths.

Check it out.

http://www.functionalpathtraining.typepad.com/

Endowed by our creator...

I heard this phrase today and it brought up some questions

1. If a person doesn't believe in a creator do they still believe in inalienable rights?

2. If they do, who gives these rights to us or where did they come from?

If no creator exists, do governments give us these rights? If so which government is the authority? and who determines which government is the authority?

Just something to think about.

Stretching...The topic resurfaces once again!!

Stretching The Truth



Written by Allan Besselink, PT, Dip. MDT
Monday, 27 October 2008
It's finally cooling off in Austin. With cooler weather comes the start of all the marathon training programs in preparation for the Austin Marathon in February. And with cool fall weather and marathon training comes ... yes, the questions about stretching.

Stretching has become a panacea. So let's attempt to put a few things to rest with some good sports sciences evidence - though I suspect much of it may come as a surprise to many.

Let's start with a couple of interesting facts. Research on 5K runners has indicated that the fastest runners are the most inflexible. The increased passive muscle tension effectively gives the runner "free speed" because it's not requiring energy to produce it. Add to that the lack of research supporting the relationship between stretching and ---insert injury here --- [options include plantar fasciitis, achilles tendonitis, IT band syndrome, etc]. So we have to assess stretching by starting with the questions "why am I stretching in the first place?".

"Doesn't stretching makes my muscles longer?" First of all, the literature is very clear on one thing - stretching (as it is performed by most athletes, coaches, and health care practitioners) does not actually make the muscle longer. What it does do - is simply increase your tolerance to stretching - plain and simple.

It is important to discuss what stimulus needs to occur at the cellular level to evoke changes in the muscle, tendon, or surrounding collagen structures. There are two primary potential effects of stretching - a lengthening of tissue, and a neurological relaxation of muscle and the central nervous system.These are two different intents requiring two different strategies.

Would the right degree of stimulus (tension) cause these tissues to lengthen? Yes. How many times must you take the tissue to it's fully lengthened position per day? The literature would indicate 40 to 50 repetitions a DAY - minimum. How much stretching does the average athlete do? Nowhere near that much! It would require many many repetitions to the end of your range of motion for you to make true changes to the tissue (as opposed to the improved "tolerance" you might experience) and these would then have to be utilized functionally (i.e in your sport activity) to maintain them. Unfortunately, the task to get the muscle and surrounding tissues to lengthen is a rather significant one that is certainly not occuring with one or two repetitions by the athlete (or provider).

A sustained gradual stretch would be an appropriate stimulus to help to get the muscle to relax neurologically. This would be beneficial as it would simply decrease the tone of the muscle and to initiate recovery. But having said that, the timing of the stretching would be AFTER exercise, not beforehand.

"I thought that stretching needs to be done before and after my runs." As part of the warm-up, the answer would be - no. You are about to go on a run. You are about to get your central nervous system firing. If you have elevated your core temperature (breaking a sweat), then the only other thing you would want to do would be activities that help to get your central nervous system "fired-up". Gradual stretching before an activity does exactly the opposite - it gets everything to relax. This is counter-intuitive and may actually put you at risk. And yes, the increased risk factor has been documented in the sports sciences literature. After the run - a time in which you want to get the central nervous system calmed down - would be a good time for slow gradual stretching, maintaining a lengthened position for a minimum of 60 to 90 seconds per position, perhaps even longer.

"But Allan, everything I have been told by my --- insert here --- [options include coach, physical therapist, chiropractor, ART practitioner, massage therapist, orthopedist, etc] is that stretching will help me to prevent injury and is the primary way to resolve an injury should it occur."

At this point I would give a resounding "incorrect". The scientific literature has yet to confirm a relationship between these factors. As a matter of fact, the only relationship that has been established is that there is a higher risk of injury when stretching before the training activity! There has not been any supportive literature relating muscular tightness or "imbalance" to the onset of any specific injuries. So if you see a tight muscle, it's not necessarily a safe assumption that it caused your injury. Of course, this is against the beliefs of many but, once again, it is an issue of beliefs and not science.

"Allan, I know that stretching has made me ---insert here--- [more flexible, more resistant to injury, more wealthy, better able to feed the starving of the world]. How do you explain THAT?".

This is something I hear every day. You can hear the emotion creeping into the discussion. The difficulty lies in what we THINK makes a difference, and what truly effects the change physiologically. There are so many confounding variables, it is simply impossible to make the statement. We can look to the sports sciences to provide a foundation upon which to optimize our training, injury prevention, and injury recovery. Much of these issues with stretching are simply counter-intuitive physiologically or unproven in the scientific literature.

But if we removed stretching from the discussion, what would all of the ---insert here--- [practitioners, coaches, running magazines] talk about?

Now THAT could REALLY prove interesting.


The problem lies in that all stretching is put into the same lump and only 1 demographic is usually used. I completely agree with the article by the way. i work with industrial athletes as it were and they benefit from stretching because 1) they never do it and 2) anything different from their 12 hour workday will help them.

Athleticism Versus Athlete

At work I posed the question about the definition of athleticism. My point was to show that we inadvertently see primarily athletes as athletic but we have to consider that all people have a certain degree of athleticism just to live life. this idea I heard of first from Gary Gray a physical therapist from Adrian Michigan. He poses the idea that even the "little old lady" walking down the street is an athlete. She too must demonstrate a certain level of skill just to get groceries or to walk. However in my attempt to discuss the via email with my co workers the default is back to athletes only. You con't have to be in a competitive arena to display athleticism.
What are your thoughts?

Watch where your going!!

Bone spurs in the shoulder are a byproduct of what many will call impingement. However impingement is a symptom and not a cause in my eyes. These bone spurs in my opinion are caused by the humerus hitting the acromion OR the acromion hitting the humerus. In either case it is the scapula's dysfucntion that makes this situation occur. If the scap is moving too slow it can't get out of the way, if it's surrounding musculature isn't strong enough to slow it down when the humerus is returning to the axial position, then the acromion will bang on the humerus. After many years spurs develop.

So what do you do? Educate the scap to do what it's suppose to do which is work in conjunction with the other muscles of the body not in isolation.

what slow down the scapula? Everything below it.