1) Lately, I’ve been interested in the connection between vision and the cervical spine. Here’s two interesting articles I found this month.
“The direction of eye movements was horizontal when the sternocleidomastoidmuscle on one side of the neck and the splenius on the other side were activated, and downward when both splenii muscles were vibrated.”
“During neck rotation SCM and MF EMG was less when the eyes were maintained with a constant intra-orbit position that was opposite to the direction of rotation compared to trials in which the eyes were maintained in the same direction as the head movement.”
I put people in challenging developmental positions and have them use their vision to either increase motion or to dissociate their vision from their cervical spine (changing muscle activation patterns).
2) Still don’t think vision and the cervical spine are related? Check out this research article on vision, cervical rotation, and pain “When vision overstated the amount of rotation, self reported pain occurred at 7% less rotation than under conditions of accurate visual feedback, and when vision understated rotation, pain occurred at 6% greater rotation than under conditions of accurate visual feedback.”
3) The sign of a great educator is someone that takes complex ideas and makes them seem simple. Here’s the Great Cantrell teaching the importance of hamstring flexibility (must watch video – share with your peers)
4) I like Kelly Starrett’s concept of the shoulder shelf.
5) Here’s best 20 second explanation of the ankle as a torque convertor.
6) You’ve never head a physical therapist talk about wisdom teeth like this – “the maxillary (top side) wisdom teeth limit the excursion of my lateral pterygoids for lateral trusive movements” –Zac Cupples
7) Erson goes over End-Range Loading and 4 reasons why it works.
8) Seth O’Neil shares a great article on the soleus and it’s implications on achilles tendonosis. Some gems:
“The actual forces it produces are around 8 times body weight.(5) In comparison the Gastrocnemius produces forces around 3 times body weight.”
“Gastrocnemius functions largely isometrically whilst the Soleus tends to function eccentrically”
“91% of symptomatic tendons have pathology in the medial part of the tendon- the part relating to Soleus.”
“Most runners with AT will need to use body weight + up to an additional 50-75%. Without this they will not be working at a high enough threshold to rehab to an eccentric strength of around 200% body weight (as shown to be the average for healthy runners).”
9) Here’s some PRI magic using occlusion for hip flexor flexibility. I would love to know what the treatment plan is with this guy.
10) “One of the best ways to keep people motivated in activity is to find something that gets them into or close to their flow state where they are engaged.” –Gray Cook on his latest checklist and the Skill:Challenge Ratio
11) Only Zac Cupples can make you think about where to sit during the evaluation – “Being to someone’s left could build a better emotional connection.”
12) Erson goes over 5 More PT Myths.
13) Mike Reinold shows you a simple accessory respiratory muscle assessment (inhale in cervical rotation).
14) “Here we show that contrary to predictions from optimal control theory, habitual muscle activation patterns are surprisingly robust to changes in limb biomechanics.”
15) Perry Nichelston teaches you some baby moves – unilateral crawl
16) “Perhaps we need to think of extension as system closure; a system closing problem. Flexion will be the solution to open the system.” -Zac Cupples
17) “Peripheral nerves require extraordinary mobility in relation to surrounding tissues, sometimes sliding up to 2 centimetres as we move.” –David Butler
18) Mike Reinold goes over some overhead shoulder mobility concepts. I’ve written detailed articles on two of these concepts (scapula upward rotation & lumbopelvic/core).
19) Allan Phillips has a great DNS Review –
“3month position is the “starting line.” Lift legs off table and secure torso w/o deviation. Starts with position at ribcage and pelvis. If not optimal, load shifts to extremities”
“Main time to influence joint morphology is in first year of life”
“Deep neck flexors require stability of abdominal wall”
“Breathing is an expression of the nervous system”
“Abdominal wall contraction can prevent diaphragm from descending”
20) Erson collects advice from Mike Reinold, Barton Bishop, Chris Johnson, Chris Nentarz, and Charlie Weingroff. Some great gems in there including: “In reality there are flaws in all of the different models of physical therapy. Don’t get locked into one thought process or you’ll spend more time defending your belief than allowing yourself to grow.”-Reinold |:| “You are only as good as your last injury and the extent to which you rehabbed it”-Johnson |:| “Anything can work for anybody, and nothing works for everybody.”-Weingroff
21) Michael Mullins teaches you about Dennison Laterality Repatterning (here & here)
22) Navin Hettiarachchi introduced me to this interesting toy for improving foot/ankle function – Cobblestone Mats.
23) Kathy Dooley is one of my favorite anatomy teachers. The “subclavius assists the scapular protraction executed by pectoralis minor and serratus anterior”. It also has a close proximity to the subclavian vein and artery thus making it relevant for all distal structures via circulation/blood supply.
Mike Robertson goes over some injury prevention strategies here.
Harold Gibbons keeps it simple and effective here.
25) In PT school, I remember learning how to teach neck patients to stretch their “levator scapulae”. In the clinic, I remember these patients coming back feeling much worse without resolving any of their dysfunction. Cranking and pulling on the cervical spine isn’t a good idea. A few may get a temporary relief, but this does not provide any permanent change in the tissues. It doesn’t lengthen the “tight” muscles. It just places a ton of stress on the delicate cervical spine. Here is an alternative exercise for neck “tightness” that provides relief without excessive stress.
26) Two of my clinical mentors are asking a good question regarding post-op knees. Do femoral nerve blocks affect the patients ability to regain their quad strength after surgery? Should they only be doing saphenous nerve blocks? What are the risks and rewards? If it’s just for pain, is it really worth the risk? Anyone that has any answers or opinions please leave a comment at the bottom of this post.
Pain & Neuroscience
27) Emotions control the volume of pain. Here’s an article you can share with your patients.
28) Radiolab Podcast has a great Placebo Episode. It’s an easy place to start for those that want to learn more about placebo effects and the processing component of the human body.
29) Erson’s 5 Pain Science Rants
30) Zac Cupples says Salient 21 times and discusses pain – “A salient input is necessary for an altered output.”
31) I’ve been studying attention focus recently. It’s pretty fascinating stuff. Apparently other people think so too.
Here are 5 questions to ask yourself about attention that can have a profound affect on your happiness.
“Improving one’s awareness of the blind spots can improve attentional focus and potentially optimize motor output without inducing a maladaptive response – such as pain, anxiety, excess muscular tension. Because the brain has already “been there” and explored the region, the sensory input (whatever the mode) is likely much less threatening to the system. “ –Seth Oberst with a great read on attentional focus
Chronic pain patients have difficulty switching their attention focus off of their painful body part. Here’s a great TED talk on attention and mindfulness from Catherine Kerr.
32) Here’s a nice collection of some higher level foot stability exercises – I like the kettlebell swap idea.
33) I like this idea of the Landmine Squat. I found it helpful to pre-activate the anterior core. Give it a try and see what you think for yourself.
34) Dean Somerset goes over 5 Squatting Concepts 1) Pause Squats are Underrated 2) Most Squat Restrictions Are Not Muscular 3) Valgus Collapse is Less About Technique & More About Reaction 4) Long Torsos Are Better Than Long Femurs 5) Breathing Patterns Change with Load and Fatigue
35) Some interesting PRI Golf exercises – I like the sidelying 45 degree leg lifts.
36) Pavel’s 5 Ab Training Mistakes 1) Chasing the Burn 2) Not Focusing on the Contraction 3) Not Using Enough Resistance 4) Exclusively Isometric Training 5) Not Making Every Exercise an Abdominal Exercise
37) Feel awkward with GMB. Here’s their thorough tutorial on How to Planche.
38) 5 Miguel Aragoncillo Tips 1) Use Discovery Learning 2) Reduce the Amount of Corrective Exercises 3) Know the Difference Between Blocked & Random Practice 4) Oatmeal 5) Band Love (including this great core engaged hip flexor mob)
39) Pavel discusses rest intervals (ordinary, stress, stimulation) – “ if you are only practicing incomplete recovery between your sets of strength exercises, you will never achieve your potential”
40) Dean Somerset shares a great modification to the side plank for those with shoulder problems.
41) Loaded Carries may be the best abdominal exercise you’re not doing.
42) Harold Gibbons shares some breathing based core exercises
43) We all benefit when Eric Cressey writes articles to promote a product. Tons of good stuff from him this month:
He take post-activation potential (PAP) and creates a system (Stage System) to improve your lifting performance.
The Split-Stance Anti-Rotational Ball Scoop Toss exercise.
“The lower the motivation of the exercising individual, the greater the need for randomness to keep exercise engaging. This is working out. The higher the motivation of the exercising individual, the greater the need for repetition to deliver a specific physiological effect. This is training.” -Eric Cressey on Repetition vs Randomness
Build Multi-Directional Strength & Power. Tons of exercise examples.
15 Random Thoughts on S&C Programs
Slowing down the concentric – “taking 3-5 seconds to externally rotate the humerus during cuff work can prevent the deltoid or lat from taking over” –Eric Cressey
44) This is a dead horse that can’t get beat enough. “Asymptomatic shoulder abnormalities were found in 96% of the subjects” Medical imaging is NOT the gold standard for movement, health, or function.
45) The latest research in fascia “supports the multiple functions of the connective tissue matrix, combining strength and elasticity – biotensegrity – a word that describes ways in which the architecture of connective tissue cells – such as fibroblasts – respond to different degrees and forms of mechanical load leading to rapid modification of chemical behavior and physiological adaptation – including gene expression and inflammatory responses.”
46) Found this entertaining. Now you can tell your RTC tear patients that it happened because they’re fat! But really, it has to do with hypovascular zones and cardiorespiratory efficiency.
47) The Top 6 Recent Tendinopathy Papers (share with your peers – most people in medicine don’t know this stuff)
48) “The infraspinatus muscle was found to be composed of three partitions: a superior, middle and inferior part were present in all muscles. In 62.5% of the muscles, full compartmentalization was established (i.e. a separate nerve branch entered all three partitions). It can be speculated that the different neuromuscular partitions correspond to different biomechanical functions of the infraspinatus.”
49) Runners need Achilles Viagra #Stiffness
50) Cuing for more knee flexion and less impact on single leg landing led to: increased knee flexion, decreased peak vertical ground reaction forces, and decreased co-contraction (quad & HS). #ACL
51) Chris Beardsley provides a thorough evidence-based review
52) Chris Beardsley also has an equally thorough evidence-based review of the Glute Max
53) “The study found that twelve weeks of sitting Tai Chi training could improve the dynamic sitting balance and handgrip strength, but not QOL, of the SCI survivors.”
54) I heard Gray Cook talking about this years ago – if he was a hipster, he’d be saying he did it before it was researched. “A simple beam-walking task and an easily collected measure of distance traveled detected differences in walking balance proficiency across sensorimotor abilities.” #ResearchLagsClinicalExcellence
55) “Surgical decompression yielded similar effects to a PT regimen among patients with LSS (lumbar spine stenosis) who were surgical candidates.” Why choose PT? One of the side effects of surgery could be death or paralyzation.
56) An interesting way to use a Ladder by Kathy Bowman.
57) The Obstetrical Dilemma – “The results show that pelvic width does not predict hip abductor mechanics or locomotor cost in either women or men”
58) I’ve been learning some Traditional Chinese Medicine from our acupuncturist. The Meridians can offer an interesting perspective.
Top Tweets of the Month
@SethOberstDPT – The meaning of sensory information to the brain is much more important than the volume of the inputs
@CWagon75 – Long term health and maximal performance in a strength sport are fairly exclusive. You can’t have both.
@FunctionalMvmt – We want trainers and rehab professionals to approach their work like Pandora does music: listen to the patterns and refine the information.
Robert Butler PT PhD
@rjbutler_dptphd – FMS is not a treatment model. SFMA is proper treatment model that fits w PRI, DNS, astym, etc
@allouteffort – Health is first and foremost a mental and attitudinal change.
@ZCupples – Claiming to ever have similar baseline characteristics among groups or individuals in research is a myth. #everythingmatters #alwaysnof1
@ASwansonPT – If they can’t feel it, they can’t control it.
Gif of the Month
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2 responses to “April Hits (2015)”
Saphenous nerve blocks are superior to femoral nerve blocks in many ways: 1. they block a majority of the same area as the femoral nerve block while not blocking motor function. 2. If the patient can actually activate their muscles post-operatively and regain function faster then they gain additional trust in their affected extremity after surgery. 3. Able to perform PT (i.e., strengthening, ROM, and WB activities) at a faster rate after surgery. 4. Less post-operative complications noted as compared to femoral nerve block.
Our anesthesiologist has been great at changing full-time to use of the saphenous nerve block due to our feedback in the rehab clinic and improved function of patients after ACL reconstruction (main use in our clinic but they are gradually switching to utilization after TKA).
My good friend and fellow PT, Josh Gellert, sent me this quick research review on Femoral Nerve Blocks.
“In this comparative study, a continuous femoral nerve block had an adverse effect on quadriceps strength at 6 months following patellar tendon autograft ACL reconstruction compared to a control group.
Significant isokinetic deficits in knee extension and flexion strength at 6 months when compared with patients who did not receive a nerve block.Patients without a block were 4 times more likely to meet criteria for clearance to return to sports at 6 months.
FNB may reduce pain on the night of surgery. However, this may not be clinically significant. FNB is not recommended at this time for use in outpatient ACL reconstruction with hamstring graft.
FNBs have not been shown to significantly affect patient pain, readiness for discharge, or outcome scores. There is a small but identifiable risk associated with performing FNBs, with potentially catastrophic effect