Unfortunately, my time in NYC is coming to an end. I’ve spent over 8 years here and I’ve enjoyed the buzz, the people, the music, and the late night slices . However, I’m ready for a lower cost of living, a little less concrete, a little more nature, and a slower pace. So I’m moving to Asheville, North Carolina in January.
I wrote this article on 5 things I’ve learned from my mentorship at Dynamic Sports Physical Therapy. I feel that one thing missing from the movement social media world is a discussion on the things that happen “behind the scenes” that make the difference between a good clinician and a great one. While evidence, trendy semantics, cool neuro language, the latest performance enhancement, and arguments over what someone else is doing can be fun to read, they don’t always translate to improving clinical performance.
If there’s anything I’ve learned from my 5 years as a PT in NYC, it’s that there’s a lot more to treating patients than what you can read in a journal, book, or blog. Hopefully the article above will help explain this concept (yes, I know it’s a blog and I’ve just contradicted myself, but if you read it you’ll get the point).
- “It is the mark of an educated mind to be able to entertain a thought without accepting it” -Aristotle
1) Great stuff from Kathy Dooley on the Jaw – “Because the TMJ has more proprioception per surface area than any other joint in the human body, you will go where your jaw shifts you to go. If the body perceives a missing link in motor control, it will go to the jaw to compensate, since the jaw muscles and joint capsule are innervated by Midpons (mandibular division of trigeminal nerve).”
Protrusion puts COM anteriorly, down regulating the posterior chain
Retrusion puts COM posteriorly, down regulating the anterior chain
2) Listen carefully to this one…”when a thorax is protracted and externally rotated, it could lose its mobility in all three planes” -Kento
3) “Lubricin is a protein that mixes with hyaluronic acid and other molecules to form a nearly frictionless environment.” “Words and phrases to power up the nugget include “lubricin is cytoprotective and chondroprotective”, “you can build up a lubricin reservoir in your joints with healthy movement” and “marvel how your eyelids slide on your eye – that’s lubricin“.”
5) “Task complexity and diversity should increase with the addition of more reference points. This will serve to inhibit the old pattern is as they have to maintain an attentional focus on what’s being asked of them.”-Seth Oberst
6) Great article on the subconscious cues that can make a patient feel more comfortable and safe.
7) Trying to improve mobility? Erson reminds you to give some PNF a try.
9) Erson shares 5 manual techniques for the ankle.
10) 3 Reasons Why It’s Important to Know Why a Treatment Works by Todd Hargrove
11) Great stuff from Noah Harrison – “Adaptation cannot occur overnight in most cases, and the rate of loading the challenge needs to match the bodies rate of ability to adapt. Load the skin with friction slowly and often: you will form a callus. Load it too quickly for the tissue to adapt: a blister forms instead.”
12) Dave Tilly goes over 10 common teachings with gymnasts. #ForrestBehindTheTrees
13) Interesting read on vision from Zac Cupples and PRI – “one must recognize peripheral space to contact ground (peripheral contact), ands notice objects in the periphery passing by (peripheral optic flow) as the body progresses forwardly via limb reaching (peripheral propulsion)”
14) Sian shares a good shoulder impingement series that looks at evidence, clinical reasoning, and exercise.
15) A ton of information on PRI in a question and answer format from Rob Palmer. Even if you don’t practice the PRI approach, there is still a lot of good information here – “Flexion allows for movement variability.”
16) 12 Things I Wish Every Patient Knew
17) Great article on the Vagus Nerve
“The nerve plays a role in a vast range of the body’s functions. It controls heart rate and blood pressure as well as digestion, inflammation and immunity. It’s even responsible for sweating and the gag reflex. “The vagus is a huge communicator between the brain and the rest of the body,” says cardiologist Brian Olshansky of the University of Iowa in Iowa City. “There really isn’t any other nerve like that.””
18) “Footwear resulted in a significant increase in step length, stance duration, and peak vertical ground reaction force compared with barefoot walking. Peak acoustic velocity in the Achilles tendon (P1, P2) was significantly higher with running shoes.”
19) “nothing empowers the patient like the ability to both self assess and self treat” –Erson
20) “We should move well enough to respond and often enough to adapt.” –Gray Cook
21) Do you know about the Transtheoretical Model or Fitts and Posners Stages of Motor Learning? If not you might be missing out on some great techniques to improve your patients’ movement. Check out the last installment of the Coaching & Cueing series for more information.
22) “One of biology’s great journeys is the flow of axoplasm – the “nerve juice” inside an axon. This nerve juice is quite thick – at least five time thicker than water, and it has to flow both ways within the longest cells in our bodies” Keep it liquid, not gelatinous”
23) A quick and easy trick to isolate lumbar extension by blocking the hips with a table. It’s essentially a prone press-up standing up.
24) “The growth is found in the middle of the discomfort.” One of 10 lessons in 10 years from Brad Beer
25) Bill recently put out a bunch of great informative videos
Complexity of knee position, movement variability, and individualism
Head Position and Stability
Breathing Affects Movement – Concept
Breathing Affects Movement – Example
Why Necks Are Stiff
26) “Rather than thinking of running as a series of jumps – leaping off one foot and landing again on the other – runners should view their sport as a series of falls, aided by gravity”
27) The Spinal Engine has an interesting take on running and the effects of gravity. #UsingGravity #PotentialToKineticEnergy
29) I met up with my old friend, Chris Johnson, for an update on his approach. Check out this review. There’s stuff you can use tomorrow in the clinic. #ControlParameter
Pain & Neuroscience
- “Focus is the new IQ.” -Cal Newport
30) Great analogy on pain with a Chinese Finger Trap – “The consequences of fighting harder, in this case, are not the consequences we want. In fact the consequences we want require us to do something a bit paradoxical, which is to push in, to the experience. To move a little bit more flexibly with the experience, to more a little bit more gently with the experience…”
31) A great article on pain from Lorimer. It’s easy to read and understand. Print it out for your patients. “A very effective way to reduce pain is to make something else seem more important to the brain – this is called distraction. Only being unconscious or dead provide greater pain relief than distraction.”
32) Make sure to inform and educate them, but be careful with your word choice. “A critical task in pain psychology is therefore to help people learn to rephrase their inner monologue so it becomes more realistic and supportive.”
33) “Pain is like climate change – they are both emergent phenomenon: they are not progressive, sequential events where, say, a 1% increase in contributing factors leads to a 1% change in the output. In emergent phenomena where things just seem to happen, multiple interacting contributing factors combine simultaneously for a collective output. No single factor leads or drives the process- although critically, a shift or change in one component/factor/agent can have massive effects perhaps leading to a system out of control. In relation to a chronic pain state it could be one ‘small’ event – returning to a particular place, a memory triggering smell or sight, a thought or something someone says.”
34) Always great stuff from Todd Hargrove. Why Pain is Like Taste – “Placebo can work by learned association. If you pair a pain killing drug with an inert treatment for a while, pretty soon the inert treatment will elicit some pain reduction even in the absence of the active ingredient. People who love running are probably runner’s high addicts”
35) Loneliness is something we need to take seriously.
“Researchers have found social isolation is a risk factor for disease and premature death. Findings from a recent review of multiple studies indicated that a lack of social connection poses a similar risk of early death to physical indicators such as obesity.”
“There is evidence in the literature that suggests loneliness is a risk factor for the development of a concurrent pain, depression and fatigue ‘symptom cluster’ with a possible immunological basis, and recent evidence that suggests that chronic and transitory loneliness are associated with higher daily pain ratings in people diagnosed with fibromyalgia.”
36) “In fact, there appears to be a linear relationship between the size of your device and the extent to which it affects you: the smaller the device, the more you must contract your body to use it, and the more shrunken and inward your posture, the more submissive you are likely to become. Your physical posture sculpts your psychological posture, and could be the key to a happier mood and greater self-confidence.”
37) A great collection of articles on pain
38) One of the better pain science articles I’ve read in a while. Ben Cormack explains why the pendulum needs to swing back to the middle and away from the “it’s in your head” side.
Exercise of the Month
39) If you checked out the exercise of last month, then you probably know many people have no transverse plane control in a single leg stance. I use this exercise as a regression to help them understand the movement and develop some control. It’s also great for shoulder patients and people that love a challenge.
40) It’s great when great clinicians share some of their favorite exercises. We’ve seen Dan Pope do this with lower extremity plyometrics (see previous Hits). Now Michael Mullin is sharing his favorite ski exercises. These are awesome and you should definitely check it out. I’ve been able to incorporate these into my practice immediately. Thank you Michael!
Tweets of the Month
@NickWinkelman – “Feeling gratitude and not expressing it is like wrapping a present and not giving it.” -William Arthur Ward
42) I might be biased, but I think his is a great article and agree with just about everything in it. Here’s some unilateral exercise combinations and some pelvis stability logic from Miguel Aragoncillo.
43) Pickle juice and mustard reduce muscle cramps?
44) A very unique read on the importance of being a practitioner and not a scientist. “It does not take a rocket scientist to fly a rocket, just a good pilot.”
45) More great coaching from Cressey – sidelying ER.
46) “You need a kyphosis (or subtle rounding of the upper back), because your scapulae are curved as well. If you have a curved scapulae sitting on a flat upper back, you lose passive stability at the shoulder.”
47) Some great advice from Dan John – 10 skills coaches need to balance. #3 – Strive to get pretty good, then strive to get better. #IgnorePerfect
48) I love the hip thrust exercise from Bret Contreras. It’s the bench press of the glutes. But I started to notice people were using it more as a competitive lift, sacrificing form for numeric achievements. I started to see tons of people lifting in an anterior pelvic tilt, thus using their lumbar extensors more than their hip extensors. So I made this video and wrote this post in attempt to change this behavior. I’m not sure if it had any effect, but now Eric Cressey is pointing out some of the same mistakes in this post. Hopefully this will help prevent people from turning a great exercise into a dangerous one.
49) Mike Robertson shares his assessment process: Joint Mobility and Position, Movement Capacity, Speed/Strength/Explosiveness, Energy System Development
50) One of the best articles on aerobic training – “Conversely, “low-fit or deconditioned individuals (read: some strength and power athletes who do no supplemental work at all) may demonstrate increases in cardiorespiratory fitness with exercise intensities of only 40 to 49% HRR or 55-64% HRmax”.”
51) Here’s 10 Landmine Exercises you can start to add in to your routine.
52) I like this. I’ve been doing it for the past few years without planning. Two years ago was kettlebells, last year was power lifting, this year is relative strength. Now I’m going to start planning the macrocycles. If you only do one thing, you’ll lose adaptability. #MovementVariability
“Let’s start here: Brady is a quarterback whose daily schedule, both in and out of season, is mapped clearly into his 40s. Every day of it, micromanaged. Treatment. Workouts. Food. Recovery. Practice. Rest. And those schedules aren’t just for this week, this month, this season. They’re for three years. That allows Brady and Guerrero to work in both the short and long terms to, say, increase muscle mass one year and focus on pliability the next. “The whole idea is to program his body to do what we want it to do,” says Guerrero. “We don’t let the body dictate to us. We dictate.””
53) This is great
54) “These results suggest that atrophy of intrinsic foot muscles may be associated with symptoms of plantar fasciitis in runners.“ I usually start my plantar fasciitis patients with one of these exercises for foot intrinsic strength.
55) Tai Chi and Cognitive Behavioral Therapy both work to reduce insomnia – “With the improvement in insomnia,” he added, “there’s a reversal of inflammation at the systemic level and the genetic level. Inflammation contributes to cardiovascular disease, depression and cancer.”
56) “HIIT (High Intensity Interval Training) lowered blood glucose and increased exercise capacity, food intake, basal activity levels, carbohydrate oxidation and liver and adipose tissue insulin sensitivity in HFD-fed WT and AccDKI mice. These changes occurred independently of weight loss or reductions in adiposity, inflammation and liver lipid content.”
57) “Human brains evolved to be more responsive to environmental influences, study finds” #EnvironmentMatters
58) “A new study has found that older adults who take more steps either by walking or jogging perform better on memory tasks than those who are more sedentary.” #ExerciseIsMedicine
59) It’s important to not get carried away with pain science and CBT. There’s a physical body too. “Pain education and specific training reduce neck pain more than pain education alone in patients with chronic neck pain.”
60) 5 sets of 45sec isometrics with 2 minute rests improved tendon pain. This article also goes over possible mechanisms.
61) “The study revealed there was a significant inter-hemispheric asymmetry of infraspinatus active motor threshold. On the affected side, the active motor threshold was higher compared to unaffected side, indicating decreased corticospinal excitability. Also, the duration of pain (>12 months), but not its intensity, appeared to be a factor related to the lower excitability of the infraspinatus representation.”
62) This one is for the breathing lovers out there – “Individuals with LBP exhibit propensity for diaphragm fatigue, which was not observed in controls.” #AmmoForYourCoworkersOrStubbornEmployers
63) Gasp! TENS can be good for something? “Sensory transcutaneous electrical nerve stimulation may help reduce knee pain and increase quadriceps function among people with knee pain.” Don’t be a Hipster PT.
64) Use Graded Exposure with Chronic Pain Patients
65) “Muscular power, especially in the legs — which are the largest muscles in the body — is widely accepted as a marker of healthy aging. Older people with relatively powerful leg muscles get around better than those with weak legs. They also tend to have sharper minds, studies show.”
66) Breaking News! Fatigue causes poor biomechanics which can put people at risk for injuries. “Impaired strength, central activation, and biomechanics were present postfatigue in both groups, suggesting that neuromuscular fatigue may increase noncontact ACL injury risk.”
67) Shoulders need exercises, not manual therapy – “Adding manual therapy to an exercise protocol did not enhance improvements in scapular kinematics, function, and pain in individuals with shoulder impingement syndrome. The noted improvements in pain and function are not likely explained by changes in scapular kinematics.”
68) “Our results suggest that aerobic exercise may have a positive effect on the medial temporal lobe memory system (which includes the entorhinal cortex) in healthy young adults.” #ExerciseIsMedicine
69) Chili peppers stop cancer? Great article that makes chemistry interesting.
Other Good Stuff
- “What we think of as “knowing” is holding on to some thing we think applies universally so we don’t have to be open to new situations” -Cheri Huber
Psychology and Communication
70) “Words can deceive, but tone of voice cannot”
71) “Visual cues for forming a habit. Get a jar full of paper clips and set an empty jar next to it. Put it somewhere you’ll see it everyday. Transfer the paper clips when you complete a positive habit.”
72) “My argument is that we should spend less time letting feedback loops shape our lives in invisible ways and more time designing the feedback loops we want and need.”
73) 8 Secret Ways We Influence Others With Our Body Language #Communication
74) A better title for this article would be, healthcare starts using cognitive psychology to improve outcomes. For more on these concepts read the books, “Thinks fast, and slow” and “Mindless Eating”. #Communication
75) “Don’t and can’t may seem somewhat interchangeable, but they are very different psychologically. And if there is one thing that social psychologists have learned over the years, it’s that even seemingly subtle differences in language can have very powerful affects on our thoughts, feelings and behavior.”
76) An unfortunate positive feedback loop – “The fatter we are, the more our body appears to produce a protein that inhibits our ability to burn fat, suggests new research. The findings may have implications for the treatment of obesity and other metabolic diseases.”
77) “As the NYPD HNT likes to say: The more information we have about a subject the more power we have.” #Communication
78) Not all daydreaming is considered equal. “Other research points to the distinct benefits of daydreaming and imagination for well-being. Asking people to engage in “positive mental time travel”, where they imagine four positive events that will take place the following day, increases levels of happiness.”
79) Biases and poor communication are the root of most of the world’s problems. “What’s obvious to you is not always obvious to others. We can all have very different interpretations of the same things. It’s a lot better to make things clear than to assume that your needs are obvious and the other person is inherently evil.”
80) Great article from Eric Barker on managing time and focusing on “deep work”
81) Might be my favorite article title for the importance of sleep – “Snoozers Are, Infact, Losers”
82) Great article on mental health and sleep. Read this one. “It is now abundantly clear that sleep problems in mental illness is not simply the inconvenience of being unable to sleep at an appropriate time but is an agent that exacerbates or causes serious health problems“
83) Another great article on sleep with some great examples to tell patients
“If you run on four hours of sleep a night for a week, it’s the same as drinking a six-pack and then going to work.”
“A week of getting four hours of sleep per night causes your testosterone levels to temporarily dip by an amount equivalent to 11 years of aging.”
“When sleep is cut short, testosterone levels don’t fully replenish, muscles don’t have as much time to build and recover, and the consolidation of new information into long-term memory is cut short. The final quarter of an eight-hour night of sleep, Maas says, is when the cycles include the greatest frequency of sleep spindles, bursts of brain activity in the motor cortex that play a role in forging new muscle memories from that day’s activities”
84) “Looking back at carbohydrate consumption over the last century reveals some interesting trends. Americans ate about the same amount of total carbohydrates in 1997 as we did in 1909—just not the same kinds. Over this time period, the proportion of carbohydrates from whole grains dropped from more than half of what we consumed to about a third. What replaced whole grains was food products made from different kinds of refined grains. In other words, for the first time in human history we now eat mostly the simple sugar part of a grain (the endosperm) and far less of the complex carbohydrate part of a grain (the bran and the germ).” #Microbiome
85) 8 Ways to Eat Mindfully During the Holidays
86) “”In our study, we found people who drank three to five cups of coffee per day had about a 15 percent lower [risk of premature] mortality compared to people who didn’t drink coffee,” says one of the study authors, nutrition researcher Walter Willett of the Harvard School of Public Health”
87) I love this study. “Summary of current literature suggests that coffee has beneficial effects on skeletal muscle. Coffee has been shown to induce autophagy, improve insulin sensitivity, stimulate glucose uptake, slow the progression of sarcopenia, and promote the regeneration of injured muscle.” #Coffee
88) “Repeated coffee consumption was associated with reduced background DNA strand breakage”
89) “Drinking coffee daily was associated with a lower risk of deaths from Type 2 diabetes, cardiovascular diseases, and neurological diseases in nonsmokers. Regular consumption of coffee can be included as part of a healthy, balanced diet.”
90) You should order coffee from this place. Best in the world.
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