Clinical

1) I first learned about the relationship between the pelvis and hip ROM from Chris Johnson – you can instantly increase hip IR on the table by having the patient posterior pelvic tilt.  Then upon studying the concepts of SFMA, DNS, and PRI, I began to understand how the pelvis (as well as diaphragm/thorax/spine) influences the hips.  Now I understand that most hip impingement patients are really pelvis patients, not femur patients.  Mike Reinold wrote a concise and simple post on this concept here.

2) The Gait Guys go over the objective hallux valgus assessment and ways to treat it.

3) Here’s a great 3 minute video that goes over both the cause and treatment of tendinopathies.

4) There’s a lot of discussion on the thoracic spine, rib kinematics, breathing, and shoulder function.  The Nominalist goes over one of the more important aspects of this kinetic chain – Posterior Expansion.  It’s an important post for all clinicians (PRI inspired, but discussed in a way that everyone can understand it).

5) Another great running post by Tom Goom.  This article includes a great graphic on the Foot Strike Continuum and some advice on changing mechanics – “In a nutshell what I’m saying is if you want to change footstrike, make a small, manageable change by adjusting stride frequency and stride length, rather than switching footstrike altogether. Increasing stride frequency by as little as 5-10% can significantly reduce loading while having minimal negative effects on performance.”

6) I’m sure Eric Cressey is having a big “I told you so” moment…”In conclusion, shrug exercises at 90° or 150° of shoulder abduction angle could be advocated to activate scapular upward rotators, decrease SDRI, and increase CTA in individuals with scapular downward rotation impairment.”

7) The Kitchen Sink – neuro-modulation techniques, compression wrap, corkscrew, pre-activation, synergistic muscles…Erson’s take on the ASLR Fix.

8) The Nominalist dissects shoulder traction exercises (hangs, farmer’s walks) and gives you a ton of ways to use them with your patients.

9) Here’s a great post by Dave Tilley on alternative reasons for hip flexor “tightness” (Part 1, Part 2, & Part 3). The List – Guarding for Instability, Breathing Dysfunction, Too Much Sympathetic Drive, Dysfunctional Core, Poor Motor Skills, Lifestyle, The Other Planes of Hip Motion

10) Erson has an MDT cervical clinical pearl – retraction and sidebending for a quick assessment.

11) Congratulations to Zac Cupples on becoming PRC.  He is one of the best resources for PRI information.  His summary on advanced integration including this gem “When exhalation occurs, exoskeletal stability increases and chamber pressure decreases.”

12) A clinical example of using MDT both distally and proximally for a chronic ankle sprain.

13) Maybe the thoracic smash isn’t the answer to all T-Spine issues.  “So, maybe the ‘stiffness’ we feel, at least in a proportion of our patients, is not truly articular in nature, but rather, a reflection of the increased resting tone and dominance of the global muscles of the thorax (which also connect to the scapula, humerus, lumbopelvis, and neck) that creates neuromyofascial compression of joints of the thorax.” -Linda-Joy Lee

14) 8 Reasons Why You Shouldn’t Release the Psoas

15) Lance Goyke has a 4 part PRI Advanced Integration series (Part 1, Part 2, Part 3, Part 4)

16) 2 Great Quotes from Gray Cook – “If you think about it, the SAID principle (Specific Adaptation to Imposed Demand) can be divided right down the middle with specific adaptation being the role of the organism and imposed demand being the role of the environment.”  |:|  “If you’re disengaged or detached from the activity you’re doing, you cannot get into a flow state.  Flow is where records are broken and the intrinsic value of movement can be realized.”

17) Here’s my review and interpretation of Andreo Spina’s Functional Range Release.  It includes an argument for histology, mechanotransduction, dynamic systems theory, why isometrics are the best, and many clinical pearls from Spina.

18) Don’t let the arms internally rotate and adduct during the wall slide – via Eric Cressey

19) Dynamic Valgus probably isn’t an adductor problem.  A long, interesting read that breaks down the adductor kinesiology, goes over valgus culprits (excessive tibial ER), has visual examples of common compensations, and explains why you shouldn’t do the split stance adductor mobilization.

20) Why only kill 2 birds with 1 stone when you can kill 5?  One of my favorite all encompassing “shoulder” exercise.

21) Good review of 5 Aspects of ITB Syndrome– 1) Direct Attachment 2) Indirect Attachment 3) Movement Culprit 4) Femur Centration 5) Morphology

22) Ischial-femoral impingement.  Never heard of it?  Me neither.  Read this post by the Gait Guys to immediately improve your assessment.

23) Leon Chaitow reminds us of the adverse effects of respiratory alkalosis.

24) Kathy Dooley goes over the functional anatomy of the QL.  “It’s tight because you’ve lost spinal stability in flexion. Stretch the QL without providing stability, and it will backfire by making itself even tighter…The opposite is true in extension intolerance. The QL is primarily a tonic back extensor and often a pain generator in those who tend to extend too much through the lumbar spine.”

25) 3 ways to get out of high-threshold system from Seth Oberst: 1) Optimize Breathing 2) Balance the ANS 3) Go Slower

26) If you’re unfamiliar with the high-threshold concept, check out an article I wrote a few years ago describing the difference between Low and High Threshold Strategies.

27) Kegels vs. Squats “Teaching women to consciously integrate the pelvic floor into the squatting action to a depth that they can control their form and not tuck under, will retrain the optimum length and function of both the pelvic floor and glutes. I like to teach women to open and lengthen their pelvic floor with an inhale as they lower into the squat, and exhale with a pelvic floor lift as they rise. To me this is the blend and the best of both worlds.” – Julie Wiebe

28) Dana Santas goes over Yoga for Athletes (it’s not about stretching) – “Incorporate core and pelvic floor work to inhibit back extensors.”

29) A simple shoulder dissociation assessment and xiphoid cues from the Nominalist.  “ …‘move the top of your sternum back and up behind your ears‘. The chin tuck move will quickly fade out of your vocabulary…”

30) I wish I would have heard this before my first PRI course “If we are hyperinflated in particular areas (think left chest wall), how can we expect to go to the left side? Left space is already filled with air. Airflow must be transferred to the right side in order for us to maximally close down our left. Maximal left sided closure via a zone of apposition is necessary to create true left stance.”-Zac Cupples with another great PRI post – this time on PRI Integration for Baseball

31) Erson’s 5’s

Erson shares his Top 5 Online Resources.  He also gives a shout out to some other blogs as well (thanks Erson!)

Erson shares his 5 Favorite Anke Resets – repeated ankle plantarflexion, repeated hallux flexion, tibial IR mob, repeated tibiotalor lateral glides, sciatic neurodynamics/posterior chain

5 Easy Screens from Erson: 1) Cervical Retraction & Sidebend 2) Terminal Knee Extension 3) Shoulder Extension 4) ASLR/PSLR 5) ½ Kneeling Dorsiflexion

One of my favorite posts of the month – Erson goes over his thoughts on 5 Common Treatments.  A great breakdown of how things really work.  Well worth the read.

Pain

32) “Perhaps, though, this is exactly what we do when we identify hyperalgesia: we assume that we know how much pain the person should be feeling – a questionable assumption in itself.” |:| “At this point we must ask for clarity on the distinction between central sensitisation and a lowered pain threshold to a given stimulus: what is the difference? To me, it seems clear that a lowered pain threshold is a clinical finding, whereas (in Woolf’s view) central sensitisation is one of two mechanisms that could underlie that finding. Peripheral sensitisation is the other option; if that can be ruled out, then the patient’s lowered pain threshold is probably due to central sensitisation.” –Tory Madden

33) Another great read from Todd Hargrove – “Dogs will eventually stop drooling if you ring the bell enough times without bringing dinner. And people can hopefully extinguish their association between pain and a movement by finding a way to move without pain.“

34) Greg Lehman shares a Pain Science Workbook for patients and therapists – you can download it or send it to patients.

Training

35) The LATD (Long Term Athletic Development) seems like a well articulated program

36) Some solid, simple, coaching cues from Eric Cressey

37) “In order to master anything, you must study, practice, experiment, and evaluate.” -Greg Robins

38) Mike Robertson shares his in-season training pearls.  1) Don’t Make Them Sore 2) Consolidate Stress 3) Keep Everyone Fit

39) GMB goes over some exercises for foot motor control, strength, and mobility.

40) If you are into human movement, you must know about Pavel Tsatouline.  Learn more about Pavel in this great Tim Ferris Interview.

41) 5 DNS Warm-Up Exercises

42) “If you’re looking for smashing heavier weights in something like a deadlift or a squat, using a fast, plyometric type jump activity immediately prior may be beneficial. If you’re looking to sprint or produce maximal velocity contractions, using some relatively heavy loading with a focus on the hardest contractions against the load could be beneficial.”  –Dean Somerset

43) Another entry point for squatting – “Consider adding the bottom-up approach one leg at a time.”

44) “a single bell forces you to constantly work hard to fight rotation and prove you are stable and in control” –Andrew Read 

45) Mike Reinold brings up a good point about progressing core training from isometrics (minimal spinal motion) to concentrics/eccentrics (lots of spinal motion).

46) What do you think about the “valgus twitch”?  The valgus twitch is transient knee valgus that occurs in advanced lifters during deep squats (see Crossfit Games for a good example).  Bret Contreras goes over this mechanism in this post.

47) The Runners 3×3 by Chris Johnson

48) A great quick and easy read on energy systems.

49) GMB categorizes different types of Body Weight Movement Approaches

50) Here’s a great post on building the braking system.  Tons of great progressions for your lower extremity patients/clients.

Research

51) VMO or Hip Strengthening for PFPS?  Bret Contreras writes a great article to display the importance of focusing on the question instead of trying to find articles that support your stance (confirmation bias).  Everyone should take a look at this one.

52) A 2 sentence review of the Polyvagal Theory by Jesse Cullen-DuPont – “Brain detecting threat – yes or no. Remaining outputs follow suit.”

53) “Deficits in sensory and motor systems present bilaterally in unilateral tendinopathy. This implies potential central nervous system involvement. This indicates that rehabilitation should consider the contralateral side of patients.”

54) I’ve had patients come in and claim that Crossfit cured much of their pain.  Here’s a study that might suggest why – “An LMC (low-load motor control) intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL (high-load lifting) intervention, but not in pain intensity, strength, or endurance.”

55) Post-surgical extremity patients should be exercising the non-involved side.  Here’s why.

56) “Take Home Message: There are many clinical special tests geared towards diagnosing labral tears and femoroacetabular impingement.  Unfortunately, these tests are largely not helpful in confirming the presence of the pathology in population that is likely to have either.”

57) Strength wins again.  “weaker athletes displayed more asymmetry than stronger athletes”

58) An interesting read on DOMS and what really helps (Yoga and Whiskey) – “Lactate and muscle soreness are not related.” -Jules Mitchell

59) “Thus, the 4-week 15:15 MVO2 kettlebell protocol, using high intensity kettlebell snatches, significantly improved aerobic capacity in female intercollegiate soccer players and could be used as an alternative mode to maintain or improve cardiovascular conditioning.”

60) Research subjects suppress immune responses using physical conditioning.  “You can’t understand immunity without understanding its neural regulation” –Kevin Tracey

61) “New research into the way in which we learn new skills finds that a single skill can be learned faster if its follow-through motion is consistent, but multiple skills can be learned simultaneously if the follow-through motion is varied.  “Since we have shown that learning occurs faster with consistent movements, it may therefore be important to consider methods to reduce this variability in order to improve the speed of rehabilitation,” –Dr. Ian Howard

Other

62) “During hopping or jumping muscle fibres contract almost isometrically, while the fascial elements lengthen and shorten like elastic yoyo springs.” -Leon Chaitow

63) The ultimate collection of articles, videos, and blogs for Pelvic Floor Anatomy.

64) “Epigenetics and deep homology are two sides of the evolutionary coin. Epigenetics helps explain rapid evolutionary changes and highlights the role environments can play in genetic health. Deep homology reminds us of our ancient origins and the glacial pace at which much evolutionary change occurs.” –Zoobiquity

65) The Evolution of the Gluteus Maximus by Eirik Garnas.

Top 5 Tweets of the Month

• TheLeakeyFoundation‏ @TheLeakeyFndtn – “Medicine without evolution is like engineering without physics”
• Doug Kechijian‏ @greenfeetPT – Too bad insurance doesn’t cover “fitness” training. For some, just getting stronger is the best rehab.
• Neil deGrasse Tyson @neiltyson – Good education is not what fills your head with facts but what stimulates curiosity. You then learn for the rest of your life
• Christopher Johnson‏ @chrisjohnsonPT – The term “RECOVERY RUN” is an oxymoron. It’s called WALKING #RunningRules
• Aaron Swanson‏ @ASwansonPT – There are some things you cannot learn from a book, research article, or lecture. There are some things you can only learn from a patient.

Gif of the Month

Developing the right movement pattern can be painful

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The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches.  I want our profession to grow and for our patients to have better outcomes.  Regardless of your specific title (PT, Chiro, Trainer, etc.), we all have the same goal of trying to empower people to fix their problems through movement.  I hope the content of this website helps you in doing so.

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