As you may or may not have read in a previous article, I’m leaving NYC and moving to Asheville, NC. My girlfriend and I have decided to take advantage of this transition and are taking a small “sabbatical”. Part of this time off involves a selfish 3 week trip to New Zealand this month. Unfortunately, this means I won’t be able to get a “January Hits” post out this month. I do have posts scheduled on my Facebook account, but other than that you guys are on your own!
Top Hits of the Hits
During the process of going through all the previous Hits, it was interesting to see how one small blog article can change my practice and help me develop a greater understanding over time. These were some of the ones that had a lasting impact on my practice. Small waves eventually change coastlines.
1) “Based on animal studies, it has been proposed that central sensitization associated to nociception (maladaptive plasticity) and plasticity related to the sensorimotor learning (adaptive plasticity) share similar neural mechanisms and compete with each other.”
2) Here’s a great 3 minute video that goes over both the cause and treatment of tendinopathies.
3) “The nervous system depends on consistent patterning in a non-threatening environment in order to best learn and perform. Patterns create security (though these patterns may not always be ideal). Security allows for one to pay attention and integrate sensory cues with minimal internal noise or distraction.” -Seth Oberst with another solid post on stress/threat (including some great clinical advice)
4) Tom Purvis goes over squat biomechanics and body proportions.
5) Zac Cupples teaches you about Salience, inputs, processing, and pain.
6) Are your patients using their Short Head Biceps Femoris to compensate for a lack of hip extension in closed chain movement patterns? Kathy Dooley thinks so and discusses more clinical pearls in this phenomenal anatomy post.
7) Erson’s 5 Rules for Resets: 1) It has to be Novel 2) Hit the End-Range 3) Frequent Reinforcement 4) No Pain 5) Education
9) Top 10 Bodyweight Exercises From GMB – Squat, Frogger, Monkey, Cartwheel, Pull-Up, Bear, Push-Up, Hollow Body Hold, Scales, L-Sit, and Handstand.
10) 12 Ways to Make Better Exercise Choices by Eric Cressey
11) Dan Pope literally bridged the gap – exercise progressions. Scapula – Part 1 – Closed Chain & Part 2 – Open Chain |:| Jump/Plyometric Double Leg Jump Progression – Single Leg Jump Progressions – Advanced Double Leg Jumps – Advanced Single Leg Jumps
12) ““Toes up” technique involves consciously firing the anterior compartment muscles, particularly the extensor digitorum longus. It fires more into the extensor pool and assists in firing ALL your extensors through spatial and temporal summation and also helps to shut down flexor tone through reciprocal inhibition. It will also help you to rocker through your stance phase and get more into your hip extensors.” -Gait Guys
13) If you’ve been following this blog, then you know isometrics have been gaining popularity with respect to decrease tendon pain while providing safe mechanotransduction (#29, #3, #47, #20, #9, #13, #3, Jill Cook, Andreo Spina Review). More research (Heavy Slow Resistance, Reduced Cortical Inhibition) and blog posts (Body in Mind, Leon Chaitow – Mechanism) are now surfacing that will hopefully change the medical mainstreams bias of eccentric exercises for all tendinopathies. Tom Goom has some of the best tendinopathy posts here (stages, treatment 1, treatment 2). Probably the best resources to share with your peers that may not know about tendinopathies.
14) Dave Tilly on Movement Variability – “It also has been suggested that there is an optimal amount of variability for skills. Too little variability in their skill, and the person is stuck with an inflexible system that has very limited adaptability. Too much variability (especially coordinative) in their skill and the person may be all over the place unable to narrow in on the important performance components that lead to skill success.”
15) Here’s a great post from Tom Goom on the importance of load capacity, the envelope of function, kinetic chain load, and the non-tissue issues. This might be the most important concept in rehab.
16) “When I think aerobic training, I think recovery, energy development, and fatigue buffer.” -Lance Goyke
17) The stress section in the October Hits
18) Great write up on pain and diet/microbiome from Andrew Rothschild – “an imbalance between bacteria in our guts can interact with our immune system causing the release of inflammatory chemicals and stress hormones, kicking off our body’s natural stress response, even when we are not truly in a stressful situation.”
19) “When you change your beliefs about a situation, your brain changes the emotions you feel.” And remember…pain is an emotion.
20) “Overextension refers to not just a position of one or more joints, but also a state of mind.” -Michael Mullin
21) “What if, instead, you approached lifting like it was your job and you got paid to not only make the lifts, but to also to look good and be entertaining while you are doing it? How often would you attempt to set a new record lift 1 rep maximum? How ambitious would that attempt be?”
22) “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“.”
23) “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.””
24) “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.”
Top 5 Research Reads
1) Esther Thelen – Dynamic Systems Theory
2) Bogduk’s Cervical Biomechanics
3) If you’re into injury prevention, you should also be into fatigue prevention – “Following a fatiguing exercise protocol, participants showed increased anterior tibial translation, compressive force, and knee flexion range of motion during the transition from non-weight-bearing to weight-bearing. This illustrates an inability of the lower extremity muscles to stabilize the knee joint.” (there were a couple other articles in the Hits supporting this concept throughout the year as well)
4) The subtle cavus foot
Top 2 Courses
1) Ron Hruska’s Cervical Revolution
God damn! Ron is answering questions that no one is even asking.
I can’t say enough about this course. I’ve taken over 30 continuing education classes. This one blows them all away. He’s not selling anything. He’s sharing as much information as he can in a jam packed 2 days. I appreciated him taking the time to go over the complexity of the human body. He helped everyone in the class gain a better understanding of the human species. There are too many continuing ed classes out there that are dumbing it down or over simplifying it for profit and social media attention.
There are two things I look for in a class: 1) something I can use in the clinic the next day 2) information or direction on where to learn more and dig deeper. This class accomplished these two things on a level I didn’t even know existed.
2) Gait Guy’s Advanced Biomechanics Course
Just like Ron’s class, the Gait Guys don’t dumb it down. It took me about 4 months to get through the 40 modules included in their online biomechanics course (not the shoe fit program). I’m sure it could have been done quicker, but taking the time to understand every detail and biomechanical thought experiment was important for me. Not only did my foot/ankle skills increase dramatically, but my overall understanding of biomechanics was also taken to another level.
- Mindless Eating – Brian Wansink
- Nerve – Taylor Clark
- Quiet Leadership – David Rock
- Spinal Engine – Serge Gracovetsky
- The Only Dance There Is – Ram Dass
What I Thought Were The Most Important Articles
- Coaching & Cueing Series – Internal Cues
- Andreo Spina Course Review
- 5 Things I’ve Learned in 5 Years at Dynamic Sports Physical Therapy
What Actually Were…
I write this blog to improve myself and help others. Not for popularity. For this reason, I only check my google analytics once a year, at this time, to see what were the most popular articles of the year. I’m surprised every year.
- Andreo Spina Course Review
- My Secret Acupuncture Experiment
- Coaching & Cueing Series – External Cues
Writing Around the Internet
WODMedic – Tying Knots
Movement Maestro – 7 Rules for Staying Injury Free
PhysioSpot – Using Physics to Increase Glute Med Activity
Layman’s Article on CureJoy – 5 Minute Fix for an Aching Back
Dr. Suzanne Fuchs – Avoiding Hip Tightness
New Grad Physical Therapy – 5 Things Learned in 5 Years
Dynamic Sports Physical Therapy – 12 Things I Wish Every Patient Knew
Clinical Self Review
4 Mistakes I Have Learned From
- 1) Pain Language
I used to avoid mentioning pathoanatomical structures or anything that could be interpreted in a negative way. I would take this kind of approach. But the reality is that my patients are going to see it on google, from another healthcare/fitness professional, or from one of their friends. So instead of using pain science as a substitute, I’ve started using it as an supplement. For example, I used to avoid telling people about excessive medial knee stress and MCL/ACL strain biomechanics during a dynamic valgus moment at the knee. Instead, I would often discuss pain science, the alarm system, movement patterns, load capacity, strength, and resilience. Now I realize that it all needs to be addressed. Since taking this approach I’ve had a much greater success communicating with patients and educating them on what their situation is from all angles. #Educating #Lawyering
- 2) Are They Ready?
This goes with the prior mistake – I often had a goal in mind or a point to make, but I didn’t consider where the patient was on the Transtheoretical Model of Change.
It’s important to understand where they are on the path to changing behavior.
- 3) Tough Love
I try to always be kind, encouraging, and motivating. But maybe I need to be a little more stern when people aren’t helping themselves (not doing HEP, lifestyle, beliefs, etc.).
- 4) Complete Rehab Takes Time
I re-injured my shoulder earlier in the year and, learning from my past mistakes, I spent a full 3 months rehabbing it and another 3 months after that with advanced rehab and integrative exercises. I still do a good amount of healthy shoulder movements in my workouts to keep it functioning well. Chris Johnson always said something like “You are only as good as your last injury and the extent to which you rehabbed it”. I understand that now.
8 Clinical Epiphanies
- Maybe it’s not always a stability or a mobility problem. Maybe it’s just a matter of getting comfortable in uncomfortable positions.
- Isometrics are the best thing in the world. Sure, it’s phenomenal for tendinopathies, strength, motor control, mechanotransduction, and true mobility work. But I think it’s one of the best ways to work on the prior epiphany.
- A lot of it is about being calm in stressful situations. Being calm for yourself. Being calm for the patient. Being calm with their injury and impairments. Being calm with their complaints and emotions. Most of them don’t have anyone else doing that for them.
- The older I get the more I realize that rigid opinions, theories, and beliefs are just another opportunity to be wrong.
- I don’t force a specific set of reps and sets on people. There are too many variables to control (diet, sleep, motivation, emotions, etc.). I look at how their moving. I listen to how they feel. I try to adapt my prescription in realtime. #ComfortableInTheUncomfortable
- Attention focus is extremely important. For everything. See #31, Eric Barker & Internal Cues.
- The more I treat, the more I realize I just spend most of my time slowing people down (breathing, movement, speech, thoughts, mind).
- The neck has always been difficult for me to treat. It’s not that all of a sudden I’ve become a the neck whisperer, but at least now I know why it’s difficult. “Amongst its several functions, the head can be regarded as a platform that houses the sensory apparatus for hearing, vision, smell, taste and related lingual and labial sensations. In order to function optimally, these sensory organs must be able to scan the environment and be delivered towards objects of interest. It is the cervical spine that subserves these facilities. The cervical spine constitutes a device that supports the sensory platform, and moves and orientates it in three-dimensional space.” -Bogduk
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, Coach, 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.
If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.