Clinical

1) These are awesome – Dan Pope shares a very useful 2 part shoulder rehab progression with a ton of exercise examples (Part 1 – Closed Chain & Part 2 – Open Chain).  And here’s his nice review of scapular dyskinesis.

2) Do you know when to use an External Cue?  Do you know why?  If not, here’s the answers – External Verbal Cues.

3) The Gait Guys teach you about Forefoot Supinatus – “A forefoot varus differs from forefoot supinatus in that a forefoot varus is a congenital osseous where a forefoot supinatus is acquired and develops because of subtalar joint pronation.” 

4) Here’s my analysis of the Deep Squat (Part 1 & 2).  Here’s Erson’s Top 5 Ways to Improve the Deep Squat.

5) An answer to your patients “how long will this take” question…“Depending on the complexity of the activity, [experiments have required] four and a half months, 144 days or even three months for a new brain map, equal in complexity to an old one, to be created in the motor cortex.” –Swart

6) “Extension or a repeated loading strategy is no longer novel if the brain is perceiving loading/WB/extension as a threat.” -Erson with a nice post on extension and the clinical bias

7) ““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.”

8) “Look down at your toes (neck flexors) and then flex forward at the waist to touch your toes. If the neck flexors are inhibited the nervous system senses threat and instability, so on the way down to touch the toes it stiffens the hamstrings so you don’t fall forward hurting yourself.” –Perry Nickelston with an interesting article on the nervous system’s influence on mobility

9) Here’s my layman’s article on how to “fix your back” and improve your toe touch in less than 5 minutes.  Sorry for the click-baiting title – it’s really on how to decrease sympathetic tone, initiate non-threatening lumbar flexion, and activate the anterior core with the diaphragm in the proper position.

10) Solid review from Zac Cupples on Dry Needling –

“Endogenous opioids play a huge role here. When this system kicks in, there is decreased immune molecule activity, reduced intracellular sodium, and increased potassium. This change increases resting membrane potential from -70 mV to -150 mV. That change makes it pretty tough for nociceptors to produce action potentials.”

“Everyone loves the nervous system, but some aneural cells also stimulate opioid production. Both keratinocytes and fibroblasts have been shown to produce opioids, which may be why many skin-level therapies are effective for pain.”

Intrinsic Motivation

11) “Providing athletes with, choice, a rationale for tasks, opportunities for initiative taking and competence feedback that does not control or direct behavior are believed to be synonymous with positive motivational climates. If a coach can successfully adopt the prescribed behaviors linked to developing autonomy then they are likely to develop intrinsically motivated athletes that, invest more effort (Peltier et al,1995) report higher levels of concentration (Briere et al, 1995) are more persistent (Peltier et al, 2001) and perform better (Beauchamp et al,1996).”

12) “As a coach, you can help an athlete develop this internal motivation by encouraging autonomy, self-efficacy, and relatedness.”

You Have to Understand Breathing to Understand Movement

13) Dave Tilly writes a very thorough breathing series (part 1, 2, 3).

14) Jon Herting also has a solid breathing series (part 1, 2, 3)

15) I’ll shamelessly promote my simple 2 part breathing series here as well (Part 1 & 2)

Tendinopathies

16) 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.

17) 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.

Pain & Neuroscience

18) “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)

19) A slightly ranty, but necessary, post by David Butler – “Overall, this is a call to be careful with Explain Pain – to understand what it is, as well as realise what it isn’t, to acknowledge the skills required to effectively deliver Explain Pain, and develop them where necessary, and finally, to recognise the need to think differently and more broadly, bringing in the rich world of education science and psychology, in the effort to achieve the very worthy goal of pain education for all.”

20) Erson goes over a cervical case study and how he educated the patient on her pain.

21) “A novel finding was that altered motor cortical organisation (number of discrete peaks and map volume) was associated with the severity and location of LBP.” #Smudging

22) Psychology may work better than than traditional physical therapy for chronic low back pain.  This is what most pain science advocates have been saying for years.  The difficult part is training physical therapists to understand the complexity of psychology and communicate this with their patients in an effective way.

23) “In fact, taking Tylenol can ease social pain just like it does physical pain. To your brain, they’re the same.” -Eric Barker on rejection

24) Another reason why the shoulders and trunk are important in neck patients?

25) You’re missing out if you haven’t signed up for ISPI’s Newsletter.

Memory

26) “The findings of both animal and human studies provide compelling evidence that stress-induced activation of the amygdala and its interactions with other brain regions involved in processing memory play a critical role in ensuring that emotionally significant experiences are well-remembered.”

27) Neural synapses store memories.  These synaptic connections last as long as the memories themselves.

28) Todd Hargrove writes a great post on pain and memory – “I think one way that therapists can help clients with chronic pain is giving them a new way to frame past experiences of injury, and better ways to respond in an emotional intelligent way to new injuries.”

More on pain and memory – “It is concluded that pain induced by physical exercise is not remembered accurately and the pain and negative affect experienced influence recall.”

Training

29) Should we add rotation and anti-rotation to the Dan John five?  Delaine Ross thinks so.

30) Nice review of Andreo Spina’s Controlled Articular Rotation (CARs) by Tom Bumgardner.

31) 3 Different Shoulder Cues for 3 Different Shoulder Types for the Wall Shoulder Exercise.

32) Dean Somerset shares some thoughts on why you shouldn’t force people to lift with symmetrical feet position.  What’s comfortable for the individual is usually the right posture.

33) “The biggest reason I include reaching exercises is to give my athletes their abs back.” -Mike Robertson on 4 ways he’s evolving as a coach.  Great stuff in this article that you can use in your practice.

34) Dean Somerset reminds you not to overcoach everyone.  Great infographic in this post.

35) “Players are often successful because of traits and not just athleticism” -Eric Cressey on what makes a big league body

36) Ryan Davis goes over 3 things Crossfitters need to do – Get Assessed, Practice, Recover

37) Dean Somerset provides a humble post on the 5 mistakes he’s made in the past.  Very useful commentary – I like the hamstring/sprinter example and the emphasis on cardio for lower level clients.

Research

38) Jeff Rich shared this great article on the subtle cavus foot and how to determine forefoot vs. rearfoot pathomechanics.

39) It’s not just magnitude, it’s also about timing – “the application of a prefabricated foot orthosis with a 5° medial rearfoot wedge was associated with a significant delay in the timing of the peak knee abduction moment during the stance phase of running”

40) “Synergistic muscles compensate for a fatigued muscle by increased muscle activity.”   Fatigue and compensation is a huge problem.

41) Knowing about the Limbic System may help you understand the different responses people have to the same input.  “The monitoring role of anterior cingulate, the trisynaptic hippocampal circuitry underlying cognitive functioning and the significance of hypothalamus in various neurovegetative functions suggest the integral role of the limbic system in understanding human behavior and its aberrations.”

42) “This study highlights the likely energy storage role of the ITB, which serves the purpose of increasing efficiency of human running. The anterior and posterior portions of the ITB store energy at different times, i.e. when they undergo stretch-shorten cycle during gait and this corresponds to high muscle EMG activity.”

43) Did you know about the two different fiber types of the Subscapularis muscles?  “The line of action of the lower fibres are biomechanically advantaged for controlling or resisting excessive translation superiorly and anteriorly (especially in mid-range shoulder elevation). The upper fibres are advantaged biomechanically for producing internal rotation and horizontal flexion/adduction range of motion and force.”

44) “Of 1283 survey respondents, only 27% of athletes reported using mental skills such as goal setting, positive self-talk, imagery, and relaxation. Of the 249 respondents who used mental skills 72% reported they felt it helped expedite their recovery process.”

Other

45) Some great advice on how to develop healthy movement in kids from Andreo Spina: 1) Don’t rush walking 2) Make them go barefoot as much as possible 3) Make them use their toes like fingers 4) Encourage standing and sitting without using hands 5) Let them play

46) “Ten minutes of a smartphone in front of your nose is about the equivalent of an hour long walk in bright daylight.”  Get better sleep.

47) “After an extended review of literature on prospection (your mental perspective of the future), and depression, they found that the perception of negative futures can trigger depression.”

48) “Previous research has indicated that there is a kind of symbiotic relationship between self-focused attention and social anxiety, in that anxiety makes people more likely to draw their focus inward — likewise, focusing on yourself seems to increase anxiety. This new finding may point to a way out of that vicious, anxious circle. Doing small good deeds for other people naturally turns your focus outward, which may leave less room for obsessive self-reflection.”

49) Communication skills are often overlooked.  The Laddering Technique can be used to get to someone’s core beliefs and values.

50) “Specifically, the study finds that people who walked for 90 minutes in a natural area, as opposed to participants who walked in a high-traffic urban setting, showed decreased activity in a region of the brain associated with a key factor in depression.”

51) The Four Foundations of Mindfulness

Top Tweets of the Month

• Charlie Weingroff‏ @CWagon75 – I’ve said this before. The more one reads about physiology, the more it appears aerobic fitness solves rehab problems before they happen.
• Rod Henderson,PT,ScD‏@HeadStrongMove – I love when providers say they “treat the whole person.” Like the rest of us have a bunch of disembodied elbows running around the clinic.
• Navin Hettiarachchi‏@NAVIN_H – We restore and reposition in the sagittal plane, retrain for stability in the frontal, integrate to get reciprocal in the transverse. JLB
• James Anderson‏@J_Anderson_PRC – “REACH” is a state of Exhalation word. “PULL” is a state of Inhalation word. Use your words. Or your words will Use you. #PRI @postrestinst
• Aaron Swanson‏@ASwansonPT – It’s just as important to back up your manual therapy with the right words as it is the right exercises. #Expectations #ConfirmationBias

Gif of the Month

Not the best way to train your hip hinge

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.

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