Clinical

1) I often have athletes come into the clinic that have been aggressively stretching their hips or shoulders.  They keep getting tight, keep stretching, and keep getting injured.  I have found that the culprit for these injuries is usually not a mobility problem.  Instead, it is often the result of a poorly tied knot.

2) Mike Cantrell teaches you about rib cage dynamics in these 2 videos (1, 2).  Great stuff for anyone that enjoys learning about anatomy, biomechanics, and movement.

3) Great summary video on prescribing running shoes.

4) 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.

5) Zac Cupples cleans out his nose and moves better – another first-person perspective on the PRI rabbit hole.

6) Lance Goyke goes over the non-popular functions of the Serratus Anterior: Rib Cage Retraction, ER Lower Ribs, IR Upper Ribs, Contralateral Translation of the Thorax, Contralateral Thoracic Rotation.

7) NOI goes over the importance of the Sural Nerve.  I actually just had a patient this week who thought she had a sprained ankle, but it turned out to be a sural nerve pathology.  Her symptoms were resolved after 1 week.  I created a chart with all the neurodynamic tensioners in this article.

8) Great TMD pearl from Erson “They are using their capital extensors, instead of gravity and diagastrics to help open their mouth. We should not have to use capital extensors to promote end range mandible depression. This also leads to overuse of cervical protracted posture, which may place stress on the mandible elevators and TM joint.”

9) Michael Mullins shared an interesting story on the teeth-ACL correlation.  Then he provided this article for more information – Teeth as Sensory Organs.  Very interesting stuff – “In this paradigm, tooth contacts are understood to initiate streams of mechanosensory information that shape oromotor behavior.”

10) Sometimes tibial IR mobilizations can be too provocative.  Shante Cofield goes over a smart alternative tibial IR mobilization that unloads the joint and gives some indications of which patients will likely benefit from this mob.

11) 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

“graded exposure to end range reduces threat associated with movement, also bombards the CNS with novel and non threatening proprioceptive information”

“the nervous system is easily tricked, but not easily convinced”

“education is empowerment”

12) The Nordic Hamstring Exercise for preventing hamstring strains is something you should know about.

13) Zac Cupples reviews Interdisciplinary Integration with some great information on the over-achievers, vision, and even the auditory system..

14) “Strength training is one of many options to buffer stress.” -Charlie Weingroff with another great share including some gems on fascia

15) Andreo Spina goes over 5 Ways to Promote a Healthy Musculoskeletal System in Children: 1) Don’t Rush Walking 2) No Shoes/Socks 3) Pick Stuff Up With Your Feet 4) No Hands When Standing 5) Physical Play

16) We’ve been using this approximation and positional release technique in our clinic with some success.  For one patient, the approximation aspect provided >50% improvement in ROM.

17) “There is no lymphatic system in the brain, so the brain uses cerebral spinal fluid to clear the toxins that build up in the brain during the day, and yep you guessed it, this process only happens during sleep.” -Paul Lagerman goes over the correlation of Pain and Sleep.  For more articles on sleep, check out the references from this article.

18) The Gait Guys, providing some of the best stuff out there:

“What ischial-femoral impingement might look like as aberrant shoe wear.”

Short Foot or the Toe Spread Out Exercise?  Here’s one of the answers.

“”The electrical signal that drives a given movement is therefore an amalgam — a summation — of the rhythms of all the motor neurons firing at a given moment.” This is of course monitored (and modified) by one of our best friends, the cerebellum.”

Why you shouldn’t just be simply activating weak muscles for a movement solution.  “You may be over riding the central pattern generators, reflex responses and complex cortical loops arthrogenic responses, which could be neuro-protectively calculated.”

3 categories of muscle weakness “Local causes include muscle injury and muscle pathologies, like muscular dystrophy and neuromuscular endplate disorders like myasthenia gravis. Segmental causes are largely due to reflexes which occur at the spinal cord level. Long loop and cortical causes are due to an increased inhibition or lack of drive from higher centers, such as the motor cortex and cerebellum.”

“Remember the foot intrinsics fire from midstance to pre swing, further stabilizing the foot “core”.”

Pain & Neuroscience

19) “And without the ability to regulate our basic needs, engagement with the environment thru sensorimotor processing is limited. This is why peripheral vision is decreased during stress (they literally have tunnel vision) and it’s probably why movement suffers because if you can’t perceive sensations accurately you don’t make good motor plans.” -Seth Oberst writes a great piece reviewing the Polyvagal Theory and correlating it with Maslow’s Hierarchy of Needs.  Read it.

20) This article covers a ton of neuroscience – top-down & bottom-up influence, expectations, biases, attention, and perception.  Very applicable to what we do in the clinic.  Expectations influence perception.

21) Good read from Lorimer Moseley – No Brain, No Pain.  “any credible evidence of danger to your body will make pain worse and any credible evidence of safety to your body will make it better”

22) “Animal studies provide convincing evidence that the sympathetic nervous system is involved in certain forms of chronic pain.” –Peter Drummond

23) Todd Hargrove goes over Greg Lehman’s course on pain science.  I agree, clinicians should be able to dissociate chronic pain from biomechanics – especially when it comes to communication and education.  But I also want my patients to biomechanically be able to dissociate their hips from their spine.  #Bathwater

24) Movement variability has been getting a lot of attention these days.  “If someone does not have a system capable of varying its movement then finding alternative strategies may be problematic and thus possibly lead to chronicity.”

Don’t forget that mobility (degrees of freedom) dictates the amount of available patterns.  This is one of the reasons why 9 year olds have more variability than 70 year olds.

Training

25) I always enjoy feeling awkward when I move.  It’s good for your body and your mind.  Here’s a couple ways to feel awkward in a “Primal Warm-Up” from Andrew Reed.  Give it a try and be the weird guy in the gym.

26) GMB teach you how to do a Muscle Up

27) YLMSportsScience shares a quick infographic on the Science of Post Activation Potential

28) The unstable ones can’t slow down.  “This is also where the pain science and movement science worlds don’t realize they’re often saying the same thing. Asking someone to move differently is training the musculoskeletal and the nervous systems. Changing how you say, move your arm, changing that habit, is training the brain.”-Brian Reddy

29) Dean Somerset goes over anterior hip anatomy, Sahrmann’s anterior femoral glide syndrome, and provides a few isolated hip exercises.

30) Eric Cressey with solid training advice as always: incorporating single leg pauses, rotational low rows, RTC exercises after overhead work, and different strength qualities.

31) “In intermediate and fast fibers mitochondria are developed by pushing the fibers into light acidity (slight local fatigue), then backing off and recovering aerobically over and over.” -An interesting read from Pavel on long rests for capacity, the effects of acidity, and why we should focus on the mitochondria rather than the energy systems.

32) Lance Goyke goes over some neuroscience, habits, willpower, diet, and exercise.  A good post to give to your clients to read – How Exercise Helps You Stop Eating Dessert

33) CrossFit is always a fun discussion topic on social media (for better or worse).

Stuart McGill had some interesting things to say in this interview – “Olympic lifting must find the lifter. Not the other way around given the special anatomical gifts needed to lift with efficiency and injury resiliency.”

These are two of my more popular articles.  This one elaborates on what McGill discusses in the above article.  This one discusses a common CrossFit mistake that most people miss.

7 Rules for Preventing CrossFit Injuries

34) 4 Unconventional Fat Loss Methods from Mike Robertson: Low Intensity, New HIIT, Focus on Recovery, Front Load Energy System Work.  I like the pyramid in this article.

35) “Begin with the end in mind” Mike Reinold goes over periodization.  I first heard about the Undulating Model from Cal Dietz a couple years ago – very interesting stuff.

36) Eric Cressey has the best Baseball stuff out there.  If you or your clients have any interest in this sport, read this quick post here.  And here’s another one on some things that should change in the Baseball Culture.

37) John O’Neil goes over Motivation, 3 important factors, and makes it clinically applicable:

“Autonomy in the training process is a client’s ownership of their program, understanding that while they are provided structure and coaching, they are the one executing the movements and looking to improve upon their given goals.

Mastery is the ability to perform the process of the given program to the point where variables – movement type, loading scheme, structure – need to be altered periodically to maintain both psychological interest and physiological adaptations.

Purpose is a client’s awareness that movements they are given have reasons in progression towards their goals and the client feeling the need to continue the process to optimize performance.”

38) I recently had a patient that introduced me to Jeff Galloway and his run-walk-run program.  It’s not just for beginners.  It’s for performance.  Very interesting.

Research

39) “A significant association was found between lumbar disc degeneration and tibiotalar joint arthritis (P < .01).”

40) “These results provide experimental support for the importance of action exploration, a key idea from reinforcement learning theory, showing that motor variability facilitates motor learning in humans and that our nervous systems actively regulate it to improve learning.”

41) “When compared to a matched comparison group, there were impairments of scapular musculature strength and endurance in patients with LE (lateral epicondylitis), suggesting that the scapular musculature should be assessed and potentially treated in this population.”

42) “beyond the amplitude of the neural drive, muscle force depends on several biomechanical factors (eg, specific tension and physiological cross-sectional area). Therefore, the VL/VM activation ratio does not provide information about the VL/VM force ratio, which is ultimately the most important information from a clinical perspective.”

43) “A program focused on eccentric hamstring strengthening may prevent hamstring injuries.” -SMR’s review of the Nordic Hamstring Exercise

44) Chris Beardsley goes over all the Kettlebell Research.  The conclusion is that Kettlebells are awesome and you should use them.

45) “Fiber bundle length decreased significantly as a result of a concentric training program, whereas the eccentric strength training did not result in a decreased fiber bundle length. Pennation angle, muscle thickness and muscle strength increased similarly in both groups. Applying eccentric training may lead to preservation of fiber bundle length, allowing the muscle to sustain force over a greater ROM.”

46) I’ve always liked this study – “The results indicate that the master cyclists have a significant asymmetry (30 ± 8 to 23 ± 13 %) during the pedaling exercise at all power output level tested in this study (100, 150, 200 and 250 W).”

47) “a nostril will drive air to the ipsilateral lung” -Zac Cupples shares this article

48) MRI Knuckle Cracking (shared by Jon Herting). Here’s the cavitation article on pubmed.

49) “‘The Placebome’; the impact of genetics to the placebo response.  There is evidence for several genetic variations in neurotransmitters and neurological pathways mediating the placebo response, which could possibly explain the variations in clinical outcomes.”

50) “The purpose of this review is not to suggest a whole-scale rejection of periodization theories but to promote a refined awareness of their various strengths and weaknesses.” -Important article from John Kiely on Periodization

51) Strength wins again!  “Individualised PRT (progressive resistance training) intervention targeting the key muscles of lower limbs is more effective than TBE (therapeutic balance exercise) in improving forward limits of stability among elderly people, aged ≥65 years who are not frail.”

52) Difference between genders and ITB “females with ITBS exhibited significantly greater hip external rotation (ER) angles during swing phase (52-54% of gait cycle) when compared to male runners. Male runners with ITBS showed decreased hip adduction angles throughout swing phase as well as greater ankle internal rotation.”

53) “The closed chain condition elicited significantly higher infraspinatus activation levels than the open chain condition. The posterior deltoid activation levels on the other hand were significantly decreased when the exercises were performed in a closed chain. Moreover, the infraspinatus:posterior deltoid activation ratio was significantly higher in the closed kinetic chain condition.”

54) “Tennis players above 16 years of age had less scapular upward rotation than the younger age groups. “

55) Still fascinated by this stuff – Catherine Kerr on the somatosensory attention

56) “Study suggests that unloaded movement facilitation is more effective than “no exercise” for chronic lower back pain” (shared by TPI)

57) Research and evidence is very important.  But don’t become a Research Snob.

“Another important consideration is the fact that there a significant number of incredibly brilliant minds in the industry, and while there are a lot of them in academia, there are a significant number who are not.” =Mike Mullins

Practice-Based Evidence

The Truth About Randomized Controlled Studies

Other

58) Communication may be the most important part of our jobs.  Here are 10 Tips to improve it.

59) 5 Ways to Make a Good First Impression 1) Assume They Already Like You 2) Drug Them 3) Solid Handshake 4) Spin a Positive Self 5) Don’t Play Cool

Top Tweets of the Month

• Ben Peterson PhD  ‏@Ben_J_Peterson – Research papers are not answers. They are clues which you must think about in greater depth to find truth. #alwaysquestion #Think
• Dr. Mark Cheng‏@DrMarkCheng – Errors in proprioception, coordination, and/or even socialization are due to a disconnect between self-perception & reality. #truth
• Doug Kechijian‏@greenfeetPT – That neurology drives biomechanics doesn’t diminish the latter’s importance
• Seth Oberst‏@SethOberstDPT – Until we take into account and measure how our inputs affect the brain, we will likely have incomplete answers on mechanisms of change
• Zac Cupples‏@ZCupples – Just because humans are adaptable doesn’t mean the adaptations will be beneficial for that individual’s well being.
• Christopher Johnson‏@chrisjohnsonPT – Trying to make performance gains in the context of injury is a recipe for disaster. #rehab2traintrain2competecompete2defineyourlimits
• Aaron Swanson‏@ASwansonPT – Effective communication skills are a pre-requisite to effectively teaching patients about pain.

Gif of the Month

Check out this Scapula Stability Flow

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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