Clinical
1) Read this one – the most detailed and thorough blog post on movement variability. Great stuff from Dave Tilley.
“With movement practice, it is believed by some that coordinative variability decreases (better able to synergies motor patterns for general movement planning) while elemental variability increases (more strategies to generate real time adjustments or handle different conditions while still successfully completing the given task or skill).”
“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.”
2) “Mini-strokes affect up to half of the population over forty, but usually go unnoticed until damage builds.”
3) Erson has had a busy month as always. He goes over directional preference and why it’s a novel stimulus to the nervous system, provides a quick presentation on the true effects of Spinal Manipulation, goes over 5 tips to improve compliance. This is a nice explanation of MDT/McKenzie Cervical interventions. And I like the idea of palpating a tender point and immediately assessing the effects of breathing – Erson’s 5 Breathing Tips.
4) “A forefoot varus differs from forefoot supinatus in that a forefoot varus is a congenital osseous deformity that induces subtalar joint pronation, whereas forefoot supinatus is acquired and develops because of subtalar joint pronation.”-Gait Guys
5) Zac Cupples shares his opinion on manual therapy. He makes some great points – everything works, patient preference is paramount, and use it with an assessment technique.
6) Very thorough and interesting series on the big toe (mechanics, part 1, 2, 3).
Hallux DF = Roll, Slide, Compression
7) It’s important to keep in mind that there is no “magical linchpin” in the human body. Most foot patients aren’t able to progress through their big toe. And there are a ton of reasons why (rearfoot position, midfoot mobility, forefoot position, pathomechanics, morphology, motor patterns, proximal influence, habit, shoewear, ankle rocker, etc.). Be thorough. Use a scalpel instead of a shotgun.
8) Quadratus Plantae muscle testing by the Gait Guys
9) “The problem with conditioned patterns lies in the inability to get out of them when the task/environment requires it.” –Seth Oberst with another great post. At the very least, spend some time studying this picture.
10) Don’t be afraid of the placebo effect. Making someone feel better is not a bad thing (as long as you have a plan of care to treat the cause as well).
11) “a fatigued muscle decreases the body’s ability to attenuate shock from running” | “The results suggested that the lower extremity is able to adapt to fatigue though altering kinematics at impact and redistributing work to larger proximal muscles.”
12) The best training modality may be The Floor
“the floor acts as a mirror to help us complete our self-image”
“It’s harder to sit still for long periods of time when seated on the floor, and that’s a good thing. Sitting on the floor makes it necessary to squirm and adjust position periodically to stay comfortable. It helps develop a better kinesthetic awareness that leads to a more dynamic posture.”
13) “Our real problem here is when we simply discuss tightness or weakness of a muscle, we can go down the rabbit hole thinking it’s a muscle problem. Very often, it’s a command problem.” –Gray Cook elaborates on his movement theory – sometimes mobility problems are really motor control problems
14) Erson displays what Gray goes over in #13 with this motor control fix to a “mobility” problem.
15) How do you know when to bring a motor control fix to a mobility problem?
SFMA (if they touch their palms to the floor and drop into a full squat you can probably bring out the motor control exercises)
Sport History (swimming, yoga, baseball vs. rock climbing, powerlifting, football)
History of Mobility Exercises Not Working
Internal Awareness
I have an interesting patient population. Most of them are very type A, very stressed out, over educated, sedentary, workaholic New Yorkers. The normal interventions that work so well with athletes are usually less effective with these stressed out patients. Below are two articles that discuss an approach I tend to use with these patients. It’s not a strict theory or set of rules, it’s simply just a different way to apply what you already do.
16) Sure, external cues are better for performance, but what about all the other variables? We need to stop the tunnel vision and consider internal cues as an important part of improving movement.
17) Sometimes the best way to change the processing is from within – here’s how mindfulness/body scan can be used to decrease stress and improve sensory processing.
Calf Strength
Not everyone can resolve all their impairments and move perfectly. Sometimes compensations are necessary. One important compensation is plantarflexion strength (especially in older patients).
18) “Of particular importance were the compensatory mechanisms provided by the plantar flexors, which were shown to be able to compensate for many musculoskeletal deficits, including diminished muscle strength in the hip and knee flexors and extensors and increased hip joint stiffness. This importance was further highlighted when a normal walking pattern could not be achieved through compensatory action of other muscle groups when the uniarticular and biarticular plantar flexor strength was decreased as a group.”
19) “From these results we can conclude that the most important muscle groups compensating for reduced strength in knee and hip muscles are the ankle plantarflexors, hip rotators and hip abductors.”
20) “These findings indicate that aging is associated with reduced plantarflexion strength of the toes”
21) “When the walking cycle is accompanied by weight bearing, plantar flexion produces a greater blood velocity.”
22) It’s not just dorsiflexion ROM – “The strength of the plantar flexors and amount of dorsiflexion excursion were identified as significant predictors of an Achilles tendon overuse injury.”
23) Supination = Plantarflexion + Adduction + Inversion
Pain & Neuroscience
24) The importance of building a curriculum to educate your patients – great read from David Butler. “As with any educational intervention, we should have a curriculum, based on what we determine the key educational performance indicators (KEPIs) are, i.e. the bits of knowledge they really need to “get”.”
25) Exercise is medicine. “Certain types of exercise, namely aerobic, are thought to counteract these age-related drops in BDNF and can restore young levels of BDNF in the aging brain.”
26) The Cerebellum
“Although the cerebellum is only 10 percent of the entire brain, it contains more than half of all of the neurons in the brain.”
“Tennis legend Arthur Ashe said famously, “There is a syndrome in sports called ‘paralysis by analysis.'” In my opinion, when the cerebrum is overthinking, and the cerebellum is disengaged, “flow” is inhibited and an athlete chokes. I believe this new research confirms that the cerebellum may be at the heart of breaking the vicious cycle of paralysis by analysis by ‘unclamping’ the cerebrum from overthinking during sports.”
“In order to learn a new motor skill, the researchers found that the cerebellum makes an estimate of the expected sensory inflow that it should get from your sensory system. Then, the cerebellum automatically uses this prediction to compute the difference between what you intended to do and what you actually did. This cerebellar process is key to creating flow and achieving what I call “superfluidity” both on and off the court.”
“Through practice and repetition, the cerebellum also gets better at predicting the unexpected and making lightning fast corrections and readjustments necessary for peak performance.”
27) “Taken together, these findings suggests that at some point in our evolutionary history, we evolved an additional attention network—perhaps in order to better process the world around us,” -Dr. Patel.
28) Maybe have them try writing about their pain? “Some researchers believe that by writing and then editing our own stories, we can change our perceptions of ourselves and identify obstacles that stand in the way of better health.”
29) Erson goes over pain science and education. Regarding discs – make it as easy as simple math ““flexion = +1, extension = -1” keep the equation balanced”. And here’s some great examples of how to educate patients on pain and imaging.
30) “As great as a threat pain can be, outputs such as fear, thirst, and hunger will usually trump pain. These outputs occur in response to threats greater than potential tissue damage. Comparing pain to these outputs can be enlightening for patients.” –Zac Cupples reviews Moseley’s pain course. Great broken bone example/logic in this post.
31) ALPIM Syndrome #Variables
A = Anxiety disorder (mostly panic disorder)
L = Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising)
P = Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis)
I = Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome)
M = Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants)
32) 10 Research backed Mind-Body Connections. It always goes back to the Mature Organism Model – inputs influence the processing which influences the output which influences the inputs which influences the…
33) Have you considered their vision? “Vision is typically the predominant sensory system used for guiding locomotion.”
34) To be a good physical therapist you must have a solid knowledge of anatomy, physiology, and biomechanics as well as a deep understanding of pain and neuroscience. However, the most important part of being a good healthcare provider is understanding the person in front of you. This is often the missing piece when exercise, manual therapy, and education fail to make people feel better. Read this classic article on the complexity of chronic illness and how it leads to suffering – Loss of self: a fundamental form of suffering in the chronically ill – Charmaz K
“A narrow medicalized view of suffering, solely defined as physical discomfort, ignores or minimizes the broader significance of the suffering experienced by debilitated chronically ill adults.”
“As a result of their illnesses, these individuals suffer from (1) leading restricted lives, (2) experiencing social isolation, (3) being discredited and (4) burdening others. Each of these four scores of suffering is analysed in relation to its effects on the consciousness of the ill person.”
Training
35) I like the elbow crawling variation.
36) Here’s an advanced hip mobility drill – 90/90 Hip Flow Transfers
37) PRIing the Push-Up – breathe into the posterior mediastinum at the top, exhale to lock abs, perform push-up.
38) More words of wisdom from the great Eric Cressey
39) The 100 Hardest Bodyweight Exercises
40) Dean Somerset shares 5 pieces of advice for training the low back/hip complex – “For speed and power development, inhales are best with more of a sniffing action where air is taken in quickly and with some development of negative pressure through the ribs and abdomen, and exhaled forcefully and quickly, much like a martial artist throwing a strike.”
41) Dan Pope cleans up your Pistol Squat (Mobility & Stability)
Exercises of the Month
42) This has been my favorite frontal plane exercise progression. You can also use it to challenge their working memory, which is great for the older population.
43) This is a great idea from Zach Long – ½ Kneeling Hip Hinge Landmine Press
*share your favorite exercises in the comments section
Research
44) “The lunge, dead lift, and kettle swings were low intensity (<50% MVIC) and all showed higher EMG activity for semitendinosus than for biceps femoris. Bridge was low but approaching medium intensity, and the TRX, hamstring bridge, and hamstring curl were all medium intensity exercises (≥50% or <80% MVIC). The Nordic, fitball, and slide leg exercises were all high intensity exercises. Only the fitball exercise showed higher EMG activity in the biceps femoris compared with the semitendinosus. Only lunge and kettle swings showed peak EMG in the muscle-tendon unit lengthening phase and both these exercises involved faster speed.”
45) “Some research on why some people don’t respond to exercise “In the following review I will discuss new developments linking genetic and transcript abundance variability to an individual’s potential to improve their aerobic capacity or endurance performance or induce muscle hypertrophy.“
46) It’s all in the hips. “The presence of LBP correlated with higher BMI, gluteus medius weakness, low back tenderness, and a positive Trendelenburg sign, particularly on the affected side for those with unilateral LBP.”
47) One of the oldest movement modalities should be considered more often – “The research described here demonstrates dance’s ability to penetrate one of the most challenging human conditions: the gradual degeneration of the ability to move.”
“Adapted tango, a version of traditional Argentine tango modified to address motor impairments, has been shown to improve balance, mobility, and cognition in older adults and patients with Parkinson disease, with better compliance than conventional rehabilitation.”
48) An update on NSAIDs – increased risk of heart attack/stroke. Tell your patients.
49) ““All participants had their working memory tested at the start and two hours later (after climbing trees, running barefoot, and walking on a balance beam) and the researchers found that while the control groups showed no change, those who completed the proprioceptively dynamic tasks had a 50% jump in their working memory capacity.”
50) Quadruped – “this study’s results provide strong evidence that actively engaging the forelimbs improves hindlimb function and that one likely mechanism underlying these effects is the reorganization and re-engagement of rostrocaudal spinal interneuronal networks.”
51) Why not only use the objective numbers (load, reps, sets) for your patients workouts? Because of the variables. What if they didn’t sleep well, eat well, drank too much, are stressed at home, did too much activity yesterday, or aren’t feeling motivated? When the variables change, the output can change. One way to help avoid overloading athletes is to use rating of perceived exertion (RPE) and/or repetitions in reserve (RIR).
52) Bret Contreras published his first paper on the hip thrust vs the squats. You know which one came out on top.
53) “In exercises that were performed in the upright position (i.e. scaption and both external rotation exercises), ipsilateral trunk rotation led to increased LT activation and increased scapular external rotation and posterior tilt. In the exercises during which the subjects lay prone, UT activation increased, thereby positively influencing (decreasing) UT/MT and UT/LT ratios.”
54) “mental imagery has the potential to influence pain-related decision and evaluative processing”
55) “They found that the subjects who developed LBP during prolonged standing had significantly larger lumbar lordosis than the subjects who did not develop LBP. Larger lordosis angles were linked to increased pain intensity”
56) Medial tibial stress syndrome risk factors : BMI, navicular drop, landing with increased plantarflexion, increased hip ER.
Other Good Stuff
57) 11 Tips for Public Speaking #Communication
58) “Most people, including many scientists, believe that emotions are distinct, locatable entities inside us — but they’re not.” If you like this article you should also see the movie Inside Out. Seriously.
59) Understanding biases is a prerequisite to understanding the world around you.
If you want more information I would read the first half of Daniel Kahneman’s Thinking, Fast and Slow. It’s very powerful stuff that you can apply to everyday situations, but gets redundant and a little boring with too many vanilla examples at the end.
60) “Want to lose abdominal fat, get smarter and live longer? New research that periodically adopting a diet that mimics the effects of fasting may yield a wide range of health benefits.”
61) How Playing Music Benefits Your Brain More than Any Other Activity
62) Eric Cressey with a great article on the hazards of a coffee addiction
“You can’t display your work capacity if you can’t leverage your recovery capacity”
“Small hinges can swing big doors”
63) 6 Communication Tips from Eric Barker
64) Mindless Eating is a must read – for everyone. It solves the overeating epidemic without a solution of a depriving diet.
65) This is sad, funny, and true – 22 Images on How Smartphones Have Taken Over Our Life
66) Get Five 90 Minute Cycles a Day. #Sleep
67) Find the right environment, make friends, and share friends. How context and social circles influence you.
Tweets of the Month
-
-
Jill Cook
@ProfJillCook – Only loading will increase capacity of tendon to tolerate load, passive treatments have no long term effect -
Michael J Mullin
@mjmatc – Frontal plane & frontal lobe activity are pretty similar–both involve ability to project future consequences resulting from current actions -
Kelsy Childers
@kCHiLL13 – “Confidence is silent, insecurities are loud” -
Charlie Weingroff
@CWagon75 – Definition of hypermobilty = not strong enough for what you do -
BPG
@The_BPG – “We must perceive in order to move, but we must also move in order to perceive” – Gibson 1981 -
Tim
@tpelot7 – Great coaching can make good science look great; while good coaching can make great science look good. Science doesn’t coach itself. -
Aaron Swanson
@ASwansonPT – Most of the time, the difference between an expert and a “guru” is that the prior is trying to educate and the latter is trying to sell.
Gif of the Month
Probably doesn’t need a mobility exercise
—
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.
