The Hits

This is just a collection of some of my favorite articles from the past month.  The bolded the numbers of the articles that I found most remarkable.  Of course, this is just my bias.  I think all the articles here have value.  However, I realize that some readers may be looking for something more brief.

Also, I want to encourage any reader to share their favorite articles, books, or podcasts of the month in the comments below.  There’s only so much information that I can go through in a month.  I know there’s a ton of great stuff out there that isn’t on my radar.  It will not only help introduce me to new perspectives, but it will provide other readers this opportunity as well.

Clinical

• “The job of a skilled therapist is to detect where the system is open to change, to provide the appropriate new input to destabilize the old pattern, and to facilitate the person’s seeking of new solutions” -Esther Thelen (via Seth Oberst)

1) One of the better ACL articles I’ve read in a while.  Read this post – especially the part on terminal knee flexion.  Great explanations and quick video demonstrations.  Very useful for the clinic tomorrow.  Here’s one gem from the article series – “The ability of the hamstring to pull the heel to butt is a necessary pre-requisite for dorsiflexion.”

2) The Longus Capitus attaches to the foramen magnum?  How did I overlook that?

3) Sick of patients asking for you to put their pelvis/SIJ back in place?  Try these 3 steps to change their thought virus.

Challenge a Concept

Provide an Alternative Concept

Provide Evidence for a New Concept

4) It’s important to be able to screen for the serious stuff, like cervical myelopathy.

5) Sometimes I feel we can get carried away with giving all of our attention to the newest tricks, theories, and/or concepts.  Often, the real clinical issues are overlooked.  Here’s a great, honest post on healing time frames.  I agree, most people think they’re supposed to get better quicker than they should and most patients and PTs overlook the long-term plan of care (>12 months).

6) If you enjoy reading about evolution you should check out this strong article by Noah Harrison. “Whether we sit or stand, humans do not tolerate stasis well.”

7) Read this slowly – “Ankle eversion ROM and peak eversion velocity were greater in uninjured runners while peak eversion angle was greater in injured runners. “  Interesting.

8) Christine Ruffolo shows you how to relax your neck and gives the best one sentence summary of the FRC system – “The basic premise of Functional Range Conditioning is to capture passive ranges of motion in the end range and make them more active.”

9) A nice post reminding us of the hazards of sitting.  Supported with links to research.

10) Mike Reinold shares his overhead shoulder mobility assessment for soft tissue vs. other factors.  He internally rotates the shoulder to slacken the teres minor and lat.

11) Erson shares 5 spinal flexion myths.  After reading that, If you’re still not sure about spinal flexion read the book The Spinal Engine.  Then if you’re still uncertain about spinal flexion you should quit your job as a physical therapist.

12) An informative post on the latest Lumbar Radiculopathy vs. Sciatica and enhanced specificity of surgical referral – “Lumbosacral radicular syndrome is a more explicit term. As our understanding of this condition sharpens to be more accurate in terms of both the clinical features and related patho-anatomy, it is helpful if we move away from the term ‘sciatica’ and embrace ‘lumbosacral radicular syndrome’.”

13) The therapist-effect. This study shows PTs who are calmer, more relaxed, secure, and resilient have better outcomes with patients with chronic diseases.

14) I see a lot of extension based back pain.  Dave Tilly has an article series on how to address this problem in the athletic population.

15) I enjoyed these great sound bites from Cinemasays’ 2015 Interviewing Summary post

16) Erson shares 5 questions you should ask yourself regularly

17) The deep squat is always a hot topic.  Dan Pope provides a new article series investigating the safety of the exercise.

18) LER Magazine is always solid – good stuff from this one

Why the half-kneeling ankle mobilization is not the end all be all to ankle dorsiflexion problems – “In 2002, DiGiovanni and colleagues authored a study that showed 88% of healthy patients with forefoot or midfoot pathologies or both presented with posterior muscle group tightness.  More specifically, they, like others, found the majority of the patients suffered from an isolated gastrocnemius equinus, as opposed to a gastroc-soleus complex equinus.”  Which is why I often give a version of this exercise to my patients with decreased ankle DF

“Typically, the center of pressure on the foot can be measured 6 cm anterior to the ankle during gait, but with equinus, it is shifted distally and laterally.”

Biomechanical vs. Anatomical Breathing

19) I was talking to Cameron Yuen at a recent course about my love for kettlebells and desire to someday become SFG certified.  I mentioned how I’m not sure I could pass the snatch test.  Cameron asked if I had tried anatomical breathing.  I told him I hadn’t even heard of it.

I went home and did some research on the topic.  Not only was there very little on this method, but the quality was poor.  I reached out to Cameron and asked if he would do a guest post to clear things up for me.  Luckily, he obliged.

Here’s a solid post on the difference between Biomechanical and Anatomical Breathing.

I’ve been able to integrate this into practice immediately.

Pain & Neuroscience

• Tension is who you think you should be.  Relaxation is who you are.

20) “Modern neuroscience indicates quite clearly (read Subliminal) that our subconscious interpretation of sensory input is largely viewed thru a predictive lens informed by our past behaviors and experiences.”-Seth Oberst

21) “Once we identify with something it becomes uncomfortable to let go of, even if we want to. So many of the persistent pain clients I work with struggle to “let go” of THEIR pain, in part because of an identification with it. IT has become part of them and is reinforced both neurologically and psychologically by every x-ray and MRI reading and every stressor that elicits the symptoms.”

22) “Pain is recognised as part of the human experience. So we tend to assume that communicating about pain will seamlessly cross cultural boundaries. But people in pain are subject to the ways their cultures have trained them to experience and express pain.”

23) “the biophysical substrates of conscious states (including pain and suffering) in any species, including humans, cannot yet be confidently identified“

24) “According to these results people with symptoms of depression have nearly 60% increased odds of developing an episode of low back pain compared to those without depression symptomatology, with the risk being higher in patients with more severe levels of depression.”

25) Spend some time with this one.  Top Ten Neuroscience Breakthroughs of 2015.  Very important one to read.

26) Great read on acceptance and commitment therapy – “From the perspective of radical behaviorism, the problem here is not limited to avoidance and its associated problems, further problems are likely when avoidance behavior persists in spite of equally persistent failures to achieve its objective (i.e., pain reduction or elimination) over the longer term.” :|: “Thus, the issue is not to just “accept it”, but to determine if there are areas in life that are worth the experience of pain.”

27) Anxiety makes blindfolded people walk more towards the left

28) Todd Hargrove summarizes Andy Clark’s Extended Mind concept – “we generally fail to appreciate how much information processing gets done in interactions between the brain, body and environment”

Training

• “If you are going to include an exercise in a program, you absolutely have to be able to justify how it’s going to create the training effect you want” -Eric Cressey

29) One of the best reads this month from Pavel – “In training, you can achieve flow by learning to love the process, by treating it as a quest for technical mastery rather than a mindless smoker. You must go deeper into your skills rather than broader. Prof. Csíkszentmihályi reminds us that, “Enjoyment depends on increasing complexity.””

30) Nice article on bottoms-up kettlebell training with exercise examples and quick summaries of the benefits (centration, stability, focus, irradiation, etc).  I’m not sure if it’s funny or sad that the title is “the weirdest training method that works”

31) Sports Science Infographics shows you the dangers of fatigue and how it can have lasting effects

32) Eric Cressey coaches the Offset Kettlebell TRX Row

33) The last several months I’ve really been interested in hamstring strength.  I think it’s often overlooked and under appreciated.  Here’s the Poor Man’s Hamstring/Leg Curl.

34) Mike Robertson goes over the cat-camel exercise.

35) Eric Cressey shares 5 of his favorite exercises that “over deliver“

36) Add upward rotation, shoulder abduction, elbow flexion, or core control to make the waiters carry more effective.

37) 3 Ways to Make Exercises More Difficult: 1) Increase the ROM 2) Change the Tempo 3) Internal Cues or Focused Tension

38) It’s important to ensure proximal control throughout the continuum of movement – not just in the high-threshold patterns.  Here’s an article on regressed core exercise.

39) Some fat loss templates by Mike Robertson

40) ”early-morning exercise in the fasted state is more potent than an identical amount of exercise in the fed state for maintaining healthy waistlines”

41) I really like Dean’s research summary and his half kneeling passive to active ankle dosiflexion rock back exercise.

42) “The abs are crucial for multi-directional speed. If you can’t control the pelvis, you can’t load the hip.”-Mike Robertson with 31 thoughts on speed and agility

Exercise of the Month

Scales are a great way to improve open and closed chain strength and motor control.  There are an infinite amount of motor patterns to work on.  Lately, I’ve been working on my open chain hip flexion in this pattern (standing ASLR).  It’s a much better option than aggressively stretching the posterior chain.

Notice how I lean back to compensate for my lack of motor control.  I didn’t know I was doing this until my wife filmed me for this video.  I’ve been able to consciously correct it, but it’s a reminder of the importance of showing the individual the movement error.

Research

43) Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch

44) Want to improve performance?  Get more sleep.  “Athletes who obtained less than 5 hours of sleep performed worse on ImPact computerized neurocognitive testing than those who slept more”

45) “Although the medical literature has not yet provided definitive evidence of effectiveness, a number of existing studies suggest that yoga interventions are associated with improved physical and mental health outcomes among adults with knee osteoarthritis.”

46) “The Amsterdam Wrist Clinical Prediction rule showed a high sensitivity (98%) and negative predictive value (90%) for fractures of the wrist”

47) Study on visceral manipulation – “64 patients with LBP were included and were randomized into two blinded groups. 32 patients received a standard physiotherapy treatment plus visceral manipulation and 32 patients received the standard physiotherapy treatment plus a placebo visceral manipulation over a period of 6 weeks. The placebo therapy was performed on abdominal areas which are not involved in any sense to any visceral issues.  After 6 weeks of intervention no differences in pain could be identified.”

48) “This study demonstrates that vagus nerve stimulation appears to improve the recovery that stroke patients make”

49) “The findings suggest that tactile acuity deficits may be characteristic of chronic pain.”  If this confuses you, check out this article on threshold strategies and then this one on sensory awareness.

50) “Disc bulging was frequently observed in asymptomatic subjects, even including those in their 20s.” #Imaging #VOMIT

51) “In this essay, I review the evidence that persuades me of the importance of intrinsic activity and then briefly survey the material presently available regarding its properties and functions.” #TheRestlessBrain

52) “This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson’s disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer.” #ExerciseIsMedicine

53) “The biological health-related benefits occur because mindfulness meditation training fundamentally alters brain network functional connectivity patterns and the brain changes statistically explain the improvements in inflammation.”

54) “Social networks as important as exercise and diet across the span of our lives.” :|: ““The relationship between health and the degree to which people are integrated in large social networks is strongest at the beginning and at the end of life, and not so important in middle adulthood, when the quality, not the quantity, of social relationships matters,” #psychoSOCIAL

55) “These findings are the first to demonstrate that non-emotional training that improves the ability to ignore irrelevant information can result in reduced brain reactions to emotional events and alter brain connections”

56) “Resistance to infections needs to be coupled with tolerance to the delicacy of the system.  Our work identifies a mechanism by which neurons work with immune cells to help intestinal tissue respond to perturbations without going too far.”

57) “Dartmouth researchers have found the first direct evidence showing how the vestibular system’s horizontal canals play a key role in sensing our direction in the environment.”

Clinical Question

58) Does anyone know where the whole 2 minutes for stretching to be effective comes from?  I’ve asked around and I usually only get general answers such as authors, books, or the non-answer of “it’s a culmination of a bunch of research and physiology”.  Does anyone have a single research article that literally supports the 2 minute theory?

Other Good Stuff

Psychology and Communication

59) “A new study has found that there are three main categories of foolish behaviour – confident ignorance, lack of control and absentmindedness”

60) The right question is “How do I get them talking about what they’re interested in?“ #Communication

61) “Shelly Gable, professor of psychology at the University of California at Santa Barbara, has demonstrated that how you celebrate is more predictive of strong relations than how you fight.”

62) “Neuroscience research shows nothing beats a story when it comes to convincing you of something.” #Communication

63) “We might be better off, in every way, when we succeed in dialing down the experience of being the center of the universe.”

64) “It’s the attention residue problem again. Any time you are reacting to new stimuli it pulls you out of focus. And then that can linger in your head, draining your ability to concentrate on what’s important.”

65) “If you’re optimistic, you’ll have more energy. If you’re pessimistic, you’ll be more stressed. It’s all about how you interpret what is going on, not what is actually happening.”

Diet

66) Evidence suggests sugar consumption plays greater role in heart disease than saturated fat

67) Low-carb beats low-fat in a meta-analysis of 17 clinical trials. Obese and overweight adults on low-carb diets lost more weight and had lower atherosclerotic cardiovascular disease risk.

68) “A new study found that eating less fiber, more saturated fat and more sugar is associated with lighter, less restorative, and more disrupted sleep.”

Sleep

69) Solid article on why you should fix your circadian cycle.  It provides a good summary of the results of poor #sleep.

70) “These results reveal that, without sleep, the mere recognition of what is an emotional and what is a neutral event is disrupted. We may experience similar emotional provocations from all incoming events, even neutral ones, and lose our ability to sort out more or less important information. This can lead to biased cognitive processing and poor judgment as well as anxiety,”

71) Want your kids to get better grades? Have them get more sleep. Or argue for schools to start later as children age so their environment supports a healthier lifestyle. “A new study that my colleagues and I have worked on illustrated how an optimal quantity of sleep leads to more effective learning in terms of knowledge acquisition and memory consolidation. Poor quality of sleep – caused by lots of waking up during the night – has also been reported to be a strong predictor of lower academic performance, reduced capacity for attention, poor executive function and challenging behaviours during the day.”

Reading

• “I took a speed-reading course and read War and Peace in twenty minutes. It involves Russia.” -Woody Allen

72) I’ve always thought reading is a lot like drinking wine.  If you sip it over time you’ll have a great appreciation for the taste and complexity.  If you chug it you won’t remember much, but will likely brag to others about how quickly you drank it.  

A new study supports my theory, “Examining decades’ worth of research on the science of reading, a team of psychological scientists finds little evidence to support speed reading as a shortcut to understanding and remembering large volumes of written content in a short period of time.”

The speed-accuracy trade off applies here.

Take your time if you’re reading to learn.

Other Useful Stuff

73) Great read on how to improve creativity (get new experience, go for walks, take a shower, get some me time, outsiders mindset, keep trying) – “It’s important to encounter new and unusual experiences. It really helps with your cognitive flexibility. Any exposure to things that take you out of your normal way of viewing the world really increases cognitive flexibility, and is a core part of creativity.”

74) Powerful 1 minute read – The Story of the Taoist Farmer

75) “When there is negation of all those things that thought has brought about psychologically, only then is there love, which is compassion and intelligence.” –Krishnamurti

76) “You have more willpower in the morning so push yourself to do that thing you’ll regret not having done. Afterwards, you’ll feel good about yourself. And the rest of the day will look comparatively easy.”-Eric Barker on 7 morning ritual habits

77) Put it away you addict!  “Replication study confirms: Mere presence of your smartphone harms your conversations”
—

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.

 

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