Click here for this edition’s Table of Contents

Upper Extremity

Shoulder

1) Too many people advance too quickly with pull up progressions.  Too few spend enough time mastering the hang.  Dan Pope writes a nice concise post with 3 basic hang exercises for the shoulders.  And he backs it up with some solid biomechanical logic.

2) Eric Cressey gives a nice 3 minute breakdown of proper cueing for the scaption exercise.  I think a tactile cue for posterior tilting the scapula is one of the best rehab interventions out there.  

3) Heart disease and rotator cuff symptoms are linked in a new study. Maybe it has to do with circulation? Or maybe the rotator cuff symptoms are just the output of a lifestyle dysfunction?

4) Erson shares a nice example of a motor control shoulder dysfunction.  Before you jump to conclusions, assess their movement impairment with different patterns (i.e. posture changes, sequencing, distal positioning, centration, etc.). Continue reading “2017 Hits : Vol. 1 : Clinical Upper Extremity”

Click here for this edition’s Table of Contents

1) Everyone is different (joint, osseous structures, myofascial structures, developmental history, etc.).  So it’s easy to understand why “there are no systematic advantages of one foot strike pattern over another when it comes to running economy”.  #DynamicSystem

2) “Proximal joints act as motors and distal joints as adjustable dampers & springs” -Derek Griffin

3) Are we overlooking the blood flow component of tendinopathies?  “Tendon blood flow tends to decrease with age and compression, which often results from increased mechanical load. This decreased vascularization, at least theoretically, can contribute to the probability of tissue damage as tissue compliance and flexibility will be compromised (LER). Oxygen consumption of ligaments and tendons is 7.5% lower than skeletal muscle, which may contribute to longer healing times (2,3).”

4) The Gait Guy’s breakdown of a case study is always worth the time.  In this one they find the driver in the spine.  In this one they breakdown the biomechanics of 4 different runners.

5) What do we use to regulate ourselves?  Thought or awareness?  Seth teaches us how using thought can lead to chronic pain.  “But we can’t think our way out of a physical “problem”. The autobiographical self (story we tell ourselves) and the embodied self (our experience in the present moment) are separate neural networks.“ Continue reading “Fall Hits 2016: Clinical”

The Hits

This is a collection of some of my favorite articles from the past month.  I bolded and underlined 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.  I realize that some readers may be looking for something more brief.

Unfortunately, I am currently busy with a couple other projects and do not have the resources to produce a collection of “Hits” every month.  However, I’ll continue to do my best to get it out as frequently as I can.

For a more real-time update of movement and health information follow me on social media:

Instagram – exercise pictures, movement flows, and Rigby

Facebook – movement and health articles (geared towards the public to improve education)

Twitter – weird abstract comments, out of context stuff, quotes, and good stuff from things I’m reading

If you enjoy this collection and find it valuable, please share it with other professionals.  If you have the resources available, please make a donation to help me run this site and continue to put information out there to help movement professionals grow.

Also, I want to encourage any readers to share their favorite articles, books, or podcasts of the month in the comments below.  I know there’s a ton of great stuff out there that isn’t on my radar.  It will introduce me and other readers to new perspectives.

Clinical

• “You can recognize a deep truth by the feature that it’s opposite is also a deep truth” – Frank Wilczek

1) “The human body is one of the most complex organizations of matter in the known universe. To understand it, we must build models, use metaphors, and deal in abstractions. This necessarily involves ignoring certain details, creating simplified pictures, and relying on metaphors that have the potential to mislead. But we have no choice! Models and metaphors are indispensable thinking tools to understanding the body. Each model is a different perspective from which to see the world, with its own unique insights and blindspots.” –Todd Hargrove

2) Michael Mullin shares his highlights and thoughts from a great article on the diaphragm.

3) Solid article from Chris Beardsley – “Eccentric training produces specific gains in eccentric strength, partly by increasing the strength of the passive elements in a muscle, which makes them stiffer. This gives muscles a greater capacity to decelerate, and absorb energy. This superior ability to absorb energy is probably why eccentric training then leads to a reduction in the risk of getting a muscle strain injury.”

4) “If existing interventions don’t adequately address the way patients use somatosensory versus visual information, that could explain why patients with CAI often continue to experience episodes of ankle sprain or giving way despite having gone through a full balance training protocol.” Continue reading “May-June Hits 2016 : Tom Myers, Self-Image, Pain & Noses, Instagram, Diet & Tendons”

News

Unfortunately, my time in NYC is coming to an end. I’ve spent over 8 years here and I’ve enjoyed the buzz, the people, the music, and the late night slices . However, I’m ready for a lower cost of living, a little less concrete, a little more nature, and a slower pace. So I’m moving to Asheville, North Carolina in January.

I wrote this article on 5 things I’ve learned from my mentorship at Dynamic Sports Physical Therapy.  I feel that one thing missing from the movement social media world is a discussion on the things that happen “behind the scenes” that make the difference between a good clinician and a great one.  While evidence, trendy semantics, cool neuro language, the latest performance enhancement, and arguments over what someone else is doing can be fun to read, they don’t always translate to improving clinical performance.  

If there’s anything I’ve learned from my 5 years as a PT in NYC, it’s that there’s a lot more to treating patients than what you can read in a journal, book, or blog.  Hopefully the article above will help explain this concept (yes, I know it’s a blog and I’ve just contradicted myself, but if you read it you’ll get the point). Continue reading “December Hits (2015)”

Clinical

• “Each time we introduce an assumption, we also introduce a new bias into the final solution” -Serge Gracovetsky

1) “Our neurological wiring has evolved into networks of patterned behavior designed to efficiently complete tasks mandated by the environment. Anatomy provides the frame to carry out these behaviors; the changes to structure are the tangible result of our habits. But once we open up some behavioral options for new habit formation, anatomical abnormalities don’t seem quite so concrete and problematic.”-Seth Oberst

2) Here’s the last category of the Coaching & Cueing series – Proprioceptive Cues

3) Want another tool for decreasing muscle tone? Try shortening the muscle and use some reciprocal inhibition.

The Gait Guys want you to decrease hypertonic muscles by stretching the antagonist?  Interesting article on reciprocal inhibition and muscle spindles.

Erson wants you to try shortening the muscle for 30-60 seconds before you go aggressive. Continue reading “October Hits (2015)”

Clinical

1) Dan Pope shares another awesome video exercise progression – this time it’s on jump variations.  He literally shows you how to bridge the gap in this one.  Great stuff.

2) Leon Chaitow goes over pulsed muscle energy technique.  A much safer and more effective intervention than cranking on joints with aggressive stretching.  Take note of his communication in the video – calm, slow, speaking – external cues – takes his time to get the patient to perform exactly what he wants.  #Variables

3) Tom Goom writes some of the best running articles out there.  Here’s a great post 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. Continue reading “September Hits (2015)”

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).” Continue reading “August Hits (2015)”

Clinical

1) Lately, I’ve been interested in the connection between vision and the cervical spine.  Here’s two interesting articles I found this month.

“The direction of eye movements was horizontal when the sternocleidomastoidmuscle on one side of the neck and the splenius on the other side were activated, and downward when both splenii muscles were vibrated.”

“During neck rotation SCM and MF EMG was less when the eyes were maintained with a constant intra-orbit position that was opposite to the direction of rotation compared to trials in which the eyes were maintained in the same direction as the head movement.”

I put people in challenging developmental positions and have them use their vision to either increase motion or to dissociate their vision from their cervical spine (changing muscle activation patterns).

2) Still don’t think vision and the cervical spine are related?  Check out this research article on Continue reading “April Hits (2015)”

One of the best things about the information age is the amount of great content out there.  There are so many smart, generous individuals sharing information that can improve your skills and increase your quality of care.  These blogs are accessible, straight forward, and clinically applicable.  Here is my year end summary of some of my favorite stuff from this past year.

I came out of the stone-age and started using Google Analytics, which allowed me to see which of my articles were most popular, and which ones were only read by my girlfriend.  It wasn’t what I expected.

Keep in mind that these lists are in no particular order.  And also, this is just a small amount of the great articles out there.  It’s just the ones I enjoyed the most from a years worth of Hits.  If your favorites weren’t listed here, please feel free to leave a comment with your Top Reads. Continue reading “The Best of 2014”

– November Hits –

1) Stress is stress.  And there are many outputs that can occur in response to stress.  Too often we get stuck obsessing over just one of the outputs – PAIN.  As movement professionals we should focus on the output that we’re the most proficient at – MOVEMENT.  If you disagree, Zac Cupples will convince you in this phenomenal article.  “Assessing movement may be the simplest way to assess an individual’s stress status.”

2) Decreased hamstring strength increases ACL loading during sidestep cutting.

3) “If your tongue is on the roof of your mouth, you are connecting palate, pharynx, hyoid, jaw, and skull.  You are stabilizing your airway, so you can breathe, while anchoring your TMJ so it doesn’t deviate. Now, your body is more balanced and can better ambulate.” –Kathy Dooley Continue reading “November Hits (2014)”

– September Hits –

1) “Maintaining the short foot position can generate an arch and produce a monstrous feed-forward loop that maintains tension and stability throughout the system reinforcing to the brain that force can be safely produced. When the arch collapses the nervous system quickly downregulates in an attempt to avoid excess force thru the entire lower quarter while in an unstable position, yielding decreased output.” -Seth Oberst on foot positioning

2) Tendinopathy research goes pretty deep.  There has been a lot of progress over the years, but there is still a ton we don’t know.  Here are 2 posts to update your knowledge: 1) Peter Malliaras’s tendinopathy research post 2) 10 Clinical Pearls from ISTS 2014

3) Adriaan Louw and the ISPI just published a great study on pain education and how it can save the healthcare system a ton of money.  Here is a quick flow sheet to understand the process.  He also has a nice post on the important question, is it a tissue problem or a pain problem?  Adriaan’s Medbridge course is worth the subscription alone. Continue reading “September Hits (2014)”

– August Hits –

1) Does your patient suffer from VOMIT?  It is one of the fastest growing pathologies in our society.  Make sure you are aware of this terrible problem and educate your patients.

2) I’m not going to stop drinking it, but here’s some good information.

3) “Our study demonstrated no benefit for intramuscular PRP injections, as compared with placebo injections, in patients with acute hamstring injuries” Continue reading “August Hits (2014)”

– July Hits –

1) Have you heard about using isometrics to decrease pain associated with tendinopathies?  I was unfamiliar with this concept so I thought I’d send out a tweet to one of the leading experts, Jill Cook.  She gave some great advice that you can immediately use in your practice.  Jill’s guidelines: Continue reading “July Hits (2014)”

– June Hits –

1) “When an imparted load exceeds the load bearing capacity of the tissue accepting it, damage occurs. Neurological errors in movement execution commonly lead to loads being placed on “unprepared” tissues. It is therefore important to focus on two aspects of training to reduce the likelihood of sustaining injuries: 1. Working on improving neural control via progressively complex movement tasks –  2.Improve the physical, mechanical load bearing capacity of tissues.” – Andreo Spina

2) Some good PRI exercises in this article by CPG.

3) A story about a man amputating his own arm to try to get rid of his pain.  It didn’t work.  #PainScience Continue reading “June Hits (2014)”

– May Hits –

1) Do you know about the anti-icing movement?  Many are advocating against cryotherapy post injury.  Some blindly jump on the bandwagon, some feel threatened and become defensive, and most of us just want to know why.  I’ve recently come across a couple great articles on the theory and evidence that explains why we should not ice injuries.  Even if you continue to ice, you should at least know what it really does (e.g. numbing effect, descending modulation, body temp regulation, placebo). Continue reading “May Hits (2014)”

– April Hits –

1) This is a MUST READ for anyone that puts their hands on their patients.  Erson shares 5 profound articles that changed his career.

2) StrongFirst Tactical Strength Challenge Program

3) “Think of PNF as a way of means of feeding the sensorimotor system specific purposeful information to create a purposeful and functional motor strategy” – Ramez Antoun

4) Post-Activation Potentiation – A phenomena by which Continue reading “April Hits (2014)”

– March –

1) Communication is just as important as the intervention.  Seth Oberst writes a great post on the difference between external and internal cues.  “It’s now being shown that athletes focusing on the results of the movement are producing more force, jumping higher, generating better performance in stressful situations, and increasing fluidity and multi-tasking.”

2) Evolution has shown us the importance of diet and the jaw on our growth as a species.  Here’s an interesting site on the jaw and it’s relation to the co-morbidities.

3) Want to learn how to pistol squat?  Click here. Continue reading “March Hits (2014)”

– February –

1) One of the best things about PRI is their interdisciplinary approach.  They’ve done a great job at providing holistic care.  Specifically, PRI Vision is putting out some great stuff.  PT’s have been stuck advising the same ergonomics with the same reasoning for the past 30 years.  Heidi Wise goes over a more methodical way to address your patient’s ergonomics (Part 1 & Part 2).

2) Kevin Carr goes over some great Row Progressions.  Use these for your patient.  Use these for yourself in the gym.

3) The language you use with your patient has a huge impact.  Be positive and optimistic.  Don’t talk over their heads.  Don’t scare them with patho-anatomy and diagnoses. Continue reading “February Hits (2014)”

– January 2014 –

1) Pain and Central Sensitization is a growing topic in our field.  And for a good reason, pain is the #1 reason people come to see us.  Plus, chronic pain is becoming more and more common.  It’s great having so much information available to learn about these topics, however, there isn’t a lot of information on the specific clinical application.  I sought out pain expert, Adriaan Louw, to answer some clinical questions on pain science in this months post.

2) Charlie Weingroff goes over some theory on why ankle mobility is important for glute activation.  He also has a great article on how different body types tend to move and perform. Continue reading “January Hits (2014)”

The Hits

1) Human movement isn’t always as simple as basic kinesiology and anatomy.  James Speck gives a great example of this in his detailed article describing the soleus as a knee extender.  “When a muscle contracts, it doesn’t think about which direction in needs to pull. It just shortens.”

2) More on pain science: “…they used newer MRI technology to see how flexible people could be in responding to pain. The mind-wanderers were more flexible.”  Pain isn’t a pathological structure; it’s a central processed perception.

3) I recently had a medial elbow tendinosis patient.  When I screened him with the SFMA his single leg balance was terrible.  He had some severe ankle/foot stability deficits.  This study was in a recent JOSPT.  Regional interdependence.  SFMA. Continue reading “December Hits (2013)”

-OverheadShoulder-Jerk-ALL-Hammy-Memory-FrontSquat-Speed-Mistakes-GMI-LowerTraps-Pain

1)  Down and back isn’t always right for our shoulder patients.  In fact, some people need the opposite.  This months article goes over how to assess and treat someone for overhead shoulder exercises.

2) This is awesome – slow-mo clean & jerk video with analysis from olympic lifting coach Jim Schmitz.

3) A new knee ligament?  Researchers have found an Anterolateral Ligament (ALL) in the knee.  Is this a profound advancement in anatomy?  Or is this just a carved out fascial thickening?

4) Great perspective on hamstring tightness.  Mike Reinold discusses how a tight hip flexor can pull the pelvis into an anterior pelvic tilt, thus decreasing the contralateral straight leg raise.  You could use the 90-90 active posterior chain test in hooklying to further Continue reading “November Hits”

– Upper Trap – Thought Viruses – Deadlift – 5×5 – Reciprocity – Sensory Fascia – E5 – Perception – Anti-Valgus – Bad Medine – Cook’s 3’s – Doga

1) The poor upper trapezius.  It might be the most understood muscle in the body.  It’s not a major shoulder elevator and it isn’t a big problem in shoulder patients.  In fact it’s usually the opposite.  Check out this months post to learn more. Continue reading “October Hits”

Kettlebells – Runners – Habits – Longevity – Med Ball – Tightness – Goblet – Yoga – Elbow Grease

1) Kettlebells are becoming more and more common in fitness and rehab.  If you don’t use them, you should.  Here’s this months article on my expirience at the premier kettlebell workshop.

2) Erson goes over 5 things to look for in runners.  “Running is one sport that arguable needs more symmetry than most. I tell my runners it’s because you’re doing the same thing over and over for 1000s of steps until you stop!” Continue reading “September Hits”

– Lumbar Extension – Selling – Pain&Expection – Evolved Shoulder – Posterior Hip Pain – Posterior Chain – Gray Cook – EBP? –

1) Our profession and our society has become so afraid of lumbar flexion that it’s almost a phobia.  This obsession of avoiding lumbar flexion has allowed another problem to slip by – excessive lumbar extension.  I’ve been noticing more lumbar extension dysfunction in the clinic.  Read about it in this months post here.

2) The more I practice the more I start to think the most important aspect of PT is the patient’s mindset.  I look for 2 things in the eval  Continue reading “August Hits”

– Fatigue – High Heels – Motor Learning – Mobility – Threshold – Strengthening – Parachute – Protocols – Armbar – Neuro –

1) I think exercise programs like crossfit and P-90X are great.  They get more people moving and interested in their health.  And in today’s society, decreasing the amount of sedentary people is very important.  However, when exercises are performed past failure a ton of things go wrong.  A new study showed there is a deterioration of lower extremity biomechanics when fatigue hits.  This causes a dangerous cascade of events: compensations, inefficient movement, substitution movement patterns, and an increased risk for injury.  While many of us already know this, many of our patients don’t.  Educate them. Continue reading “July Hits”

– Butler Cliffnotes – Deep Squat – MDT Reset – Hip Thrust – Hamstring Strains – DNS & Powerlifting –

1) So Zac Cupples does Cliffnotes for PT books.  Here’s his post on the Sensitive Nervous System by David Butler.  If you aren’t familiar with Butler and the NOI approach you should check it out.  “Pain is an unpleasant, sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

2) As a deep squat advocate, I loved this post by James Speck.  To perform the deep squat you must have BOTH mobility and stability.  This alone makes it a great assessment and intervention. Continue reading “June Hits”

Language – Hip Hinge – Ankle/Hip – Weingroff – Boyle – Core Exercise – Knee Valgus

1) “An alteration of the language output may be as clinically potent in desensitising pain neurosignatures and it certainly has not been considered as deeply in rehabilitation.”  David Butler discusses how correcting patients language & thoughts relating to their pain is just as important as it is to correct their movement output.  This month’s JOSPT has a related article on the how movement system diagnostic labels can prevent the disconnect between diagnostics and treatment processes that pathoanatomic labels create.

2) The hip hinge is one of the most important movement patterns for anyone that moves.  This months article goes over what it is, how to assess it, and how to correct it. Continue reading “May Hits”

Joint Laxity – Davis’ Law – Deep Squat – Foot Types – Standing Help – Step Up

1) Beighton Laxity Scale gives a good indication of your patients congenital laxity.  If your patient is extremely hypermobile then you shouldn’t be spending alot of time doing joint mobilizations and/or manipulations.  These patients require a great deal of stability.

2) Davis’ Law, the soft tissue equivalent to Wolff’s Law, describes how soft-tissues adapt to stress.  It describes how muscles adapt in a reciprocal manner.  For example, a strong and inflexible gastroc will usually cause the anterior tibialis to become weak and flexible.  With this law in mind, you should always consider the antagonist when trying to achieve an increase in strength or mobility. Continue reading “April Hits”

5 Ways to Expand – Lateral Stability – Video Analysis – RTC Myths – Breathing – SIJ – Carbs

1) PT School lays down the necessary foundation to develop your career.  There are many important things that we don’t learn in school.  Erson goes over 5 of these things.  I completely agree.

2) This might be a nice progression for patients that have already mastered the sagittal plane and have topped out with isolated hip strengthening (bridges, clamshells, side-step, etc.).  Eric Cressey goes over advanced lateral stability training.

3) Chris Johnson goes over the details of how to videotape your runners for analysis.

4) Mike Reinold describes his 4 RTC myths in this article.  Mike makes a great point on Continue reading “March Hits”

Breathing – Thoracic Mobility – FMS – Neuro – Pendulum Theory – Warm-Up – Glutes

1) Bill Hartmen uses the downward dog to increase pre-load on the diaphragm, activate the serratus anterior, and unload the scalenes while facilitating deep neck flexors.  All this can significantly help your breathing patterns.  Check out this months post on breathing.

2) This is a great thoracic mobility technique using the NMT T-Bar.  A good way to increase thoracic mobilization and
integrate with scapular movement.

3) Nice summary of FMS corrections (from Mike Reinold’s site). Continue reading “February Hits”

Coordination – TRX Y’s – Nocebo – Hallux Mobility – Neuro Approach

1) Maybe we should slow down a little bit.  Todd Hargrove goes over why slow movement is important for coordination and movement efficiency.  This can be very useful when attempting to teach the “motor morons” how to move right.  I specifically liked the Weber-Fechner Law, which describes that the relationship between the physical magnitiudes of a stimuli and the perceived intensity of the stimuli.

2) Overhead movements are usually butchered by patients.  When trying to activate the lower trap many patients compensate with a rib cage flare, hyperlordosis, forward head, and unusual grunts.  Cressey quickly goes over how to teach the TRX Y’s in this 2 minute video. Continue reading “January Hits”