Clinical
1) Sure, it’s a dynamic system and the nervous system has a huge influence. But you can’t dissociate the physicality of our world from the human body. Simple biomechanics can have a profound effect on your patient’s movement. Here’s an example of how the first class lever works to Increase Glute Med Activity.
2) Don’t forget about the frontal plane aspect of the bunion deformity – “the degree of first metatarsal pronation is linearly related to the amount of medial deviation of the first metatarsal”
3) Kathy Dooley goes over the Obturator Externus – “When this muscle is locked long, it will contribute to hip compression. Since the muscle travels from the anterior outer pelvis posteriorly to the greater trochanter’s inner fossa, it works as a sling with obturator internus to keep that femur jammed into the acetabulum. “
4) “Short-term practice of LNB (left nostril breathing) improves vagal tone, increases HRV, and promotes cardiovascular health of medical students.”
5) Here are the first two posts to my Coaching & Cueing Series
6) If you ever treat cervical patients you need to read this. Erson shares 5 Ways to Modulate Acute Cervical Pain (PNF/Isometrics, Traction, Functional Mobilization, IASTM with Movement, Education). Great share of useful clinical information.
7) Perry Nickelston goes over a hypothetical piriformis syndrome case (assess bilaterally!)
8) Tom Myers has a great post on Foam Rollers
“In epithelial and muscle tissues, the water is squeezed out of the tissues, and then is sucked back in when the pressure moves on or is taken away. Like squeezing a sponge over the sink and then letting it fill again while doing the pots and pans, this is generally a good idea.”
“More time won’t help; more accuracy of placement will.”
9) For more on Foam Rollers check out #11, this quick literature review write up, and this layman friendly article on foam rolling tone with Doug Kechijian
10) Here’s a very good article on crawling – “The increased “little brain” activity during cross-crawl, on top of the stimulation to the high-order thinking function of the frontal cortex, contributes to better balance and coordination, which becomes particularly important when kiddo starts to walk and develops an interest in sports.”
11) One of the things I learned from Qi Gong was the Teacup exercise. Here’s a unilateral version shared by Erson. It’s pretty much good for everything from your hand to your spine.
12) Eric Cressey shares a nice quick postural assessment story in #4.
13) Inside the Mind of Charlie Weingroff – June Edition. These have a lot of good stuff in them. Example – “T=R Principle: If you are a good enough coach to train around an injury, then the most important part of human performance is fitness. Because it’s resiliency to stress (aka fitness) that led to your injury in the first place. The only reason we need rehab is because we didn’t have training.”
14) APTA shares some great information on Dry Needling
15) Do you know your foot pathomechanics? Forefoot varus can be a big problem – it can lead to hyperpronation and excessive internal rotation of the kinetic chain.
16) I thought our profession was starting to understand the latest research on tissue deformation. Then I had an eval last week who left her old PT because he left bruises on her back from trying to “break up knots and scar tissue”. Don’t be that guy. Read this and remember that it takes a ton of force (literally >2000lbs) to deform tissue 1%. And share this with your peers!
17) 5 things you should ask your patients from Erson
18) “Considered another way, from the top down this time, if at the moment of heel contact the gmedius is delayed (as suggested in the study below from achilles pain), the pelvis is likely to drift laterally and this could cause a reactive inversion strategy of the rearfoot, and maybe even forefoot as well, as an instinctive measure to try and draw support beneath the laterally drifting body mass center of gravity. (This in essence sets up the “cross over gait” deployment strategy we have talked about here for years now).”-Gait Guys
19) Kinetic Control goes over our 6th sense (proprioception) and why it’s so important for movement.
20) I’ve been doing this Bridge Walkout Exercise with one of my proximal hamstring tendinopathy patients. It offers solid mechanotransduction without compressing the tendon (hip flexion). If done correctly it also works core stability.
21) “low level activity in the rectus abdominis and external oblique throughout the gait cycle, more concentrated activity of the internal oblique at initial contact/loading response (heel strike).”-The Gait Guys
22) Learn how to go from Gary Busey to Denzel Washington in Zac Cupples review of PRI Cervical Revolution – “The neck is the top priority because its mobility maximizes cranial sensory activity”.
23) The Postural Restoration Institute (PRI) approach can be quite confusing. Especially to those who have not attended a live courses. There’s a lot of complexity and there isn’t a very thorough explanation easily accessible. For those that want to dive deeper into the rabbit hole and learn more I would suggests these three sites:
Integrative Human Performance (1, 2)
Pain & Neuroscience
24) “Tone seems to be dictated by our perceptions of threat and the ability to cope with external demands.” -Another great read on the autonomic nervous system and threat/stress perception by Seth Oberst
25) Zac Cupples goes over some gems from the BSMPG Conference including stress response, every neuroscience fan’s favorite animal (Zebras), thoraxes, decision making, and the Cynefin Framework.
26) Stairs look steeper for patients with ankle pain? Interesting read on how pain changes the perception of one’s environment.
27) Great piece on Spondylolisthesis and other threatening diagnoses. “The purpose of dethreatening any diagnosis is not to ignore, belittle or dismiss it, but rather to bring it into the light of a modern understanding of pain – under the ever-increasing power of this spotlight, many diagnostic DIMs [Danger In Me] can be dramatically deflated.”
28) “researchers at the University of Virginia School of Medicine have determined that the brain is directly connected to the immune system by vessels previously thought not to exist”
29) “Some of these brain changes will remain long after the injury, with epigenetic changes in a number of brain areas evident 6 months after peripheral nerve injury (Tajerian et al 2013) and glial cells remaining ‘experienced’ and on alert for years (Banati et al 2001).”
30) The Placebo Effect should be used with more of an warm/empathetic style rather than technical (up to 82% better). But is it really a placebo? Or is it a change in the brain that we have not yet identified?
31) Random Opinion – it seems that all successful pain science clinicians have one thing in common – HUMOR
Training
32) Hip Thrusters are a great and easy exercise that can easily increase glute strength and improve lumbopelvic function. However, I’ve noticed many people tend to perform this with terrible form.
Here’s Ben Bruno going over neck position
I wrote an article on why it’s good in the rehab setting
And this video displays the correct and incorrect form
Don’t sacrifice form for more weight – you’ll pay for it later
33) I’ve been doing a lot of this stuff lately. Top 10 Bodyweight Exercises From GMB – Squat, Frogger, Monkey, Cartwheel, Pull-Up, Bear, Push-Up, Hollow Body Hold, Scales, L-Sit, and Handstand.
34) Don’t let the click baiting “butt wink” title fool you, this is some serious stuff. Dean Somerset writes a great series on hip morphology and how it affects range of motion (Part 1, Part 2, Part 3).
“those with more acetabular anteversion (forward placement on the pelvis) had greater flexion range of motion and less extension, lateral placement of 45-55 degrees gave the best overall mobility, but a lateral angle of less than 45 degrees gave more flexion range of motion and more than 45 degrees gave less rotation capability. He even showed that if the femoral neck was thicken by 2 mm in diameter it significantly reduced the range of motion in all directions, irrespective of placement.”
“The recipe for deep squatting seems to be slight femoral anteversion combined with acetabular anteversion, lateral placement of less than 45 degrees, and a thin femoral neck.”
“If someone has a very high degree of mobility, the likelihood of their having a thin femoral neck and a shallow socket is pretty high. If they have all the mobility of a clam, they likely have a deeper socket and thicker femoral neck. This combination, regardless of orientation of the acetabulum, will limit the overall diameter of the conical range of motion of the hip due to earlier contact with the acetabulum compared to a thinner neck and shallower socket.”
35) Very informative read on blood flow restriction training from James McCarron – “Setting initial pressures of around 50 mm Hg, a target pressure of 150 mm Hg and using loads of 20-30% 1RM would appear to be best practice from the what data is showing us.”
36) Eric Cressey goes over ways to increase your training density
37) Dan Pope displays some great hanging scapula exercises.
38) Dean Somerset has a nice logical article on unstable surface training. Make sure to read Eric Cressey’s article on this topic as well. Unstable surface training has a place in training, just make sure you find it and don’t force it.
39) Gray Cook discusses the Squat vs. the Deadlift – I like the “coil the spring” concept. For more information, check out this article.
40) I still like Mike Robertson’s easy exercise introduction format:
Name the Exercise
Describe Why They’re Doing It
Demonstrate the Exercise
Coach the Exercise
41) “Potential productivity is a complex process which depends on integration and interaction of different systems and organs on different levels of organization: from biochemical to genetic to social.” PP is determined by a host of physiological and psychological factors: genetics, gender, body mass, age, the state of health, energy systems’ power, capacity, and efficiency, the state of the neuromuscular apparatus, the psychological state, motivation, the climate, the season, work conditions, etc.’ -Pavel on work capacity
42) It’s good that more people are starting to understand the importance of recovery. Lance Goyke writes a piece with some advice on how to recover the other 23 Hours of the day that you’re not in the gym.
43) Regretting winter decisions? Me too. Here’s Eric Cressey’s 15 tips for leaning out for the summer – “Avoiding liquid calories is the still, in my opinion, the biggest dietary game-changer most folks in the general population can implement.”
44) 12 Ways to Make Better Exercise Choices by Eric Cressey. #12 is one that is often overlooked and not discussed on social media.
Research
45) Watch this. Then make your peers watch it. Great talk on Evidence Based Medicine and why it can be “rubbish” – Trish Greenhalgh #PatientBasedEvidence
46) Study on the kinetic chain influence on Serratus Anterior anterior – the best activation involved the anterior spiral line (serratus-external oblique-internal oblique-hip flexors/adductors). This is pretty much gait.
47)Craig Payne shares some gems from ACSM
48) “Tendon microcirculation increases after ultrasound and vibration massage intervention concentrated on the Achilles tendon.” [Gasp] ultrasound can be useful? Hipster PT’s won’t like that.
49) Sometimes research is just good to help spread the word – “This study showed that a single bout of isometric training reduced PT pain immediately and for at least 45 minutes following. An insight into the mechanism was provided by the concurrent increase in cortical inhibition.”
For more on Isometrics for Pain Relief look at #1 here.
50) “Previously injured athletes demonstrated significantly reduced biceps femoris muscle activation ratios with respect to ipsilateral gluteus maximus, ipsilateral erector spinae, ipsilateral external oblique, and contralateral rectus femoris in the late swing phase. We also detected sagittal asymmetry in hip flexion, pelvic tilt, and medial rotation of the knee effectively putting the hamstrings in a lengthened position just before heel strike.”
51) It’s sad that this may be news for some people in our profession – “Both hip as well as core strength were significantly correlated to frontal plane alignment during the single leg squat, especially hip abductor strength was an important predictor of the frontal plane kinematics.”
52) Interesting article on plantar flexion static-stretching (SS)
“Hence the SS-induced impairments prior to 10-20 minutes post-warm-up may not impact competition performance.”
“The effects of prolonged and intense SS on the joint receptors might lead to inhibitory effects on motoneurons, such as autogenic inhibition and Type III (mechanoreceptor) and IV (nociceptor) afferents and Golgi tendon organ discharge, and their greatest effects can remain for 5-10 minutes (Behm and Kibele, 2007).”
‘In conclusion, the SS protocol effectively increased passive ankle ROM of the stretched limb. The increased ROM appears to decrease the muscle peak force and pre-activation; however these finding were only a temporary effect (less than 10 minutes after the SS protocol was applied). The decrease of jump height and impulse for the non-stretched limb suggests a central nervous system inhibitory mechanism from SS.’
53) “The bit of the brain that maps muscle change, changes when muscles change, and can be measured by muscle changes.” -Roger Kerry’s one line summary of this article
54) Strength wins again! Here’s a new study showing the importance of shoulder/neck strength in patients with tension headaches. As Dr. Andreo Spina has says – “you can’t rub someone strong.” #Context
55) “The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs.” This doesn’t make sense to me. Is it along the lines of if it’s really bad it can only get better? Does anyone know the time for disc regression?
Other
56) 23 Alternative Ways to Reduce Pain & Joint Inflammation. Patients seem to always ask about these things.
57) Zebra and Reptile lovers will enjoy this article – “”Traffic noise may influence metabolic and cardiovascular functions through sleep disturbances and chronic stress,” lead study author Dr. Andrei Pyko told Australian Associated Press. “Sleep disturbances may affect immune functions, influence the central control of appetite and energy expenditure as well as increase circulating levels of the stress hormone cortisol.”
58) “The loss of prefrontal function only occurs when we feel out of control.” -Amy Arnsten in Eric Barker’s article on how to control Fear
59) Maybe we’re fat because of the artificial light? “Excess artificial light is a circadian disruptor: same diet & exercise will have a very different impact on someone with circadian misalignment.”
60) I’m a big fan of Louie C.K. I think he’s as smart as he is funny. He summarizes dysfunctional human communication in this skit.
61) Aaron LaBauer shares some great business advice for Cash-Based PT Practices.
62) I patient recently introduce me to Mandalas. It’s a form of art therapy, meditation/mindfulness, and has great psychological implications.
Top Tweets of the Month
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Robert Butler PT PhD
@rjbutler_dptphd – There is a stark difference between “doing corrective exercises” and normalizing a movement pattern. The goal is to keep the goal the goal. -
Scott Johnson, PT
@PTnomad – If you’re a PT and only do exercise with pt’s, aren’t you just an over qualified personal trainer?#manualtherapy -
Sarah Haag
@SarahHaagPT – We don’t assume ‘head injury’ when we have a headache… Why do we assume ‘back pain’ = ‘back injury’?#Bronnie2015 -
Michael J Mullin
@mjmatc – Don’t automatically attach strength principles to rehab. In rehab, less is often more… -
Gif of the Month
The moment when stability training becomes pelvic floor training
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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.
