Clinical

1) There’s a weird campaign by some Hipster PTs who are arguing that posture isn’t important.  Maybe they’re doing it for social media popularity.  Maybe what they’re really trying to say is that we shouldn’t create thought viruses.  Maybe what they’re saying is that we shouldn’t blame all of our patients’ problems on a static postural assessment.  Maybe they don’t understand that posture is a biobehavioral pattern.  Regardless of their underlying point, dogmatically saying posture doesn’t matter is like saying physics and physiology doesn’t matter.

2) “From a sensory perspective, moving fast has a lot of sensory noise – it’s loud…By lowering the magnitude of the sensory stimuli, we can better perceive excessive muscular rigidity and help to regulate it.” – Seth Oberst

3) “The 90-90 hip lift says that the pelvis is too far forward, especially on the left and we would like to put it back to a neutral position and we are going to use a couple muscles to keep it there” –The Nominalist

4) Here’s a list of some DNS based exercises.

5) A Therapeutic Alliance as “a trusting connection and rapport established between therapist and client through collaboration, communication, therapist empathy and mutual understanding and respect.”  |:| “Quite a bit of literature links a trusting therapeutic relationship to superior patient outcomes”

6) The squat is a very trendy social media topic.  Which leads to a ton of people discussing it with a black and white approach.  And someone always has the newest way to squat better or the real reason you can’t squat well.  Tom Purvis goes over the gray of squat biomechanics and body proportions.  One of the best explanations out there.  

7) Here’s some easy to read pain science analogies and the weighted sleeper exercise for shoulder internal rotation by The Nominalist

8) “In most cases, the perception of tightness is just that, only a perception.” –Erson

9) “Every exercise is an assessment. Each time your clients and athletes move, they’re providing you with information. The more you pay attention, the better you’ll be able to individualize their programs and coaching cues moving forward.’ -Eric Cressey goes over 10 assessment tips

10) Pelvic floor, breath holding, and crossfit.  “Lifting with a belt also increases the IAP by bracing the back, sides and front of the abdomen…but what about the top (diaphragm) and bottom (pelvic floor) of the abdominal canister? What often happens is that the very strong diaphragm can hold its own and so the pressure gets directed downwards into the pelvic floor.”

11) Mike Robertson shares his 3 Safe Shoulder Exercises

12) Inside the Mind of Charlie Weingroff (Random Thoughts #2)

• “Screening generally with unlearned movements first will allow for a more organic appraisal of joint position, which is all any movement screen should be judged against.”

• “Testing with another series of movements very different from your training but requiring the same “bucket” of movement qualities is likely far more indicative of general motor skill acquisition.”

• “One of the summary interpretations that I have made is that for balanced joint position with ideal co-contraction to be achieved, we require full non-threatened joint motion in all planes and vectors.”

• “Develop motor skills and fitness simultaneously with carry over to terminal athletic goals”

• “Can you have any kind of legitimate grip without a particular centration of the scapula and t-spine?”

13) “The craniocervical region is incredibly mobile for a reason. That reason is to create precision for our sensors: vision, audition, olfaction, respiration, and vestibular sensation. This precision occurs reflexively, whereas other appendages act proprioceptively.  These sensors drive the neck. Losing the ability to sense is what can increase the need for a neck to become stable. And when you can’t move a stable neck, teeth may be one thing you try to use.” –Zac Cupples with a great article on the cervical spine, occlusion, and the girl he wants to marry

14) “When a patient cannot move properly without pain, paraesthesia, or perception of stretch, and a manual technique is performed, we are really modulating that perception.” –Erson Religioso

15) The Foot Core System – a great read on foot function, evolutionary adaptation, and intrinsic foot assessment & treatment.  An important read for anyone that works with people that have feet.

16) Erson shares 2 studies on the importance of vision with cervical patients.

17) Louis Gifford’s Mature Organism Model really laid down the blueprint for how I view my patients (inputs, processing, outputs).  Zac Cupples shares his interpretation of this model, jokes about your mom, and lays out a way to influence this system.  A great read that everyone can relate to.

18) “When we’re going to move, it’s very biologically important to be engaged in our movement.  If we look at the natural environment around us, animals are 100% engaged in the moment and in their current activity.  When we have two electronic devices on our hip just so we can run—one so we can text and the other so we can listen to music—I’m not sure that many of the lessons that running in the environment could teach us are even accessible.” -Gray Cook

19) “What’s the point of asking an athlete to commit an hour a day to more efficient movement if you’re not going to address the four hours per day they are reinforcing an unhealthy movement?” –Lee Burton on texting posture

20) Erson reviews SFMA 2.  “you can ride a bike after not doing it for 10 years, but can you still do calculus?”

21) 7 Reasons to Goblet Squat from the Nominalist 1) Comfortable Hips Below Knees 2) Opens Up Areas that Stretching May Not 3) Increases Hip Capsule ROM 4) Exposes Foot/Ankle Weakness 5) Pelvic Floor Alignment 6) Easy to Reproduce Independently 7) Helps to Isolate the Shoulder

22) Shameless Self Promotion – I agree with John, it’s a lot easier to put people in positions where they can’t compensate instead of using 17 different verbal cues.  Sometimes I use the same concept for overhead movements – the deep squat locks out the lumbar spine and prevents a compensatory rib flare.

23) It’s important to remember that the human body is an adaptation machine.  If you play basketball 3 times a week, it will adapt to handle those loads (assuming graded exposure).  However, if you only play basketball every several months, the body will not be adapted to handle those loads.  Injury risk and pain are potential outcomes.  Brian Reddy discusses this concept in this article – “Soreness is a sign of working your body in a way it’s not used to.”  Educate your patients.

24) Another great post from Zac Cupples.  You might have a different view of the Thomas Test after reading this one.

25) Ron Hruska describes my NYC patient population.

26) I was having some difficulty determining the driving force of the pes cavus foot type.  Specifically I wasn’t confident whether it was a plantarflexex forefoot or a rearfoot varus.  Dr. Suzanne Fuchs pointed me towards the Coleman’s test (5 min into this video).

27) Loukia Lili is getting treatment from the cueing master, Mike Cantrell.  Here are 4 videos using PRI and some solid coaching to ensure proper muscle activation (1, 2, 3, 4).

28) Dennis Treubig shares 5 things he wishes he would have learned in PT school 1) Treatments aren’t very specific 2) A movement assessment system is important 3) Modern Pain Science 4) How to pick CEU courses 5) Medical imaging is clinically irrelevant 

29) One thing I wish we would have learned more about in PT school is psychology.  It’s such an important component that was not covered well in school.

30) “attempting to achieve sufficient dorsiflexion through the combined ‘foot pronation-ankle dorsiflexion’ mechanism, as opposed to just dorsiflexion from the ankle mortise joint alone, may change the dynamics of the entire limb…. in this case, hip flexion range observation. Is this because when dorsiflexion is cheated via foot pronation, instead of just ankle dorsiflexion, there is more internal tibia/femoral spin than would normally occur from just sagittal ankle hinging which can in turn impair terminal hip flexion range via impingement type action ? I think so. It would be cool to see what would have happened in the study had the pronating clients been shown my foot tripod restoration exercise.”   –Dr. Allen

Pain

31) “when I can’t find something physically stopping you from doing something, I have to help you get back to normal by using graded exposure (CBT techniques) and explaining pain to you” –Antony Lo

31) Kento Kamiyama discusses the lion-pain metaphor.  “The adrenaline rush is a normal response and once the lion goes away, everything returns back to normal.   However, when it is prolonged the body starts using cortisol instead of adrenaline.  Cortisol is a more potent and longer lasting chemical to deal with longer lasting threats.“

32) What your adrenal glands really looks like.

33) Sometimes new terms are created for self-promotional reasons or for the sake of argument.  Many times I find this trivial – we often waste too much time on semantics.  However, when new terms are created for educational purposes it can be powerful.  NOI recently released a new book to help patients understand pain.  They created the terms DIMs & SIMs (Danger In Me & Safety In Me) – “This is a reminder of the power of context.”

34) “Social context matters. It can affect our learning processes, and does so also in the context of pain. While we can only speculate about the underlying mechanisms at this point, it seems plausible that a threatening environment (be it social or not) could facilitate the rapid distinction between threat and safety”-Kai Karos

Training

35) Pavel teaches you why and how to build your slow fibers (1, 2, 3, 4)

36) Eric Cressey goes over 7 Thoughts on Speed, Agility, & Quickness Training.  “Understanding what “normal” looks like is important, but don’t think “abnormal” is necessarily always inappropriate.”

37) Mike Reinold shows you how to prep for throwing – Part 1 & Part 2

38) 4 Reasons Why You Should Bear Crawl 1) Anit-Extension 2) Reaching 3) Breathing 4) Dynamic Exercise

39) Bret Contreras lays out specific plan to build stronger glutes and goes over specific approaches for different populations (powerlifters, bodybuilders, crossfit, beginners, etc.).

40) Cressey Coaching Cues 1) Create a Gap 2) Don’t Let the Plate Fall 3) Don’t Break the Glass

41) Shante Cofield shows you how to instantly improve mobility – Shoulder Flexion, Functional Internal Rotation, Elbow Flexion, Hip Flexion

41) Eric Cressey shares some tips on long-term development for young athletes.

42) 5 Reasons Why Your Squat is Difficult 1) Too Much Knees 2) Poor Anterior Core 3) Hyperextension 4) Wrong Squat Type 5) Not Taking Advantage of Irradiation

Research

43) Why kinesiotaping works? Neuromodulation.  A fancy term that just means we’re changing sensory input in attempt to change the way the brain processes information.

44) John Snyder goes over scapula strengthening exercises through a EMG lens (Part 1 & Part 2)

45) “hyaluronic acid (HA) – the key lubricant in the sliding function of fascial layers – lies at the heart of the problem” – Leon Chaitow 

46) If you breathe bad, you’ll move bad.  A good read on the FMS and breathing.  “These results demonstrate the importance of diaphragmatic breathing on functional movement. Inefficient breathing could result in muscular imbalance, motor control alterations, and physiological adaptations that are capable of modifying movement.”

47) There’s a lot of great work being done on tendinopathies.  Please share this study with your peers – too many people in the medical field are only using eccentrics.  “There is little clinical or mechanistic evidence for isolating the eccentric component”

48) If you only practice evidence-based medicine, you are almost 2 decades behind!  “Studies have shown that it takes an average of about 17 years for new knowledge generated by randomized trials to be incorporated into practice.”

49) If you’re into injury prevention, you should also be into fatigue prevention “Following a fatiguing exercise protocol, participants showed increased anterior tibial translation, compressive force, and knee flexion range of motion during the transition from non-weight-bearing to weight-bearing. This illustrates an inability of the lower extremity muscles to stabilize the knee joint.”

50) A sensorimotor approach to Chronic Ankle Instability – “The STARS interventions include ankle joint mobilization, plantar massage, and triceps surae strengthening.”

51) A great read on proprioception and body awareness.  Tons of great references throughout.

52) You can explain this with basic biomechanics, physiology, breathing, DNS or PRI philosophies, or just common sense – standing with excessive lumbar lordosis isn’t the best posture for your back.

Other

53) “When individuals speak slowly and clearly, they tend to sound more credible than those who speak quickly.”

54) Phrenology is interesting. 

55) Todd Hargrove’s post on what we can learn from robotics.  “A big part of motor intelligence lives in the “design” of the passive elements of the motor control system – the bones, fascia, tendons, connective tissue, etc. When the passive structures are optimally designed (by natural selection) for a certain task, the muscular and neural systems don’t have to work very hard to produce optimal movement patterns.“

56) Stress, Homeostasis, Allostasis and the Bank Account analogy by James Cerbie

57) Some nice example dialogues to help change patient behavior from Erson

58) “Titin, however, seems to be an essential missing link in how muscles actually work.” –Jules Mitchell

59) A Solid Read on Tensegrity by Donald E. Ingber

• “There my studies of cell biology and also of sculpture led me to realize that the question of how living things form has less to do with chemical composition than with architecture.  The molecules and cells that form our tissues are continually removed and replaced; it is the maintenance of pattern and architecture, I reasoned, that we call life.”

• “changing cytoskeletal geometry and mechanics could affect biochemical reactions and even alter the genes that are activated and thus the proteins that are made.”

• “At the Johns Hopkins School of Medicine, Donald S. Coffey and Kenneth J. Pienta found that tensegrity structures function as coupled harmonic oscillators. DNA, nuclei, cytoskeletal filaments, membrane ion channels and entire living cells and tissues exhibit characteristic resonant frequencies of vibration. Very simply, transmission of tension through a tensegrity array provides a means to distribute forces to all interconnected elements and, at the same time, to couple, or “tune,” the whole system mechanically as one.”

Top 8 Tweets of the Month

• Charlie Weingroff‏ @CWagon75 – To suggest SMCD, TED, and JMD are the same is awful. The CNS put them there, but it will be wildly different approaches to get them removed.
• Doug Kechijian‏ @greenfeetPT – “Tricking” the nervous system is ok provided you exploit that neurological window of opportunity by applying the right stressors afterwards
• What The Foot‏ @AnatomyMotion – If it extends, flex it, and if it flexes, extend it! #WhatTheFoot
• Anthony Donskov‏ @Donskovsc – “The less you know, the more opinionated you are.” -Buddy Morris
• Mark Reid, MD‏ @medicalaxioms – A little extra diagnosis or treatment can get you into a lot of trouble.
• Seth Oberst‏ @SethOberstDPT – It’s all about pattern recognition – the human brain is really adept at it provided we’re aware and present in the moment
• Michael J Mullin‏ @mjmatc – Conscious awareness before subconscious competency = You have to learn it before you can own it
• Aaron Swanson ‏@ASwansonPT – The answer to a question should be followed by another question. #ThereIsNoFinalAnswer #DigDeeper

Gif of the Month

Why you should work on your extension patterns

 
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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.

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