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.
4) 5 Thoracic Mobility Drills to Improve Overhead Movements
5) Great advice from Erson on improving the effectiveness of your interventions “make sure the patient understands the indications and what the treatments do”. I wish someone would have told me that when I first got out of PT school. #Expectations
6) Dan Pope “Bridges the Gap” with this must watch jump/plyometric progression series
7) A new study shows that back pain is correlated with a positive thomas test. Here’s a basic stretch and how to coach it correctly. Sometimes coaching this stretch can reduce the positive thomas test. Other times it requires more advanced techniques.
8) Nothing good about prolonged static postures. Get them to move. If they can’t get out of the chair, advise them FIDGET.
9) Do your patients have control of their long extensors? The Gait Guys teach you how to test it.
10) Pain alters motor control. “This is why you should probably mitigate threat; in doing so, reduce or abolish pain prior to performing ANY movement based treatment.” Erson elaborates on the complexity of the mobility/stability debate.
11) “Choice is control and in the presence or history of pain we begin lose choices. People in pain have their movement options reduced, losing variability in their task achievement until there may be only one way left to move. Restoring these choices and rebuilding an agile movement system can be done and the research emerging from the field of neuroscience is assistive in showing just how. Changing the brain’s perception of the movement system resides central to this pursuit.”
Stress
Stress is one of the most important variables we have to manage everyday – for both ourselves and our patients. Understanding stress is just as important as understanding biomechanics and pain science. Sometimes the keystone variable is something to do with stress. Being able to identify it and make recommendations can make or break the patient’s recovery.
12) Books
Polyvagal Theory is a great, complex read on the subject. It goes over the evolutionary physiology of how we react to stress and why. It gets quite redundant, but overall is worth the time investment.
Nerve is a much easier, enjoyable read that deals with the neuroscience and psychology of fear, stress, and anxiety. It’s filled with useful anecdotes and gives some solid general advice that you can share with your patients.
Why Zebras Don’t Get Ulcers has been recommended by many as well. I haven’t read it yet, but it’s on my list.
13) It’s important to understand that stress is stress. It’s cumulative and it all matters.
14) Then it’s important to have a couple different recommendations to help alleviate this stress that is within your scope of practice.
15) This is a must read – a new study shows that students are more likely to get injured during periods of high academic stress. Just being able to paraphrase this study to your patients should help them understand their pain better and decrease the threat.
16) Psychoneuroimmunology for Physiotherapists – Stress decreases tissue healing.
17) Think about your commuter patients – “Physical activity can mitigate commuting-related stress if workers can include it in their daily routines, but the obvious constraint is time scarcity. Longer commutes mean less time for other activities, which leads to lower life satisfaction.”
18) I love living in NYC. I feed off the buzz and the stimulus drives me further. But after a couple years of living in the concrete jungle it can start to break you down. One solution to the high stress environment is practicing meditation. I took a UCLA course, did some studying, and came to this conclusion for both myself and my patients.
19) Living in NYC makes me appreciate getting outside the city much more. Getting outside into nature isn’t just refreshing, but it’s healing. This might be why half of NYC has weekend homes outside of the grind.
Six all-natural (yet scientific) strategies for improving your mind and body.
“This study revealed that forest environments are advantageous with respect to acute emotions, especially among those experiencing chronic stress. Accordingly, shinrin-yoku may be employed as a stress reduction method, and forest environments can be viewed as therapeutic landscapes. Therefore, customary shinrin-yoku may help to decrease the risk of psychosocial stress-related diseases, and evaluation of the long-term effects of shinrin-yoku is warranted.”
20) You should subscribe to Psychology Today‘s email list. They provide a tone of great articles. We’re not psychotherapist, but we build relationships from the premise of trying to help people get better. Sometimes this leads to our patients opening up to us and telling us some serious things. It can help to identify certain patterns and recommend some basic stress reduction techniques, but it’s more important to recognize when someone needs some help and to have someone to refer them out to.
Exercise of the Month
This is my go to lateral stability exercise. Most people perform it too fast and need specific cues for pivoting from the outside of the bottom knee.
Pain & Neuroscience
21) “For true healing to take place, you need to learn how to move out of the intellectual realm and into an experiential one. For instance, if you were hurt and afraid in your past, then you need to be guided to refind feelings of safety and security on an experiential and body level.” -Dovid Meshchaninov, MS
22) Great write up on pain and diet/microbiome from Andrew Rothschild – “an imbalance between bacteria in our guts can interact with our immune system causing the release of inflammatory chemicals and stress hormones, kicking off our body’s natural stress response, even when we are not truly in a stressful situation.”
23) Great read on Chunking
“Consciousness and chunking allow us to turn the dull sludge of independent episodes in our lives into a shimmering, dense web, interlinked by all the myriad patterns we spot. It becomes a positive feedback loop, making the detection of new connections even easier, and creates a domain ripe for understanding how things actually work, of reaching that supremely powerful realm of discerning the mechanism of things. At the same time, our memory system becomes far more efficient, effective — and intelligent — than it could ever be without such refined methods to extract useful structure from raw data.”
24) “it’s the lack of “other things to do” or be aware of that really flares up the pain at night” -Erson with a great post on a question that patients often ask us
25) “Sleep deprivation is associated with disturbance in descending pain inhibitory control mechanisms and results in increased pain sensitivity.” Great read on pain and sleep from Rayner & Smale
26) “providing contrasting information is a known and effective way to promote optimal learning” It’s also best to use 2 examples with this approach. #Education
27) Many of the best clinicians have struggled with their own injury. “This finding suggests that pain empathy is grounded in neural responses and neurotransmitter activity related to first-hand pain.”
28) “The part of the brain that is responsible for seeing, for the apparently ‘simple’ act of generating the picture in our mind’s eye, turns out to have the ability to do something akin to choosing, as it actively switches between different interpretations of the visual input without any help from traditional ‘higher level’ areas of the brain.”
29) “Our study hypothesis was supported. Individuals with more alpha asymmetry (reflecting greater left than right sided frontal alpha; that is, a relative suppression of left frontal activity) reported more subsequent catastrophizing”
30) “Researchers have demonstrated that the music we prefer has greater positive effects on pain tolerance and perception, reduces anxiety and increases feelings of control over pain. In older people with dementia, listening to preferred music has been linked with decreasing agitated behaviour.”
31) “In adults, it has been well-documented that stress promotes habits and reduces cognitive flexibility“
32) This is a big part of why my bosses are so successful in treating patients – “The results show that pain thresholds are significantly higher after laughter than in the control condition. This pain-tolerance effect is due to laughter itself and not simply due to a change in positive affect. We suggest that laughter, through an endorphin-mediated opiate effect, may play a crucial role in social bonding.”
Training
33) You should share this with your patients in a newsletter or print it out for the waiting room. 3 Signs that your relationship with exercise is unhealthy:
Cancel social plans to exercise
Exercise to make up for your diet
Continue to exercise despite fatigue, illnesses, and/or injuries
34) Interesting read on using mindfulness for performance.
35) Here are some nice tips on coaching and cueing from Eric Cressey. For a more detailed overview on coaching and cueing, check out my new series that simplifies cues into easy to understand categories.
36) 6 things you should focus on with your baseball players (attributes of elite hitters)
37) Always good coaching cues from Eric Cressy
38) “In many ways, fitness should be viewed as a long-term concept, much like saving for retirement.” –Dean Somerset
39) You should do some cardio
40) Reverse engineer to meet your goals. Use the the SMART method (Specific, Measurable, Attainable, Realistic, Time-Bound).
41) Some must read advice from Eric Cressey
Research
42) Very interesting article on cranial biomechanics – “It is proposed that the cranium behaves somewhat as if constructed of cardboard, with the sutures acting as pre-folded lines or perforations.”
43) “A careful analysis of EMG activity and kinematics during gait suggests that, in the transverse plane, the adductors may be eccentrically controlling internal rotation of the femur at the hip during the loading response, rather than the previously reported role as concentric internal rotators. In addition, these muscles may also concentrically produce external rotation of the femur at the hip during terminal stance and preswing.”
44) “The consensus in the research is that the tendon gap will gradually fill in with tendon-like tissue and be nearly healed between 2 & 3 years.”
45) Sleep and your cardiovascular system. “Findings showed that adults who slept less than five hours a night had 50 percent more calcium in their coronary arteries than those who slept seven hours. Those who slept nine hours or more a night had even worse outcomes, with 70 percent more coronary calcium compared to those who slept seven hours.”
46) Pelvis thorax counter rotation. “This is because during bipedal walking in humans, the ribcage and arms rotate in one direction, while the legs and pelvis move in the opposite direction. You can see this as your arms and legs move in opposite directions when you walk. These opposite rotations are beneficial because they help to conserve a physical quantity called ‘angular momentum’. The angular momentum of the upper body cancels out the angular momentum of the lower body. In humans, this helps to reduce work, and saves energy during locomotion.”
47) Mindfulness improves performance and skill acquisition.
48) ACLs that were reconstructed with allografts had three times higher failure rates than autograft reconstruction
49) Fascinating read on how the jaw/mouth can profoundly influence the rest of the body. “In fact, unilateral anesthesia of the trigeminous causes a shift in body weight onto the contralateral limb, which leads the homolateral inferior limb to contract.” Probably one of the best articles I’ve read in a while.
50) The moment I got on one of these I knew it had some value. It requires good frontal plane control, single leg stability, focus and attention, and allows for full kinetic chain integration. It was only a matter of time – Slackline was shown to improve postural control in this study.
51) “It was shown that young adult men with cam-type FAI presented with excessively inverted hindfoot at heel strike with a reduction in the overall maximum eversion during stance phase.”
52) “Tendon-related issues seem to have increased inflammation, while torn tendons have significantly lower inflammation than tendon-related conditions in intact tendons.”
53) “A single resistance training bout of isometric contractions reduced tendon pain immediately for at least 45 min postintervention and increased MVIC. The reduction in pain was paralleled by a reduction in cortical inhibition, providing insight into potential mechanisms.”
54) The importance of the mouth – “These findings suggest that it is advisable to use a customized bite-aligning mouthpiece to improve strength and power performance.”
55) Cellular Mechanotransduction – “The presence of isometric tension (prestress) at all levels of these multiscale networks ensures that various molecular scale mechanochemical transduction mechanisms proceed simultaneously and produce a concerted response. Future research in this area will therefore require analysis, understanding, and modeling of tensionally integrated (tensegrity) systems of mechanochemical control.”
- Tom Myers
@myers_info –#FRC4 Proprioception and Myofascial pain are like oil and water. The more Proprioception the less pain and ice versa. Langevin via Schleip -
Christopher Johnson
@chrisjohnsonPT – Rules of Running Injury Management: 5 will give you 20…5% increase in step rate will reduce energy absorption by 20% at the knee.#running -
Michael J Mullin
@mjmatc – With reaching activities w/breathwork, don’t reach faster or further than the airflow allows. The air & diaphragm mvmt will “reach” for you -
Aaron Swanson
@ASwansonPT – Developing Motor Control: I sometimes forget that adding load is a great way to reinforce the pattern.#NotJust10000Reps
Other Good Stuff
- “Time is a created thing. To say ‘I don’t have time,’ is like saying, ‘I don’t want to.” ― Lao Tzu
56) If somebody is unsure about a decision, their pupils dilate
“We think of persuasive people as good talkers, but maybe they’re also observing the decision-making process,” he says. “Maybe good salespeople can spot the exact moment you’re wavering towards a certain choice, and then offer you a discount or change their pitch.” #Communication
57) Before you give advice (#Communication):
1. Listen for emotional undertone
2. Name the core emotion
3. Relate to the emotion to show understanding (mirroring, vulnerability, validation)
4. Withhold Judgement
5. Offer Advice Last
58) “So empathy is distinct from expressions of sympathy — such as pity or feeling sorry for somebody — because these do not involve trying to understand the other person’s emotions or point of view.” Listen, practice loving kindness meditation, read fiction, and get a dog to increase your empathy.
59) True experts are able to say they don’t know something. “Accepted knowledge can get in the way of healthy ignorance” -David Butler on the importance of ignorance
60) Diet and Depression #Variables
61) A nice quick review of the vagus nerve and 9 things it’s good for
62) 9 great tips on how to read emotions and influence people. #psychology
63) Control your emotions by labeling them – “affect labeling seems to pull us out of an emotional quagmire by engaging our executive brain.”
64) “the previous week’s effort influenced this week’s passion, such that more effort led to more passion.”
65) “Touching is incredibly powerful. We just don’t give it enough credit. It makes you more persuasive, increases team performance, improves your flirting… heck, it even boosts math skills.”
66) ““Never Make ‘Em Feel Stupid.” – The Cardinal Law of Persuasion” #Communication
Gif of the Month
How some of my patients perform their exercises
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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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