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.
4) Here’s a nice shoulder exercise – Horizontal Abduction with Press. This can also be used to improve rotation.
5) Visual cues may be the easiest way to immediately correct faulty movement patterns.
6) Zac Cupples reminds you about the ZOA and teaches some good subscap stuff in this I&I review.
7) Read this great review of static foot posture and arch height correlations. Even if you don’t like the foot, reading this will give you a great biomechanical thought experiment and strengthen your movement knowledge.
Sure, you don’t want to make too many assumptions when assessing static foot postures, but “low-arched runners exhibited more knee, soft tissue, and medial injuries (e.g., adductor strain, medial knee and ankle injury, and sesamoid/first metatarsophalangeal joint injury), while high-arched runners had a greater prevalence of bony injuries (e.g., stress fractures) and lateral injuries (e.g., greater trochanter bursitis, iliotibial band friction syndrome, and/or lateral ankle sprains).”
“During midstance, because the adducted talus is held in a fixed position by superimposed body weight, the external rotation moment created by the swing limb is unable to generate a force strong enough to abduct the talus. As a result, the torsional forces associated with this external rotation moment must be temporarily stored in the stance limb. The release of these stored torsional forces is occasionally evidenced by a sudden “abductory twist” of the rearfoot as heel lift occurs; i.e., because ground reaction forces no longer maintain the plantar heel, the entire rearfoot is free to snap medially, as though released from a loaded spring.”
8) Here’s one reason why your jaw may be a compensator “your body loaded the TMJ with the most amount of proprioception per surface area of any other moveable joint.”.
9) A good read from Charlie Weingroff on the difference between a warm up and corrective exercises. Hint: they are not analogous.
10) “Consider someone who has a femoral retroversion will likely have a bone to bone contact sooner in a flexion range of motion compared to someone who has more of an anteversion alignment, and if that difference is 20 degrees or more, that could be the difference between squatting above parallel and sitting your hamstring comfortably on your calves.” –Dean Somerset with an awesome article on hip morphology. Seriously, read this one.
11) The eyes are window to the soul, the nails are a window to foot biomechanics? Interesting post from the Gait Guys on how pincer nails develop – ““the pincer nail group had significantly lower pressure on the first toe than the control group. In both the barefoot and shod state, the peak pressure area was mostly the metatarsal head area in the pincer nail group, whereas it was mostly the first toe area in the control group.”
12) “I don’t believe breathing drills will cure everything. However, I do believe that utilizing good breathing mechanics along with other intervention is an essential part of optimal function mentally and physically.“ –Kento Kamiyama
13) While I think muscle slings are fairly limiting and over-simplified terms for clinicians, they’re great for patient communication. Here’s a nice easy article with some great graphics on the “muscle slings”
14) Very interesting TED talk from Peter Lovatt on dance, thinking, and hormones. He has another TED talk on psychology and dance. Thanks for the share Suzanne Fuchs.
15) Erson shares some useful wrist directional preference cases.
16) “So it is good to remember that our capacity to think and feel is supported in large part by the neural hardware and software that creates our ability to move and perceive. By developing one we develop the other. It’s all connected of course.” -Great post by Todd Hargrove with quotes on the importance of movement
Pain & Neuroscience
- “One of my biggest clinical mistakes is forgetting graded exposure rules apply to explaining pain” -Zac Cupples
17) An rare, honest article on explaining pain
18) Intrinsic focus improves tactile sensation in new study. For more information on this concept and how it relates to movement science read this article (int cue art).
19) “Be suspicious of any statement that says a brain area is a center responsible for some function. The notion of functions being products of brain areas or centers is left over from the days when most evidence about brain function was based on the effects of brain lesions localized to specific areas. Today, we think of functions as products of systems rather than of areas. Neurons in areas contribute because they are part of a system. The amygdala, for example, contributes to threat detection because it is part of a threat detection system. And just because the amygdala contributes to threat detection does not mean that threat detection is the only function to which it contributes. Amygdala neurons, for example, are also components of systems that process the significance of stimuli related to eating, drinking, sex, and addictive drugs.” –Joseph E LeDoux Ph.D.
20) Pain is always a translation.
21) Pain is also a verb.
22) An interesting way to use imagery to work with a patient with a thought virus.
23) Well this is disappointing…”Of 100 studies published in top-ranking journals in 2008, 75% of social psychology experiments and half of cognitive studies failed the replication test”. Another reminder that research isn’t always the gold standard. Difference between evidence based practice and research based practice is huge.
Training
24) Michael Mullins shares a great warm-up routine that focuses on “centering, grounding, alternating and reciprocal, and proprioceptive integration.”
25) “The vertical tibia requirement is an intention and not a “reality” for many people. The ability to keep the shins vertical (another way of saying vertical tibia) is highly dependent on structure, and an individual should not give up the stability of their spine in order to achieve the intended “vertical shin”.” -Bret Jones on the perfect swing and a great car analogy for individual structure #Variables
26) Energy production is pretty important – Joel Jameison on Energy Systems
27) Work Capacity is the buzz word, but really it’s just conditioning. Here’s a great article from Joel Jameison on Conditioning. It goes over all the important concepts.
28) “When I think aerobic training, I think recovery, energy development, and fatigue buffer.” -Lance Goyke
29) Probably the best hip mobility drill out there by Andreo Spina
30) Great cues from Dean Somerset | Rows – “keep your head behind your chest” Squat – “aim your butt to your heels”
31) “So this is another piece of evidence that one of the benefits of hard training is that you learn to tolerate more pain”
32) Look at #1 from Bret Contreras – anatomy is not a death sentence. Scoliosis, Lamar Grant, and monster deadlifts.
33) “With overhead athletes, stick with the overhand grip on the dominant side during alternate grip movements.”-Eric Cressey
34) One of the better “__ Steps to Improve ___” I’ve read in a while. Read this by Alexandre ‘Alexey’ Senart if you want to improve your pistol squat or coach it better. “The idea behind this first tip is to prevent our internal “alarm” from going off by taking away half of our bodyweight—source of “danger”—and by maintaining the closest control over our position all the while.”
35) Interesting visual cue to improve the squat – “Think of your femurs as being on sliders rather than being hinged on a single pivot point. The intent is to think that they can be shifted away from the pelvis, “making space for the hips” on these imaginary sliders.” Make sure to watch the video for a better understanding.
36) Here’s a nice easy read on the vagus nerve and yoga.
37) Research based deep squat defense by Felix Sempf
38) Here’s an advanced supine trunk rotation exercise from Brian Schiff. If this is too difficult or if you patient has pain with rotation, then try this regression.
Exercise of the Month
Contralateral Cross-Crawl Creep
This had strange origins. Some believed that you could reverse brain damage, developmental delays, autism, and other neurocognitive problems just by correcting the “missed” stage. This theory has been disproven and most in the field do not consider it a valid approach.
That said, we don’t need to partake in the common social media act of throwing the baby out with the bathwater. Cross-crawl patterns and the neurodevelopmental postures are still very useful. Good movement is good for the brain. Especially for brains that have dysfunctional movement.
When people have dysfunctional movement in the standing posture, one way to reduce the difficulty is to decrease the load on the body and the demands on the brain. An easy way to accomplish this is to move them down to the ground. Feldenkrais has been doing this for decades.
The contralateral cross-crawl creep not only takes people to the ground, but it does so in a very sensory rich fashion. It provides a ton of feedback (tactile, visual, vestibular, proprioceptive). In the prone position the body (and the brain) has to do a lot less work – it doesn’t have to manage as many kinetic forces, there’s not as many degrees of freedom in the system, the center of gravity is much lower, the base of support is much larger, force is distributed across a greater area – and because of this, it’s a safer position. Plus, there’s no need to progress the body forward – even less variables. It’s basically free movement.
Flip Flops Promote
reflex integration
body awareness
gross motor coordination
spatial orientation
tons of tactile stimulation
proprioceptive input
stimulates both sides of the brain/body
reciprocal motion
hand development and eye hand co-ordination.
development of fine motor skills, rhythm and timing
When I Use This
Sling Dysfunction
Decreased Rotation
Proximal Dysfunction
Over Toned (stuck in High Threshold)
Over Stressed (loss of attention and mindfulness)
Begin with simple “chunking” exercises. Then perform the full movement together. Then progress towards full, rhythmic, reciprocal movement with no pause between movements.
Look at the hand, go slow, be mindful, feel the movement.
Common Problem: surface friction – it may help to place towels or slide pads underneath the knee and/or hand. Too much friction can turn this nice low-threshold exercise into an uncomfortable, high-threshold, grind.
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For more information on the brain, movement, and development I highly recommend looking into Dynamic Systems Theory and Sensory Integration concepts.
Special thanks to Perry Nickelston for introducing me to this exercise and to Shante Cofield for hooking me up with this article that goes over some of the concepts discussed above.
Research
39) “Well, there you have it. The “E” in EBP doesn’t translate efficiently into the clinic, will not protect you in lawsuits, and has it’s own inherent (even worse, hidden) biases. On top of that, it could make you delusionally overconfident, despite at least 50% of it being false.”-Cinema Air
40) Research shows that sleeping on your side improves waste removal from the brain.
41) You know what they say…when you assume…“Our findings suggest that the FPI (foot posture index) may not be an accurate representation of rearfoot or midfoot movement during walking regardless of the measurement technique employed.”
42) “Peak knee flexion moment and flexion moment impulse during the second half of stance are related to the progression of PFJ OA “ Correct the variables that affect early knee flexion, then correct the gait pattern.
43) “Although the Thessaly and deep squat tests have a moderate level of reliability, neither test is sufficiently accurate to help in the diagnosis of meniscal tears in primary care. Future research should focus on other relevant patient variables instead of on physical examination tests in the detection of meniscal tears.” I guess primary care will have to focus on more than just pathoanatomy…
44) Great interview with Kathleen Cullen. Worth a read.
Here’s one of the best explanations of movement variability I’ve heard – “You probably don’t think about it that often but even if you’re working on a tennis serve and you feel you’ve got the movement down perfectly, your muscles are still changing. They’re fatiguing. You have to be updating your motor commands constantly in order to deal with the fact that your motor system is dynamic and changing over time. Put another way, because the biomechanical properties of the motor system constantly change over time we need to keep it calibrated.”
“The sensory prediction error is the difference between the sensory inflow your brain is expecting if you generate a movement vs. the actual sensory inflow it pulls in.“ #MotorStates
45) “With increased physical development improved messages flow to the brain from all the senses.“-Great article from The Learning Connections Program (thanks Shante)
Other Good Stuff
46) There’s not a ton of this out there in the social media world unfortunately – “positive emotions broaden the scopes of attention and cognition, and, by consequence, initiate upward spirals toward increasing emotional well-being” #StopBeingSoNegative
47) “A confident and positive mindset can be both the cause of your actions and the result of them.” –James Clear
48) “Socratic questioning helps patients examine the validity of their negative thoughts and gain a broader, more realistic perspective.” #Communication
49) Trouble sleeping? Try Sleep Restriction Therapy. Great concept that makes a lot of sense.
50) “Asking people to eat less, he says, is like asking them to breathe less. It sounds reasonable, so long as you don’t expect them to keep it up for long….Much of the obesity research for the past century has focused on elucidating behavioral techniques that could induce the obese to eat less, tolerate hunger better, and so, by this logic, lose weight. The obesity epidemic suggests that it has failed.” -Gary Taubes
51) Here’s how to build mental toughness from Eric Barker
52) James Clear goes over what’s overrated and underrated in life. Some great points in this article.
53) Mind-Gut Connection – Higher Anxiety Risk for People with IBD – Another reason for the importance of diet?
54) Great video on the science of persuasion #Communication
My good friend and outstanding PT, Shante Cofield, has introduced me into the world of Instagram. It’s taken me longer than it should to understand it, but I’ve really come to enjoy it. The focus is on quick visual content, so there’s much less trolling, negativity, and emotional nonsense than twitter and facebook. Plus, some people share some beautiful movement, great exercises, and novel interventions. I don’t have much of those on my account, but if you’d like to see pictures of my awesome dog, Rigby, and a couple exercises, then you can follow me here.
Here are a few of my favorites from this past month:
Tweets of the Month
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Eric Barker
@bakadesuyo – I do not fear the 10,000 kicks you have practiced once; I fear the one kick you have practiced 10,000 times. –@MatthewEPolly -
Jared Burch, SPT
@BurchJared – 90% of your long term happiness is predicted by the way your brain processes the world -
Emma Seppälä, Ph.D.
@emmaseppala – “More people would learn from their mistakes if they weren’t so busy denying them.” -Unknown -
Christopher Johnson
@chrisjohnsonPT – Trying to make performance gains in the context of injury will only lead to a prolonged recovery -
Eric Cressey
@EricCressey – When athletes think of how much force they can put into the ground instead of just how much weight they can lift, coaching gets much easier. -
Dr. Michael Chivers
@drmchivers – “Science” does not make clinical decisions. -
Aaron Swanson
@ASwansonPT – If what’s “proven” in research doesn’t always work in the clinic, then why does everything in the clinic have to be backed up by research? - Zac Cupples
@ZCupples – One of my biggest clinical mistakes is forgetting graded exposure rules apply to explaining pain#meetthemattheirstory
Gif of the Month
Even dogs understand the importance of teaching the creep cross-crawl
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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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