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By dr on April 4, 2016
- “For every complex problem there is an answer that is clear, simple, and wrong” -H.L. Menken
Keeping “it” simple is important at times. It prevents us from becoming overwhelmed, clarifies concepts, aids in general understanding, and directs the focus towards a single goal. Most importantly, keeping it simple is necessary when communicating new topics or concepts to others. However, the problem occurs when keeping it simple is used a substitute for understanding the complexity. Continue reading “Embracing Complexity: The Mountain Stream Metaphor”
Posted in Patients, Professionals | Tagged assessment, Lumbar |
By dr on September 2, 2015
Since our species is vision dependent ( >50% of cortex dedicated to processing visual information), visual cues can be an easy way to invoke a sensory change that alters movement patterns. This includes not only the sensory input from our external environment, but also our unique ability to create an internal vision (motor imagery). Continue reading “Coaching & Cueing (Part 5 – Visual Cues)”
Posted in Professionals | Tagged assessment, Prevention / Recovery |
By dr on August 14, 2015
Our brain is quite complicated. It is constantly going through extremely complex processing to achieve many different outputs (movement, speech, vision, thoughts, emotion, pain, allostasis, etc.).
STRESS is one of the most influential factors on our brain’s ability to process efficiently. And in today’s society everyone has had it, many people live in it, and some people can never escape it.
Stress an epidemic and it will Continue reading “Problem & Solution”
Posted in Patients, Professionals | Tagged assessment, Nervous System |
By dr on August 2, 2015
Unfortunately, the rise in popularity of external cueing has led to a bad stigma of internal cueing. After reading the last article in this series you may be thinking why would you ever internally cue someone?
Here’s why: Continue reading “Coaching & Cueing (Part 4 – Internal Verbal Cues)”
Posted in Professionals | Tagged assessment |
By dr on June 15, 2015
We need to first clarify an important concept before we go into coaching and cueing:
- NOT ALL MOVEMENT REQUIRES COACHING
To Coach or Not to Coach
If someone is performing a movement/exercise correctly, all you have to do is shut your mouth and smile.
If someone is performing a movement/exercise incorrectly, you should ask yourself two questions: Continue reading “Coaching & Cueing (Part 2 – The Categories)”
Posted in Professionals | Tagged assessment, Biomechanics, Hip |
By dr on June 1, 2015
My co-worker was on vacation recently and I was seeing one of his chronic pain patients (years of pain). She was doing very well and was becoming independent in a full exercise routine. I did a quick evaluation and noticed one thing that she could improve on from a movement perspective. I didn’t use any dangerous pathoanatomical language. I just simply pointed out that she could be stronger if she kept her rib cage down when she performed certain exercises. We went over this cue a bit more with some basic proprioceptive exercises before she started her exercise program. Continue reading “Coaching & Cueing (Part 1 – Intro)”
Posted in Professionals | Tagged assessment, Core |
By dr on February 1, 2015
I was lucky enough to be invited to another one of Dan Park’s quality continuing education classes at Perfect Stride. This time it was for Functional Range Release (Upper Extremity) with Andreo Spina. I had been reading a lot about Spina’s work and was excited at the chance to learn about the FR/FRC techniques and principles. Continue reading “Andreo Spina’s Functional Range Release”
Posted in Professionals | Tagged assessment, Biomechanics, Prevention / Recovery, Review |
By dr on November 1, 2014
As many physical therapists have probably noticed, there is an increase in the amount of Crossfit athletes showing up in our clinics. This isn’t because it injures everyone. It’s because it’s becoming very popular and people love it.
We see the same thing happen during ski season and marathon season. It’s not necessarily the activity, it’s the increase in participation.
However, that’s not to say that it’s only an increase in participation that leads to a higher incidence of injuries. There are many other variables involved. Some of which can be improved upon to decrease the risk of injury.
I’ve noticed a few trends in my experience with Crossfit athletes. The crossfitters that tend to get hurt are the ones that seem to make the same 2 Mistakes: Continue reading “An Open Letter to Crossfit: The 2 Mistakes (Part I)”
Posted in Patients, Professionals | Tagged assessment, Biomechanics, Lumbar, Prevention / Recovery |
By dr on July 1, 2014
Two of my favorite things to do in my practice are to assess movement patterns and use kettlebells. So when I heard about the amalgamation of FMS and StrongFirst I was pretty stoked. Throw on top that Gray Cook and Brett Jones were teaching the course, and it was my most anticipated course of all time. Continue reading “Foundational Strength Course Review”
Posted in Professionals | Tagged assessment, Prevention / Recovery, Review |
By dr on June 1, 2014
The deep squat (aka full squat, aka ass to grass/ATG squat) is one of the most debated, talked about exercises/assessment we have in human movement. Some talk about the deep squat as if it’s the cure to cancer, some talk about it like it’s going to cause the apocalypse. I have found that Continue reading “The Deep Squat (Part 1 – The Good, The Bad, & The Not So Ugly)”
Posted in Professionals | Tagged assessment, Biomechanics, Knee, Review |
By dr on May 1, 2014
I am a big fan of the FMS (Functional Movement Screen) and SFMA (Selective Functional Movement Assessment). Together these screens and their associated principles make up the Functional Movement Systems.
I’ve been using this system for a couple years and have had a lot of success with it. The more efficient I become at this approach, the more my outcomes improve.
I still have much to learn and am by no means an expert, but I thought I’d share the 4 biggest mistakes I see people make with the Functional Movement Systems. Continue reading “4 Mistakes People Make with the Functional Movement Systems (FMS/SFMA)”
Posted in Professionals | Tagged assessment, Biomechanics |
By dr on March 1, 2014
One of the most difficult questions to answer in rehab is: “when will I get better?”
Coming out of grad school my response was usually mumbling some ridiculous time period with a deer in the headlights look on my face. I had no idea. I knew the tissue healing timetable…and that was about it. I had little experience with specific injuries and didn’t yet understand the complex, multi-faceted factors that influence recovery.
Now I’m a little better at hiding that deer in the headlights look, I have more clinical experience, and I know more about the art of recovery. Continue reading “The Art of Recovery (Part 1 of 2)”
Posted in Professionals | Tagged assessment, Prevention / Recovery |
By dr on February 4, 2014
In the past 10-20 years there has been a trend towards stabilizing the proximal joint. Everything seems to be going more and more proximally. And this is a good thing! It is providing us with better outcomes and quicker pain free rehabilitation.
If you look at the knee joint you can see the progress. We’ve gone from isolated patella mobs and VMO strengthening to hip strengthening. And now we are going even further up the chain and looking at lumbo-pelvic complex.
The same thing is happening with the shoulder. We’ve gone from isolated thera band ER/IR to scapula stabiliztion. And now we are going even further and looking at the thoracic spine and ribs.
And if we go just 1 step further at both joints we end up where it all began in the first place…the core. Continue reading “Everything is Moving Proximally”
Posted in Professionals | Tagged assessment, Core, Hip, Lumbar, Pelvis / Sacroiliac, Prevention / Recovery, Shoulder |
By dr on December 1, 2013
I have been following Erson Religioso, a PT and blogger, for quite some time now. He has repeatedly (no pun intended) discussed the effectiveness of Mechanical Diagnosis & Therapy (The McKenzie Method or MDT). He’s a very knowledgable clinician and runs his social media with integrity. Over the years he has provided a great deal of clinically applicable information and I have seen results in my practice using some of his methods.
I decided I had to check out MDT first hand and learn about their method. This past July I took McKenzie Part A – The Lumbar Spine with Dave Oliver. Continue reading “23 Things I Learned From McKenzie Part A”
Posted in Professionals | Tagged assessment, Lumbar, Pelvis / Sacroiliac, Review |
By dr on November 1, 2013
In Part I you learned the concepts behind upward rotation and the overhead shoulder. This article builds off of these concepts and will show you how to properly assess and treat for the overhead shoulder.
I cannot emphasize enough how important a thorough assessment is before prescribing overhead shoulder exercises. Without an assessment to determine any impairments or movement dysfunctions you will not be able to properly prescribe the correct exercises. Before someone starts overhead movements you should make sure they’re clear in all of the overhead shoulder characteristics (Part I). Failure to do so could result in injury. Continue reading “The New Overhead Concept (Part II)”
Posted in Professionals | Tagged assessment, Shoulder |
By dr on August 1, 2013
Low back pain is one of the most common injuries we see. Traditionally you always hear a lot of information regarding excessive lumbar flexion. And with the amount of information readily available in our society, many patients already know this as well. This has caused some therapists and patients to walk around terrified that the next time they bend over their L5-S1 disc will splatter against the wall behind them. But what about the other direction? What about the potential problems in extension patterns?
We’ve concerned ourselves so much about “blowing out a disc” with flexion that we’ve completely overlooked extension problems. Continue reading “Lumbar Extension Dysfunction”
Posted in Professionals | Tagged assessment, Hip, Lumbar, Pelvis / Sacroiliac, Prevention / Recovery |
By dr on July 1, 2013
Understanding the difference between low and high threshold strategy is a very important part of rehab and training. If a patient is using the wrong strategy for the task they will not only be inefficient, but they can make the injury worse and cause more harm. Continue reading “Low vs. High Threshold Strategy”
Posted in Professionals | Tagged assessment, Prevention / Recovery |
By dr on June 1, 2013
The quadruped position is a very important developmental posture. From this posture we learn to crawl and transition to half-kneeling (which then transitions into standing). Through this posture we develop core, shoulder, and hip stability, learn reciprocal UE/LE motion, and begin to control our spine through our weight-bearing extremities. The quadruped position has many details that are often lost or forgotten when training. Mastering these subtleties and progressing within the edge of your ability will lead to a great effect on your stability. Continue reading “Quadruped”
Posted in Professionals | Tagged assessment, Cervical / Neck, Core, Hip, Lumbar, Pelvis / Sacroiliac, Prevention / Recovery, Shoulder |
By dr on May 3, 2013
The hip hinge is a basic movement pattern that everyone must have. When people have atrophy of this movement pattern they end up compensating in all sorts of ways (trendenlenberg, dynamic valgus, knee dominant movements, lumbar flexion). This leads to decreased performance and increased risk for injury. Continue reading “Hip Hinge”
Posted in Professionals | Tagged assessment, Hip, Lumbar, Pelvis / Sacroiliac |
By dr on December 3, 2012
On November 3rd & 4th I had the pleasure of taking the NeuroOrthopedic Institue course – Mobilisation of the Nervous System. I was lucky to have Adriaan Louw as the course instructor. I learned a tremendous amount over the weekend and returned to the clinic on Monday with an additional approach to treat patients with. The NOI provides a paradigm shift in the way we view the nervous system and pain. While it is impossible to cram a weekends worth of great information and techniques into a post, I’ll try to provide some key points I learned from the course. Continue reading “NOI – Mobilisation of the Nervous System”
Posted in Professionals | Tagged assessment, Review |
By dr on September 29, 2012
It is widely known that hip strenthening plays a significant role in the rehabilitation of knee pain. When it comes to our sagittal-plane loving runners the hips become even more of an issue. However, in 2011 Wiley and Davis published an article in JOSPT that found hip strengthening alone was not enough to alter running mechanics. This gave movement hipsters and research snobs more fuel to trash talk exercises that aren’t “functional” or that “research shows” it doesn’t elicit some desired EMG number. While I find remedial exercises to be an important step in rehab, I do agree that there needs to be a better transition between rehab and sport specific training. Continue reading “Functional Hip Strengthening”
Posted in Professionals | Tagged assessment, Hip, Prevention / Recovery |
By dr on May 12, 2012
The half-kneeling position is a great way to assess and treat your patients hip and core stability. While it seems like an easy exercise, it has many subtleties that can make or break the position. Having a greater understanding of the half-kneeling position will help ensure that your patient achieves the maximal benefit. Continue reading “Why You Should Use the Half-Kneeling Position”
Posted in Professionals | Tagged assessment, Core, Hip, Lumbar, Pelvis / Sacroiliac |
By dr on November 14, 2011
Static stabilizers are the non-contractile tissue of the glenohumeral joint. They are very important in shoulder stability at end-range ROM and/or when there is a dysfunction of the dynamic stabilizers. These static stabilizers set the base of support for the shoulder joint. Continue reading “Shoulder Stability – Static Stabilizers (2 of 3)”
Posted in Professionals | Tagged assessment, Shoulder |
By dr on August 21, 2011
Sensitivity and Specificity
Often when reading peer-reviewed articles I feel like I need an advanced degree in statistics to understand how the hell they analyzed the information and quantified the results. There is an amazing amount of jargon when looking at the objective measurements. This is rarely a clinical problem since understanding the statistical analysis is not applicable to the patient. I’ve never been mobilizing a patients shoulder and been concerned of whether it was a pearsons analysis or t-something in the article I just read.
However, the one part of statistics that is very important clinically is understanding specificity and sensitivity. Continue reading “Sensitivity and Specificity”
Posted in Professionals | Tagged assessment |
By dr on June 20, 2011
Low back pain patients are not a homogeneous group, but unfortunately they are often times treated like one. There is an overwhelming amount of causes of pain (disc, ligaments, facet joint capsules, muscle strain/spasm, stress fracture, etc.) and possible diagnosis for low back pain. However, research has shown that the specific “diagnosis” of low back pain rarely correlates with Continue reading “Treatment-Based Classification System for LBP”
Posted in Professionals | Tagged assessment, Lumbar |
By dr on May 29, 2011
When examining and assessing patients it’s easy to get caught up in all of the esoteric and minute details. With the overwhelming amount objective measurements (joint mobility, AROM, PROM, MMT, DTR, etc.) and the endless list of special tests, it can be difficulty to obtain a clear clinical picture. While a full examination is necessary to prevent overlooking any possible impairments/pathologies; it is also just as important to make sure you come away with a strong simple assessment and clear clinical picture of your patient. I have found that focusing on 3 simple assessments helps to maintain clinical clarity throughout the plan of care.
Continue reading “The Trio of a Simple Assessment”
Posted in Professionals | Tagged assessment |
