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Here are some recent random thoughts and musings:

  • Anyone interested in Detroit Lion’s Quarterback Matthew Stafford’s Beighton Score? I’d be really curious to see what it is. With 4 injuries in the last two years and all four injuries being ligamentous in nature, I’d just be curious to see what it is.
  • Mulligan techniques are probably my favorite manual therapy technique. We indicated, they work like magic. If you have yet to incorporate these techniques into your repertoire, you are missing out. Best CEU course I ever attended because I was able to take back some principles and instantly apply them.
  • I am puzzled about the new Affordable Care Act that is part of the health care reform legislation. Part of that legislation involves Flexible Spending Accounts. For those of you not familiar with what a Flex Account is – in a nutshell, an employee can have money deducted from his/her paycheck (tax-free) and use this money towards non-covered medical expenses. Such examples would be eyeglasses, dental work, prescriptions, and more. Well, one of the great benefits is that one could buy over the counter meds via this account. So you get the pre-tax benefit as well as not having to buy OTC meds out of pocket – you simply tap into you Flex account at any time and there you are. Well, not anymore. OTC meds will no longer be able to be reimbursed (unless you have a prescription from a doctor- huh?). So an act that actually makes it more expensive for an individual and actually pushes someone to the doctor increasing medical costs is part of the Affordable Care Act?!?! Way to take something that has been a tremendous asset to the individual and totally mess it up.
  • Lots of great webinars on Strength and Conditioning Webinars.com – good investment if you looking for some final CEU spending this year or planning for next year.

Take care and have a great week!

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Hope all is going well. Here are a few things to share midweek:

  • A few weeks ago, in a previous post I referenced Mike Boyle’s A Day in the Life Post.  So over the last few weeks, I have put some of those recommendations to use – especially getting up earlier in the morning.  I’m getting up anywhere from an hour to hour and a half earlier, even on the weekends and this has been very productive. I have used this time mostly to read. I read my Bible during this time but also have 3-5 other books going at a time as well. I have polished off 5 books thus far and have 2 more close to being done. I don’t say that to brag – simply to say that the time when everyone else is sleeping can be highly productive. And I don’t feel exhausted or lacking in sleep. Give it a try.
  • One of the books I have finished is a book entitled The Talent Code. It was an interesting book. Not necessarily related to sports medicine but it does describe how people learn and develop skill. It focuses on some of the key factors in developing talent and skill and draws information from some of the world’s talent hotbeds. If you are an athletic trainer working with high school or college athletes or a strength and conditioning coach, it is a worthwhile read and will give you a little different perspective.
  • Another book that I am currently reading is Swing Flaws and Fitness Fixes by Katherine Roberts and Hank Haney. It is a book about golf and discusses improper golf swing mechanics as they relate to muscular weakness and movement impairments. The book is written for the general public and not overly technical but I would still consider it a worthwhile read for athletic trainers, physical therapists, and fitness professionals – especially as the faulty swing patterns are discussed. Probably the biggest benefit is being able to equate hip immobility, thoracic immobility, glute weakness, etc with deficient swing mechanics.  Seeing this relationship is a important aspect of this book. Even if you don’t work with golfers directly, chances are you probably treat someone who enjoys the game and this book will help you to some degree get a better handle on swing patterns and proper movement. It has been a quick read and should be available at your local library.
  • Joe Pryztula wrote a recent post and had a pretty interesting recommendation regarding ankle taping vs. bracing. In a nutshell, to manage your training room more efficiently, don’t tape when you can brace.
  • Stuart McGill is the featured guest tonight in the interview series on SportsRehabExpert.com. He is one of the foremost experts regarding the spine in the world. If you can’t listen tonight, it will be archived on the sight for 48 hours. It promises to be a worthwhile listen.

Have a great rest of the week.

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Here was an interesting abstract  that I read from the Journal of Bodywork and Movement Therapies comparing multiplanar myofascial release vs. moist heat in relation to ROM gains of the shoulder.

The hypothesis of this study was that MFR would be as effective as moist heat in relation to ROM gains. The reason it was interesting to me to some degree is that both treatments – myofascial release for 3 minutes and moist heat x 20 minutes did result in significant increases in ROM at the glenohumeral joint.

Now, I am not necessarily sure this is a surprise to anyone but it does help to give some validity to these treatment choices. Myofascial release and moist heat are sometimes maligned as treatment choices and their therapeutic value called into question. This snapshot makes a small case that these techniques can be utilized in this scenario. Although I think the approach to this study was to demonstrate that myofascial release could be as effective and more efficient as moist heat, I would argue that while the hypothesis was proven – this study helps to validate both choices based upon the goal.

Again, this is an abstract and all the moving parts aren’t completely accessible but this does provide some insight and give you some more information about the treatment choices you make.

At the end, they also do discuss the time variation between the myofascial release and moist heat. I would be curious to see if additional MFR treatment would result in even greater ROM increases. That would be interesting to see.

So in the end – this abstract does show in this instance – with increased ROM being the goal that both MFR and moist heat were effective choices and accomplished the goal. MFR may be superior in terms of efficiency. But again, in terms of understanding why you choose the treatments that you use, this abstract can help to be a small piece of evidence to support those treatment choices.

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Earlier this week, I wrote about how Lindsey Vonn was having cheese applied to her injured shin as a part of the treatment regimen. I went on to discuss how the how a patient’s confidence in treatment can affect the end result.

As I was thinking this week, I recalled a webinar on the low back by renowned Physical Therapist, Dr. David Magee. He made a couple of interesting points on this subject during the webinar.

  1. He spoke of a case in which he was treating a woman with back pain who was from the Middle East region and still had family living there. It was during a time of war and upheaval in the particular region that I cannot recall. If the woman had recently talked with her family and had recently had a good report about the safety of her loved ones, her mood was improved and her back symptoms were improved. If she hadn’t heard from her loved ones in several days, her anxiety increased – as did her back symptoms.
  2. He also spoke of a strategy where after treatment, the physical therapist would remark – “well, that feels better doesn’t it.” This wasn’t done to pull the wool over someone’s eyes so to speak but to simply reinforce some of the good things that have taken place during the treatment session.

Psychology does collide with the treatment process and I was reminded of these examples this week.

I am treating a patient right now with a shoulder injury. He is making a lot of progress at this time and is headed in the right direction. He was treated for the same injury at a local clinic this past summer and I remember seeing him at the time and he was talking about his treatment experience. For whatever reason, he had no confidence in the treatment strategy that was being used and the results were limited. With the treatment he is currently undergoing, his confidence level has been high and the results have been very positive thus far.

I don’t say that to brag because I have been on the flip side many a time. I have been the person “at that other clinic before.” Patient’s begin to question to process and the rationale and that does affect their willingness to participate in treatment and their confidence about the process.

And as always – psychology must also be paired with sound treatment strategies in order to really have a chance to achieve the results you and the patient are hoping to achieve.

Some more things to consider regarding the intersection of treatment and psychology.

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“Regardless of whether it’s a home remedy or passed down from generations or something someone thought of, if the athlete believes in it, there is significant value in that,”

This was a quote from Ralph Reiff, an ATC quoted in an article on CNN regarding Lindsey Vonn, Olympic Skier. The article discusses how she incorporates spreading cheese on her injured shin in an effort to help with the healing process.

Not exactly a proven, scientific treatment modality is it?

And yet therein lies the rub.

In this age of evidence based medicine and trying to deliver the best and most proven care, there is still one wild card if you will – we work with human beings and human beings have a psyche and they have quirks. How do I know, I am one of them.

When I was a high school baseball player, I’d have elbow pain. Whenever I put an analgesic balm on my elbow, the pain went away almost instantly. I was convinced that all I needed to do was rub a little of that on and I would feel much better. Was that the balm working physiologically in my body – probably not but I was convinced it was helping. You could tell me that research shows that physiologically it had no effect but you were not going to convince me that it didn’t work.

Have you ever had a patient come in and tell you something like this: “I had … injury and they used ultrasound on it and it got better in less than a week. Do you think this would help for this injury?” I have and my guess is that you have as well.

So what do we do with this little situation that we have?

In our quest to deliver treatment techniques that are sound and proven (evidence based medicine), this scenario does not fit too well within that box. We are being asked to use a treatment technique that has varied evidence to prove its value (and you can insert any treatment modality here) and yet quite possibly is of value as a means to the end in the treatment of the patient.

A little conundrum we have here. This intersection is truly the intersection of science and art. The two really do weave together and managing both is a skill.

My philosophy has always been – “If standing someone on their head is going to help them feel better, then I am going to do it.” Well that is a ridiculous philosophy you say. Here is why I say that – If I can get them to feel better, to feel more confident in me and the process, and use this as one of the means to the end, then the chances to be more successful in the injury rehabilitation process increase.

I am not saying that we allow patients to dictate the injury rehabilitation process – they are coming to us for a reason. But…we do need to be aware of things that will help us to be successful in their treatment along the way. If this is one potential piece of the puzzle, we need to be aware and consider how it fits in the injury rehabilitation process.

So in our quest to deliver sound, proven methodologies – we are still dealing with human beings and that road to the end may not always be a straight line.

Just something to consider.

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I listened to the interview on SportsRehabExpert.com with Gary Gray and also watched the accompanying videos that were posted. Again another fascinating interview – just listening to individuals like him and others that Joe has given us access to is an awesome opportunity. If you are still not taking advantage of this resource, you are missing out. Six more left!

As I said before, in listening to an interview – it is also a little tough to wrap your mind around everything being said – there are no visuals to assist in the learning process so I try to grab on to things that resonate the most with me and focus on that.

Gary obviously has a great appreciation for the human body and he can break down how the body works blow by blow in a sequential fashion. Everything has a role.

In the accompanying cervical spine pain video, a question was asked about where to look when someone complains of cervical spine pain. Gary’s response was:

“In the neighborhood.”

As he spoke during the interview, the body’s function is intimately connected with one another and the body is a wonderful adapter. You give the body a job, and it will find a way to do it. For better or for worse.

So let’s go back to the cervical spine pain as mentioned in the accompanying video. If the thoracic spine is exhibiting limited mobility in any one or all of the planes of motion, this will inevitably affect the cervical spine. If someone needs to rotate and turn to look at something, even if thoracic mobility is limited – the body will do it’s best to accomplish this task. That may mean that the cervical spine is going to have to do something it really does not want to do. But rest assured, the body will do whatever it can to accomplish this task. Unfortunately, as a result, pain may ensue. The body will accomplish the task, but it may be at it’s detriment.

We can look briefly at the shoulder. If someone presents with an anteriorly tilted  scapula(among one of many things), the amount of motion that is going to be available at the glenohumeral joint is not going to be as optimal as it should be. And yet, when the body is called to perform an overhead task, it is going to do it – potentially at the risk of the rotator cuff and more.

When walking, if the muscles at the butt and hips aren’t doing their job properly- you will still walk, but compensations will ensue potentially putting the foot, knee, etc at risk of injury.

So the point is – as we try to discover where the scene of the crime is – where is the source of the injury coming from- it is likely “somewhere in the neighborhood.”  So during the search for evidence, make sure widen the investigation.

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If you are looking for a great way to learn from some of the greats out there in the field of sports medicine, strength and conditioning, and performance –  then you are in luck.

Joe Heiler, PT, CSCS will begin hosting an outstanding teleseminar series beginning next Wednesday evening. Did I mention that you can listen in for FREE? Even if you can’t listen in on the night of, they are made available for a very short time afterward on his site.

I listened in on a couple of his interviews last year and was impressed and this year Joe has lined up an another All-Star team.

Some of those participating will be Stuart McGill, Gray Cook, Gary Gray, Mike Boyle, Eric Cressey, Mike Reinold and more. You’ll really be missing out if you don’t take advantage of listening to some of the real experts in the field.

Go to SportsRehabExpert.com and sign up today.

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