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Mid-Week Musings

Here is some good stuff that I have come across recently and wanted to pass it along to you:

  • Thoracic Mobility – This is an area that unfortunately gets neglected in the assessment, evaluation, and treatment of the athletes and patients in our care. Bill Hartman has a good post on this topic. I particularly like the emphasis on mobilizing the thoracic spine in all three planes. (Thanks to Eric Cressey for posting this link on his site). So make sure that you pay special mind to this – in our increasing sedentary and computer-driven society, thoracic mobility deficiencies are increasingly problematic.
  • Free Online Journal – Joe Przytula posted on his site regarding a free online medical journal. I took a look yesterday and there are some worthwhile articles. This journal “is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of musculoskeletal and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.” So take a look – some pretty good stuff at a great price – FREE!
  • Time Management and Focus – Alwyn Cosgrove talks about how he is able to accomplish so much in a recent blog post. Laserbeam focus is the key – so if you are easily distracted (like me) or have a hard time making the most of your day, this is a good read.
  • More Harm Than Good – Over the last week or so, the subject of quality patient care has been raised. So it was with great interest, as I was reading in the Bible in the book of Mark (5:26 to be exact) this verse in speaking of a woman who was ill for 12 years, that I read the following: “She had suffered a great deal under the care of many doctors and had spent all she had, yet instead of getting better she grew worse.” I just found that particularly interesting – so again, let’s do the best that we possibly can to make sure we are doing right by those in our care.

Happy Wednesday All.


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The worlds of Athletic Training and Strength and Conditioning are much closer than most would admit. The line of distinction is blurry between the two (as it is with most professions working within the field of Sports Medicine) and individuals who are successful in each field have a solid functional knowledge of the other. We don’t work in a bubble – we often work side by side with each other and knowing (and using that knowledge) the principles and strategies utilized in each can only enhance your skill and abilities as a professional. As a result, it is important to have a solid understanding and working knowledge of each profession.

Jason Price, MS, CSCS, ATC, CPT, USAW Club Coach recently presented at the Eastern Athletic Training Association Conference on the subject of the relationship between Athletic Training and Strength and Conditioning. He has posted his PowerPoint slides of his two presentations on his Athlete’s Equation website. They are worth a look to help you understand how the two worlds are really not that far apart.

So if you have simply existed in your isolated world of Athletic Training, take a venture out into the world of Strength and Conditioning – find some experts (you can start with Jason’s presentations) and learn as much as you can. You’ll be a better Athletic Trainer for it.

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Functional training and functional exercise – what does it look like?

Well, if we are honest with ourselves, we probably all at some point or another have put someone through an exercise that “seemed functional” but was anything but. Or maybe at the local gym, have seen someone trying to perform an exercise in the name of function.

Just because an exercise “looks like”  it may be functional activity doesn’t mean that it is.

Case in point – I have seen folks use a handle attached to a cable column while trying to “simulate” a golf swing in a controlled and methodical motion.

There was no mistake in watching these folks that they were trying to replicate a golf swing.  But a golf swing is a far reach from a look-a-like cable column exercise.

The golf swing is filled with strength, speed, power, coordination, and control. It is a dynamic activity. This particular drill was probably being performed at fraction of the speed of a golf swing.  So while it may have  “looked” like something functional,  it was probably anything but.

On the other hand, you could take that same individual and take them through some side med ball throws that are more functional – they may not necessarily look like a golf swing but the speed, power, and explosion generated during this activity are much more “functional” than the cable column exercise.

So just because something “looks” like it may be “functional”,  doesn’t mean that it is.

So the next time you try and have someone do something functional – think it all the way through and see what you are actually accomplishing.

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Flexible Spending Accounts (also referred to as FSA or cafeteria plans) are oftentimes offered by employers to employees as an additional benefit. What an employee can do is select a pre-arranged amount at the beginning of the year that they want deducted from their paycheck. This money is put into a  FSA that the employee can use for a variety (and I mean wide variety) of medical expenses that they may have for the year.  The money is taken out of your check pre-tax and so there are some great benefits there. Essentially it serves as little savings account for medical expenses.  As I said before, it can be used on a wide variety of expenses. From non-covered office visits, to dental and vision expenses, to buying Ibuprofen for you sick child with a raging fever, etc.  My wife and I have used this benefit over the last several years and it has really been worthwhile.

The only drawback is that if you don’t use the money by the end of the year, you lose it. So let’s say you elect to contribute $500 in your flexible spending account and you only use $400, what ever is left at the end of the year vanishes somewhere and that money doesn’t roll over.

So what in the world does any of this have to do with the Athletic Training Profession???

I am glad you asked but let me digress just a little further…

Knowing exactly what is eligible for being covered as an FSA expense can be a little bit tricky. I normally don’t carry the manual with all eligible expenses around with me and so knowing exactly what medication or what medical related expense can be confusing. A little bit of guesswork so to say.

So on a recent trip to the pharmacy, a kind employee showed alerted me to the fact that the tag on the shelf identifying the item for sale will have a little FSA on the sticker indicating if item is an eligible FSA item.  It was a eureka moment.  Now, I know that Rite-Aid and Wal-Green both utilize this method of identifying eligible expenses – not sure about other pharmacies, you’ll have to look or ask to find out.  But I found this to be a neat little discovery and very helpful when choosing what items to purchase using my FSA.

Great – and your point!!! What does Flexible Spending Accounts have anything to do with an Athletic Trainer’s Kit???

Well, as I looked around what was covered and what wasn’t, my interest became piqued.  I saw things such as elastic bandages, athletic tape, band aids, hand sanitizer, etc that were eligible as an FSA expense in many cases (you may need to check by the chain as there may be some variance in what is listed as eligible from chain to chain). And my mind started tracing back to my Athletic Training kit that is running a little low on supplies.

Now you and I both know that the brief list of items I just mentioned are finite and run out. Tape, band aids, hand sanitizer, etc all need to be replenished.

So…back to the point of this entire post – if you happen to have some leftover flexible spending money AND your kit is a little low, that is a great way to make sure you use your money and restock some of the basic supplies that you may need in your kit.

So if you have some money still left in your Flexible Spending Account and weren’t sure how you were going to use it, you now have a way to take care of two things at once.

Happy Shopping.

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I’ll tell you right now – this is post is a little off topic from my typical posts but still hopefully informative nonetheless.

I must admit – I am a bit of a germaphobe. Not sure when this really came about but this “condition” has gotten progressively “worse” as the years have gone by. I am usually not too far away from the nearest sink and bottle of hand sanitizer is generally well within reach.

So…as we are knee deep into the flu season, cleanliness becomes even more paramount. Well I came across this promotional video (organizations can actually purchase this to promote proper hygiene) about “proper ways ” to cough. I found the video entertaining and informative. Very well done. Then when I go out and view the public, I become mightily disturbed when I see folks out totally butchering proper coughing technique. Call me crazy but my guess is that most people probably aren’t too keen on getting sick – so then why in the world do their hygiene habits leave little to be desired.

I know this is not really a sports med related post but hey, it’s pretty tough to work when you are in bed and unable to move because you have the flu and feel like death warmed over. So put some of these tips to work and better yet – compliment those who use good “coughing technique” and help those with bad technique to get a clue.

Here’s hoping for a healthy holiday season.

Photo Credit by daveparker

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Shoulder Course Wrap-Up

This past weekend, I had the privilege of being able to attend the shoulder course presented by Mike Reinold and Eric Cressey. It was an outstanding seminar and those who attended were not disappointed. Mike and Eric are two of the best and brightest in their field and they were able to put their vast knowledge and experience on a shelf “that everyone could reach”. The mixture of rehabilitation and exercise professionals worked seamlessly and really the only thing that stood out – everyone in attendance was trying to learn as much about the shoulder as possible. Thanks to Eric and his staff for opening his facility – they were fantastic hosts (plus the food prepared for us was outstanding) . And also special thanks to Mike and Eric – each is an expert and they did a great job putting together a course that brought fitness and rehabilitation professionals together (what a concept).

The information shared was vast but here were some of my personal takeaways – (click here to see Eric’s recap of the course):

  • I=NF/AR (Law of Repetitive Motion); Injury= Number of Repetitions x Force or Tension of each repetition/Amplitude of each repetition x Relaxation time between repetitions
  • Total Motion of ER + IR compared between shoulders may be a better measuring stick than simply deficiency in one range or the other: both ranges together shoulder equal about 180 degrees
  • Irritation > Inflammation > Fraying > Tearing: It is important to catch problems in the irritation stage; Once the inflammation stage is reached, the rotator cuff quits functioning.
  • The posterior capsule probably is not involved in joint tightness as we much as we credit it for; this paper thin structure that can have a light shined right through it is probably not as responsible for joint tightness as we are led to believe
  • The “shrug sign” = the rotator cuff is not working
  • Don’t work through the shrug sign or through pinch points. People won’t progress through these red flags. Back off – concentrate on symptom reduction, improving inefficiencies, and rotator cuff dynamic stabilization and progress through from there.
  • The Beighton Laxity Score can be a nice supplemental test to help you determine laxity of a patient or client; as you measure joint mobility, this series of mobility tests can serve as nice cross-reference
  • The scapula and humerus are really like a seal balancing a ball on it’s nose. The seal is the scapula and the humerus is the ball – not much contact area. The function of the labrum really serves to expand that area of contact and give more depth to the joint.
  • Internal (anterior) and external impingement (posterior/superior) are completely different – they are assessed via different testing and require different rehab protocols
  • Scapular protraction and anterior tilt put the shoulder at risk of injury – retraction and a posterior scapular tilt are goals to move toward when determining rehab protocols and exercise selection
  • Rhythmic stabilizations are great techniques to utilize to establish the function of the rotator cuff – this can also serve as a great warm-up to “turn on” the cuff prior to activity
  • Serratus and Lower Trap function are very important to the integrity of the rotator cuff; to strengthen the lower trap properly, Y-exercises need to be aligned with the fibers of the lower trap

Obviously – there was a ton more that was taught in this course and I will still be reviewing my notes months from now – this was a brief overview to get those gears in your mind turning.

If you ever have an opportunity to see Mike and/or Eric speak at a seminar, it is well worth it and I’d highly encourage you purchase the DVD from the course once it comes available. Check Mike and Eric’s sites for more details in the next month or so.

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What is your focus?

imageFirst of all, if you aren’t a member of Strength and Conditioning Webinars, you should really consider joining. There are currently over 18 webinars available and more to come. The presenters are top notch and Anthony Renna does an outstanding job with the site.

Secondly – a couple of related points from two separate webinars on the site:

In listening to an archived webinar by Mike Boyle, he talked about the pain site and the pain source. Two different things – separate entities. In the most recent webinar by Gray Cook, he discussed how you can treat someone and take away their pain but not necessarily take away the problem. Again the pain site and the pain source.

These are great points to remember. Symptoms vs. source and it is so easy to get caught up in attacking the region of pain and we can neglect the true cause. We get so tunnel visioned that we can miss the global picture.

Case in point:

You have someone that complains of left heel pain and has a diagnosis of plantar fascitis. You dig right in and go to town treating the left heel pain. You break out the modalities, the massage, the stretching, the taping, and everything else at your disposal to treat the heel pain.

That’s kind of how we tend to think but as we take a step back, we may find out that this individual is lacking in internal hip rotation or maybe he presents with glute weakness, etc.

So back to the treatment plan – IF the cause of the heel pain is the lack of hip internal rotation or glute weakness, etc – and even though you may alleviate most or all of the pain, have you solved the REAL problem???

So the next time you are performing an assessment – consider not just the pain site but the actual cause of that pain.

Photo Credit by procsilas

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