Posts Tagged ‘advances in functional training’

I read an article in the local paper today that was entitled “A Pain in the Budget: More back surgeries, not improvements.” The essential point of the article was that back surgery is not necessarily the answer to back problems. In a past blog post, I have discussed how diagnostic tests don’t always tell the whole story. And yet a patient presents with a positive MRI result or a patient’s complaint of pain that goes unresolved, surgery is quite often the next option.

I found this quote by Dr. Richard Deyo from the article quite profound.

“Intense pain is not necessarily an indication for surgery.”

If you have heard Mike Boyle speak or read his recent book, Advances in Functional Training, you have probably heard him talk about the 3 I’s. When a patient goes to see a surgeon – there are three options.

  • Ingestion – take anti-inflammatories; if that doesn’t work
  • Injection – if that doesn’t work;
  • Incision or surgery

Those are really the three choices when a patient goes to see a surgeon. Injury rehabilitation may be part of that picture but is not always a given. Essentially, there are three options for a patient with pain that doesn’t subside.

And so that is where the rubber meets the road: a patient presents with pain and the conundrum is what is the best way to rid that patient of the pain. When it comes to back pain, 80 percent of the population will suffer from back pain at some point in their life.  And yet the article alludes to several studies that indicate that 90% of low back pain will heal (or let’s just say the pain will dissipate) on their own.

So what is the best choice? – that is the question.

Deyo went on to offer another great quote:

“Many people have a very mechanical view of how the body works and imagine it is like a car. So if a tire wears out, you’ll just put in a new one. It just doesn’t work that way.”

And yet I think he is correct. Many of us look at our bodies like that. And yet we all know that the replacement parts are not as good as the originals.

So what does this mean for us – I think it means what it always has. We owe it to those in our care to continue to improve our skills and make sure we are providing the best service possible. Some surgery can’t be avoided – we know that. But let’s keep improving – expanding our knowledge and examining all that we can to do best by those in our care.

I’ve always maintained that just because everyone is doing something or just because that is how we have always done things, it doesn’t mean it is right. Just because surgeries, such as spine fusion operations, are on the rise doesn’t mean this is the best option. Let’s keep searching…


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One book that I have recently added to my library is Advances in Functional Training by Mike Boyle.

I have read about half of the book so far and it has been an excellent read and I would recommend adding this resource to your library.

The things I appreciate about Mike and they are parlayed in this book are:

  • He has an athletic training background and so he does have that unique perspective of both a strength coach and an athletic trainer. The fact that he is primarily a strength coach gives additional insights for ATCs into the strength and conditioning realm that we may not normally see.
  • Much of his coaching is based upon injury prevention reduction strategies – what lifts, training regimens, etc. are going to help reduce the likelihood of player injury. He is constantly tweaking and re-fitting to put his athletes in the best position to be successful and avoid injury.
  • He is great at using the wisdom that he has gleaned from others to help formulate his training philosophies – the book is littered with insights from individuals such as Shirley Sahrmman, Gray Cook, Gary Gray, Stuart McGill and many more. We can’t be smart enough to know it all and Mike is master at seeking out experts in the field and melding their expertise into his training to develop even better programming and training strategies
  • He is not afraid to go against the grain and to question sacred cows. My philosophy has always been – “just because we’ve always done it that way doesn’t mean it is right” – I think that is a pretty fair summary of how Mike does things and what is illustrated in the book. He continually challenges traditional thinking and is not afraid to challenge his own practices and strategies as well.

Overall, there is a ton of information in this book that will reaffirm what you are currently doing and will challenge some of the strategies that you are currently using.

I’d definitely recommend picking this book up and adding it to your library.

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Using the foam roll as method of massage and myofascial release is common in the strength and conditioning field as well as in the fitness and personal training industry. It probably isn’t as common in the athletic training setting, particularly in the injury rehabilitation venue. However, as athletic trainers, w need to become more knowledgable of this modality and how it can effectively help those in our care.

Probably, the first step is understanding what foam rolling actually does. A great way to gain understanding of this process is through the use of analogy.

I’ve heard Mike Boyle speak on this topic and he addresses it in his book Advances in Functional Training. One of the primary roles of the foam roller is to serve as a self massage and self myofascial release. Foam rolling will help to reduce knots within the muscle and prepare it for effective stretching. Mike uses the analogy of a knot in a band. If you don’t roll and remove the knots beforehand, stretching will simply cause the knot to tighten. Rolling removes the knots and allows one to effectively stetch. This is a great analogy and the premise makes sense to me.

However, a colleague questioned this when I shared this analogy with him and he aksed how knots get formed in a muscle to begin with. When you think of a band or a rope, a knot is formed by the strands actually being tied and twisted together. Instead of adhering to each other, a knot actually becomes entangled into each other. Think about your garden hose. The only way to remove the knot in this instance is to feed one part of the band, rope, or garden hose back through the loops until the the knot is completely unwound. Compressing that knot would not really relieve the knot, it may actually make it tighter. This is not really possible to separate muscle fibers and feed them through each other.

So, my colleague’s question caused me to think a little more – while we can’t deny the knots and increased tissue density in these areas, is there another analogy that possibly fits this process better.

So, as I was thinking about this – does a “knot” in a muscle as it relates to the relationship between foam rolling and stretching more closely resemble a ball of dough.

A ball of dough is made up of fibers and is initially tight, dense and inflexible. Stretching a ball of dough in it’s round state is pretty tough and really won’t do much in the way of lengthening the dough. However, as you roll and knead the dough, it becomes more pliable. Adhesions break down and the dough ball begins to become more accepting of change. Once the dough becomes less dense and pliable enough, it can now be stretched and lengthened. Rolling, in this instance doesn’t necessarily “remove a knot” in the tissue in the technical sense but it breaks down aherences, restores muscle density and function, and realigns the fibers into a more workable state. Rolling the dough makes the task of stretching or lengthening the dough much more easier to accomplish.

Ultimately, the point remains the same – foam rolling improves tissue quality, restore normal tissue density and prepares the body for stretching and activity. This is merely a question of semantics. As we explain this strategy to our athletes and patients, does this analogy drive the point home a little more?

This is more of a thinking out loud post. What are your thoughts? Does this analogy work a little better? Do you have another analogy you use altogether? I’m curious to hear your thoughts.

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