Is Junk Food Really Cheaper

• Sometimes the truth hurts. This article from the New York Times was published last year but I was reminded of it when I bought a 2lb bag of organic carrots last night for $2. Thats more than $1 less than a bag of chips.

Recognizing Fractures (and describing them)

• This was shared by Jas Randhawa, a great strength coach and soon to be fellow chiro. Going through these slides reminded me of when I was studying for my Fellowship exam but you truly can never review them enough. For those interested in more, a great site to check out is auntminnie.com. Just go to “Education” and click on “Case of the Day”. Note: It is a registered site for health care practitioners.

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Packing the Shoulder

• Here is a VERY interesting post by David Whitley on packing the shoulder. Using an example visualized by fluoroscopy (thanks to Mark Toomey), the importance of this maneuver is demonstrated in overhead pressing exercises showing the likely mechanism of acromioclavicular injuries such as osteolysis that is so common in lifters

There’s a Reason There’s a Box

• As someone who strives to think of the most effective and practical means to help my patients and athletes get better, I often find myself attempting to “think outside the box”. Here is a really good read by Mike Boyle to remind me to keep myself in check and make sure that I’m not getting too out of hand.

What is the Difference Between a “Confidence Cure” and a Mere Placebo?

• A very good read from a very good site. This is just an example of Paul Ingraham’s work. Some of which may move you, others of which may make you uncomfortable. But all of which will educate you.

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Thankfully, the folks at Precision Nutrition and Livestrong have put together clear and concise lists of such considerations.

Have a look:

Top Lessons for 2012 – Precision Nutrition

The 10 Rules of Living Healthy – Livestrong

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As always, these interviews will be held on a weekly basis and will profile the following world-renowned experts in our field.

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…and the best part about it is the cost.

It’s FREE!

The teleseminars will start on Jan. 17 so make sure you head on over to the sign up page to register!

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• The repeated and massive blows to the abdominal region were simply too much for Brock Lesnar to handle and as a result, Overeem defeated the former heavyweight champion by technical knockout.

The possible explanation:

• Pain Science: While nociceptive input from the abdominal region may previously have been regarded by Brock’s brain as non-threatening and therefore non-painful, the nociceptive (and possibly non-nociceptive) input he experienced through such abdominal blows may likely have been interpreted interpreted as threatening and subsequently painful as a result of his recent experiences with diverticulitis.

The analogy:

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Today I visited a really great friend, Thomas Lam of FITS Toronto. Having no real agenda planned other than a little lift session, I was more than aware that there would be plenty of discussion as always. What I didn’t know was that I would be there for 7 hours.

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www.fitstoronto.com

Joining us was the wife/boss/sugarmomma, former CIS football star and current strength coach Cory Kennedy, and student extraordinare, Ricky Singh.

The unique thing about Thomas and I is that when we both sit down to chat – regardless of who we are speaking with and especially together – we always go off on tangents. Sentences become paragraphs and paragraphs become chapters. There really is no such thing as a period in our discussions.

Amongst the endless variety of topics discussed, the following question was asked: “what were the 3 things that I learned in 2011″.

Here were my answers:

1. The importance of being able to truly read people - In the clinical setting, patients come in with a variety of presentations. Many will be musculoskeletal in nature, others will be more psychosocial. Some will be neurological and few, if not more, will be cardiovascular. Because we as humans are multidimensional and each of our systems are interrelated, there exists a continuum where each of the above – and our other systems – sit. So where our patients and their given presentations sit within this continuum becomes perhaps the most significant variable that we must uncover during each patient visit. To me, this is accomplished through the skill of “reading” people.

2. The effect of what we say is highly influenced by how we say it - As we are clinicians – and strength coaches for those who are reading - we too are teachers. We are interactors who constantly communicate with whom come in contact (i.e. our patients). Much of our clinical interactions are learning experiences. Learning experiences for our patients and learning experiences for ourselves if we are willing. And what I’ve learned is that what we say only matters if we put it in a context that reasonates well with our patients. If stated it before and I’ll state it again, if a patient is not compliant I think it is more important that we look in our own mirrors prior to looking in theirs.

3. Context Specificity - In this age of information, there are endless exposures of successful anecdotal clinical experiences. Unfortunately, with this comes plenty of opportunity for criticism. Over the past year and especially over the last several months, I have realized that unless we are present, we truly do not have a complete understanding of each others’ experiences. I, for one, used to be a member of the critics anonymous society. Maybe not publicly but certainly privately. I’ve learned to get over myself and understand that a success story is a success story, regardless of whether or not I truly understad the system or methods used. I still believe that certain principles must be respected, but again if it works, it works. And if it works, I probably need to study it.

What were the 3 things you learned this year?

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This workshop is designed for any strength / fitness professionals who are seeking guidance and practical advice on research based strength and
conditioning practises for developmental athletes. During the course of this presentation, coaches will be exposed to a novel method of organizing individualized training programs, while touching upon different methods of teaching weightlifting exercises and components.

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The presenter will be Lindsey Materi,  MA, CSCS, NCCPII and the workshop will be held on January 14th at Foote Field.

For more information, please go here.

Hope to see you there.

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Sometimes good. Sometimes bad. But powerful.

Earlier this week I read a blog post, that in some minds was controversial. In my mind, irresponsible.

Here’s the link: Corrective Exercise for Disc Herniations

While suggestions were made to seek care from a health care practitioner, clearly the intent was to treat such conditions. Treatment can come in many forms, from medications to manual therapy to cognitive coaching. In this case, treatment was exercise. One problem with this is that each and every patient presentation is context dependent. And while this is so, there are certain rules that must be respected when it comes to discogenic presentations.

On the other hand, I also read another blog post this week from an educated and responsible non-therapist. Again context is important but in my opinion, this post was much more contemporary, responsible and educational.

Here’s the link: How to Lift with a Herniated Disc

I hope you see the difference and understand that my main message is that if you intend to educate, not only do you need to do your homework, but more importantly you need to accept responsibility.

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www.achieveperformance.net

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50 Fitness “Things”

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1. Squat (often)
2. Eat meat, fish, fruit and veggies most of the time
3. Fish oil is your friend
4. Crawling makes you more athletic and smarter
5. Floss everyday
6. Cardio is overrated
7. Strengthen your feet they are your foundation
8. Strength training does everything
9. Cardio: try 5min of walking lunges
10. Throw medicine Balls
11. A strong grip could save your life
12. Learn to skip
13. Perfect Knee push-ups are better than crappy regular push-ups
14. Olympic lifting is worth learning
15. sprint
16. cereal is not breakfast
17. learn to pick heavy things up off the floor
18. drink water
19. Pull-ups are hard but worth it
20. Jumping gives you legs
21. carry heavy things
22. get strong in the stretch
23. hang from a heavy pullup bar for as long as possible
24. eggs are not bad for you
25. Pizza is not a vegetable
26. stand up every 20 min
27. abs come from eating well not situps
28. elipticals, bikes, treadmills and machines makes things easier not harder
29. Go for walks outside all year around
30. Dumbbells are smart
31. Move or die
32. Run up hills
33. More than one way to get strong
34. warming up means moving not stretching
35. your core is attached to everything else
36. the best core exercise is training your whole body
37. Take the stairs not the elevator
38. Calisthenics
39. Bread is bad
40. Eat broccoli and Blue berries
41. no such thing as upper body day or lower body day only total body day
42. P.M.A.
43. Physical Education is important
44. Olive oil
45. Sandbags
46. No one ever drowned in sweat
47. Consistency, effort and single minded purpose
48. Play
49. Sleds are made to be pushed
50. The longer you are sitting down the harder you must train standing up

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The night before this TEDx event, my cousin and I (along with some of his friends) attended Vitaly Beckman’s Sensation of Magic here in Vancouver and let me just say that it was a nice little break from reality. A break that enabled us to enter into the world of imagination.

Now, I’ve been reading about illusions over the last several months to give me a better understanding of how humans perceive the world (*note: this is relevant when it comes to pain management) but sometimes it’s just nice to tune out.

Let me share with you this TED talk to transition into my writeup.

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Some of you may be wondering why I, as a health care practitioner, would want to attend TEDx Vancouver. If you’re a regular on this blog, you’ll know that it comes down to this.

A passion for education…and knowledge dissemination.

Not one of today’s talks had anything to do with health care, save for one of the speakers who was a physical therapist, but as one speaker mentioned today, ideas come about when professions overlap. Just like we create opportunities…rather than simply find them…we create ideas. We think laterally, we reason spatially, and we collect all of our experiences from everyday life to create that one idea. That one idea that’s worth spreading.

The main concept of today’s event was The Frontier, a topic they selected as a reflection of the new wonders undreamt of in our time. And to get our wonder juices flowing, we were handed a two piece name tag, one to wear around our neck and the other to make origami with.

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To me, this was both relevant and significant. Framing and context are important in every day life. You saw this in the magic talk above but this is also especially so in health care and our interactions with patients. Take, for example, walking into a dreary-looking clinic filled with “miserable” staff and condition-specific “educational” artwork. How difficult do you think it would be to affect a person’s “painful experience”? I wrote about this in a previous post of mine.

I hope you see where I’m going with this as it definitely affected the TEDx experience.

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There were thirteen different live talks with six various talks streamed from ted.org. Naturally it will be difficult to summarize each talk, especially since none of them, as mentioned above, pertained specifically to sport medicine, rehabilitation or sport performance, but here are some ideas stemming from the talks that may be relevant to athlete and patient care today and for the future.

From Reid Gower’s talk

• Necessity changes us, we are an adaptable species. “We humans are capable of greatness”.

From Romeo Dallaire’s talk

• “The future aint what it used to be” – Yogi Berra
• There is no way that we can sustain status quo, we’re in a revolutionary time
• “Inaction is an action”. Not wanting to do something is an event…a negative one
• We need our youth to become activists
• “Don’t tell me you can’t influence the future…get engaged”
• It’s a time of great opportunity for those willing to take the risk .

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Here’s a recap:

Gray Cook on Profiling Movement

• We sometimes view movement through a filter. A filter which is based on our backgrounds, be it our techniques, professions, or specializations. The goal of the FMS team is to talk about the principles because we all need standardized principles to govern our principles.  The principles of which they speak are based on the neurodevelopmental perspective, a perspective that is based itself on motor learning, and trial and error. Think of babies…in order to improve movement, they must learn it.
• With respect to fundamental movement patterns, it is important to know if the individual is a) competent and b) symmetrical. Delving into competency a little deeper, consider vision. In order to obtain your drivers license, you must first take a vision test. Therefore, first establish competency, then go after performance.
• Dentists are smart. They make you come in twice per year for check ups (screens). This standardization is important. The functional movement system model is all about a “standard operating procedure”. Pilots figured it out. Due to the risk of death, they collectively established a standard operating procedure, a checklist, prior to flying. Death is not a risk in movement. This is why we have faulty movement patterns.

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“We have risk factors for every organ in the body…except the neuromusculoskeletal system”

“Don’t change your system, just throw a movement competency system in front of it”

“Movement pattern atrophy…it’s possible”

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• Athletic performance is defined by durability. Athletes cannot perform if they’re not on the field.
• The NSCA requires CPR for certification. But you don’t see heart attacks in the weight room, you see a bunch of people in the squat rack with a bunch of injuries
• Stiffness (i.e. in low back pain) is a strategy. A compensation for poor motor control. To slow you down and prevent you from further injury. This is your parking brake.
• Strength training stabilizers is not stabilization training.
• True stability should really be called motor control. Movement pattern improvement is a product of motor control, which is a product of stiffness (or lack thereof). Therefore, first clear mobility to minimize compensation in order to improve motor control.
• You can treat the pain, just don’t exercise the painful pattern.
• Don’t bring expert evaluation to the screen. Call it like it is. Then group them based on the screen and move on.
• Motor control isn’t just about activating a muscle, it may also be about deactivating another. To move efficiently, the body must be safe. It cannot be threatened. Sometimes we just need to find a way to remove the parking brake. Because typically, we’re already strong enough. We simply lack the stability-motor control.
• Clinically, we must first treat the dysfunctional non-painful in order to assess its influence on the painful area. Treating the painful area first may only exacerbate the problem.

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“Don’t be tied to your methods…be tied to your systems and principles”

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Phil Plisky

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“It’s not about the natural history of pain and injury, it’s about the recurrence rate”

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Kyle Kiesel on the Functional Movement Screen

• Always think about the bigger picture
• “Whether you are a waiter or a brain scientist, if you want to get the particulars correct, in a hierarchical fashion, don’t start with the details. Start with the key ideas and, in a hierarchical fashion, form the details around these larger notions.” – John Medina, Brain Rules
• How to use the FMS. 1) Near discharge to bridge the gap from rehab to fitness. 2) To help with return to sport and sport decision making. 3) To help with injury prediction

• It’s about the assessment and the logic behind the assessment.
• On proprioception – there’s no input into the system if the joint can’t move. The true definition of motor control also includes adequate mobility. This is Charlie’s core pendulum theory.
• If the body doesn’t know what to do, the first thing the body does is create stiffness or achieve control in a different manner.
• Mobility and stability form the foundation of the SFMA

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“Our diagnostics (our thought process and clinical decision making) is just logic”

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• Breaking the movement down magnifies the problem. First do gross movement, because too often we break it down before looking at the big picture. Think about Usain Bolt. Let’s say his multisegmental flexion (toe touch pattern) is good, yet his active straight leg raise is limited…would you go after his ASLR?
• The SFMA is simply a roadmap, it tells you where to go so that you can utilize the most appropriate tool in your toolbox (Graston, ART, Needling, etc).
• The SFMA scoring system i based on 2 questions. 1) Did it hurt? and 2) Was the movement good or bad?
• Most of the time, the region that is hurting is the region that is doing something right.

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The Rules of Screening

• No warm up
• If it looks like a dog and smells like a dog…call it like it is!
• Be picky. The bottom line is, if you think you can make it better, it’s dysfunctional
• No shoes
• Monkey see, monkey do. Demonstrate the movement you want to see. Unfortunately, problems arise when you can’t perform the movement yourself.

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“It’s not magic, it was just a stability problem”

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• No coaching in the SFMA. Monkey see, monkey do.

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“Never bring a mobility problem to a stability correction…DON’T BE A ROOKIE!”

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• Don’t skip steps. More mistakes are made in the examination because of not looking than for a lack of knowledge.
• Most stability problems aren’t strength problems, they’re motor control problems.
• Once you find the white elephant (the big Dysfunctional Non-painful pattern), it just becomes logic

Kyle Kiesel on Pain and Motor Control

• Kyle started off this lecture by introducing to us a recently published paper by Hodges and Tucker.
• The new pain theory:

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1. Redistribution of firing between and within muscles
2. Involves changes at multiple levels of the motor system
3. Leads to protection from further pain and injury
4. This adaptation has short term benefit and long term consequences
5. It changes mechanical behavior and modifies movement

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“We don’t need more injury prevention programs, we need a better system” – Phil Plisky

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Mike Voight  on Breaking Down Function

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“If you train the muscle you may not completely develop the movement, but if you train the movement the muscle will develop appropriately!”

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• The importance of mobility and stability for efficient movement. Compensations and incorrect mechanics secondary to deficient mobility and stability may result in inefficiency and increased energy expenditure, possibly leading to poor performance and injury. Thus, mobility and stability testing as the starting point for “functional” rehabilitation.

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SFMA Breakouts 101

• Unilateral vs Bilateral
• Loaded vs Unloaded
• Active vs Passive
• Consistent vs Inconsistent

• Functional training is motor learning
• This book was highly recommended by Greg

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By Richard Schmidt and Tom Lee

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• If you are doing functional training, the above book is the first book you should ever reed.
• We need to be experts in motor control. We need to be neurofunctional trainers
• Cognitive skills are easy to lose. Motor skills are difficult to learn. Focus on feel, not form. Because what matters is the discovery…the learning.
• There are three phases to learning – 1) Discovery 2) Grooving 3) Automatic
• We must do a retention test after practice to gauge learning. This is the clinical audit process. This retention test is the SFMA.
• The more the individual struggles with the exercise (as long as they perform it relatively well) during the visit, the less change of injury tomorrow. If you exercise on a machine that doesn’t let you make a mistake, you’re not learning
• On feedback – The less the feedback, the more the learning. Intrinsic oriented feedback (what the individual feels) >>> results oriented feedback.

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The Functional Continuum

• Subconscious dysfunction (screen here)
• Conscious dysfunction (reset, reinforce here)
• Conscious function (reload here – motor learning)
• Subconscious function (improvement)

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The 4×4 Matrix for Reloading a Stability Problem

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4 Functional Positions

1. Non weight bearing (supine, prone)
2. Quadruped (I assume also triped)
3. Kneeling
4. Standing

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4 Functional Exercise Resistances

1. No external load with pattern assistance (*an example of pattern assistance is RNT – Reactive Neurmuscular Training)
2. No external load
3. External load with pattern assistance
4. External load

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Doc Cheng demonstrates the Matrix

1-4 = 1/4

7,8 = 2/4

9 = 3/4

10 = 4/4

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“Rookies only do 4×4′s”

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• The SFMA tells you where to start.
• The 4×4 Matrix gives you exercise progression principles.
• Motor learning principles give you sets and reps.
• On providing us with a list of exercises:

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“Isn’t it a better idea if I just gave you a philosophy and you make up the exercises?”

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Final Objectives

• Logic for screening
• Philosophy for exercise corrections in a logical order
• Mobility fixes for mobility problems
• Stability fixes for stability problems
• DON’T BE A ROOKIE!

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