So for those of you who have yet to take the SFMA and DNS courses, and still have yet to join SRE.com, I’d say “the math” is pretty simple. ISCRS is free

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The Bad

Earlier this morning I failed on my last set of triples on the bench which really pissed me off. Part of it, I think, had to do with the fact that I had to rush my workout to make it into the city on time to treat a bunch of soccer players, but truthfully, I think the main reason was simply because of soft shoulders.

My shoulders are my weakest link, this I know. And while, I’ve been spending some extra time over the last few weeks to build them up from a “stability” standpoint, I’m still not confident in them. I know my cuff and my scapulothoracic joint can be more dynamically stable and I know my thoracic cage can have more mobility.

I’ve been working on it, but apparently not wisely enough. My TGU is decent and I’ve been taking some of the tricks learned from both Kettlebells From the Ground Up to work stability and mobility at each stage. I’ve recently started up with the clubs lately and have been working on building strength with presses, pull ups, bat wings, etc.

I’ve also felt substantial soft tissue restrictions and joke to my wife that if I had a clone, I’d book myself in every day. I’ve had work done but “for some reason”, the “tightness” keeps coming back.

Serves me right.

Anyway, yesterday morning Kettlebells From the Ground Up 2 finally arrived at my door and during my lunch (and after work), kept me glued to my screen until I finished the DVD.

Don't order this until you've watched the first one

I wish I had ordered it sooner. The correctives and troubleshooting exercises from this DVD were money.

For those of you who have the first set, you will know that the Get Up is probably one of the best exercises for mastering ultimate mobility and control…with strength. And because of this, it is often difficult for most to nail the exercise perfectly. As such, I use many components of the TGU for rehab and correctives in the clinic. This is one of the main reasons why decided to host and take the HKC.

Focusing mainly on the shoulders and the hips, the TGU and especially this DVD, provided me with perfectly timed ideas to help me troubleshoot these soft shoulders. Some of the correctives included in this DVD included:

• The Brettzel 2.0
• The Bottoms Up Screwdrivers (that I’ve talked about several times previously)
• The Crooked Armbar
• Halos
• Windmill Variations
• Hip openers

The Good

So after work, I went back to the gym in an attempt to redeem myself. Somewhat. I knew I wasn’t going to attempt the triple again but I did know that my shoulders needed some work…FAST. So I started off with bottoms up screwdrivers and armbars, went to traditional armbars, and bottoms up and traditional 1/4 get ups. I then moved to crooked armbars, the Brettzel 2.0, tall kneeling halos, and half-kneeling windmills. Now because it was a redemption “workout”, I really wanted to take my time and be precise.

Feeling great afterward, I knew immediately that this is exactly what I need moving forward to harden the soft. But more importantly, one lesson learned was that I can soft tissue the serratus anterior all I want, but if I want real long standing results, the crooked armbar is where its at.

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This is one of the key concepts that I’ve really taken and run away with. I’d say that my understanding of this concept would in large part be a product of my DNS learning, but this principle can definitely be applied to many other situations and techniques.

We know that the rotator cuff can be a big problem for many of our athletes and patients and we know that with dysfunction of the cuff comes limited mobility. I used to be “that guy” who would soft tissue and mobilize the heck out of the glenohumeral joint only to be confused as to why the “restriction” would keep coming back.

According to the Joint by Joint theory, we know that the GH joint needs mobility. But how often do we pull out the stability card to try and get this mobility?

I would say that dynamic stability more often than not translates into mobility.

Some of the techniques I typically use to get stability in the cuff include (but not limited to):

• Grip strength (Fat Gripz, Captains of Crush, etc)
• Bottoms Up Kettlebell Screwdrivers
• Supine Shoulder Packing

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And sometimes I have to improvise. Like today.

Here’s a patient who presented with a ton of shoulder pain and very limited mobility.

Yes, I am working with the Dysfunctional Painful pattern but I did work both the DN and the FP and well sometimes, you just do what you gotta do.

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I would have used a heavier weight if I had one but 25 lbs is currently the heaviest I got (*FYI, I just became a Canadian distributor for Dragon Door and the bells arrive next week so if anyone wants to order, you know where I am).

My 50lb sandbad didn’t work but I was able to get him to do a suitcase carry with it a little later on to work the cuff in an upright position.

Obviously you need a HI-Lo table to do this and for me, the best way to do so is to do holds counting from 10 downwards.

And for homework, aside from a few others, I just told him to do a bunch of suitcase carries with a sack of potatoes to simultaneously work his grip and his cuff.

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With all the research and resources that have been put forth to date, I find it difficult to swallow many individuals have a hard time comprehending that first and foremost, our objective is to do no harm. I do understand that in certain athletes, there does exist the concept of risk vs reward but still, I truly believe that the basic and foundational principles differ very little if at all.

Among the hundreds of research articles that have provided us with a blueprint understanding of what and what not to do when it comes to addressing that magical place between the neck and the knees (as well as the rest of the body and the person him/herself), there also has been a number of educational avenues that we have relatively easy access to in the event that reading research isn’t one’s cup of tea. I do understand that financials may limit access for some but really, I think we should be putting our best effort forward to be at the top of each our games. Some of the key resources that have played a huge role in my own understanding of core function have been the following:

• Ultimate Back Fitness & Performance and Low Back Disorders (Books) and The Ultimate Back (DVDs) by Stu McGill
• Rehabilitation of the Spine (Book) and DVDs by Craig Liebenson
• Movement (Book) and everything else by Gray Cook
• Dynamic Neuromuscular Stabilization by the Prague School
• Research Review Service by Shawn Thistle

But going back to the point of this post, I really find it difficult to understand why we continually see clinicians and trainers doing more harm than good both in the clinic and in the gym. I hate sounding negative but again, there are countless resources out in the open that are simple to understand, that respect the foundations of human movement, and that are quite effective in achieving functional stability.

Take for example, Mike Reinold and Eric Cressey’s newest educational resource, Functional Stability Training for the Core. Subtitled, “Integrated Rehabilitation and Performance System“, this DVD set is exactly the type of educational resource that is easily accessible and valuable for most if not all musculoskeletal clinicians and training professionals.

But why are we still not getting it?

Is it because that we don’t have time to read research? Is it because going to continuing education seminars cost money with no guarantee that we’ll receive CE credits in return? Or is it because we only treat our patients 5-10 minutes per visit with a couple soft tissue passes and don’t have the luxury or interest to do rehab?

I don’t know. But what I do know, is that there are a number of resources currently out there that I have personally learned from that provide us with almost everything we need to cover the 80 in 80/20 when it comes to working with both athletes and the general population.

Now in the coming months, I will do my best to collaboratively share some information in some upcoming seminars here in Western Canada. The first one will be the Spinal Health and Core Training Seminar in Edmonton with Rick Kaselj, Tony Gentilcore and Dean Somerset. And the other will be the Okanagan Strength and Conditioning Conference in Kelowna with Charlie Weingroff, Martin Gibala, Joel Jamieson and Sean Skahan.

But in the meantime, for those of you who want to get a head start in expanding your knowledge about the core and stability training, here are some thoughts from Cressey and Reinold’s Functional Stability Training for the Core.

• We all know that rehab and training is truly the art of scientific integration. If you are familiar with Mike Reinold, you will know most if not all of his work is grounded in scientific backing. And you will also know that he always finds a way to integrate the evidence into what he does on a day to day basis. His lectures within FST are no different as he breaks down the concept of “Dynamic Joint Stability” into its component parts of force couples, neuromuscular control, joint compression and ligament tension.
• Sometimes, we get too caught up in the minutia in both our learning and day to day interactions with our patients and athletes. One of the main things I liked about Mike’s presentations was that he constantly stressed that it is the big picture that’s really important and that ultimately, we should strive to “train the body to perform coordinated functional movements without compensation”. It’s that simple. This is DNS. This is the SFMA.
• We know that some joint regions need stability and some need mobility. But the lumbar region…….?………then why oh why are we still handing out exercise sheets with low back stretches?
• While some of you are clinicians and some of you are strength coaches, all of you work with movement based populations. Now because we all live and work 21st century, we all work with people who have certain limitations. In Eric’s lecture(s) he provides us with a comprehensive overview of possible and common considerations that may potentially affect the ability of the individuals we work with to achieve true functional stability. Certainly some of you may not be able to “treat” such considerations directly, but I do think we should at the very least be able to recognize such presentations so that we can refer out to the most appropriate professional(s) in their best interests.
• Finally, progressions…progressions…progressions. Both Mike and Eric provide us with an excellent arsenal of systematic progressions in both their lecture and lab presentations to help us deepen our exercise progressions and widen our toolshed.

But just remember, before we can build our toolshed, we must always start with a blueprint of principles. And hopefully the above resources, including the recently released Functional Stability Training for the Core resource by Eric and Mike, will provide you with the core principles you need to first do no harm.

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*note: as usual, some of the links above are of the affiliate variety…but remember, the more money I make, the more courses and DVDs I learn from, and the more reviews I put out

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Porter Brown

I have been fortunate to have had several students work with me over the past year. While most of these bright students have typically come from chiropractic colleges across the continent, Porter Brown is a graduating kinesiology student from the University of Alberta who will be entering his first year at CMCC this fall.

Aside from the daily assistance with my patients, Porter has been through many of the books on my bookshelf and many of the DVDs in my library. To say that he has saved several thousand dollars in the past 3 months is quite accurate.

Here is his unedited review of the book, “Movement.”

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You can pick one up at www.ontargetpublications.net

Gray Cook, MSPT, OCS, CSCS with Dr. L. Burton, Dr. K. Kiesel, Dr. G. Rose & M.F. Bryant

Movement: Functional Movement Systems – Screening, Assessing, Corrective Strategies

On Target Publications

Aptos, CA. 2010

ISBN: 978-1931046725

Hardcover, 407 pages

www.movementbook.com

Movement is such a radical and ingenious book, that I am skeptical I can do it justice in just a few lines. Movement fills a gap in our knowledge about natural authentic movement that I never even knew existed. It proposes a paradigm shift is required for the way we view authentic movement patterns. Instead of dissecting human movement into individual parts (like our physiology, anatomy, chemistry classes taught us) we examine natural movement from a holistic perspective. With this new stance in mind, the author Gray Cook and his team, explain the lack of underlying principles for fundamental movement that exists in fitness and rehabilitation theory to date. Cook’s goal is to point out the lack of a standard operating procedure in existence for movement fundamentals and offer up the Functional Movement System to fill the void.

Gray Cook has his foot in the door for both the fitness (CSCS) and the rehabilitation (MSPT and OCS) fields; pairing these with years of experience makes him one of the leading minds in physical therapy and strength and conditioning theory.

Movement could be beneficial to everyone, but the intended audience are the health care and fitness industries. Professionals such as medical and chiropractic physicians, physical and athletic therapists, personal trainers, coaches, physical educators, and even people looking to become healthier (and not limited to this list) will gain the most from this read.

The organization of the book follows the same pattern as someone administering the functional movement system. It progresses from reasoning/explanations, to administering the screen/assessment, to creating and prescribing corrective exercises.

The book opens with a preface from Gray Cook, providing a hook that I’m afraid no one could resist, followed by chapters that are the meat and potatoes of Movement. This is where Cook presents the paradigm shift in the way of thinking. The ah-ha moment that sold me, occurred as Cook explained that the number one predictor for injury is previous injury, implying that something is drastically wrong with our current rehabilitation process. The process of looking at dysfunction, limitation, and asymmetry, as opposed to pain, was completely alien to me. I always believed that pain indicated where the problem is, but instead it’s the fire alarm going off telling us there’s a fire somewhere else in the body. Further, Cook’s explanation about the importance of breathing was so simplistic yet undeniably eye-opening. There is so much in these first chapters that one can read it over and over and take something away from it each time.

Movement progresses into explanations and instructions for administering the Functional Movement Screen (FMS) and the Selective Functional Movement Assessment (SFMA). The FMS is a screen for discovering faulty fundamental movement patterns in the absence of pain, which can be used to correct patterns to reduce the chance of future injury. The SFMA is systematic clinical approach to discovering which movement patterns are dysfunctional/functional when there is pain present, a concept known as regional interdependence. The appendix provides SFMA flowcharts to assist the clinician in mastering the assessment process.

The subsequent section provides an understanding of corrective strategies, ways to develop corrective exercises, and methods for recording exercises on a corrective framework checklist. This section is unique compared to the last because it isn’t a pre-constructed system. It provides the reader with principles to follow without strict guidelines (which is one of the strengths of the FMS/SFMA). This makes it applicable to real life, because as new and better exercises are developed, this section will allow one to check them against logical principles.

The undisputable theme of this book is quality over quantity, a phrase that Cook incorporates into his philosophy: “First move well, and then move often”.  This theme is well supported throughout the book as it is one of the underlying principles to Functional Movement Systems. The purpose of these systems is to provide a standard operating procedure to ensure there is fundamental movement quality instilled before movement quantity is of concern.

One aspect that I had a tough time deciding whether to call a strength or weakness is Cook’s thoroughness/repetition with certain topics, such as the mobility before stability rule.  Upon reflection, I realized that the only thing Cook is repetitive about is the very important principles he wants to engrain into our thinking. I decided to refer to it as a strength indicating that he is thorough almost to the point of repetition.

Cook is an excellent communicator, something that is easy to see in his writing. He reduces and simplifies complex ideas with a few sentences and examples. It’s uncanny how many times I was forming questions in my head, only to be answered in the next sentence. It’s things like this and his first person informal tone, that make it seem more like you’re having a conversation with the man than reading his 400 page textbook. Not only is it expertly written, the content is just as impressive.

Although I’m sure Cook can sell me the shirt off my back, he’s not just a sweet talker.  After reading this book and stepping away, I’m amazed at the common sense of it all. How in a world where fundamentals are stressed in so many aspects of life, are they not stressed in movement patterns?

I believe the philosophy behind this book is invaluable to absolutely everyone; movement quality over quantity. However the book itself is indisputable in its value to the fitness and healthcare world. I would recommend it to anyone in those fields. I personally (having borrowed the book) am going to purchase it so I can read it again. It’s one of those books that has so much in it you have to keep reading it to catch things you missed. I have seen both the FMS and SFMA in use and can attest to its usefulness, I even plan to become certified in both systems once I graduate from Chiropractic College.

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Thanks Porter!

*PS. He deserves this celly for the great write up!

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Where will it be located?

• The Foundry Athletic Training Centre

When?

• May 12, 2012

Who is it for?

• Contemporary Strength & Conditioning Coaches
• Forward thinking rehabilitation-based MSK clinicians (PTs, DCs, etc)
• Personal Trainers and Fitness Professionals
• Sport Coaches
• Anyone else

What you will learn?

• A deep understanding of the true benefits of kettlebell training—for both yourself and your clients
• A solid knowledge of vital kettlebell training safety procedures
• A workmanlike grasp of the fundamentals of biomechanics—to ensure your clients move with perfect form and avoid injury
• A grasp of the key HardStyle skills and principles of strength
• The ability to competently perform the three foundational kettlebell exercises (the Swing, the Get-Up, and the Goblet Squat)
• The confidence you can now correctly teach the three essential kettlebell exercises—and troubleshoot common technique problems
• The unique HKC template for designing an unlimited number of effective kettlebell workouts.

What is contained in the manual that you will receive?

• What makes kettlebell training unique?
• What Russian research says about the benefits of kettlebell training?
• What is “Hardstyle”?
• Kettlebell safety 101: ten key items
• The Swing: its benefits, technique, teaching progression, and remedial drills
• The Get-Up: its benefits, technique, teaching progression, and remedial drills
• The Goblet Squat: its benefits, technique, teaching progression, and remedial drills
• HKC program design
• The three key principles of effective training identified by Russian sports scientists: continuity of the training process, waving the loads, and specialized variety,
• Ten program design tools for an unlimited variety of effective kettlebell workouts:
  • Rep Ladders
  • Weight Ladders
  • Time Ladders
  • Breathing Ladders
  • Reverse Ladders
  • Drop Sets
  • Super Sets
  • Timed Sets
  • Series
  • Active Recovery Exercises

How you can register?

• DragonDoor.com

No related posts.

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• This was a really good post by my colleague, Greg Lehman. I guess I liked it so much that it deserved it’s own blog post. There are quite a number of gem quotes in this piece not only from the blog itself but also from the comments section.

“I can’t fillet a chicken breast with a rolling pin.”

“I’d love to do that research but I am not a researcher nor do I recommend that individuals use a foam roller on the ITB.”

• I too dislike foam rolling the IT Band but for my own personal reasons: 1) I think it’s too painful and 2) I just don’t think it’s necessary. That said, I myself do utilize and often recommend the foam roller but also never claim to know the exact mechanism.
• For those that really want to foam roll the outer thigh, this is the technique that I recommend:

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• Daily and game day rituals. Are they just superstitions or are they the right habits? Here’s a nice piece on the effects good habits may have on performance, especially come crunch time. This piece reminds me of when Gray Cook talks about the importance of having a standardized checklist, not dissimilar to pilots, to ensure that one stays on target.

Stress Tested by Alex Hutchinson

• I really enjoy Alex’s work. This is a nice little piece that just may shock some of you. Personally, I am a big fan of this mindset. I think that we baby ourselves far too much and put ourselves in the “amber” a lot less than we should. For those of you in sport medicine, I urge you to reconsider your tactics when managing acute injuries. When it comes down to playoffs, by all means, do what you need to do to get the athlete back in the game. But early on in the season or even in the off season, you may just want to let the athlete’s body figure figure itself out. I’m not saying don’t do anything, but definitely let it do as much as possible.

Teller Reveals His Secrets

• If you’re a clinician like myself, you’ll know that patient management goes far beyond muscles, joints, and nerves. You’ll also know that patient interaction plays a very big role in facilitating recovery. This article here may be helpful to you regardless of whether you work with patients suffering from acute or chronic injuries and essentially, it all boils down to “framing” the ideal patient visit.

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Well recently, I had the privilege of taking part in another DNS A course that was put forth by Michael Maxwell of Somatic Senses and taught by Alena Kobesova and Brett Winchester. This particular experience was quite special for me because not only was it local (hence no flight costs), but it provided me with the opportunity to share my experiences to date with many of my friends and colleagues who attended the course…including my wife.

I would say however, that the most beneficial aspect of being present was that it afforded me the opportunity to “fill in the gaps”.

Now while I would say that my current understanding of the DNS approach (“it’s not a technique, it’s an APPROACH”) is quite solid, I do believe that like sport, it certainly will take years of deliberate practice to master.

So let me share some of the knowledge shared throughout this most recent course that helped me fill in the gaps. Some of the information below will be based on the course material and others will be based on my thought processes as my mind traveled a million miles a minute. As always, please remember that these were my own interpretations. And for those of you who have yet to read my previous reviews, please make sure you click on the links above.

Here we go…

In general, there are two schools of thought to Musculoskeletal Medicine: Structure and Function. While we normally focus on structure, it is often forgotten that we really cannot have one without the other. And while in our later years (especially in today’s society) structure may certainly play a role in dictating function, in developmental kinesiology, it is known that function governs structure. Therefore, viewing MSK medicine in this light may provide us with a more accurate model of care.

The unfortunate news however, is that unlike anatomy, functional norms have still yet to be clearly defined. If you look at bodybuilders, martial artists and runway models, which of the three would you say is the ideal? I know what you are thinking but is there a “why” to your answer? If you think about it, babies no nothing about bodybuilding, martial arts and modeling, they simply achieve “normal” posture on their own…using neurophysiology to change (aka develop) their own posture to explore the world.

“It’s not just that the baby ‘grow’s up’…it’s CNS development.”

Therefore, developmental patterns are related to the environment and are likely ideal. And this gives us every reason to study developmental kinesiology.

Speaking of development, the arch of the foot forms around 4 years of age. So if a mother brings in her 3 year old child to your clinic because little Johnny has flat feet, just agree…and don’t put orthotics underneath the child’s feet! (Disclaimer, you do have every reason to evaluate for dysfunction however)

Many of you are familiar with Stuart McGill’s work. And many of you are likely aware that much of his research investigates loads on the spine. Like McGill, it was stressed within the course that it is often not external load that really hurts us, but internal load. That is, the load placed on our bodies through muscular contraction. Because lacking functional joint centration (maximal instantaneous congruency between two joint surfaces) decreases balanced activity between musculature, resulting in relative muscle hyperactivity. And it is this relative muscle hyperactivity that exceeds the body’s physiological capacity resulting in potential injury (amongst other potential mechanisms of course).

One example to conceptualize is the hamstring strain. Often the common explanation is a “weak glute”. This may or may not be the case but consider decentration of the opposite foot sending a “chain-reaction” up the body, resulting in compensatory hyperactivity of supposedly stabilizing muscles. Therefore rendering (for example, the hamstring) a victim due to its new found force generation responsibilities. Because as the DNS folk would  put it, a deficient punctum fixum results in greater activity of its associated muscles, likely leading to strain or tear due to compensation from contributing to the deficient punctum fixum. It’s a ripple effect, if you will.

Note: If you’re “releasing” an acute hamstring strain you may be missing the boat.

Speaking of which,

“Are you treating the body’s compensations? Or on what’s wrong/the cause of dysfunction?”

The moral of the story…if one segment is dysfunctional, it can compromise the whole system. Search for the key link!

Another gap filler I took home with me was the importance of the sensory system. From tactile sensation to proprioception, optic, vestibular and acoustic, Janda taught that we must respect the bottom up approach of environmental feedback during clinical management. I previously wrote about the short foot but for those of you unaware, the inability to attain a short foot (what I call “dead feet”) may increase the activity of larger muscles upstream and lead to injuries not dissimilar to the example I provided above.

(another post that may be of interest is a previous one on plantar sided foot pain)

Another consideration is spinal stenosis. Early on in this short career of mine, such a presentation often led to guarded prognoses. However, as I’ve learned throughout the year utilizing a “DNS mindset”, spinal stenosis may simply be thought of as a desperation by the body to utilize structural anatomy to stabilize the spine due to decreased stability and motor control of the core musculature. And spondylolistheses? Well, you can probably guess my answer.

Think about it, the next time a patient presents with a spondylolytic spondylolysthesis, it may be wise to assess and determine whether or not a diastasis recti is present. You’re likely to find one. Because rather than a 6 pack being the ideal, my thought process has shifted toward the “belly”. And although it may look like some individuals solely possess a 6 pack, if you ask a successful powerlifter to load up under a bar with shirtless (ouch), you’ll probably see that he actually possesses a “belly”.

Several questions were asked throughout the weekend about releasing restrictions.

“Shouldn’t we release the muscle first if it’s adhesed”?

Some might argue “yes” but I’ve learned to counter with the question, of why is it restricted in the first place? Is it doing the job of something else?

You also may remember the above image. If not, it’s a diagram of the “stabilizing system of the spine” by Panjabi and depicts the important 3-way interaction between the nervous system, the musculature and the passive structures. Unfortunately, this 3-way interaction is often forgotten by many practitioners today. Because how often do we solely address the muscles and / or joints, yet forget the important contribution of the neural system?

And as Alena asked,

“How did his ’92 papers not change our treatment philosophy? Why are we still “fixated” on just joints and muscles?”

So we must remember that understanding the functional standpoint of joint centration is respecting the role the CNS plays in control. For more information on this, make sure you take the time to read some of Peter Reeves’ work.

During the course Brett Winchester discussed the role of the anterior structures of the core which prompted me to post the following on facebook.

“I think we can be even more precise with our thoughts on the rectus abdominis. We’ve moved away from flexion to anti-extension. But we can move even further away toward contribution to IAP. If we think about this muscle as a team player then maybe we’ll be less confused.”

Because in my opinion, very often, the Rectus isn’t for flexion nor is it for anti-extension, it’s for IAP to buttress the spine against erector load.

For those of you that work in the sport setting, yet still have a difficult time comprehending DNS principles, here is a little quote from a recent article about Steven Strasburg.

“To throw a baseball properly, a pitcher must get into the right position at the right time with the right succession of movements, like dominoes falling. Disruptions in this kinetic chain, as experts call it, cause problems at the weakest link, most often the elbow or shoulder.”

Note: Clare Frank goes into more detail on the “whole body approach” in this interview, courtesy of pttalker.com.

“Good diaphragmatic function is like a natural manipulation with every breath”

So as you can see, DNS is about filling the gaps. It’s amphoteric nature of every exercise being a test and every test being an exercise certainly widens my continuum of assessment and exercise, effectively deepening my toolshed. It’s about facilitating breath where patients lack and engaging muscle activity where inhibited and/or decreased. And for those of you who have learned this approach, you will see why, from a clinical perspective, I believe that very few people need more open kinetic chain training in rehabilitation. We need to spend more time respecting centration and the body’s support function just a little bit more.

But most importantly, learning the DNS approach will get you into the habit of asking “why”. And as a clinician this should be your primary question.

Because in it’s truest sense,

“The definition of “Failed Back Syndrome” is operating on a consequence, not a cause“

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*note: for our purposes as manual and exercise rehabilitation therapists, feel free to substitute “disease” with “injury”.

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Study Title: A Neuroscience Approach to Managing Athletes with Low Back Pain

Authors: E. Puentedura & A Louw

Journal: Physical Therapy in Sport

Date: 2012

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Summary:

• I have written previously on the importance of respecting neuroscience with managing athletes suffering from pain. While many injuries are acute in nature, especially in collision sports, chronic pain and injuries are certainly very prevalent in the athletic population. This particular paper (not an actual study) provides an excellent review and summary of the rationale for utilizing a “neuroscience approach” when managing athletes suffering from pain, especially of the chronic variety.
• Puentedura and Louw suggest a complete biopsychosocial approach to management that, in addition to anatomy, biomechanics and tissue pathology, incorporates the integration of pain mechanisms in interactive care. In my opinion, this is probably the most concise paper I have read to date that explains the rationale and one that is an appropriate introduction for those unfamiliar with this paradigm.
• Among the explanations described for using such an approach, the authors describe the contributions of environmental (situational) influence, sensitization mechanisms, and the role of cognitive states. They also explain the role of representation maps in the brain as well as triggers for “neurotag” activation. Many images were provided to enhance the readers understanding of this approach and the parallel relationship as “outputs of the brain” between pain and sports performance were discussed.
• Finally, suggestions were made for appropriate treatment of athletes with chronic pain utilizing this neuroscience approach, although it is my opinion that such an approach may also be taken when managing athletes who suffer from acute injuries as well.
• Overall, I really enjoyed this paper not only because it was all encompassing in nature, but also because it can be of great benefit to those who may be novel to the idea that pain and injuries may not solely be of the tissue variety.

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Puentedura, EJ & Louw, A. (2012). A neuroscience approach to managing athletes with low back pain. Physical Therapy in Sport.

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To me, “passive” continuing education such as audio downloads give me the opportunity to stay up to date with current concepts in sport medicine and Laree has just given me another excuse to spend more time in my vehicle. There are a large number of clinicians, strength coaches and scientists on the list of lecturers, many of whom you may currently follow. I, myself, am hoping to be able to contribute a lecture or two sometime in the near future.

But in the meantime, Laree is offering a 24-hour $7.00 coupon to the movementlectures.com facebook subscribers so make sure to “like” this page by Wednesday, March 28th, 2012.

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1. Functional Movement Systems Internship Evansville, Indiana - 2011...

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