Years ago I wrote about exercises for plantar sided foot pain. Much of what I thought back, then I still think today. However, there are two key principles I overlooked that currently find very important. That is,
For the former, many are aware of the importance of extension of the first metatarsophalangeal joint. It is not uncommon to see many ways of improving mobility of said joint. What I have learned over the years however, is that attacking first MTP mobility is futile in the absence of medial arch mobility. That is, in order for the first metatarsal to clear room for the phalanx to extend, the joints upstream must be in doing their job well. It's not uncommon to see arthopathy and spur formation at the junction between the cuneiform and first metatarsal, so before we aggressively stretch and mobilize the first MTP joint, we need to ensure that we give respect to all joints of the foot and ankle. One isn't more important than the rest.
As for the latter, it was noted by Thomas Michaud that collectively we often strengthen the foot in neutral and/or plantar flexion. And that we often fail to do so in toe extension, if not eccentrically in toe extension. Concentric toe flexion exercises are common. So are eccentric toe extension exercises. What aren't so common are isometric and eccentric exercises, in closed kinetic chain, and in toe extension. These are key in athletics/sport and they are paramount in fall prevention in the elderly.
In the video below are some progressions of low level foot strengthening exercises. For the complete videos, simply go to my youtube page. And for those curious, I'm using Toe Spreaders from The Foot Collective.
There is no greater agony than bearing an untold story inside you
I stopped writing several years ago. It wasn't a big deal, it just wasn't there. The waters stood still so to speak. Looking back, there came a point in time where I had nothing to say. Not that I did before - touché - but I didn't enjoy writing if I felt like I needed to post for the sake of posting.
Today, we exist - I wish I could say "live" - in an era where posts are forced. Social media used to be a destination, today it exists as an avenue. Be it Instagram, Facebook, whatever. I would say blogs as well but in this circle of life, it's easier now to short post on IG than it is to write a blog. Not too long ago, blogs evolved from diary and journal entries to opinion pieces to "scientific" regurgitations. There was a lot of cut and paste. No shortage of references, simply a shortage of thought.
To each their own. But for me, the ink ran dry.
I learned a lot over the last decade. I learned how to chase. And I learned first hand the effects of "the chase." It was a decade of accumulation. One where in the first half of the decade my thoughts and opinions were shared along the way. In the second half, all I had were thoughts. It got to me.
Some use the phrase #alwayslearning. Again to each their own. I prefer sometimes learning. And sometimes living. Sometimes thinking. And sometimes reflecting. Sometimes relaxing.
And sometimes writing. I guess.
I think we can learn a lot from each other. Especially when we openly share our thoughts and opinions. But I think we need to be more honest with ourselves and actually have thoughts and opinions of our own. We need not be afraid to be wrong. More often than not we're almost right. But be ourselves we must.
If the above is indicative of anything, it is this: My mind is spinning, bordering on gibberish. And the urge to write is there. Maybe it's to organize my thoughts. Possibly to solidify my opinions. Regardless, it is there. For me.
I knew this day would come.
If the goal is to develop the shoulder and arm's contribution to pulling, doing so with the scapula relatively fixed appears to generate the most force production and minimal GH joint wear.
In this video, I performed Prone Kettlebell Rows (isometric holds) and progressed in bell size until form significantly diminished.
A focus on "pinching the shoulder blades" - or retracting the scapula - would have disallowed the load I was able to achieve. This would be very clear to those who perform loaded rowing movements on a regular basis. As mentioned above, a fixed scapula appears to generate the most force production.
Whether dragging sleds, playing tug of war, or helping someone from falling off a cliff, most likely do not focus on pinching the shoulder blades. Particularly with heavy loads, the shoulder girdle generally assumes a centrated position and holds itself there with an isometric contraction enabling the remaining segments of the upper extremity to function in phasic contraction. Including the lower extremities (thinking dragging sleds).
This is why yielding isometric holds are being utilized above.
This message should not be confused with never retract or even never retract with pulling.
This brings us to Bat Wings. Dan John states that the aim with his exercise should be indeed to squeeze the shoulder blades together. Often as hard as possible. Those who are familiar will admit the ease of which loads heavier than the exercise intends may be used. Thus, my preference is the use of the FRC principle of End Range Lift-offs and perform Bat Wings in such position.
The aim here is short-range neurological control and force production. Or, increasing the surface area under the left side of the arc of the length-tension relationship curve.
A reminder that requisite mobility precedes. Meaning, adequacy with no external load prior to the use of external load. Elevating the kettlebell/dumbbell - a minimum of 7 inches off the floor facilitates proper Lift-off starting position, but more importantly, prevents the use of heavier loads than would be effective. Bracing and maximal irradiation are a necessity here.
At the end of the day, however, the system - a set of things interconnected - will "produce its own pattern of behaviour over time." (See @drmchivers for more information on Systems Thinking.) And the above, are ways of training its component parts.
One thing I'm trying to do more of is to say the word "don't" a lot less.
I've learned along the way that instead of saying "don't do this" or "don't do that", it's more effective to give the person in front of you an alternative action. For example, how often do the following work:
We are creatures of habits. And the research will tell you that in order to stop a habit you have to create a new one.
Just think of when a toddler is crying. Children usually "move on" when you give them a candy, tell them a joke, etc rather than tell them "don't cry".
The same with someone you know being stressed. Have you ever successfully told someone who's stressed not to be stressed? I haven't. And I find that patient under stress respond better when I explain that to them. They get the point and look for alternatives.
And in coaching, if you're trying to get an athlete to perform a skill in a different manner, rather than saying "don't do ____", it's a much better (motor learning) approach to directly give them the alternative instead. Otherwise they'll continually cognitively focus on what not to do.
Fighting fire with fire. It just doesn't work out well. So in essence, I'm not necessarily saying don't say don't. Instead what I'm suggesting is to do this instead. And "doing this" meaning find the alternative.
This one will be short but I wonder if Manual Muscle Testing should really be renamed Postural Stability Testing?
During manual muscle testing, which is often if not always performed in an open kinetic chain manner, a "muscle" may demonstrate high strength or activation levels...and it may not.
The local region tested may demonstrate a faulty pattern but so can the global / whole body pattern as well.
We know (perhaps assume with high confidence?) that muscles need a fixed point in order to pull toward. If that fixed point is relatively "stable", then I would think that the potential for ideal neuromuscular output would be greater.
But what if that fixed point is not actually "fixed"? That is, what if postural stability proximal to the region being tested isn't actually "stable". Would you get a reliable (let alone valid) reading?
Also, what about the true function of the muscle for that given position in which it is being test? Tonic? Phasic? Reflexive? Support function? Stepping/Grapsing function?
Do we even want full neuromuscular activity (hypothetical example: 100% MVC) in the first place?
There goes the can of worms...
I know many have already thought about this before and perhaps this was one of the things Janda was thinking about when he came up with his testing arsenal. But since it was currently at the top of my head, I thought I'd just blog about it.
I was recently asked by a colleague what my opinion was on the most important tool (as a student) that she should put in her toolbox.
To first give you some context, Katherine is a coach, trainer and strength & conditioning specialist who recently started chiropractic college.
Fully knowing her professional background, I still intentionally gave her a bit of a difficult answer.
I told her that experience, was single handedly the most important tool that she should put in her toolbox as a student. Let me clarify.
In my opinion, whether you are studying to become a coach, trainer or clinician, you absolutely need to accumulate hours upon hours of working with people. It has everything to do with hard work.
From figuring out what works and what doesn't and learning how to interact with people, to growing one's network and truly understanding what sacrifice and sweat mean in the real world, every student should start accumulating experience from day one. Be it volunteering, shadowing, or interning, experience is the fast track to separating oneself from simply being book smart.
Because your clients, athletes, and patients will not only ask you how long you've been working but they'll also use the sniff test on you.
And believe me, credibility matters.
In an age where talking the talk is commonplace, the number of individuals who have walked the walk are relatively decreasing.
Today, (face)book smart is reigning supreme. But unfortunately, those who are (face)book smart are also easy to pick out.
Is it easy? No. But it's doable.
Aspiring coaches, find a rake and rake the sandpit. Student trainers, turn on the faucet and fill water bottles. Students therapists, roll up your sleeves and get your hands on people. And young strength coaches, mop some floors.
Go to bed hungry (literally and figuratively) and wake up tired.
Trust me, having a diploma does not an expert make!
"When you're earlier in your career, I think the best strategy is to just say 'yes' to everything. Every little gig. You just never know what are the lottery tickets." - Derek Sivers
On November 16th I gave a lecture at the RCCSS(C)'s Run Faster Conference in Whitby, Ontario. The objective for my lecture was to put forth a therapists viewpoint of treatment integration into a performance enhancement environment whereby my goal was to suggest ways we can make 1% of our interventions 100% better.
I started off by suggesting that every interaction between athlete and therapist is to be considered a “treatment” or more accurately, an intervention. That is, there is always an input - physical or not-physical, conscious or subconscious - with a subsequent output or adaptation by the athlete. Be it passive therapy, exercise intervention or communication, there will always be an after effect of each encounter. It is our job to understand this and do our best to ensure that every adaptation is a positive one.
I spoke about performance therapy - aka performance engineering - and that in a performance enhancement environment, that it may be important for us therapists to be able to wear many hats. Trent mentions this in a recent Q&A, that:
“In many ways, the applied sports practitioner has to become an “expert generalist” being able to link and apply many interventions across many scientific disciplines to optimize performance.” Because we may often need – and therefore know how – to play the role of an associate coach."
I also suggested that everything we do should be athlete centered. That all interventions in a performance enhancement environment will have the end goal of performance enhancement (obviously), cognitive resiliency and injury prevention.
The guiding framework and its application were discussed and in so doing, we must not be a be a slave to our methods. Being athlete-centered will minimize the opportunity for this.
I spoke about three key components of dynamically assessing the athlete: the neuromusculoskeletal, the cognitive integrity, and the physiological. For the neuromusculoskeletal, I generally like to think of assessing along a static-dynamic continuum where I’ll start with watching the athlete in action (dynamic) in order to know what I see and what I don’t see, then progress along the continuum toward the static if I want to know why I don’t see what I don’t see. It is important though, that we have a standard operating procedure to be able to decipher what’s normal, when we expect it to be normal and when we expect it to be abnormal.
Dynamically, I will also want to understand – assess though interaction, observation, etc – the cognitive integrity and resiliency, or mental hardiness, of the individual since mindset always differs between individuals. Understanding athlete physiology is important as well since levels of stress may vary at any given moment in time. Therefore, how we intervene in their current state should be kept in consideration. Athlete monitoring comes to mind when it comes to physiology but in my opinion, just being present should be the top priority.
As I mentioned above, if every interaction we have with, and every intervention we give to, the athlete is considered a stressor that results in adaptation – positive or negative – then we need to “pick our battles” and intervene where we think is necessary rather than all the time. Manual therapy, in particular, can be a negative input on speed/power days or prior to competition if performed either too aggressively or in too high of a quantity. Additionally, we must time our recovery interventions as Joel Jamieson explains in this video.
While many of the attendees at the conference were clinicians who specialize in clinical rehabilitation, part of my discussion was how we can implement traditional rehabilitation exercises into a performance enhancement environment. Especially during warm up and in general strength training circuits. Because whether it be rehab, corrective exercise, or skills coaching, my opinion is that it all falls through the filter of motor learning toward neuromechanical adaptation.
We do need to remember that there are two methods of attacking motor learning: 1) The Hard Disk via direct upload through automated subconscious control and the other; 2) The Working Memory via conscious control. Unfortunately, the latter – internally directed attention - often results in reinvestment (excessive conscious control of one’s skills) and may be more prone to breakdown in automaticity/fluency of performance through such means as paralysis by analysis so we must keep in mind that any of the techniques (physical or verbal) we employ can be positive or negative. And what we don’t want to achieve is paralysis by analysis.
Other methods to foster motor learning that I spoke about were implicit learning, good cueing and effective communication. Implicit learning is essentially presenting information at levels of perception below normal levels of awareness, whereby how we set up our intervention environment takes priority over verbal feedback. Again, verbal feedback can result in overthinking during motor executions and subsequently excessive conscious control of one’s skills. So often, we should STOP telling athletes what to do, LOOK – assess motor skills, and LISTEN to the athletes thoughts.
Effective communication essentially boils down to three main objectives: prevent paralysis by analysis, facilitate an optimal state of mind and readiness, and remove doubt. I shared my thoughts on effective communication through explaining what nocebos were (the same principles apply with Trent's Q&A above) and how we may be creating nocebos in our interventions. Again, we want positive adaptations and while many of us possess highly effective skillsets, it’s less about what we do and more about how explain it. Remember, it’s about the adaptation and it’s about what we leave behind.