In general, swimmers generally possess hypermobile shoulders.
And by hypermobile, I mean greater than necessary ranges of motion and subsequently, often lacking synchrony of instantaneous neuromuscular firing in the scapulothoracic and/or glenohumeral joint regions.
As a result, we know that since the body will always find the "easy way out", compensatory patterns and presentations commonly occur.
And often, one of these presentations is reactive posterior cuff hypertonicity as a protective measure against further injury and/or pain. Whether it leads to bicipital tendon pathology, bursa irritation or other is besides the point. The main point, in my opinion, is why are some individuals still so enamoured by the sleeper stretch? I mean, for any given shoulder injury, presentation or diagnosis, out comes the sleeper stretch.
In my mind, there's a difference between stiffness and hypertonicity. And sure, the glenohumeral joint "needs" adequate mobility. But perhaps more important, the GH joint needs dynamic, instantaneous neuromuscular control. And when we go to town with the sleeper stretch, we get sloppy. ESPECIALLY in swimmers!
Because really, should we be treating the compensation or the cause?
In a similar light, swimming mechanics incorporate both open and closed chain movements. Or in a Prague sense, alternating both support and stepping/grasping functions (read this article if you're unfamiliar with what I'm talking about). Now it's quite common for me to see corrective exercise prescription for the latter - YTWL's, theraband internal/external rotations, etc - but what I rarely see is the former.
Coincidentally, here's a timely clip from Gray about motor control, stability and prime mover training:
Because from the catch to (at least) the end of the pull falls under the "support function" category, in my opinion of course. And since this is the case, closed chain exercises should be the primary focus. Particularly if this is where mechanics are most faulty during skill execution.
So my recommendation to other clinicians is this...
It's okay to think critically and ask yourself why. Why you are seeing what you are seeing. And why you are doing what you are doing.
For those of you that have attended conferences with multiple presenters, you'll know that some conferences hold a Panel Q&A to wrap up the weekend.
Well recently I attended the Canadian Athletics Coaching Centre's National Throws Conference and one of the topics during the Q&A was feedback during competition. The panel included all the presenters and was moderated by Coach Derek Evely.
Here are my notes on this particular topic:
Feedback During Competition
"The best were those who worked for, and obtained, 'intuitive consciousness'. Those who learned to blend thinking with sensing, knowledge with intuition."
- an excerpt from A.T. Still: From the Dry Bone to the Living Man by John Lewis
Back in 2011, I wrote about my observations when posted at the Gymnastics venue during the Pan American Games.
As I am currently at the 2013 World Championships in Antwerp, Belgium, I thought it would be a good idea for me to revisit this post and see if anything has changed. In normal text you have my original post, while in red, are my thoughts from the last 5 days.
Foam Rollers – There are none. Not one. Obviously I use them in practice but watching gymnasts prep for training and competition is making me think that such devices could be used less with proper preparation.
Warm Up – These gymnasts meticulously mobilize each and every joint in their body dynamically. They spend the time starting from distal to proximal, from specific to general, and in all planes and directions. We might be shortchanging our athletes without this attention to detail.
Stretching – There’s no shortage of it here. Warm up here comes first then stretching. Warm up aside, stretching went from static to dynamic and is in general, mini-ballistic.
Focus – Little chatting. Deathly stares. And full concentration. Period.
Crunches Flexion/Flexing Based Movements – Lots of v-sits, and lumbar flexion warm up exercises as well. I don’t think it’s a green light for all gymnasts, but it would be hard for me to flip on the red for half of them. I see integration of all joint and myofascial segments and load sharing from head to toe. Even see the joint by joint respected (think sternum crunch in a dead bug position). In this case, I think its ok. In the normal population, I’ll still set up a road block. Remember, it was warm up, not training and definitely not volume.
Bands – Plenty of resistance here during the warm up. Band pullaparts, straight arm pulldowns, etc. Great progressions.
Amazing feats of strength, mobility, and stability - Here’s an example of a commonly performed movement seen today. This video is obviously not by the gymnasts themselves as filming them warm up is not only prohibited but creepy. Naturally, the girls were much more precise than this video but he did a great job nonetheless. Note, the girls did multiple continuous reps.
All in all, watch some of the top athletes in the world and you’ll quickly see that generalizing rules of the human body to all populations is guessing at best.
More often than not, I prefer looking for the why.
Looking for the what is simple.
Looking for the why is not as easy but I think it's more effective. More often than not, you will find it in the history. But on occasion, you'll find it in the physical. If neither, you may need to go searching (in the gym, on the pitch, on the track, etc). But you need to go and look for it.
Because in looking for the why you may find the what.
It's rarely ever the other way around.
I have a keen interest in the role that magic and illusions play in the clinical environment.
Most of us are aware of the role of illusions in pain science. For those that don't, feel free to click on the previous link or read this review of a "pain" seminar I attended to get a better understanding.
What it ultimately comes down to is that all interventions should exploit the nervous system in some form or another. And in many cases, through the use of illusions.
Think about the last patient who stumbled through your door in severe acute pain. Or that individual under extreme stress with chronic pain. What sort of strategies did you use to get them on their way much happier and in less discomfort?
Like I alluded to above, it's not uncommon for me to utilize the power of illusions to care for my patients. Now this is not to say that treatment is all an illusion, but more so that illusions can be used as part of your "treatment" strategy.
Before we move forward, let's watch the following video:
As you can see, magicians utilize various known techniques to exploit neuroscience and influence perception. And for us clinicians, I don't think this should be any different. Here are some examples based on the video:
Misdirection of attention
Joint attention and mirror neurons
As you can see, the brain is limited in that it has a one track mind. And when someone is experiencing severe, acute pain or chronic pain, very often that one track = pain. So we need to know how to redirect their attention. Again, not as a stand alone treatment - otherwise we would all be magicians - but as part of our strategies when working in the clinic.
Remember, it's not just what we can do with our hands but also how we interact with our patients! And when it comes to humor, the first individual that comes to mind is Patch Adams.
For more information on what the neuroscience of magic reveals about our everyday deceptions, make sure you check out the book, "Sleights of Mind".
I've mentioned this previously, but one of the main reasons I keep this blog is to keep myself in check. To welcome constructive criticism.
Initially it's purpose was to summarize my notes in a relatively coherent manner so that I can revert back to them for studying purposes. It then became an avenue to share knowledge for the benefit of others (some of you might have noticed that I rarely write info pieces - not because they're not valuable, but more so because everyone else is doing it). Occasionally I'll summarize a research article and often I'll review or summarize a course I attended. I can't say I'm always proud of it, but if you've been here before, you'll know that some of my posts are rants.
But again, one of the main purposes of this site is for my own benefit. To seek criticism. If I've written something incorrectly or if my thought processes are off the mark, then (hopefully) someone out there will call me on it.
This is important. Not only for myself but for anyone and everyone I work with.
So for many of you out there, I humbly ask you to seek out criticism. Because as Debbie Millman states in the video below, the most important thing to know, is when we don't know what we don't know.
While this isn't directly related to what Nike is doing, I think the principles are the same.
This brief post has to do with our little ones and what we may - or may not - be doing with them. Around the same time last year, I posted my thoughts on Bumbo chairs which garnered no shortage of attention. Most of it was positive and understanding of my viewpoint, but there was certainly some confusion. Particularly when it came to developmental milestones.
I'm certainly no expert when it comes to infants and toddlers, and it's no secret that I don't have children. But I have studied and I have observed. Objectively. And I have seen who looks like they're on the right path and who doesn't. And the one's that are, are the one's that are moving.
We humans are creatures of the stimulus-adaptation relationship. When faced with a good stimulus, we'll adapt. But when faced with inappropriate or no stimuli, we'll either shut down or do nothing.
To some it may be difficult to swallow. To me, it's almost common sense.
You keep a kid down in a car seat, high chair or one's arms all day, that'll be it's throne. It's place of comfort. The very place where they will develop very little biomotor abilities!
Children need to move. They need to explore. And there's no better place for them to do that than on the floor with lots of toys. Some will fuss and some won't. But usually the one's that fuss are the same one's who've been artificially supported by devices and contraptions meant to do just that...support.
Remember the phrase "use it or lose it"? Well in children, if you don't use it, you won't even learn it.
Crawling and walking just don't magically happen. They're learned. And they're learned via necessity. Our little ones learn how to do things out of want and need. If they see a toy they want to eat, they will figure out a way to go and get it. Unless we grab it for them of course.
So why isn't your kid crawling or walking? It's simple. They haven't been asked to. At least not from the get go and likely not enough (an hour a day on the floor vs eight hours sitting doesn't cut it). Asking a child who's been artificially supported for the first 8-12 months of their life to locomote is like asking a rock to come over and sit beside you. Of course they'll fuss and no question it'll look like their rear end is duct taped to the ground. That is, if they haven't already face planted five or six times.
It's hard, I know. Well, I don't. Because I don't have any children.
But what I do know is this. If you always do something for them, they'll never learn how to do it themselves.
A common phrase often used as a metaphor to "suck it up", "rub some dirt on it" has recently been considered a no-no in the medical world.
I understand the need for caution as well as the potential ramifications and liability of neglect, but I think in some cases, telling someone to rest, take it easy, or not do ____, might actually be iatrogenic.
Take for example the athlete who comes to the training room on a daily basis complaining of this niggle and that owie. Or the weekend warrior - who's "injury" correlates very little with pain that's reportedly getting worse as the days go by. Coincidentally, this same warrior has been receiving "treatment" by the therapist down the street for the last 8 months.
What I'm trying to get at is that sometimes we simply need to provide reassurance that they're actually going to be okay. I'm not literally suggesting that we tell our patients and athletes to "rub some dirt on it", but what I am advocating for is the ability to decipher whether or not one's clinical presentation is actually a reflection of their lack of confidence. Because pain itself is a societal construct:
And believe me, you don't always have to put your hands on someone to provide a therapeutic intervention.
I'm here at Frans Bosch's course in Arizona and as I was having (what was supposed to be) a brief text conversation with one of our coaches back home in Canada, I realized that my rambling is simply "putting thoughts down on paper".
So since this the purpose of this blog is to virtually - but literally - put thoughts down on paper leading to my own personal development, I figured I would share the conversation.
"How's the course?"
"Course is good. Deep."
"I love courses that teach dynamic - somewhat abstract - thinking, rather than traditional or typical protocols. Even if you don't think some parts are applicable, I still like feeling mentally drained by the end of the day."
"Really trying to wrap my head around long tendons, passive tissues, elastic properties, etc. I.e. in comparison to high energy cost of muscle contraction...also what/how to identify, then how to address."
"But on somewhat of a tangent, thinking about how the body compensates and the role of "tight muscles". Is it the body's way of creating passive stiffness? I.e. "turning muscle into tendon" since the tendon itself can't sufficiently transmit forces passively in the first place?"
"Sorry for the rambling, just needed to get my mind wandering thoughts down on "paper"".
"Lol. No that's it. Just while he (Bosch) was talking about "the passive", that's what was going through my mind."
"Which then goes back to "feeling loose" (a separate earlier conversation the coach and I had). It doesn't always mean increased performance. BUT that said, a muscle that's more loose - "slack" as Frans would call it - can adapt to variable situations (i.e. distance events) more easily."
"I remember when working with the Jamaicans at Penn. Their connective tissues were thick and stiff. I think that's (possibly) one reason why they can sprint. That it's not just the fast twitch ratio, but also the ability to transmit high forces rapidly."
"Their feet were also stiff and flat. And according to Bosch, the foot's purpose is to "recoil" energy. If they had high arches, when the foot dynamically goes into (over/prolonged) pronation, the energy would leak."
"Do you think once you "clean up" movement to a near optimal level, you can focus on improving muscle tension?"
"What I'm really asking is: do they need to happen in that order or can you work on it simultaneously?"
"Or does that require trackside therapy?"
"That's actually what I was going to answer with. I think it can and should be done simultaneously."
"Going stepwise won't lead to progress (I don't think). I think you would always be "chasing". (Versus) doing it simultaneously would allow
you to address what's necessary but also lead to improvements (at the same time)."
"I have so many thoughts on this."
"What is the balance then within a microcycle and how do you balance workouts with therapy?"
"I think therapy is twofold, but not necessarily mutually exclusive. 1 - for mechanical efficiency and 2 - performance enhancement."
"The first being a range from fine tuning to injury prevention to mechanical performance enhancement."
"The second being more neurophysiological and autonervous system/readiness based."
"So from a microcycle standpoint, the first would be governed by what you and I see with out eyes."
"The second would be governed by the athletes' subjective (i.e. health & wellness / fatigue questionnaire), their readiness and fatigue level (mood, etc), tapping quality, ground contact times, monitoring scores, etc."
This conversation is still transpiring but now onto a different subject but I figured I'd stop here.