BSMPG - Educational Conducivity

EDUCATIONAL CONDUCIVITY

"Refers to how easily a conference lends itself for learning. Specifically related to education, how conducive is a place or space for learning, creative thinking, problem solving, and decision making. To educate yourself you need to go to a space that promotes discussions at the bar and allows you to concentrate and surround yourself with professionals that are smarter than you."

​(modified from idea-sandbox.com)

Year after year, Art Horne and the gang at the Boston Sports Medicine and Performance Group host their anual Summer Seminar. Having heard nothing but positive feedback from colleagues who have attended in the past, I decided that this would be the year to finally attend. Living in Western Canada, it certainly isn't easy to travel across the continent both from a time and financial perspective, but I felt that in order to continually better myself as a professional, attendance was a must.
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Like many of my previous educational endeavors, it was important for me to be 100% confident that this event was grounded in "educational conducivity" and not just a place where many of my friends were going to be. However, upon looking at the speaker lineup, it was more difficult to convince myself not to attend.

Day 1

Day 2

Perhaps the most challenging task however, was deciding which sessions to attend. So aside from the keynote lectures where all delegates were present, I found myself attending lectures from the following: Sean Skahan, Dr. John DiMuro & Mark Toomey, Art Horne & Dr. Pete Viteritti, Joel Jamieson, and Keith D'Amelio.

*Please note that while I was a note taking machine, I am going to limit this post to an informal, point-form summary of my synaptic moments.
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Bill Knowles (Keynote) - "Return to Competition Strategies for the Joint Compromised Athlete"

• What is truly important is Evidence Based Medicine (the science) in conjunction with Experience Based Evidence (the art)
• Remember, it's about the athlete, not the "specific" problem. Work with the athlete as a whole, not just the (knee) injury
• Rehab progressions should be CNS driven -> speed-strength before strength-speed
•  Myelin - the "Deep Practice Cell" (think Talent Code). You have to fail in order to learn. You have to make mistakes in order to not make mistakes
• Master coaches - PTs, S&C coaches, coaches, ATCs, etc - We are all cultivators of myelin
• Our primary purpose should be athletic development
• Our goals should be to 1) Prepare athletes to be adaptable, 2) Do no harm, 3) Prepare them to thrive, not survive...both physically and psychologically
• Return to Competition Stages: Rehab -> Reconditioning -> Return to Training -> Return to Play -> Return to Competition
• Bill suggests that our goal should also be to promote a longer preparation period and not necessarily a faster return to competition. This period should be as long as possible, to achieve "Stress Sustainability"
• Injury should not interfere with the athlete's Long Term Athletic Development
• If injuries occur in deceleration, why do very few people talk about triple flexion? *To me, Triple Flexion Control consists of timing, stability, motor control, eccentric strength, etc.
• Bill also talked at length about ACL injuries, including the reality of early osteoarthritis and neuroplastic changes in post-operative athletes. *For myself, I want to know if any of these findings are present in athletes PRE-injury (if anyone has any research, please let me know).

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Dr. Craig Liebenson (Keynote) - "Regional Interdependence: How Functional Pathology Limits Performance"

• *Having been under Craig's tutelage for the past several years, you will find many of the principles included in this lecture simply by typing his name in the search box to the right or visiting his blog. That said, because he spoke about regional interdependence, thoughts about the "joint by joint" spun in my head throughout the entire lecture. I should be posting about this sometime in the very near future.

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Sean Skahan - Injury Prevention Strategies For Hockey

• *I truly believe Sean spoke from the heart in this lecture and cannot thank him enough for reminding us to not give a ____ what people think and just believe in what we do
• Getting guys stronger can help prevent injuries
• Injury prevention training is just training nowadays
• Sean outlined his methods of training for preventing injuries and while I didn't take the notes down verbatim, you can find most of his programming on hockeysc.com
• Sean will also be one of the presenters at the Okanagan Strength & Conditioning Conference this August.

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Dr. John DiMuro & Mark Toomey - "Primary Movers, Secondary Injuries"

• We're spending so much time on movement and not enough time on strength
• Dr. DiMuro and Mark spent much of this lecture demonstrating the effects of limb position on joint loading in many different exercises. Through the use of fluoroscopy in their work, they were able to demonstrate that exercises such as behind the neck shoulder pressing may actually be more favorable to minimizing loads sustained by joints in the shoulder
• You can find some of the information from this talk here

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Art Horne & Dr. Pete Viteritti - "Improving Function with Manual Therapy Techniques"

• We don't consider the effects of dorsiflexion on regional interdependence enough. Perhaps this is because we've been ineffective with our approaches (a low R.O.I.) - why would our athletes keep doing a stretch/mobility drill if they're not seeing results with the stretch/drill you gave them. It all starts with a better assessment
• The more hip extension you go after, the more dorsiflexion you also need
• Lack of dorsiflexion will cause an early heel lift/rise resulting in less ground production and subsequently reaction forces. Thus, less power production
• You only know your capacity when you exceed it
• Several palpation and soft tissue techniques were demonstrated for mobilizing the soft tissues posterior to the ankle joint. *Aside from a combined Cook/KStarr/Cobb/Boyle approach I use for active ankle DF mobilization, I generally use a combined ART/Mulligan approach to passive DF mobilization

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Irving "Boo" Schenxnayder (Keynote) - "Multijump Exercises: Applications for Teaching, Training, & Rehab"

• *I love learning from trackies
• Base your approach on commonalities. Don't copy (verbatim) what others are doing as each individual is unique but find out what the best athletes and coaches are doing in common and make sure you do the same
• Triple Flexion (again) - make sure the angles are equal during amortization
• "Be adamant about preparation because if so, what you want will take care of itself"
• He's not so concerned with perfect neutral but more so Pelvic Flux. This is a "Dynamic Neutral Position" where the pelvis oscillates and moves around this neutral position
• Lower Leg Conditioning is perhaps the best way to prevent shin splints (and in my opinion, plantar fascia and other soft tissue injuries of the foot). Do a ton of little hops and jumps. Do foot and ankle mobility work - and by mobility work, Boo steals from the sport of...ballet to get his exercises. The key variable is the surface which should be varied (sand -> padded mats -> grass). *This is an approach I recently took with a triathlete patient who's had nagging plantar sided foot pain for several months. I believe that having her do conditioning drills on the grass got her to a better place. I really think this is a superior approach (if done regularly) to manual therapy for soft tissue foot injuries in runners
• Boo spoke about "Educability" which to me meant the optimal environment, stimulus and readiness to maximize (motor learning). However, as always, I was kept in check via facebook by my graduate supervisor. He stated: "In the field of motor skill acquisition, it refers to an individual's ability to learn (i.e., their ability to be educated). Also, the idea that someone would have a general motor educability has been largely discredited since the 1950s because skills are so domain specific...When you get into task specific motor educability, you are really starting to talk about a general plasticity that is being refined in very specific ways. Most scientists in this area would suggest that most people have a high potential for learning just about any task (educability) that is rarely realized." 
• For motor learning, Boo suggested that we must utilize the overload principle. That we need to introduce error: 1) Use an appropriate exercise 2) Progress to a more difficult exercise inducing error 3) Go back to the appropriate exercise (the athlete demonstrates learning and improvement) 4) Then go back to the more difficult exercise (the athlete demonstrates improvement) *I'm definitely going to play with this approach in rehab
• For rehabilitation, maximize tension and minimize the joint angle. While this will be safe, it will promote a high neural component and stimulus
• Tension is the variable you're trying to progress and periodize. Boo provided us with his progressions from Mercury to Neptune or Pluto (is it still even around?) which I'm sure you can find somewhere here
• When you ask an athlete "How are you feeling?", REALLY ask "How are you feeling?". You need to know their current state!
• Don't be a slave to the training program that you write, especially in the competitive season...because there are too many variables at play and you just never know
• Everything you do has a purpose, and as soon as you accomplish a purpose, you move on...otherwise it just becomes baggage
• Rehab is just an extension of purposeful training. It's all integrated and is subjected to the same principles of training: overload and specificity. Aim to continually approach competition intensities. Understand concentric and eccentric work. We need eccentric work to prepare for competition! Because this is the only way to meet the requirements of competition. We need to load them at > 100%
• The stimulus curve must always precede the progression curve
• Look what I found!

Joel Jamieson - "Allostasis and the Training Process"

• The basis of Joel's talk is the maintenance of homeostasis for the production of energy
• They body is always looking at the short term. We need to understand the implication that this has on the long term
• We all have tons of assessment tools and approaches to evaluate and predict injury but we must also look at the body's ability to respond (appropriately) as well as its response to stress
• 3 Goals of management: 1) Train each day within the adaptability threshold 2) Avoid accumulation of fatigue across the microcycles 3) Use optimal amount of loading to ensure adaptation and improve performance
• When athletes are in a high readiness state, use developmental loads. When in a reduced readiness state, use stimulative loads. When in a low readiness state, rest!
• Learn how to effectively manage the training process!
• Joel will also be one of the presenters at the Okanagan Strength & Conditioning Conference this August.

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Keith D'Amelio - "Solving the Performance Equation"

• There's more to athletic performance than just movement
• Keith provided us with an overview of some of the approaches he uses (in a comprehensive manner) at Nike.
• Some of the key variables they use are sensory analysis (i.e. vision), movement (i.e. FMS, Y-Balance, Single Leg Hops) and readiness (i.e. HRV-Omegawave)
• He reminded us that our athletes aren't paid to lift weights. They are paid to make baskets, score goals, block shots, etc. So one of our primary objectives should be to keep them on the court, field, ice...*Truthfully, I too think we often forget this. It's not only about performance, it's also about durability.
• To see what Keith and the gang at Nike are doing, watch these videos: Assessment, Physical Training, Skills Training, Basketball Never Stops

Chris Powers (Keynote) - "Proximal Factors Contributing to Running Injuries"

• Running is a series of repetitive single limb impacts that needs both adequate shock absorption and limb/core stability. Lacking either of these may result in an increased risk of injury.
• Patellofemoral Pain Syndrome is predominantly a sagittal plane problem of quad dominance. Chris suggests that we must increase the hip moment by bringing up the glute max. He suggests a 1:1 ratio of hip extension and knee extension strength. *This also makes makes me think about foam rolling. I think foam rolling is more of an autonomic nervous system reset (as opposed to a fascial release) and perhaps this may be why I don't think rolling the quads is a bad idea
• He suggests that a forward center of mass via trunk positioning (slightly forward) will encourage an increased hip moment
• Because barefoot running shortens stride length, hip moments and contribution to control are decreased. He doesn't think that this is necessarily a good idea, that you can also lower peak ground reaction forces even with heel striking. That you don't always need to go to a midfoot or forefoot strike. You just need better shock absorption and limb/core stability.
• Quad dominance may lead to increased ACL strain, quad tendon overuse and patellofemoral compression
• Chris calls triplanar hip flexion, internal rotation and adduction "hip pronation". Lack of stability in this can result in FAI, lateral hip pain, ITBS, patellofemoral stresses, increased ACL and MCL load, and tibialis posterior stresses
• Chris considers the pelvis to be the true core when considering single limb activities. And he'll take pelvic stability over trunk stability. Because without pelvic control, you can't have trunk stability. *Personally, I don't think they're mutually exclusive...but that's just me! 
• "VMO training is false" - It's not a patella problem, it's a femur problem
• Iliotibial Band Syndrome is a problem of hip adduction, internal rotation and knee varus moment/positioning. Adduction and femoral rotation increases the tension of the ITB - you can't lengthen the ITB and besides, why would we want to stretch it out anyway (if it's already being over tensioned)?
• Chris suggests a proximal approach to treatment: 1) Dynamic hip stability 2) Pelvic and Trunk Stability 3) Dynamic Shock Absorption 4) Hip Influence  *In rehab, how many of us truly consider #3...at least in a conditioning way? 
• Chris places more emphasis on the GMax over the GMed. This muscle is triplanar, a "hip supinator", and can influence the hip more than the GMed. *Again, I think the relative contribution of all muscles are important...but that's just me. I do think he would agree with me though
• Chris talked a lot about a slightly increased forward trunk lean (with a neutral spine) to increase the hip moment. *I wonder if adding Goblet / Anterior Weight Shift work would achieve the same result
• He suggested that you get more bang for your buck if you emphasize the hip over the foot. *I would look at both but again, he probably does look at the foot as well
• Don't forget about speed-specific evaluations. Sprinters and runners are two totally different beasts. It's rare to see sprinters with a huge valgus collapse...you see them a lot in people who jog...slowly!
• Heel striking can be safe...if done correctly. Remember, barefoot/midfoot/forefoot running increases the stride rate, but this would also increase the number of impacts per minute. This is significant if such impacts are greater in load than the ideal. It's your choice, just make the right one.
• We need both strength and motor relearning
• Ways to decrease the risk of injury 1) Lower the peak force 2) Increase the time to peak force. "You do not have to take your shoes off to lower the peak force"

Thanks again to Art, the folks at Northeastern and BSMPG for such an opportunity in educational conducivity!