Vern Gambetta's "Building the Complete Athlete" video set is one of the resources that I have finally been able to get through and one that I enjoyed.

Consisting of 15 separate excellent-quality videos, Vern does a great job of providing a well rounded approach to athletic development. This video set which was derived from a filmed workshop given last fall in the UK, was essentially an extension of his book "Athletic Development: The Art & Science of Functional Sports Training".

From his views on physical literacy, periodization, core strength, and work capacity training - amongst other topics - Vern provided us with 15-20 minute lectures that reminded me of Ted Talks.
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I would suggest that the only downside to this format was that they didn't really allow for more in-depth material. Sure you can find it in his book, but for a "product" I would have liked a little bit more detailed content within each lecture.

That said, I could see myself referring back to these lectures quite regularly.

That... or his blog.

This important conference was recently held and although I wish I had attended, I cannot wait for the consensus to be published.
In the meantime, here are some highlights taken from the IIHF website.

• No return to play on same day
• Discussions about SCAT3 (refinement of SCAT2) to exclude neck injury
• Discussions about a revision of the pocket SCAT for non- health care personnel to recognise concussion
• Discussions about a possible Child SCAT

 

• Treatment of Concussion
  • Relative rest (not bed rest)
  • Proactive approach in treatment that could involve low level activity and therapy before symptoms have completely disappeared

 

• Multimodal management of patients after one month
  • Low level activity
  • Psychology
  • Physiotherapy (neck, brain, vestibular)
  • Neuropsychological consult

 

• Baseline Testing not necessary to evaluate patients’ post-concussion but SCAT could serve as an educational tool.
• Computerised Neuropsychological testing is not necessary in most athletes who have a concussion but can be used in those whose concussion persists.

 

• Pediatric Athlete
  • Concussions can last longer
  • Return to learn before return to sport
  • Return to learn a progressive stepwise process

 

• Risk Reduction strategies
  • No evidence that helmets protect against concussion
  • No evidence that mouth guards prevent concussion
  • Evidence that full facemasks may decrease the time of recovery from concussion
  • Neck strengthening may help reduce concussions
  • Rule enforcement and no tolerance on head checking
  • Strict penalties for head checking
  • Body checking in pee wee hockey has led to increased concussions

 

• Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease that has been found in five hockey players and some NFL football players from brain biopsies taken after their death. No proof that there is a causal effect from concussion. More research is needed on the subject.
• Translation of knowledge with new tools (App) and media
• Legislation in 40 states in the U.S. and One province (Ontario) in Canada on concussions.

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This weekend found me at the National Jumps Conference organized by the Canadian Athletics Coaching Centre. Featuring the likes of Boo Shexnayder, Dan Pfaff and Nelio Moura, to say that I was privileged to attend would be an understatement.

Working closely with the team at UofA and the CACC, my primary objective for the conference was this: To immerse myself in the sport of athletics, and deepen my knowledge, to help improve and refine my day to day workings as an integrated sport medicine and performance professional.

Therefore, from a harmonized training and therapeutic perspective, below are some concepts of what I took away:

Please remember that this is solely based on my interpretation and potential confirmation bias :)

• Training considerations - especially from a developmental perspective - should be based on the continuum concept. That from beginners on one end to the elite high performer on the other, we need to find where - along this continuum - the athlete fits, always keeping in mind where they're going to be.
• Coordination, being a theme stressed regularly throughout the conference, can often equate to freedom of movement. That a lack of freedom of movement often leads to, and results from, a lack of coordination.
• Thus, coordination development may be THE variable determining success and failure. Because general coordination training is the base upon which you build techniques. And that "injury prevention" essentially is giving (young) athletes the greatest number of tools to develop skills, so that once they develop into ferraris, greater coordination will increase degrees of freedom - or greater resilience for injury - with higher speeds and power.
• General strength is important for all athletes. For the younger athletes, it is a window into coordination. For the older athletes, it serves a different purpose - insurance for overtraining syndromes.
• In the information age that we live in, it is easy to want to fit everything (from the smorgasbord) in, be it programming or rehab. But as Henk Kraaijenhof (relayed through Dan) stated,

"...it is not so much (important) that one does all that he can, but that one does what is necessary".

• So sometimes we simply need to be more dynamic and creative with programming, implementing more rest and recovery than what is traditionally prescribed. As Dan stated, "Why don't we study rest like we study work...when you rest and unplug, certain things happen, and I think they're positive".
• Although specifically suggested (at least I think) from a coaching standpoint, I personally take the following from a therapeutic strategy standpoint:  Training management (I see it as injury prevention and performance enhancement as well) is all about "error detect and correct".
• Work capacity is the ability to execute a skill perfectly, more often. The ability to do specific things really well, for unique periods.
• Analysis can be both quantitative and qualitative. The ideal is to mix them together. The qualitative is a coach's - and performance therapist's ;) - most basic tool. And for the qualitative, it is important to have 1) a trained "eye", 2) a clearly defined model, and 3) methodical observation
• Motor coordination at speed is very important. "If the rhythm is there, the position will be there"
• Postural skills are comprised of "Postural Stability" and "Postural Alignment" (in a dynamic sense)
• The more variety you have in training stimuli, the greater the ability to adapt
• On the value of the preparation period - we must recognize what we've already put in. That just because you may stop putting water into a tank at a given point (i.e. competition), it doesn't mean you don't have any water left in the tank. The regression/evaporation process is slow.
• We must aim to breed independence in our athletes rather than dependence. Are you a dictator or a facilitator? Because sometimes, even in the most grandiose of settings, the inherent danger of a good support system is what is no longer present when an athlete graduates from your program.
• From Dan,

"Many forms of training exist in the world today, but research confirms that a synthesis of these systems always leads one back to a classification scheme of BASIC BIOMOTOR ABILITIES".

• Psychology is a skill that needs to be incorporated into a training program.
• Most athletes who fail in major games, it's not the athlete who fails but the coaches who fail them.
• The tendency in this generation is to read what's modern, hip and new with little foundation in reading the classics (such as Geoff Dyson's "Mechanics of Athletics". Thus, many lack the ability to think critically and truly understand the big picture. 

• Multithrows can be substituted in for multijumps with leg, foot and ankle injuries
• Rehabilitative and regenerative therapies (i.e. manual/massage therapy) should be creatively and strategically integrated into an athlete's program. For example, on highly technical days, this is where targeted soft tissue work can be utilized within an athlete's warm up whereas on recovery days, deep tissue work can incorporated - so long as you respect the days that follows.
• Additionally, "F1 race car tuning" can also be implemented actively  (athlete independent) through motor-reeducation schemes (movement patterns to re-educate brain plasticity in consideration of training through and around injury), special walk series with heavy implements held overhead (hurdle mobility for postural analysis/improvement in fatigued states), and dynamic fascial mobility/flexibility drills (i.e. during cool down)
• An interesting thought regarding hydrotherapy that was noted was the consideration of athletes who may be high in tone or "fascially tight". In such athletes, cold baths may be less advantages than a nice soak with epsom salts.
• Although "athlete-centered" coaching and ethical planning models are commonly spoken of in sport, perhaps our contemporary planning and applied periodization strategies may actually have negative impacts. Athlete empowerment and learning essentially should be top of mind when developing adaptive athletes, because it is those adaptive athletes who are most likely to attain success come competition time. So we may need to address the unintended consequences that can come with strict organization of space, time and movement in our training plans. I will be posting more on this in the near future.

I cannot thank the folks at the CACC and UofA enough for this opportunity. For those interested in athletics, the Canadian Athletics Coaching Centre website is highly educational and one built upon academics. There's a wealth of information, such as podcasts and lectures from expert coaches around the world, so I would highly encourage you to check it out.
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*Note: My good friend Thomas Lam also posted a nice review. Click on this link to check it out.
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There comes a time when one must take their learning to another level. The Leaders in Performance conference was one of the five conferences within the Leaders Sports Summit program. Held on the grounds of Stamford Bridge of Chelsea FC in London, this full conference consisting of 1700 delegates was not only an opportunity for networking, but more importantly, a means to uncover applicable best practice strategies from multi-disciplinary panels of global leaders in sports today.​

With a conference of this magnitude and a delegate list of such high caliber, it was of utmost important for me to unravel the most practical of messages and lessons for my current day to day work. And unlike much of the educational conferences I am accustomed to attending, it is certainly easy to fall in awe of the glitz and glamour of the environment. Aside from the keynote lectures that started off each day, the sessions were formatted in a manner whereby leaders and experts sat together in a panel, sharing their knowledge and viewpoints in question and answer format. Thus, leading to insightful discussions of sports performance.

But amongst the discussions, it was clear to me that the most prominent message was the importance of a strong and foundation of culture in sports performance success. And inherent within this message, lies the inextricable being of the human.
So without further ado, here is the summary.

Day 1

Aspetar Pre-conference Sports Medicine Symposium

• Panel:Prof. Roald Bahr, Prof. Louise Burke, Dr. Rob Duffield, Dr. Sebastien Racinais, and Prof. Martin Schwellnus
• This pre-conference discussed strategies for the attainment of best performance through training hotter environments. The ongoing debate in the literature pertaining to deliberate increase critical core temperature for performance adaptation versus performance decrement was recognized as was the wisdom of the subconscious body to thermoregulate. Similarly discussed was the reminder that levels attained in the lab, in controlled environments, while important, may be missing key elements (i.e. the central governor) that on field data do not. Also discussed was the importance of recognizing individual physiological responses to exercise intensity - in addition to environmental temperatures - since it is not uncommon for athletes (i.e. open water swimmers) to suffer from hyperthermia in colder conditions. One key element discussed, often underrecognized, was the importance of food and beverage as "equipment" in thermoregulation, that timing, quantity and quality of consumption is equally as important. Finally, heat acclimation was heavily discussed specifically relating to the positive adaptation through improved thermoregulation (i.e. sweat loss) not only for performance in hotter environments but also in more familiar temperate environments.

Keynote - Leading from the Top: How Team Culture Predicts Team Success

• This address by Stuart Lancaster, the Head Coach of England Rugby, was a vital jumpstart to this two-day conference. Stressing that "it's about culture (and being connected) and leadership (that drives this culture)" Stuart navigated his way through the last nine months of his experience in revitalizing the English national program of rugby. Here are the seven lessons he learned about culture in sport:
• 1. Culture comes before performance - How you define your future environment shapes your behaviour.
• 2. A "Star" team, not a team of stars - Self belief and team belief are more important than experience.
• 3. Focus on the reason why - It's not about what you can get out of it, it's what you can give back.
• 4. Demand commitment & sacrifice - Identity, purpose and standards are important.
• 5. Connection & Extension - Connect with the hear first and connect at a grassroots level. Leadership is about influence
• 6. Effective leadership is key - Give authority as well as responsibility. Even young members of the team need to feel like leaders
• 7 . Inspire a vision for the future - Behave like champions way before you become champoins
• 8. The score will take care of itself - This was borrowed from Bill Walsh and it was suggested that there's no time table for winning. Build a culture and the score will take care of itself.

Fail to Plan? Plan to Fail: How to Get Your Team Ready for Action

• Panel: Charles van Commenee and Mark Verstegen
• Like most of the other sessions, this was in the format of a formal "question and answer" with the panel members. The first question, asking of their underlying philosophies, was answered by Charles as being the preparation of athletes to win under pressure, when it counts. Thus, mentioned was made of the psychological component of this philosophy. The philosophy of an underlying foundation of mindset, culture, nutrition, movement and recovery was made by Mark, likely unsurprising to those of you who are familiar with his work. That it is important to treat every day as game day, so that game day comes easy...not dissimilar to Gambetta's "race as you train" philosophy.
• On fostering athlete responsibility - Charles mentioned that he deliberately builds one mistake within each phase of his program in order to ask the athlete what they did about it and what they felt. Mark stressed the importance of understanding what intrinsically drives them so that their "it" becomes recognized in order to prepare, train and recover for "it".
• On technical excellence - Charles reminded us that there's more than one way. That bad or poor technique and mechanics create injuries but precise technicians don't always win. Therefore, he noted that in addition to stressing biomechanics at early ages, equally important is the need for a great eye and objective input (i.e. technology).  Mark suggested that technical proficiency is actually a broad term or concept, but one that includes technical competency in fueling and recovery as well. Thus, he suggested that we embrace the individual's biomechanical input but not forget to improve movement to maximize efficiency for their sport and style of play.
• On engaging with specialists - Charles recommended that coaches need to create a strong bond with their performance staff due to the need to understand all areas of support since it is the coach that ultimately has the big picture in mind. Mark suggested the "one team" philosophy and the negative influence of having 10 different voices in the athletes' ears. The message rendered needs to be consistent for maximal interpretation..."high definition" communication to deliver the outcomes.
• Finally, on monitoring - It was agreed that while in this day in age, data collection may be popular, we are also in a time of information overload. Therefore, it was suggested that data must only be collected to support the coach's tactics and styles.

The Perfect Storm: Innovation, Technology and Performance

• Panel: John De Witt, Scott Drawer and Jonathan Neale
• One of my favorite sessions, this panel comprised itself of a senior biomechanist from NASA who is also a coach within the Houston Dynamo's Academy, the head of research and innovation of UK sport and the managing director of Vodafone McLaren Mercedes F1. An all-star cast if you will. Being one of the more rich sessions of this conference, several thought provoking and lesson learning ideas were brought to surface in the relationships between technological innovation, human behaviour and performance. Specifically, the significance of "the question being asked" in modelling, the importance of the aggregation of data and the necessity of practicality in technology application and lastly the inextricable nature of human behaviour in modern day science.
• The question being asked - Although many scientists are building models - read modelling - few remember to actually possess a question that must be answered.  Because the question is most important and the model is only as good as the question it asks as well as the data you put into it.
• Data aggregation & practicality - It was made clear by Jonathan Neale that we need to make decisions at the point of most knowledge - a meritocracy and not a lottery - and that we must possess an attitude also embraces risk and failure. With the growth of data analysis in sport today, Scott Drawer reminded us that we must filter information for quality and that the only possible way is to truly understand the components of performance and the relevance of the data to such components.
• Inextricable Nature of Human behaviour - That humanity must always be viewed in parallel to innovation and technology in performance.

Testing in the Pursuit of High Performance: The Do's and the Don'ts

• Panel: Matthew Wilson, Jean-Pierre Meersseman and Fabrice Muamba
• Much was spoken of the role of testing in pre-participation pertaining to risk-screening and injury prevention but perhaps one key lesson was to be learned: That although testing is extremely important, perfect accuracy and sensitivity is never guaranteed.

Working in elite level sports, it is important for me to holistically understand all aspects of health and performance. As such, I felt that it is no one's responsibility but my own to improve my current knowledge relating to sport science, sport medicine and innovation.

Enter the SPIN Summit.

For those of you unaware, the SPort INnovation Summit is a Canadian symposium for professional development and networking in the areas of applied sport science, sport medicine and innovation. Spear headed by Own the Podium, the theme of this year's summit was "optimizing the IST" - Integrated Support Team - in an attempt to challenge the IST toward continuous improvement in supporting the Canadian Coach driven – performance based model in high performance sport.

Perhaps the main impetus for the theme of this year's summit was the question, "are we doing enough of what we need to do to arm the coaches to achieve podium performances?" as asked by Dr. John Kolb (Own the Podium Director of Sport Science, Medicine and Innovation). Because although meticulous planning, an uncompromising attitude and brilliant execution may be three key components to gold medal performances, in a coach driven, performance based model, the reality is that the coach cannot do it all. And often in an integrated system, many of the parties involved (service provider) may truly have their own plan or agenda.

Thus, the suggestion of a shift toward a "strategies" approach was made. A strategies approach that, for example, includes such components as enhanced monitoring, recovery, and training adaptations.

There was a lot to be learned from this summit but because some of the information disseminated is proprietary, below you will find some key take-aways from this three-day event.

Day 1

The Summit was kickstarted by a presentation on Sports Medicine and the IST by Mike Wilkinson. It was made clear that the role of the medical team was to get athletes to train as the coach want's them to train. What this means is that come competition, we as medical professionals should be bored. As a huge advocate of consistency of care, it was a bittersweet pleasure to hear the comment that "there is still a battle to find practitioners to provide day to day care". A constant presence is the key to preventing injuries as this enables the ability to catch the little things. Yes, time and funding are limiting factors but with the effort and dedication that coaches and athletes put into training, it is only fair that they deserve a matched level of support from the IST.

But with that must come a "culture of focused professionalism". That the members of the IST must be less of a distraction. Nobody wants a "Getty IST" member on their team, spending more time taking pictures than doing work.

Trent Stellingwerff followed with a powerful lecture on the Multidisciplinary Approach to Nutritional Physiology. The main question he asked, and one that we should ask ourselves is, "what are the building blocks/substrates required to optimize the stimulus to achieve the desired response. In addition to a case study, he provided us with several examples of evidence-based key factors that may indeed be difference makers.

For example, through a brief review of research, he stated that 20-25 g/kg of whey protein is the optimal dosage for both absorption and sustained muscle protein synthesis. He also stated that approximately 90 g/day is generally recommended (naturally this is individual dependent), ideally broken up throughout the day in increments that again maximizes absorption and protein synthesis - read, 3 x 20 is better than 9 x 10.

He also reviewed the benefits of beta-alanine supplementation in the creation of the buffering agent, Carnosine. Much of the current research on this comes from Roger Harris, also the pioneer researcher on creatine, and that approximately 5 g/day is necessary to provide a 50% increase. I will caution that although there may be a direct correlation between muscle carnosine and performance, the greatest effect is seen only for muscle buffering events that last 60-240 seconds (i.e. middle distance runners and 200m swimmers) and as prescribed by a knowledgeable professional.

Finally, he discussed the impact of nitrates on performance and the recent research pertaining to beetroot juice. Again, I would suggest a cautious prescription although the recommendation of 500mL/day over 3-5 days prior to competition was made. Please note that supplementation of beetroot juice may cause GI symptoms so prior to using in competition, Dr. Stellingwerff naturally recommended to first practice this strategy in training.

One of my favorite lectures came from Dr. Charles Samuels on Sleep and Performance; an integrated approach. We all know that sleep is important but we often fail to assess sleep quality and quantity in our athletes. Prior to lecture, an important disclaimer was first made. That athletes who fall asleep within 30 minutes, have only brief awakenings while sleeping, and feel refreshed within an hour of waking on most days are likely normal sleepers.

The importance of screening sleep in your athletes was stressed and that sleep forms the basis for recovery. Dr. Samuels highly suggested we read his paper, "Jet lag and travel fatigue: a comprehensive management plan for sport medicine physicians and high-performance support teams" but also reminded us that in a study of 220 athletes, approximately 31% slept less than 7 hours/night, 23% take longer than 30 min to fall asleep and 25% report dissatisfaction with their sleep quality. It is no question that we can all do a better job screening for sleep so for those of you who are interested in learning more, especially as it pertains to young athletes, I highly suggest you take a look at this document.

Karen MacNeill provided us with suggestions on Crisis Management in the Face of Traumatic Events in Sport based on her experience with the 2010 Vancouver Olympics. The quote, "You cannot adjust the wind, but you can adjust your sails" was a reminder of the importance of planning and adhering to the plan in the event of crises in your sport and with that said, it was strongly suggested that each "team" develop a crisis intervention plan.

Major Stephen Boyne of Defence Research and Development Canada provided us with a talk on Multidisciplinary Military Training; Analogies to Sport. This was an intriguing talk since elite sport differs very little to military when it comes to training and competition...other than shooting people of course. He suggested that "after operations, training is the most important activity a military undertakes". To me, the relevance to sport is loud and clear and much like the command-driven approach in the military, training in sport should be coach-driven as well.

One key message that I hope was loud and clear was the importance of the "affective" component of training activity. That is, the mental toughness and resilience. So aside from the physical and cognitive, it is important that training programs must also simultaneously incorporate opportunities to improve adaptation in the presence of adversity.

Breakout workshops were also scheduled into the summit and it was nice to see a large delegation of like-minded professionals in the Innovations in Strength & Conditioning workshop headed by Matt Jordan. This assessment-based workshop was unique as Matt utilized the expertise of Tyler Goodale, Chris Chapman and Matt Price to provide us with their expertise on the topics of assessment in each of warm-up, risk management and strength and power. While it is beyond the scope of this post to go into great detail, I want to bring attention to the fact that in this current age of social media, there are a plethora of hard working, stealth-like coaches in our country that receive a lot less recognition than they deserve. And I am glad to have met and spoken to several of them!

Brenda Comfort led the second workshop I attended on Project Management. With my current role and interest in optimizing performance readiness, I felt that it was important for me to improve my understanding on the practical application of project management in high performance. The key take home message from this workshop was as simple as it sounds: Plan - Execute - Monitor - Control.

Completing day one were two plenary sessions pertaining to Innovations for Gold. Jason Vescovi provided us with the practical application of GPS for Team Sports and Sam Blades provided us with a summary of Applications of the Multi Measurement System through Canada's most recent canoe/kayak success in London. Although these innovations may be beyond my own personal scope in my current setting, it was no doubt interesting to see how such innovations can take training and performance to the next level.


Day 2

David Smith from the University of Calgary started off the second day providing us with some insight into Haemoglobin Mass as a Factor in Endurance Performance. Stating boldly that Hb [ ] has no impact relative to VO2 max, he instead suggested that Hb mass does - along with blood volume, via plasma volume - and that it is trainable up to 32 % improvement. He also suggested that Hb mass possesses stability, it may play a role in what excites many who are involved in sport today, talent identification. And that there may be a window of opportunity for trainability between 16-21 years of age.  For those of you who are specifically interested in this realm, he suggested the work of Schmidt and Prommer, naturally in addition to his own work.

Another one of my favorite lectures came from Maxime Trempe. His talk on Accelerating Motor Learning & Increasing Long-Term Performance in Elite Sport went into some detail on skill acquisition.  Starting off by stating that he attempts to design training programs to maximize optimal learning is significant because sport has certainly evolved in terms of execution of motor skill. He provided us with a comparison of Olympic performances by Jean-Luc Brassard and Alexandre Bilodeau to express this clearly. For those of you familiar with this field, and specifically with coaching, you may resonate well with the following definitions he provided: Performance - punctual execution of a certain skill; vs Learning - long lasting changes in capacity to perform a certain skill. Clarifying further that, "what you do today may not be a predictor of what you learned tomorrow". He suggested that it is time that we start quantifying motor learning in light of the fact that we already quantify both physiology and biomechanics. He also disclosed that for learning to occur, athletes need to be successful on approximately 65% of trials in a given training session. Because "learning occurs between practices" and not within, he suggested the importance of post training process in the brain for the consolidation of motor learning. And for this reason, he is currently studying the influence sleep may have on this process.

Although the summit ended with perspectives on key components for success - read podium performances - from both an athlete and coach perspective, lunch was bookended by the second session of workshops. The more I involve myself with higher level athletes, the more I realize the importance of performance readiness. As such, the two workshops I attended improved my understanding on fatigue monitoring and recovery, namely Hooper-MacKinnon Testing; a valuable tool in mastering the art of recovery and Sleep and Human Performance Questionnaire. Led by Judy Goss and Charles Samuels respectively, these workshops not only provided me with greater insight into the value of questionnaires, but also a better understanding of their specificity/sensitivity and the role that they may play. Because, regardless of what measures you may use, it is still important to realize that questionnaires must not only be reliable and valid, they must also be practical as well.

​While this summary cannot do justice to the amount of information shared during the summit, if you are interested in more specific details or journal articles pertaining to any of the above topics, please do not hesitate to contact me. Especially relating to the sleep lecture and workshop, I do have a lot of information to share.
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Several months ago I received Gray Cook's new DVD set, "Functional Movement Systems: Applying the model to real life examples" from Laree Draper of On Target Publications. While I have been meaning to post a review on this site for quite some time, life and learning has simply got in the way.

Thankfully, I have the privilege of supervising several bright young "interns" throughout the year who use me for my library of books, dvds and articles to help with their own learning.

Here is Dr. Elisabeth Pang's review of Gray's DVD set. She is a recent graduate of Logan Chiropractic College's Master's in Sport Science & Sports Rehabilitation Program.

​My first day at the clinic with Dr. Jeff, and I was welcomed by a stack of DVDs which were practically taller than me.  On the top of the stack was “Functional Movement Systems: Applying the Model to Real Life Examples” by Gray Cook.  But wait, I had just graduated from chiropractic college, so how much more did I have to learn?  I already had my philosophies, my exam methodologies, my manual techniques and most importantly my small group of exercises to prescribe.  Little did I know that watching this DVD would be an unexpected the start of a completely new way of thinking for me.  Gray’s evident passion for creating respect and consistency within the manual therapy and fitness professions made me begin to look back at all that I had learnt.  Immediately I was forced to respond to the questions he repeated:

• Why do we not have a standard operating procedure?
• Why is the most common cause of injury a previous injury?
• Are the exercises you are prescribing effective?  Keep in mind that 80% of your effectiveness is from 20% of what you do, so how do you know what is working and what isn’t?
• Why are there so many different methodologies for interpreting movement when we are all humans who essentially have the same movement patterns?

After just the first hour of this DVD, Gray had already captivated me with his presentation capabilities, his thought processes and most importantly his explanations.  Through asking tough but honest questions, I began to reconsider things I once thought I was sure about and for the next few hours I was pulled onto the proverbial “train” which was taking me towards a movement paradigm, one which I had not fully considered or understood before.

After the introduction, Gray shifted into describing some of the foundational components of the Functional Movement Screen.  What appeared to be a never-ending plethora of knowledge was at times overwhelming for somebody who had never been exposed to FMS, or Gray Cook before, however after revisiting some of the ideas it began to make complete sense.  Gray then cemented it in as we saw real-life examples of people with movement dysfunctions and possible corrective strategies or limited time activity restrictions. The best part was that he chose people from all sorts of life; a young triathlete, a previous college athlete, an aged fitness guru, etc. – people who obviously move often, but not necessarily well.  This helped to emphasize in my mind the previous mantra that athletes are the humans who have the best compensatory outputs.

As a new comer into the movement paradigm shift, I am sure that I only picked out the basics of this methodology.  However, a good foundation must come before all of the little nuances.  With that, the following are points which stood out to me, and ones which I will need to remind myself of time and time again as I focus on becoming better versed in FMS;

• Motor learning is based on full movement patterns as opposed to specific body parts and muscles;
• Faulty movement patterns are typically due to muscle inhibition rather than weakness; and
• Clear mobility issues first, because stability is sensory driven (you need mobility to provide the sensory input to the body for reflexive stability).

Admittedly, this wealth of information and new way of thinking has given me a lot of work to do.  But this DVD was a great starting point.  It provided a solid base of knowledge with applicable examples to even further support FMS.  He brought simplicity and logic to a system that strives to ensure minimum proficiency in movement and functional standards.  For people who like me are new to Gray Cook and FMS, or even for those looking to further their comprehension of this approach this video is a great resource!  Now, looking back I can understand why it was on the top of the pile of DVDs I had to work my way through (which yes, I am still in the process of doing).

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.

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!

Is it just me or do some people still have a difficult time understanding "the core" as it pertains to clinical rehabilitation, functional training, and athletic performance?

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.

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.

It's been over a year since I first began the Dynamic Neuromuscular Stabilization program. Since that initial "A" course, my clinical thought process has expanded exponentially through following up with the "B" and "C" courses, my privileged opportunity to visit Motol in Prague, and the day to day reflections of my current practice.

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!
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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 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?

Along with the medical staff members of several major league baseball teams, prominent and budding physical therapists and chiropractors, I was fortunate to attend the "C" course, where our knowledge of the system was tested, advanced and enhanced throughout this 4-day learning weekend. Because the "A" and "B" courses in this program form its foundation, this "C" course not only packages all the DNS principles together seamlessly, but also takes its principles to specific conditions whereby troubleshooting becomes much, much easier. Now because I am a big fan of learning principles over specific tools and methods, the following information will be based on some of the key points that resonated best with me. My apologies for those that are new to the DNS system and may not be familiar with some of the concepts below. Should this be the case, please check out my review of the "A" course here prior to moving forward.

• One of the key tenets stressed in this course was the thorough understanding of the anticipated movements. Knowing what should "come next" and what you should expect, essentially will help guide and gauge whether you are right or wrong in your approach and treatment.
• When encountering troublesome hip problems, it may be wise to check the muscle activity and pressurization ability low down in the abdomen (near the groin) to assess for compensation. The body may be robbing Peter to pay Paul. Most, if not always, the goal should be balanced intraabdominal pressure throughout the entire cavity.
• Unilateral hip flexion is dependent on Thoracolumbar junction stability and contralateral hip stability, among other regions.This is based on the concept of the punctum fixum.
• Quite often, dysfunctions in neck stability/motor control stem from lower down the body. Just like the glenohumeral joint needs a stable scapulothoracic girdle, so too does the cervical spine. The "cannon from a canoe" concept applies here as well. Again, the importance of IAP cannot be stressed enough here.
• In chronic posterior chain dysfunction patients such as achilles tendinopathies, plantar sided foot pain, etc, again it would be more than wise to assess intraabdominal pressure. Trust me.
• Too much concentric activity of the abdominals, pectorals, trapezius, etc may negatively affect the diaphragm's ability to induce pressurization. The diaphragm and pelvic floor largely play a concentric role. All other muscles (i.e. above), are more important eccentrically.
• This is a no brainer, but a muscle's ability to relax is very important.
• Gluteal filling (volume expansion) is important for lumbosacral and sacroiliac stabilization.
• Very often a lack of coordination of muscle activity is more important that a lack of strength. Proportion of muscle forces is important.
• Hips often do not need surgery, they need to improve their movement patterns.
• For stabilization, it is likely more important to simply hold the position (i.e. isometric holds) than dynamic repetitions.
• We can learn a lot from sumo wrestlers. They are very strong but rarely bench. They simply do thousands of centrated movements in a slow and controlled manner. Therefore, when working with young athletes, training a high number of centrated movement patterns is likely more important than loading.
• It is always important to assess whether the problem is a contralateral pattern dysfunction or that of an ipsilateral pattern.
• In high tone/stress individuals, it may be wise to first start with mobilization and/or release. In persons possessing a parasympathetic state, load them up with stabilization.
• You can use which ever exercise progression you want, just respect the principles of a) centration and b) support and stepping functions.
• "Train the same pattern, only in different positions"
• The body's ability to relax is related to body awareness. A lack of body awareness can be called "Body Blindness" - the inability to know the body, especially with the eyes closed.
• Low back (i.e. discogenic) patients with good quality of stereognosis (body awareness) will have a better likelihood of surgical success. Those who lack stereognosis would be wise to improve body awareness prior to surgical referral.
• The principles of stereognotic training (which is based on Feldenkrais and Ayres) is slow, precise, repeated and simple movement with high central nervous system control. To me, it is the "recognise" of movement based rehabilitation. The objective is to learn to differentiate movement, controlled relaxation of the body with movement, and progression to higher level positions. Essentially, this may be an excellent intervention for motor morons.
• The goal of DNS rehabilitation is not only to improve the integrated spinal stabilizing system, but also to restore stereognosis. Therefore, Tai Chi may be an excellent method of physical activity for patients of all ages. As a side note, I'm really looking forward to Tai Cheng.
• DNS is not about the baby, it's about optimal movement.