Thanks to Patrick, Keith and Charlie, I recently had the privilege to attend the SPARQ summit in Portland, Oregon.
This summit of "discovery" and "passing knowledge" was one of learning, sharing, building and networking and included some heavy-hitter presenters from around the globe. In addition, interspersed between the presentations included several exciting Nike-led presentations including the FuelBand, Designed to Move, etc.
While the days of having the time, energy and patience to provide full and detailed reports are long gone, here are highlights of some of my brain-engaging moments throughout the two days.
From Gabriele Wulf:
From Michael Gervais:
From Aaron Coutts:
From Henk Kraaijenhof:
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.
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.
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 :)
"...it is not so much (important) that one does all that he can, but that one does what is necessary".
"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".
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.
*Note: My good friend Thomas Lam also posted a nice review. Click on this link to check it out.
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.
Aspetar Pre-conference Sports Medicine Symposium
Keynote - Leading from the Top: How Team Culture Predicts Team Success
Fail to Plan? Plan to Fail: How to Get Your Team Ready for Action
The Perfect Storm: Innovation, Technology and Performance
Testing in the Pursuit of High Performance: The Do's and the Don'ts
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.
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.
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.
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:
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;
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).
"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.
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.
Bill Knowles (Keynote) - "Return to Competition Strategies for the Joint Compromised Athlete"
Dr. Craig Liebenson (Keynote) - "Regional Interdependence: How Functional Pathology Limits Performance"
Sean Skahan - Injury Prevention Strategies For Hockey
Dr. John DiMuro & Mark Toomey - "Primary Movers, Secondary Injuries"
Art Horne & Dr. Pete Viteritti - "Improving Function with Manual Therapy Techniques"
Irving "Boo" Schenxnayder (Keynote) - "Multijump Exercises: Applications for Teaching, Training, & Rehab"
Joel Jamieson - "Allostasis and the Training Process"
Keith D'Amelio - "Solving the Performance Equation"
Chris Powers (Keynote) - "Proximal Factors Contributing to Running Injuries"
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:
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.
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!
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?
You also may remember the above image. If not, it's a diagram of the "stabilizing system of the spine" by Panjabi and depicts the important 3-way interaction between the nervous system, the musculature and the passive structures. Unfortunately, this 3-way interaction is often forgotten by many practitioners today. Because how often do we solely address the muscles and / or joints, yet forget the important contribution of the neural system?
And as Alena asked,
"How did his ’92 papers not change our treatment philosophy? Why are we still “fixated” on just joints and muscles?"
So we must remember that understanding the functional standpoint of joint centration is respecting the role the CNS plays in control. For more information on this, make sure you take the time to read some of Peter Reeves' work.
During the course Brett Winchester discussed the role of the anterior structures of the core which prompted me to post the following on facebook.
"I think we can be even more precise with our thoughts on the rectus abdominis. We've moved away from flexion to anti-extension. But we can move even further away toward contribution to IAP. If we think about this muscle as a team player then maybe we'll be less confused."
Because in my opinion, very often, the Rectus isn’t for flexion nor is it for anti-extension, it’s for IAP to buttress the spine against erector load.
For those of you that work in the sport setting, yet still have a difficult time comprehending DNS principles, here is a little quote from a recent article about Steven Strasburg.
“To throw a baseball properly, a pitcher must get into the right position at the right time with the right succession of movements, like dominoes falling. Disruptions in this kinetic chain, as experts call it, cause problems at the weakest link, most often the elbow or shoulder.”
Note: Clare Frank goes into more detail on the “whole body approach” in this interview, courtesy of pttalker.com.
“Good diaphragmatic function is like a natural manipulation with every breath”
So as you can see, DNS is about filling the gaps. It's amphoteric nature of every exercise being a test and every test being an exercise certainly widens my continuum of assessment and exercise, effectively deepening my toolshed. It's about facilitating breath where patients lack and engaging muscle activity where inhibited and/or decreased. And for those of you who have learned this approach, you will see why, from a clinical perspective, I believe that very few people need more open kinetic chain training in rehabilitation. We need to spend more time respecting centration and the body's support function just a little bit more.
But most importantly, learning the DNS approach will get you into the habit of asking "why". And as a clinician this should be your primary question.
Because in it's truest sense,
"The definition of “Failed Back Syndrome” is operating on a consequence, not a cause"