Training = Rehab, Rehab = Training DVD

Finally!

It took me a while to get through all of Charlie's educational dvds but I did. Will admit that I have to watch each disc several more times to soak up all the information but for those of you who have yet to check it out, I suggest you do so asap. 

As a strength coach, an athletic trainer and a physical therapist Charlie shares a wealth of information in his recently released dvd set, Training = Rehab Rehab = Training. On top of that, he's been a competitive powerlifter and an RKC in training so he definitely walks the walk. This is an important point to realize since while many clinicians often restrict clients and athletes from performing specific exercises for "safety" purposes, Charlie has both put himself under, as well as lifted, hundreds of pounds of load and truly understands the human body's true capacities. That is not to say that this dvd is meant for the hard gainers. It very well could be, but I'd say its for anyone involved in a training or rehabilitative capacity. It simply illustrates the fact that when he tells a trainer to "back off and refer out", he truly means it!

Here's a little Q & A where I asked him to delve a little bit further on some of the principles he espoused.

1) Charlie, in the dvd set you quoted several times that "Stability is the ability of a joint system to control movement in the presence of potential change"

The working continuum of spinal stability training from the Spine Control Symposium that I attended in Toronto stated that based on the load (high vs low) and speed (slow vs fast) of a given scenario, a certain amount of stiffness (high vs low) is required. For example, situations that are slow in duration and high in load require high stiffness - think squats and deadlifts. Would you consider this similar to your thought process of “stability” and if not, perhaps you may describe how your definition may differ?

"Keep in mind, this definition of stability is more contextual to begin the understanding of human movement.  It is important to understand that stability can come from many different components and strategies.  Some are desirable and have tissue integrity, while others are degenerative.  This can be the movement in general like repetitive touching your toes or relying more on bony approximation in a deadlift that meets a visual marker of integrity.

Stiffness is definitely a friend to maintaining stability as one of the potential components adding to movement integrity.

I would be cautious to rely overly on muscle tissue stiffness for spinal stability if it inhibits segmental stability.  I believe we need both.".

2) You also mention that “the painful joint is usually doing something right” and that "the hip has more to do with ankle sprains than the ankle”. I think this really sums it up. Many of us have heard of Mike Boyle’s noose example, but ultimately it comes down to the statement you made above. You also mentioned that “the knee is stupid”. Many of us are aware of the influence the “core”, hip, and ankle have on patellofemoral stability and while minibands and Cook bands are quite widespread in the rehab industry, my guess is that you utilize a strict, no nonsense approach to patellofemoral rehabilitation. I’m sure you do use the above equipment but are there others in your toolbox or are you simply strict on form and focus on progressions?

"I definitely use the bands, and I definitely devalue the knee proper in terms of rehabilitation. That being said, it is critical to restore patellar mobility when it's deficient, and there are some rotational mobilizations that can restore centration to the knee.

Also far too often, knee pain that lingers or tough to crack is a function of compression of the patella as a result of rectus femoris tone that is quickly treated with IASTM.  This approach though is more treating the hip musculature than the knee.".

3) On the “Core Pendulum Theory”:
When discussing this theory, do you simply mean the proprioceptive input involved at (normal or pathological) end range via the joint capsules and ligaments? Or are you implying mid-range input from the muscules and musculotendinous junction as well? This is may be a rhetorical question, but an important one nonetheless.

"I am implying both.  I believe the receptors through joints, capsules, muscles, tendons, etc. yield information to the brain that shifts neural flow away from tonic muscles and towards phasic muscles.

My theory is that regardless of the individual joint position at a given time, the mechanoreceptors "know" the mid- and end-range capabilities of the joint.  Those "conversations" govern the local stability of the joint based on a "need" basis.  If the joint can stabilize off tone and neurally driven stiffness, local stabilizers are inhibited."

4) Being trained in Ontario, many of my colleagues are well versed in the concept of “bracing” the core in order to achieve spinal stability. However, being familiar with the work of those in both Australia and Prague it seems as though there may be a requisite precursor to this approach. Would you mind briefly discussing the “High Threshold Strategy” and the neurological and physiological rationale to targeting the inner and outer core in rehabilitative and corrective exercise?

"A High Threshold Strategy is based off Hodges nomenclature that buckets 4 levels of stability patterning.  I forget the name of the first local pattern, but it is just a visualization of muscles activating.  Local stabilization is the rank and file low load training that they believe in like draw-ins and multifidus training.  This is the inner core cylinder where I believe is managed by the diaphragm feeding forward to the TA, multifidus, and pelvic floor.  Obviously others are comfortable with the TA or other pieces driving the pattern. Global Stabilzation is the plank series, push-up, heavier diagonal patterns, the tried and true McGill-like training. Global Mobilization is the foolishness such as crunches, supermans, movements that involved repetitve and loaded movement of the lumbar spine.  Champions of the Queensland methods I believe espouse this type of training which varies in my mind from unfortunate to nauseating.

Based off the solid research of delayed onset of the inner core (local stabilzers) in the presence of pain, there is a parlay of overactivity of the outer core (global stabilzers).  This is a high threshold strategy, when the globals and not "balanced" with the activation of the locals.  This is actually very consistent with Janda's message in as much as the globals such as RA, obliques, QL phylogenetically are phasic muscles, and the locals are tonic.  The High Threshold is when the tonics are inhibited, and phasics are facilitated.

The key to appreciate is that after the pain is remediated, the high threshold strategy often remains and fouls ideal movement.  I do not believe that harnessing the body's full "juice" for loaded and powerful patterns is possible without the inner core stabilizing in sequence and allowing for the phasic muscles to deliver.  These patterns can be retrained, sometimes quite rapidly."

5) You introduce the Selective Functional Movement Assessment with restrictor plates. Basically this is the top tier, 7 tests in the assessment technique used to guide manual therapy and rehabilitation. My question is this. If you are suggesting that performing the breakouts should only be performed by clinicians, why not simply utilize the original FMS?”

"I believe Gray wrote in Movement that you actually can use the FMS to treat pain.  I would suggest you must be on your game and quite skilled to be able to cull out if it is pain causing bad movement or bad movement causing pain.
Also consider that the deeper screens to the FMS are designed to bucket mobility vs. stability fixes. When there is pain, it is still challenging to always discern if you are seeing a limitation of some level, or if it's pain creating the situation.  You may be able to diffuse the pain, and the limitations fixes.  Or it may not fix.

My goal was to establish a common language in terms of non-medical clinicians and medical clinicians working off of the same template without dishonoring the natural and logical boundaries between the 2 skill sets.  Many trainers don't or won't refer out for somewhat fair reasons.  I believe what I presented was a fair and honest way to provide those individuals, along with a whole host of other valuable information, a way to not screw up the situation if they choose to work with someone in pain.

Referring out is the best approach, which I believe is something I might have mentioned more than 6 times on the DVD.  That is the bigger take-home rather than this SFMA with Restrictor Plates."

Many thanks to Dr. Weingroff for taking the time to answer these questions. If you yourself have any questions for Charlie, feel free to let me know or contact him directly through www.charlieweingroff.com.

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