Applying Fear Avoidance to Athletes: The Athlete Fear Avoidance Questionnaire (AFAQ)

Greetings Readers! I am excited to share some new and important research with all of you. The Journal of Athletic Training (JAT) released a new study for early publication on March 20th, 2015 titled Development and Validation of the Athlete Fear Avoidance Questionnaire by Geoffrey Dover, PhD, CAT(C), ATC and Vanessa Amar, MSc, CAT(C) from Concordia University in Montreal, Quebec, Canada.

What is this and Why is it exciting?

The fear avoidance model and specifically tools like the Fear Avoidance Belief Questionnaire (aka the FABQ and it's derivatives) as well as the Pain Catastrophizing Scale (PCS) have been vital assets to the revolution of modern pain science, the ability to predict rehabilitation time lines, and for identifying individuals prone to exaggerated pain perception or with a high likelihood of developing chronic pain. 

While the fear-avoidance model definitely isn't brand new, this is an exciting study because it sets the groundwork to develop an FABQ equivalent for athletes. Specifically, the FABQ was developed, validated, and used for a general population. Despite it's success and the success of other items like the PCS when dealing with athletes...it is NOT a perfect fit for use in an athletic population. I personally gave the FABQ to several athletes on several occasions and they would often become confused and disgruntled with the "work" related questions. This is where the AFAQ or Athlete Fear Avoidance Questionnaire could potentially come in handy.

Do you educate your patients on pain science? Are you even aware of the benefits of doing so?
-Photo Courtesy of Dr. Erson Religioso, PT of TheManualTherapist.com

What did they do?

The authors of this study assembled a squad of "experts" such as medical personal, sports psychologists, and sport coaches to develop a questionnaire using education on the fear-avoidance model, statistical methods developed for the creation of questionnaires, and the experience of the panel and their interaction with athletes and injuries.

The authors then took the AFAQ which underwent many revisions to its question and the scale system used for points until they were satisfied. Afterwords, they took the questionnaire and gave it to a variety of athletes (some healthy but previously injured and some with current injuries) to determine the correlation and thus validity of the new questionnaire compared with the previous but different FABQ and PCS questionnaires.

Here is the finalized AFAQ, courtesy of the Journal of Athletic Training.

What did they find out?

The authors were able to establish based upon their results that they had developed a questionnaire with both good internal and external validity, and that they had concurrent validity with both the FABQ (r=.352,p<.005) and the PCS (r=.587,p<.001). However, there was not a significant correlation between the work version of the FABQ (FABQ-W, r=.137, p=.176). This insignificance highlights the need for something like the AFAQ because it was hypothesized that the "work" related questions did not correlate or work well at all for athletes.

What should the take home point be?

I could write a conclusion for you all but I thought that they authors of this study did a great job of concluding this study in a very succinct manner. So I will let them take it away...

 "The AFAQ is a scale that measures injury–related fear avoidance in athletes. This scale could be used by sports medicine professionals, including athletic therapists and athletic trainers, as an extra rehabilitation tool to identify fear avoidance in athletes as a potential negative psychological barrier to rehabilitation. Fear-avoidance scales for the general population have already been used to predict return to work and the development of chronic pain. Similarly, identifying athletes with high levels of fear avoidance using a sport-specific scale could allow clinicians to address this psychological barrier early in rehabilitation and potentially reduce the time until return to play."

One last thing, in the discussion the authors are quick to take note but I wanted to make sure you all took this point home with you too before running off to use the AFAQ. This was an initial study that solely developed this new questionnaire and established it's validity with reference to the pre-existing FABQ and PCS.

There is still additional research needed on the AFAQ to see if it truly can be as essential and predictive as the aforementioned tools for the general population. Considering the positive correlations we can feel confident that it may but as always...we need some real evidence to be sure! However, pain science isn't just something for our "zebra" patients and is something that can be applied to everyone and that is why this is exciting. Being able to quantify emotions and beliefs related to pain and then educate our patients is a great step in the right direction for us to truly help them.

Read More

When Is Cryotherapy/Ice Supported By Research?

Howdy Readers! After yesterday's post ice seems to be a hot topic. I may have misled some of you yesterday with my thoughts on ice. Like many things in healthcare, science, and research the answers to questions are often shades of grey...not black and white like many would prefer. Therefore, today I wanted to share with all of you a guest post that I wrote for another website regarding a study that showcased a time when icing is warranted and was found to be very beneficial. This isn't the first article that shows evidence for this idea but it is the most recently published.

Additionally, I wanted to hammer home the idea that ice can still be used to modulate pain...if a 14 year old high school athlete suffers a severe ankle sprain for the first time and is in a lot of pain it would be unethical and unreasonable to deny him a bag of "ice" because research shows that it may not change blood flow. I can still help to modulate his pain without the use of narcotics or NSAIDs (a whole different bag of worms).

Nevertheless, pain should still be viewed as a perception and as something that can alter movement/motor control. We do not want to associate pain purely with structural damage because we know that is not the case based off the latest pain science. What I am against however is clinicians that ice to "treat" or "fix" injuries instead of using sound clinical reasoning, causative biomechanics, and taking pain science into consideration. We need to question the mechanism of why we are choosing a certain treatment, exercise, or modality. Enough with the ranting, here is my article!

Source:
http://pds.exblog.jp/pds/1/201404/11/09/b0112009_5555964.png

A Novel Approach for Treating Arthrogenic Muscle Inhibition in Post-ACLR Patients?

Hart JM, Kuenze CM, Diduch DR and Ingersoll CD.J Athl Training. 49:6, 740-746.

How many of you have had the struggle of dealing with an ACLR patient that has suffered from an inability to regain full volitional control of their quadriceps group? This is a known pathology called Arthrogenic Muscle Inhibition (AMI) which has been defined in the literature as an inhibitory reflex in response to damage that has been suffered by the joint structures of the knee and it affects the musculature surrounding the knee. It is currently theorized in this condition that efferent input to the quadriceps has been inhibited in response to “aberrant” afferent input from the joint and the amount of motor units available for volitional control has been decreased.

            Initially, AMI may work as a protective reflex loop to protect the joint structures from further damage. However, in the scenario of an athlete that has undergone arthroscopic surgery to reconstruct an ACL injury it can be a burden that prevents a return to pre-injury levels of strength and side-to-side asymmetries. This condition would definitely be considered a detriment when it prevents our patients from receiving the entire benefits from their rehabilitation program and may wreak havoc upon their gait and other movement patterns.

Source:
http://www.physio-pro.com/files/2014/02/icing-the-knee1.jpg

What if this could be overcome with a simple and cost-effective intervention; perhaps an intervention as simple and globally available as applying an ice-bag prior to exercise intervention? Well that is exactly what this group of researchers did in this current study. Hart et al built upon previous research that showed that Hoffman reflex (h-reflex) could be increased when cryotherapy was used on subject’s with inhibited quadriceps due to knee-joints that had been artificially effused.

There is lot to discuss when it comes to the intricacies of methods and procedures for this study and the SMR already had a great post recently going over those details. You can read their take in more depth right here. On a global and applicable scale you may be wondering what they found out. Well let me cut to the chase; using a cryotherapy intervention immediately before performing rehabilitation exercises resulted in better quadriceps function and strength gains compared to the other interventions. This study was another brick laid for this theoretical foundation and it is forming quite nicely. However, there is still more research to do on this topic such as investigating other knee injuries like PFPS, patellar tendinopathy, meniscal injuries, and longer intervention trials >2 weeks are definitely warranted.

This study should be kept in mind that sometimes cryotherapy is warranted. Especially at a time when so many love to blindly point fingers at “passive modalities” such as cryotherapy. Anything can be the perfect intervention if applied in the right place, at the right time, and especially if it is guided by the right evidence. This is something to keep in mind the next time you find yourself struggling with a patient/athlete who is struggling to regain quadriceps function. It can’t hurt to try (unless they have a cold allergy), uses something that is most likely already located in your athletic training clinic, and has some promising research in the works.

Read More

New Research Continues to Support the Ending of an “Ice-Age”.

-Thanks for pic, WebMD.com

Hating on cryotherapy or “icing” musculoskeletal injuries seems to be the flavor of the month thing to do. Decades of conventional wisdom has told us that everything should be iced immediately after injury. RICE & PRICE were so-so nice we thought. However, when held under the light of scientific inquiry the evidence for cryotherapy was found to be on thin ice.

This blog post today isn’t going to be a rehash of previous arguments against cryotherapy. Here is a recent post by Josh Stone, MA, ATC where he gave his top 10 reasons to cease the cryotherapy craze. Instead, today I am going to discuss a recently published study on cryotherapy. This study by Selkow et al¹ was just published early online by the Journal of Athletic Training. 

What did they investigate?

The authors wanted to investigate the effect of repeated cryotherapy treatments on microvascular perfusion after a bout of eccentric exercise. Why eccentric exercise? They did this because it has been previously shown in the literature that eccentric exercise results in increased blood flow just like the vasodilation associated with musculoskeletal injury. Therefore, this study would look directly at a very common clinical scenario (using cryotherapy on an acute episode of local inflammation.).

In this article the authors used a single-blind randomized controlled trial study design. They recruited 18 healthy subjects for this study and divided them into three separate groups (intervention, sham, and control.). If you are looking to find a good level of evidence when it comes to studies this is grade A stuff. The investigators were the ones blinded to the intervention not the subjects. I can imagine it would be difficult to blind a subject from whether or not they were receiving cryotherapy and that is why the authors didn’t use a double-blinded study design.

How did they investigate it?

The authors used microbubble infusion via an intravenous catheter that was measured using ultrasound imaging. This allowed the investigators to determine blood flow/local perfusion. After establishing a baseline, the subjects performed an eccentric exercise protocol. Within 1 minute of finishing the eccentrics the subjects were provided with the intervention (ice, sham, or control) depending on their random group allocation. 

After applying the intervention, perfusion was once again measured using the microbubbles and ultrasound. This began within 30seconds of completing the intervention. After this the participants returned 10, 24, and 48 hours after the initial intervention to reassess pain using a visual analog scale (VAS) before undergoing another intervention session (the same as the first, depending on their group placement). This closely mimicked what may be seen in an athletic training or by a person following traditional RICE advice at home.

Kind of like this...but not quite.

So What Did They Find Out?

The authors found out that there was NO difference in the amount of microvascular perfusion between the different intervention groups. This means a sham ice modality, doing nothing at all, and a bag of ice all had the exact same influence when it came to perfusion levels. In other words, the cryotherapy treatment was useless in terms of influencing perfusion. However, there was a difference between pain levels as assessed using the VAS. This was not much of a surprise considering cryotherapy has previously been noted for its ability to influence pain levels.

What does this all mean?

It is just another piece of evidence to support the idea that icing may not be doing what we thought it was doing. Specifically, cryotherapy does not seem to make a big difference in local blood flow after injury. Especially when considered in the light of an eccentric exercise model in this case. However, cryotherapy still remains a viable modality to alter pain perception within patients. While cryotherapy may not fix anything it may still be an option to modulate pain or suffering associated with experiencing a musculoskeletal injury.

Update:

I want people to realize that ice does currently have a time and a place. However, that place may not be where we once thought it was. Despite cryotherapy not changing bloodflow it does a great job of modulating pain. Additionally, cryotherapy has recently been found to be a great modality for treating arthrogenic muscle inhibition...Specifically in the quadriceps after knee injury. So ice is still cool for some mechanisms! Remember that! 

References:

1. Selkow, N. M., et al. (2015). "Blood Flow After Exercise-Induced Muscle Damage." J Athl Train.

Read More

My Top 5 Posts of 2014

Howdy Readers! It is that time of year again when everybody begins to look back and review the past year. 2014 was definitely a big year for myself professionally and personally. In fact, 2014 was my first full year of blogging since beginning to write back in early 2013. Some highlights of my past year include finishing my master's thesis and degree, going to the final four (NCAA Div. III) with my basketball team from Illinois Wesleyan University. Additionally, I moved between Normal, IL to Madison, WI and finally settled here in Miami, FL where I have started work on my PhD at the University of Miami. This means I have gone from being a student and clinician to full time student/research assistant. Finally, in my personal life I was lucky enough to somehow become engaged to the woman that I love.

Now that I have reviewed my personal and professional life...let's take a look and recap the 5 most popular blogs that were published on my blog this year. I only included posts that were written & published in the past year for eligibility. Cue the cheesy drum roll please!

5. Healthy Running Course Review

This post was a recap of my trip to Portland, Oregon where I attended the Healthy Running Course that was put on by Dr. Mark Cucuzzella and Jay Dicharry, MPT, SCS. I had a great time at this course and in my mind the information presented here is a MUST for people interested in running, coaching runners, or treating running injuries.

4. Please Leave Your Poor Hamstrings Alone!

This post was kind of a personal rant about what has been deemed "The Epidemic That Never Existed". If you haven't read it yet and think you might have tight hamstrings or find yourself thinking that many people might have tight hamstrings then you might want to check this post out! The sensation of a tight muscle is often no more than that...a sensation.

3. Tibial Internal Rotation Mobilization w/ The EDGE Mobility Band

This post presented a way to help increase tibial internal rotation mobility using the EDGE mobility band. I've said it once and I'll say it again that the band is not necessary and this technique can be done without it. While I have no research to back this (idea!) it does seem plausible that using the band can help with hand grip, increasing afferent input to the nervous system, and perhaps offer a superficial fascial glide at best. These three things together may help increase the efficacy of the technique.

2. Rocktape: Fascial Movement Taping Levels 1 & 2 Course Review

This post is the second course review to hit the top 5 list for the year. In this post I reviewed my time spent at Rocktape's Fascial Movement Taping course. While I haven't used any kinesiology tape in many months now because most of my time is spent in the classroom and in the lab. However, I still believe that kinesiology tape still has a role as a tool in the clinical toolbox. I hardly believe there are any true mechanical effects going on with its application and instead think it is mostly related to sensory input and/or the individual's perception(placebo potential!) of the taped area. (This could be argued because you need the mechanical stimulation to provide sensory-afferent input) I think the evil side of kinesiology tape is often the explanatory and specificity models offered by many and the fact that the research isn't strong for it at all. I do however think that there needs to be better research studies with better "questions" asked as well.

1. Are Your Shoulders Ready for Brazilian Jiu Jitsu?

Finally, the #1 post of the year. The fact that this post became my #1 viewed post of the year was very surprising to me. I wrote this post in honor of starting back up my Brazilian Jiu Jitsu (BJJ) training that had been on hold since sometime during my undergraduate degree. In this blog I proposed a simple but not necessarily all inclusive way of trying to screen a person's shoulders for the mobility needed to withstand the rigors of training BJJ. 

Specifically, I discussed how the Apley's Scratch test positions or the SFMA Shoulder Movement Patterns did a very good job of examining the motions needed for BJJ and explained how these movement patterns matched those of very common submission attempt positions. An inability to properly place your shoulders in these positions active or passively is probably a red flag considering that others will be trying to force your shoulders into these positions and beyond. This could result in increased levels of stress and strain placed on your joint and its surrounding soft tissues. An ounce of prevention is worth a pound of cure.

There you have it, my top 5 posts of 2014. Later this week I will share with you all the top 5 viewed videos of 2014! I hope you all are enjoying the holiday season and I wish you all the best in the coming new year! Thank you all for reading my rambling!

Read More

Stiff Ankles Could Pose a Serious Risk When It Comes to ACL Injury Risk.

Howdy Folks, today I wanted to discuss a growing body of literature that highlights a relationship between ankle dorsiflexion and movement patterns (kinematics) that are associated with anterior crucial ligament injuries. One such article that was recently published online by the Journal of Athletic Training was conducted by Dill et al¹.

Photo Taken from Dill et al journal article.

What did these authors do exactly? They actively recruited and grouped subjects by their levels of ankle dorsiflexion. Specifically, they wanted a population of subjects with limited (Less than or equal to 5 degrees) ankle dorsiflexion and subjects with normal amounts (> or equal to 15 degrees) of ankle dorsiflexion. A unique aspect of this study was that the authors used a weight-bearing lunge test for assessing ankle dorsiflexion.

 It could be argued that this test is both more functional and easier to assess in the clinic compared to nonweight-bearing ankle dorsiflexion measurements. They also took non-weight bearing ankle dorsiflexion range of motion measurements but the authors hypothesized that this measurement may have caused discrepancies in previous studies because this method isn’t a good representation of the functional movements and tasks that were assessed. The weight-bearing lunge test can be assessed using common smartphone apps like Clinometer or the iPhone’s compass application if an inclinometer is not readily available.

Photo Taken from Dill et al journal article.

What are the functional tasks that they tested? Well they had the subjects perform an overhead squat, a single-legged squat, and a jump-landing task. These tasks have been in previous research and are common in clinical settings as well to assess lower extremity movement patterns that help evaluate risk of ACL injury. These are relatively easy to perform tasks and are representative of common physical activities and functional movements in general.

What did these researchers find? They found NO differences between normal and limited ankles when using the traditional nonweight-bearing ankle dorsiflexion range-of-motion assessment. However, there were significant differences when they looked at the two different groups for both the single-legged squat and the overhead squat using the weight-bearing lunge test. They did NOT find a difference in movement patterns when they looked at the jump landing task. 

Previous research by Fong et al² found a difference with the jump landing task but the current study utilized an immediate countermovement jump for maximal height but the latter researchers did not. This could have been the reason for the differences in findings because the immediate countermovement jump may not have required a significant amount of ankle dorsiflexion to complete.

The next question that you may be asking yourself is what are the kinematics that are associated with increased loading of the anterior cruciate ligament and which of them were present in the subjects with limited ankle dorsiflexion? Well excessive frontal plane, and transverse plane motion accompanied with an anterior tibial shear force (in the sagittal plane) place the greatest stress on the anterior cruciate ligament. Noncontact injuries to this ligament are associated with a minimally flexed or relatively extended knee position. That being said, the subjects with ankles that had limited ankle dorsiflexion did not flex their knees as much as the subjects with normal ankle dorsiflexion during the single-legged squats and overhead squat. This means their knees were relatively extended and as mentioned earlier that is not ideal when it comes to loading of the anterior cruciate ligament. Additionally, the limited group had less ankle dorsiflexion displacement compared to the normal group as well.

So what should you take conclude from all of this and take back with you into the clinic? Well, for one it should be noted that using a non-weight bearing ankle dorsiflexion assessment may not be sensitive enough. The weight-bearing lunge test was much better at identifying these subjects with altered movement patterns. This test is much more field-expedient, is reliable, and can be assessed without the need of a goniometer. Finally, it is evident that there is a growing body of evidence that limitations in ankle dorsiflexion result in kinematics that are associated with increased loading of the anterior cruciate ligament of the knee. This is just another example of how the entire kinetic-chain is important when screening for or assessing injuries. Do you currently assess ankle dorsiflexion when looking to return patients to physical activity or when preventatively screening for risk of injury?

1.      Dill KE, Begalle R, Frank B, Zinder S, Padua DA. Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing Lunge Ankle-Dorsiflexion Range of Motion. J Athl Train. [Epub Ahead of Print].
2.      Fong CM, Blackburn JT, Norcross MF, McGrath M, Padua DA. Ankle-dorsiflexion range of motion and landing biomechanics. J Athl Train. 2011;46(1):5–10.

Read More

November Blog Traffic & Income Report

Welcome readers to my second monthly traffic & income report. I started this tradition last month by reporting my statistics for October. You may have noticed that this is only my second post this week. I attribute this to it being finals week so the only things that I have done are studied for my own exams, given the class that I lecture their final exam, taken exams, ate and slept, and trained brazilian jiu jitsu to help relieve stress and use as an excuse for a study break. It is interesting to me to see how my perception of injuries and their etiology related to brazilian jiu jitsu has evolved since my days as an undergraduate athletic training student to now.

I really do love this sport/art.

The Numbers:

So let's get down to the numbers because if you've actually read this far down you are probably truly curious about them. There is an issue with the statistics for November because at the very beginning of last month I implemented a new template for the blog. However, when I did this I forgot edit the html code of my blog to include the tracking code that I use for Google Analytic's statistics. Due to this error I lost out on about a week worth of statistics so please keep that in mind. Nevertheless, November did not fair as well as October for both YouTube and the blog itself.

Traffic

Regardless of whether or not I lost out on some statistics I definitely do not think it was that many lost page views. It is evident that I just happened to have a much lower amount of hits overall. This is evident by my ad performance. So what could possibly have attributed to this change? Here is the breakdown of those views.

What pops out first and foremost obviously is the difference in bounce rate and the pages per session statistics. Despite having similar amounts of users and sessions it was evident that people were viewing much less pages per visit to my website and thus a greater percentage of people were leaving after viewing the first page on my blog. I attribute this to me blogging about brazilian jiu jitsu related topics and sharing them with that community. These readers often are just interested in the initial article or one of the other very few articles related to brazilian jiu jitsu that I have written to date. Past readers may have found many articles to be related and therefore spent more time on my website reading multiple pages.

This statistic could potentially get better if I continued to develop more content related to brazilian jiu jitsu and injuries or if I ceased to continue writing on that topic. However, I could be wrong and that could be the nature of not establishing a readership with that community but as I establish one with them it would modify the behavior of readers. Maybe that behavior is a trait of readers of that community. How about we continue on to the revenue and ad statistics.

Revenue Breakdown by Source:

It is obvious that there was a decrease in ad revenue compared with the last three months. If you aren't careful it looks like adsense earnings have really declined in the past few months but the biggest drop there should probably be associated with the addition of Sovrn Ads. 

I am really curious how some of these graphs and stats will change over the next year. It is very unpredictable still at this point and things are still changing at a very rapid rate. For instance, my YouTube earnings for the month of December after only 13 days have just about surpassed the entire month of November. I had actually expected a huge increase in YouTube performance for November because of my "Movie Monday" series, and when that didn't occur I was confused. Now that I see a big increase so far this month I wonder if it is just a delayed response. If you have any questions or want clarification on anything don't be afraid to ask. Additionally, if you have any ideas or pointers I would love to hear them as well. 

Read More

Movie Monday: A Clinical Pearl For Assessing Great Toe Mobility

Another Monday means another movie to be shared with all of you. This week's video is a clinical pearl to keep in mind when assessing great toe dorsiflexion/extension (whatever nomenclature you like for sagittal plane motion at the great toe). This is especially important when dealing with runners and running injuries due to the influence of the great toe  during gait. Specifically, the ability to extend the hip, achieve terminal stance and proper toe-off. This is another pearl that I learned from Jay Dicharry and his book, Anatomy for Runners/The Healthy Running course.

The major point of this video is that the position of the ankle can have an effect on motion at the toe. This is important to consider because at terminal stance/toe off the ankle is placed in dorsiflexion and the toe must also dorsiflex as well to allow for a proper "ankle rocker" mechanism to occur. Failing to check toe mobility in both positions could lead to an improper assessment. The big toe really can be a lynch-pin when it comes to movement so we want to ensure it can do what it is supposed to do. Have a great day!

Read More

There's No Such Thing as a "Bad" Posture

Many of us have been scolded since childhood to "sit up straight", to stop slouching, to keep our chins up and other various cues in attempt to hammer home "perfect posture" habits. However, the more I think about it and think about human movement I start to think more about how there isn't really such a thing as bad posture. When I say this...I mean that there is nothing wrong with putting your cranium into a forward head position, nothing wrong with arching your low back, rounding your shoulders, and for you PRI people out there...favoring a Left AIC pattern.

There are some clinicians, coaches, and parents that hammer home the importance of "proper posture" and even go to such lengths as bracing, taping, or even strapping down body parts to limit people into their ideal of perfect positioning. Remember the fcliche scenario with the girl in boarding school that must learn to walk and sit with a book balanced upon her head? There are also some clinicians and researchers that scoff at the idea of trying to place blame on posture for pain and injury because of some of the existing literature.

The real problem or dysfunction I feel is often times the target of these "postural correction interventions" and that is limitations. I believe the only true "bad" posture is one that a person can not get out of very easily or very often. Prolonged limitations in movement or habitual overuse of a certain movement is where the problem is really located. My neck is supposed to go forward, my shoulders meant to round, my thoracic spine to slouch but they were never meant to stay in those positions. I want to be able to both protract and retract my shoulders, utilize the left AIC and then get out of AIC. We don't want to get stuck but most of us spend 90% of our life either laying in bed, sitting in a chair, or standing. There is very little variance for many people.

We need routine, habitual movement through entire ranges of physiologic motion. I'm not saying we need to train or load our bodies at every range or in traditional "bad" positions. I am also not arguing that certain biomechanical alignments are better able to produce force, perform better, and be more efficient at reducing risk of injury.

It might be flavor of the moment to talk about "play" but think about how children or even animals in the wild move about for instance. Their movements are often random, varied, and the interactions between each other and the environment is very dynamic. I think about movements like parkour, MovNat, the teachings of Pavel and Ido Portal as a step in the right direction but they are still the minority. I would love to play on an "adult" playground but unfortunately as I write that it sounds more like something that is advertised on billboards near truck stops or in spam emails. Take a second and think about it though...Can you touch your toes? When was the last time you got into a full squat, sat cross legged on the ground, hung from a tree branch, or did a bear crawl? These were all once routine and daily movements for many of us humans.

We really do need to change our "culture" and ways of thinking when it comes to movement. It is entirely true when it comes to the human body and human movement that if you don't use it...you will lose it. Perhaps a better slogan would be, "Move It, or Lose It." We shouldn't be taping people's shoulders in place for 8 hours straight at work as much as we should be getting the person to move not just their shoulders or head but their entire body more frequently. We also shouldn't be blaming benign structural positions or postures necessarily. We need to go deeper and further back in time...If that makes any sense to you. You do not need perfect alignment or positioning at all times to be pain free, you are not doomed if you have rounded shoulders, and its okay to go ahead and slouch sometimes. There is a time and place for everything.

Read More

Movie Monday: Tibial Internal Rotation Self-Mobilization

Good Morning Readers! As you may have noticed last week was a busy week for me with the holidays and I only ended up getting one post done for all of you. My fiance and I actually drove across the country to see family and then had to drive back. I don't really want to sit in a car anymore in the foreseeable future. I don't understand how people can sit at a desk for 8-12 hours a day...It was killing me and made my body feel terrible.

Today's video will feature an easy way to have somebody work on tibial internal rotation on their own. Perhaps they don't respond very well to and/or they have pain when performing this tibial internal rotation mobilization with movement variant...then this may be something to try instead. Additionally, it is pretty simple and most people can do this with very minimal instruction. Nevertheless, it should be pain free and you should Test-Intervene-Retest to see if this technique makes a difference. You don't want to repeatedly try and mobilize a segment like the tibia if the reason it is limited is due to bony abnormality.

Give it a try and let me know what you think. I forgot where I learned this one but I think I remember some story associated with this technique about how a power or Olympic lifter used it to help his tibial IR before setting a world and or/personal record. Credit goes to whomever that was, sorry for not remembering.

Read More

Movie Monday: An Easy Way To Assess for Glute Inhibition

Howdy Folks. Today's video is a simple test that I use when assessing gluteus maximus function of my patients.  I learned this test from Jay Dicharry, MPT, SCS, the author of Anatomy For Runners and he also taught it as part of his Healthy Running seminar.

It is a simple bridge test that looks at the ability to activate the glute max as the primary hip extensor, with a minor contribution from the hamstrings, and a neutral lumbar spine. We don't want to see lumbar extension when trying to extend the hip. A proper activation strategy with this test is not a "good thing" to see but instead should be viewed as a necessity for athletes and perhaps the non-athletic population as well. 

A person could have "strong glutes" and still fail this test if they don't know how to use them. Additionally, if a person failed this test and had weak glutes with manual muscle testing then it may be a waste to prescribe glute strengthening exercises when in reality they need to work on activation first.

Lets Recap:

What We Do Want To See/Feel:

• Neutral Lumbar Spine
• Stable Lumbopelvic control
• Patient to "feel" the effort come from their butt/glutes and hamstrings, Jay taught us 70% - 30% contribution, respectively.
• An ability to hold steady for 20-30 seconds with easy. It may be beneficial to do this for reps as well.

What We Don't Want to See/Feel:

• Hamstring "Cramping"
• Lumbar Extension
• Patient to "feel" the effort come from their low back
• Tilting/dipping/rotation of the pelvis when transitioning from double leg to single leg.
• Excessive Effort and/or Labored Breathing
• An inability to maintain the bridge position or excessive shaking while doing so

Read More