Showing posts with label SFMA. Show all posts
Showing posts with label SFMA. Show all posts

Oct 13, 2014

Are Your Shoulders Ready for Brazilian Jiu Jitsu?

brazilian jiu jitsu, BJJ injuries, BJJ injury prevention, sports medicine for jiu jitsu, athletic trainer, SFMA, selective functional movement assessment, gray cook, biomechanics, shoulder injuries in BJJ

I have been keeping busy down here in Miami, Florida. I am about a quarter of the way through my first semester as a PhD student and I have been kept busy with teaching my first class (Introduction to Athletic and Sport Injuries) and by being a research assistant for my adviser as well. I have also had the opportunity to keep myself busy yet physically active by taking back up a long-lost but much loved hobby of mine: Brazilian Jiu Jitsu (BJJ).

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BJJ took a backseat for me after training regularly during my bachelor's degree. It stayed on the back burner as I worked on my master's degree but my schedule has normalized enough to allow me to resume training. My sports medicine breadth of knowledge has grown and advanced while my BJJ was placed on hold, and because of that I feel that I have a expanded view on the biomechanics of the sport that I didn't necessarily have previously.

Specifically, I am going to touch briefly on a bit of injury prevention for anyone out there that may be into BJJ or for those of you that may treat people that participate in BJJ (actually this stuff applies to everybody not just BJJ guys). Nevertheless, this post is definitely geared more for the BJJ practitioner and not the clinicians out there...this may not even be new information for those who have visited this blog before.

While I am not somebody that you should go to for submission or any BJJ advice for that matter...I feel that I can give some good insight to help you stay on the mats. Specifically, when I was training I often saw a lot of people struggle with shoulder injuries. In fact, traumatic shoulder dislocations and subluxations were more prevalent than one might assume. Perhaps one wouldn't be surprised considering this is a sport where people enjoy catching each other in joint locks and submission-holds that work by forcibly placing one another's joints at their respective end ranges of motion. So when it comes to a sport where we are already pushing the limits with our body (within reason) then we need to ensure that we are not already at risk of damaging ourselves or our training partners.

brazilian jiu jitsu, BJJ injuries, BJJ injury prevention, sports medicine for jiu jitsu, athletic trainer, SFMA, selective functional movement assessment, gray cook, biomechanics, shoulder injuries in BJJ
I'm no Kenobi.
Having strong, mobile, and stable shoulders is just as important for your ability to submit as well as your ability to not get submitted. The status of your shoulders can also have repercussions up and down the kinetic chain. This is evident when a shoulder issue can manifest itself as a grip strength (I won't be touching on it in this post but proper grip strength can also play a huge role on proper shoulder stability) problem. Not to mention proper shoulder function, especially based upon the tests that I am about to show you, is entirely interdependent on proper function of the elbow joint, glenohumeral (shoulder) joint, the scapula (shoulder blade), the thoracic spine, and arguably the neck or cervical spine as well.

brazilian jiu jitsu, BJJ injuries, BJJ injury prevention, sports medicine for jiu jitsu, athletic trainer, SFMA, selective functional movement assessment, gray cook, biomechanics, shoulder injuries in BJJ
You can bet this guy needs some help, even if he doesn't have symptoms...yet.
So what is a quick an easy way to check for potential shoulder dysfunction? If you know me by now you know I am a fan of the Selective Functional Movement Assessment (SFMA) and think its a great way for everybody to look at movement despite the fact that we may all treat movement in many different ways. So that is where these tests originate!

1) Upper Extremity Pattern #1

brazilian jiu jitsu, BJJ injuries, BJJ injury prevention, sports medicine for jiu jitsu, athletic trainer, SFMA, selective functional movement assessment, gray cook, biomechanics, shoulder injuries in BJJ
What does this shoulder position look like?
This test requires adequate motor control and mobility of many different segments including: Shoulder internal rotation, shoulder extension, and horizontal adduction of the shoulder. Additionally it requires elbow flexion and thoracic spine extension/rotation. Any issues found here indicate a potential stability and/or mobility problem. One must not assume that it is a mobility/flexibility issue that needs stretching or cranking on.

brazilian jiu jitsu, BJJ injuries, BJJ injury prevention, sports medicine for jiu jitsu, athletic trainer, SFMA, selective functional movement assessment, gray cook, biomechanics, shoulder injuries in BJJ
Looks a lot like our test above...If you can't easily put your own arm here, how do you expect it to feel when does it for you?
What is a passing test? The ability for the finger tips to reach the inferior angle of the contralateral scapula without excessive scapular winging of the moving arm, without excessive effort, no deviations in starting posture, and a symmetrical result when compared to the other side. A failing test would require a local biomechanical assessment and to break down of the components of the movement to search for the weakest link. This is a normal range of motion to be able to move through. Deficiency here can lead to increased strain, tension and shearing forces through your upper extremity and its soft tissues.

#2) Upper Extremity Pattern #2

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For this test you need adequate shoulder external rotation, shoulder abduction, shoulder flexion, and elbow flexion on top of thoracic extension/rotation as well. To pass this test you must be able to reach your fingers to your contralateral scapula. Where at on the scapula? The midpoint of the spine of your scapula is our targeted destination. However, you need to look for symmetry of movement from side to side, check out how much effort is required, and if there is any deviation of posture to achieve this position. Additionally, a person is not allowed to "crawl" their hands up or down their back for either test. It has to be done with one smooth motion and without "warming" up.

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This is not the same as Upper Extremity Pattern #2 but it IS the same. Get it?
If you want a quick and easy way of doing this if you are unsure of your anatomical landmarks just grab yourself a tape measure and assess the distance from your longest finger tip to the first wrist "crease" or wrinkle of your wrist just below your palm. Got that measurement? Okay well you want your hands to be within 1.5 times that measurement to be considered acceptable and don't forget to switch arms and check both ways.

brazilian jiu jitsu, BJJ injuries, BJJ injury prevention, sports medicine for jiu jitsu, athletic trainer, SFMA, selective functional movement assessment, gray cook, biomechanics, shoulder injuries in BJJ

So what do you do if fail these tests? That is a debate for another day but you honestly need more information. However, if you want to use a trial-and-error method then all you need to do is try something out like flopping on a foam roller, lacrosse ball, or getting a massage and seeing if there is  a difference afterwards. How will you know if there is a difference? Retest! Mobility may work may not fix this so don't assume that is what it is! It could just as easily be a motor control or stability issue. Here is a sample of what breaking down one of these tests looks like.

While these tests are far from all-inclusive or the be-all-end-all they are a great starting place to screen or assess for potential risk of injury. If you can do this it doesn't mean you won't injury your shoulder or that you are 100% good to go but if you can't I do know that you deviate from normal into abnormal. Abnormal or dysfunction in my book is the same as pathological and may lead to future injury down the road. Get to work on bullet-proofing your shoulders before it is too late and you are under the scalpel.

 Some people asked for a video to help clarify a few questions that they had regarding this post and I have finally gotten the time to deliver. Here it is...

Jun 17, 2014

Do I Believe in Chiropractic Medicine?

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Supposedly this is a painting of the first chiropractic "adjustment"
That is the question that was asked of me recently by a client. This question was offered to me in a hushed manner as if it was a taboo or risky thing to ask somebody.

In reality, I can understand the demeanor of the question due to the previous issues between the chiropractic profession and societies like the American Medical Association.

Curious to what my answer was? I told her that I do NOT believe in chiropractors...Pause...I also do not believe in physical therapists, athletic trainers, medical doctors or osteopaths. However, I do believe in critical thinking, sound clinical reasoning, clinicians that get results, evidence based practice, and the scientific method. There will always be good eggs and bad eggs in any profession. There will always be some patients that will respond to some clinicians/treatments/therapies/exercises better than others. It doesn't mean they are bad but they weren't appropriate at that moment in time.

I think she has lost her marbles.

As Charlie Weingroff would say, "I don't care if all you do is spread peanut butter on somebody, if it makes them move better or with less pain from baseline to post-testing."

Test - Intervention - Retest.

That is starting to be my new gold standard for how I feel about different clinicians. I could turn this into a profession bashing fest but its almost like discussing stereotypes...they just are not true for everybody. Not to mention it would be unprofessional of me. ;-) 

I am also biased towards systems of evaluation like SFMA/FMS/PRI/MDT because they guide treatment and funnel down issues to specific dysfunctions. This is a step in the right direction compared to trying to guess why somebody strained a hamstring, or treating all shoulder impingements the exact same way.

In conclusion, when you really start to look at stuff on a broader scale you will notice that the overlap between professions of physical medicine is constantly increasing and the points of distinction really aren't that distinct. I also see the need for more clinicians to be willing to work together. Do not let ego get in the way of referring to another provider just for the sake of keeping your cash flow constant. The real future is who can become distinct by delivering the best outcomes and results to the patient. This is customer service after all.

Jun 10, 2014

Please Leave Your Poor Hamstrings Alone!

"Tight Hamstrings, The Epidemic That Never Existed."

 -Dr. Erson Religioso, DPT

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Trying to touch my toes at my first SFMA seminar.
This little nugget of knowledge developed during a conversation that my good friend Dr. E of The Manual Therapist and I were having together after his recent post. It is crazy how many times you will hear people mention how tight their "hammies" are or how often you can look at people exercising in public and the only thing they stretch is their hamstring group after some light arm circles. It is bewildering to me sometimes.

I think there is a real epidemic in progress and is growing at an exponential rate. However, the epidemic is NOT hamstring tightness...The real epidemic is a plethora of people, old and young alike, that can not touch their toes. Touching your toes without bending your knees is...or should be a fundamental human movement pattern. I know many of us fear lumbar motion and especially extreme lumbar flexion but spinal (that includes lumbar) motion is completely normal and necessary. We aren't talking about lumbar flexion under load here.

On top of the population of people that can not touch their toes...there are plenty of people that can do so. However, I didn't say everyone that could do this was able to do it satisfactorily. Using the Selective Functional Movement Assessment (SFMA) standards a person should be able to touch their toes without bending the knees, should have a uniform spinal curve throughout all of the spinal segments, have a sacral angle of > 70 degrees, and should utilize a posterior weight shift or hip hinge to achieve this goal. An inability to achieve this pattern satisfactorily represents an inability for athletic movements such as the deadlift, and an inability to reflexively stabilize the spine.

So what does this have to do with hamstrings? Most people that can not touch their toes often jump the gun and assume that it is due to posterior chain tightness or tight hamstrings. In reality, this is rarely the case. In fact, I would recommend you always get a second opinion or never evaluate yourself. I actually made this mistake myself and it was evident in a previous post where I did an SFMA video of my own multi-segmental flexion (toe touch pattern). I was wrong in my assessment and I actually had a core stability/motor control dysfunction.

This wasn't evident to me because during a certain breakout assessment I falsely associated the sensation of neural tension to equal soft tissue tension. I didn't realize my mistake until I was auditing the SFMA certification course for the second time. I volunteered myself to be the case for teaching the multi-segmental flexion breakouts. This SFMA course was being taught by Behnad Honarbakhsh, MPT, BHK, CSCS, CAFCI, CGIMS, DO (c) (whom I thought was brilliant) and low and behold in front of the entire class he humbled me and showed me my true dysfunction. Nobody knew that I was humbled because I didn't discuss my prior self-assessment. However, I probably hadn't touched my toes since I was a toddler before elementary school. Michele Desser and Dr. Todd Arnold quickly took me out into the hallway and had me perfom rolling and core stability exercises for about 5 or so minutes. They then brought me back into the seminar and showcased how I went from being about 14 inches from touching my toes down to about 2 seconds. Later that night, back in the hotel room I practiced some more on my own and was able to touch my toes.

So lets find out where I went wrong really quick to showcase how you can check to see if your hamstrings are tight or not.

Step 1. Check to see if toes can be touched. If not, continue on. 

Why can't I? We don't know. Don't blame the hamstrings yet.

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Step 2. Remove Parts and Compare Left to Right. 

Here I unweight one of my legs and check for change. Nothing. Continue on. Still not the hamstrings.

Step 3. Long Sitting Test - Unload body parts. 

Now the hips and below will not be bearing weight and only the spine will be partially loaded against gravity. Still can't touch the toes? Continue on. (Still not the hamstrings despite my P.E. teachers scolding me for my tight hamstrings as a kid)

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Step 4. Unload More, Check Left to Right, and begin Active versus. Passive Comparison.

In this test you are looking for & 70 degrees of hip flexion with both knees remaining straight, feet dorsiflexed, and hips neutral. An inability here STILL is not due to tight hamstrings.

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Step 5. Checking Passive Motion compared with Active Motion from the previous step. 

An inability here to increase motion here beyond what you achieved actively = Ding. Ding. Ding. Winner Winner, Chicken Dinner. You DO have tight hamstrings! There are a few more steps you may take after this finding to pinpoint where the mobility dysfunction is located. However, If you increase more than 10 degrees compared to active but still do not reach normal hip flexion (now 80 degrees instead of 70) then you have a mobility and stability/motor control dysfunction present! If you find that you go from ~40 degrees to normal like I do below then you sir...DO NOT HAVE TIGHT HAMSTRINGS. You have a stability/motor control dysfunction. Continue on to step 6.

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Step 6. Now you must find out how poor your motor control deficit is.

To pinpoint this you regress yourself to the most basic form of stability and motor control...rolling around on the ground. If you can not roll from supine to prone with each of your different limbs then you have a primitive motor control dysfunction. Restoring the ability to roll may fix your inability to touch your toes. However, at this point we are encroaching on the area of the 4x4 matrix of the SFMA. If you aren't in pain currently then I would recommend you finding an FMS certified professional and get screened and start with working on your most dysfunctional issues there first.

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Look at me now...Just a tiny bend in the knees. Working on it. No hamstring stretching needed.

In conclusion, don't evaluate yourself and if you do...Get it rechecked by another set of eyes. The plumbers pipes always leak. Don't be that plumber. Secondly, practice your systems of evaluation or assessment if you have one so you can own it. If you don't use a system how can you be sure you aren't throwing spaghetti against the fridge and hoping that something sticks? What are your metrics for improvement? It has been said a million times and I'll repeat it. You do not need to use these metrics but you should be using something to set a baseline, intervene, and then compare to baseline to check for change.

May 14, 2014

Thoracic Extension Doesn't = Thoracic Extension

Howdy Folks! Today I wanted to take a quick moment to comment on some discrepancies that I have noticed when hearing people discuss thoracic mobility and the need for thoracic extension. Anyone that is familiar with the Functional Movement System is probably well aware of the lack of thoracic mobility that many people seem to suffer from. This is something that you often see targeted by FMS corrective exercises or may be a common finding during an Selective Functional Movement Assessment (SFMA) for some.

On the other hand, there is the kind folks associated with the Postural Restoration Institute (PRI) that are trying to promote thoracic flexion and minimize hyperextension of the thoracic spine. Then I have heard stories from colleagues at PRI courses mention how they are lacking thoracic extension only to be told they have too much. So what is the answer? Do we need thoracic extension? Who is right here?

Well I believe that both of these systems or schools of thought are trying to achieve the same thing, and are essentially saying the same thing despite it sounding different. I am arguing that people are not differentiating between the different hinge points of the spine and the exact levels of the thoracic spine that they are referencing. Look at this first squat picture below. Nobody from either school is going to like this squat form and PRI'ists will notice the excessive thoracic extension from T8 and down while FMS'ers will notice the lack of thoracic extension from T1-T4.

Now if I hit my first sticking point and decide to take another breathing cycle to help draw my ribcage down and promote lower thoracic flexion I am able to come down even further in my overhead deep squat as you can see below in the next picture. However, it is still less than ideal squat form. I still struggle with getting adequate upper thoracic spine extension

Now what happens if we lessen the burden of the upper thoracic spine and by switching this experiment over to a front squat? I am still hyper-lordotic in the lumbar spine and still extend the very last few segments of the thoracic spine.

If I perform another big exhale into the balloon I am able to decrease the lordotic curve, increase thoracic flexion from T8-T12 and my femurs actually break parallel! However, if you look closely you will still see a little bit of hyper-kyphosis in the first few segments of the upper thoracic spine.

In conclusion, I think there is a lot of confusion by some people when they learn about or speak about the thoracic spine between these two different schools of thought. In reality, I think that both schools are really trying to achieve similar things but sometimes there is definitely a lack of differentiation. I also think that these pictures can also help signify the importance of proper breathing, and the power of the diaphragm, obliques and transversus abdominus over form, function and movement. Just some food for thought! Thoughts?

Apr 29, 2014

Low Back Pain in a Collegiate Basketball Player

Howdy Readers! Today I wanted to take some time to report on a case that I was presented with during this previous basketball season. Then I will discuss how I addressed the case and what I wish that I could have changed about the case. I will also be using my findings from the patient's Selective Functional Movement Assessment (SFMA), and so here is the SFMA acronym legend:

FN: Functional & Non-painful
FP: Functional & Painful
DN: Dysfunctional & Non-painful
DP: Dysfunctional & Painful


A 21 year old NCAA division III basketball player was competing in a JV basketball game when he suffered a direct blow to the low back by an opposing player's elbow. The supervising athletic trainer (I was busy prepping the varsity team to play) determined there were no gross deformities, ruled out neurological involvement (dermatomes & myotomes WNL), and ruled out any potential fractures. Nevertheless, the player was unable to return to play and finish the game due to pain.

This player had a previous history of catastrophic injury as a high school basketball player when he was undercut by an opponent. He fell on his upper back and hit his head suffering a fractured scapula and traumatic brain injury that lead to him being placed into a medically-induced coma. Additionally, he had a history of low-back pain during high school. The year previous to the current incident this athlete suffered a season-ending concussion as well.

After the game was over this athlete returned to his hometown with his parents. The parents and the athlete planned to see a family friend that is an orthopaedic surgeon in the following days. Upon consulting with the doctor it was revealed to the athlete that he had degenerative joint disease (DJD) in his lumbar spine and he was sent back to me for rehabilitation at my discretion.

Upon hearing this I definitely began to dismiss the DJD because I knew that suffering an elbow to the low back in one game of basketball didn't give this player DJD. I began to talk with the patient about pain science, how it didn't matter if he had DJD because he had it before when he was pain-free, and how we weren't going to attempt to change it. I did discuss how we would perform an SFMA and evaluate in which patterns he was moving dysfunctionally & why they were dysfunctional.


SFMA Top Tier Results & Breakout Findings--
Cervical Flexion = DN: Tissue Extensibility Dysfunction
Cervical Extension = FN
Cervical Rotation = Left - FN / Right - DN: (Tissue Extensibility Dysfunction)
Upper Extremity Pattern 1 = DN (Bilaterally, Left worse than Right): (Functional Shoulder Pattern Stability/Motor Control Dysfunction)
Upper Extremity Pattern 2 = FN (Bilaterally)
Multi-Segmental Flexion = DP (Posterior Chain Tissue Extensibility Dysfunction)
Multi-Segmental Extension = DN: (Thorax Extension Stability/Motor Control Dysfunction, Hip Extension Tissue Extensibility Dysfunction)
Multi-Segmental Rotation = DN (Fundamental Rotational Pattern Stability/Motor Control Dysfunction, Hip ER Tissue Extensibility Dysfunction)
Single Leg Stance = DN (Lower Posterior Chain Tissue Extensibility Dysfunction)
Overhead Deep Squat = DN (Hip and Lower Leg Posterior Chain Tissue Extensibility Dysfunction)


Based upon my SFMA findings I decided to attack the greatest areas of dysfunction first. I determined that the hip flexion/posterior chain TED (~40 degrees passive SLR), and cervical flexion & rotation were the patient's greatest limitations. This is what I formulated my initial treatment plan around as well. I began with an easy 5 minute warm-up on a stationary bike followed by some instrument assisted soft tissue mobilization (IASTM) to the posterior neck, proximal hamstrings attachment near the ischial tuberosity and distal attachment of the biceps femoris to prepare for some Muscle Energy Technique (MET).

Day 1: Pain (7/10)

Upper Trap MET

I performed MET techniques (redundancy?) for the upper trap, scalenes, and posterior neck extensors. I performed 3 sets of autogenic isometric inhibition on the right side and an extra set on the left side. This brought cervical flexion and rotation to FN immediately following application of the MET treatment.
I then instructed the patient to perform a couple sets of supine kettlebell carries. Each set lasted until the patient neared fatigue and was unable to retract and "pack" the shoulder/scapula. This was performed bilaterally. Reassessing the upper extremity pattern 1 revealed decreased winging compared with baseline.

MET for the Scalenes
Before Treatment
Next, I performed MET for the posterior hamstrings. Specifically, I also instructed the patient on performing an autogenic isometric inhibitory technique. I performed this bilaterally and found that the patient's passive SLR increased ~20 degrees immediately by the end of treatment.
After Treatment
The patient was unable to attempt rolling exercises due to passive back pain so instead of attempting to restore rolling I had the patient perform some light stretching hip external rotation and calf stretching after having their glutes and gastroc/soleous worked out using a rolling stick by my student.
Easy Hip ER Stretch
Straight Leg Gastrocnemius Stretch - Towel prevents pronation

Bent Knee Soleus Stretch - Towel prevents pronation again

Day 2: Pain (4/10)

The patient returned the second day with increased cervical flexion and rotation patterns but they were no longer functional. I repeated the previous days IASTM and MET techniques and once again these patterns were FN after application. In attempt to prolong these gains, I applied some Rock Tape to the upper traps and scalenes. Once again I had the patient do some kettlebell carries while in a supine position. 

The passive SLR was still increased from the previous day but was still about 15 degrees short of normal. The patient was able to foam roll without increased pain and so I had him foam roll the entire posterior leg chain before IASTM to the aforementioned patterns. Again, we used the previous day's MET application to the hamstrings and this increased the passive SLR to normal.

Due to the patient's ability to have such drastic increases in mobility in such a small amount of time I suspected crucial core stability issues. In attempt to progress this patient quickly I wanted to restore rolling ASAP for the supine to prone upper extremity rolling pattern. I spent about 15 minutes working on rolling with him before calling it a day. Rolling was definitely not perfect but was much better than when we began.

Day 3: No Pain?

On the third day of treatment the athlete returned with FN cervical flexion, and rotation patterns and now Multi-Segmental Flexion was a DN. The athlete reported being sore in the shoulders and hips but no longer was experiencing any pain. We were now about 7 days out from initial injury. I continued to work on rolling patterns and was able to progress to some quadruped and tall-kneeling exercises before the day's end. I could tell that the athlete was very excited to return to basketball so I began his RTP progress with some easy free-throw shooting.

Return to Play and Further Treatment:

Unfortunately, the next day the athlete returned home for spring break and was no longer under my supervision. Despite my best efforts to provide a substantial home-exercise program for this athlete he was so enthused by his progress that he did not stick to his HEP and instead played basketball and rested his entire break.

Upon returning to school the athlete was no longer compliant with his rehab despite the presence his many dysfunctional movement patterns (MSF, MSE, UE #1, MSR, SLS, ODS) and would no longer come for rehab. Reluctantly, I continued to let him participate in practice and JV games. It wasn't because I didn't care about making him better but more because of it being an issue of me being stretched too thin between other athletes that had issues and wanted my help and patients like him that needed my help but wanted none of it because they no longer suffered. It is not an ideal situation but it is the way the world works sometimes. Ideally for me I wish I had been in a position where there was somebody(like a strength coach) that was familiar with the FMS and corrective exercises to help these athletes overcome their dysfunction.

Points of Distinction & Conclusion:

What I thought was interesting regarding this case was the patient's history of traumatic injury to the left scapula and the presence of ipsilateral hypertonic neck muscular and poor scapular stability when compared bilaterally. I do not know if this was present since his previous injury but its hard for me to ignore such a glaring "coincidence" when I see it. When I initially worked with this athlete I had a little contempt for the incomplete rehabilitation that he must have been put through following his previous injuries. 

However, I soon began to feel and conclude that much of this could have been the athlete's own doing and not that of previous clinicians. I even tried the route of touting injury prevention, performance enhancement and how he may be a ticking-time bomb for re-injury and recurrence of back pain. Some people, patients, and athletes just do not seem to want help unless they are physically writhing in pain and unable to walk. I am not sure if this is pride or pure laziness! 

Mar 2, 2014

Help Me, Help You: I'm on Google Help Outs!

Hey everybody! It's an exciting yet very interesting time for me right now. I am half way done with data collection for my master's thesis, and if I finish it on time then I'll be graduating in the beginning of May.

On top of that and the focus of this post is that I am trying a new hat on for size with an endeavor into the world of Google Helpouts.  Google Helpouts is a relatively new service where Google tries to pair up everyday people needing specific help with experts in the respective fields of need. For instance, if I needed help with my car Google would set me up with a car mechanic to see if they could assist me via video chat.

So here is the part where I come in... I want to use Helpouts to assist people with moving better, feeling better, and performing better. I believe with my movement based system of assessment (FMS & SFMA) I will be able to help others achieve these goals. I am going to approach this initially with an injury prevention, movement analysis, performance enhancement and nutrition focus.

I look forward to broadening my pool of people to work with and if that person is you I can't wait to get started in assisting you to achieve your goals. Google has generously offered me a code allow you to have your first Helpout session with me for free (ADAM99V). Each session will last a minimum of 45 minutes if needed at a rate of $25. Check out my profile and schedule a Helpout with me ASAP! Can't wait to see what this brings! 

Feb 19, 2014

Where Have I Been?

Howdy Folks! I am sorry that I haven't been blogging even a quarter as much as I would like to be lately. However, in all fairness I have been pretty busy. What have I been busy with you might ask? Well...on top of being an athletic trainer for a collegiate basketball team (that is ranked #4 in its division for the entire country and likely to win their second conference championship in a row), I have been busy working on and trying to complete the research project for my master's thesis.

Dr. Erson Religioso over at The Manual Therapist has been interested in my research project and asked me to write a guest blog for him where I would discuss what I was doing with and looking at for my research. I was honored but it also gave him some time off from blogging to spend with his new-born baby girl! Congrats to him for sure! Anyways, here is a link to my guest blog where I talk about my research! I need to get back on the blogging train and finish my self-SFMA series as well! Sorry for the delay, everyone.

I've got some cool cases related to my patients, SFMA, PRI, and Rock Tape to blog about once I get some more free time! Can't wait to share them all!

Feb 3, 2014

Rocktape: Fascial Movement Taping Levels 1 & 2 Course Review

Swollen Knee? Try this on for size.
Howdy Folks, this past weekend I had the opportunity to attend both levels of Rocktape's Fascial Movement Taping(FMT) Seminars. This was a Saturday/Sunday conference and to an outsider it probably looked like an odd waxing/hair removal ritual with the use of some brightly colored kinesio-tape. In the past, I have been very skeptical of things like kinesio-tape and other various magical fixes for ailments. However, I have a background with and an interest in using movement assessments as an integral part of injury evaluations, treatments and prevention work. Therefore, I found myself intrigued at the description of the FMT course and by the amount of respected clinicians that were beginning to incorporate this tape/taping school of thought into their clinical practices. Here is the description straight from Rocktape's website:

"...Not your average taping course. Fascial Movement Taping Certification is a 2-part certification process led by industry leading experts in functional movement assessment and treatment. Fascial Movement Taping (FMT) is based on the obvious yet largely overlooked concept of muscles acting as a chain. Say good-bye to thinking about origins and insertions and memorizing directions of tape. Say hello to a framework of ‘taping movement, not muscles’."

I was immediately attracted to what they were promoting ("Taping Movement, Not Muscles") and how they were separating themselves from the reductionist style of taping muscles via origin and insertion. So...I signed myself up for the most readily available seminar! I also noticed that Dr. Perry Nickleston, DC, FMS, SFMA, NKT was lecturing/teaching this conference. This excited me because I knew of his writings via his blog, Stop Chasing Pain, and I also knew that he was integrating this style of taping with movement assessments via the SFMA and FMS. Perfect. This seminar was hosted on the campus of the National University of Health Sciences in Lombard, Illinois.

Day 1

Both days the course started at 8:00am and while I usually like to arrive to things like this at least 20-30 minutes early I have to admit that I ended up being about 5 minutes late for this course. There were primarily two reasons for this, a fresh blanket of snowfall left us with undesirable travel conditions and I ended up getting lost on the campus due to the poor communication of the room location. Fortunately, it seemed as if the bulk majority of people got a little lost including Dr. Perry himself!

The first day of the course followed a rough outline of these topics:

  • History
  • Effects & Potential Benefits of Taping
  • Differences between other kinesiotaping schools of thought and FMT's
  • Importance of and the interplay between the brain, skin, the nervous system, pain and the relationships with human movement.
  • Tape Properties
  • Taping for Acute Care/Fluid Dynamics/Edema Control
    • Indications
    • Contraindications
    • Precautions
  • Taping for Acute & Chronic Pain Control
  • Taping for Proprioception
  • Taping for Posture
  • Neuro-Taping
  • Scar Taping

That is a lot of stuff to cover in just the first day alone but in reality so much of the different topics build upon one another and have a lot of interplay. Also, this is a rough outline of what Dr. Perry went reality Dr. Perry jumped between topics, subjects and ideas at seemingly random times. Not because he was unorganized but because he wanted to promote critical clinical thinking that sometimes begins as unorganized and seemingly random observations. Skilled clinicians must then take these random puzzle pieces and turn them into something meaningful for both the patient and themselves.

Edema strips...I pretended to have some bursitis for my partner
Dr. Perry also delivered the content with an energetic and interested tone. He wasn't the boring monotonous type but you could tell he had a vested interest into what he speaking about. While he did use colorful language at times it was definitely not tasteless and provided some much needed levity for when your brain started reeling from all of the knowledge bombs being dropped upon it.

For this review I can't go into everything that I learned nor does anyone want to read that much about it. I also don't want to spoil all of what we learned but I would like to highlight some of the things that I really liked.

  • Integration of many schools of thought, such as:
    • Regional Interdependence
    • Tensegrity Theory
    • Current Neuro-Pain science
    • The works/ideas of great minds like:
      • Shirley Sahrmann
      • Vladimir Janda
      • Lorimer Moseley
      • Gray Cook
      • David Butler
      • Karel Lewit
      • & More
    • Movement Assessment

Things were both practical and philosophical.
Day 1 was definitely a day for developing a framework or laying the foundation for what we would learn on day 2. However, there were many universal concepts and taping techniques that we learned on day 1 that could be used and applicable after walking out the door that night. In fact, that is exactly what I did...Let me set the stage:

In the morning when the conference had begun I had received a text message from one of my patient's (a collegiate basketball player) that their back was very stiff, painful and locked up. They were barely able to dress themselves because of this. This wasn't pleasant news considering I was 2 hours away at the conference and wouldn't be able to treat him until that night...even worse was that he had a basketball game to play that night at 7PM. However, one of my colleagues was going to travel with the team and prep them before the game. He was able to help treat him before the three hour bus ride began and when they finally arrived. The bus ride was reportedly miserable and the athlete had to stand up or lie in the aisle for the bulk of the ride. With 30 minutes to go before tip-off the athlete was better than that morning but still wasn't sure of his ability to perform.

This is when I arrived to the game, I had been thinking of applying a tape job that I had learned that morning that involved taping the thoracolumbar fascia and the paraspinals for pain control and muscle spasm. I thought it was worth a shot and would hopefully work in synergy with the other various treatments he had received that day. I didn't have any Rocktape with me and just used some cheap kinesiotape from my kit(ended up starting to fall off halfway through the game). Nevertheless, the athlete reported that he felt much better and more comfortable with the tape and subsequently was able to play the entire game. Could this have been purely placebo? Possibly. Could it have been related to the prior treatments from my colleague? Absolutely. However, I don't care if it was just a placebo that made him able to perform...There was no downfall to trying and he wasn't suffering from an injury that should have removed him from participation. The entire experiences was a giant +1 for how I felt about what I was learning from the seminar.  Potentially I am even biased because of this experience but pain is a construct and I was able to help alter how he assessed his status.

Pre-FMT Seminar.
Post-FMT Seminar...Much better.

Day 1 Memorable Quotes/Knowledge Bombs:

  • Tape Movement, Not Muscles (Rocktape Slogan)
  • "Movement Never Lies"
  • "Treating scars is really cool s#^t!"
  • "Movement is the common denominator of injury"
  • Your body is always training and working out...against gravity.
  • "If you have a body, then you are an athlete."
  • " need all of that s**t to be STABLE!"
  • "If I change your posture, can I change your mood?"
  • "You need to have blueballs if you want to stick out"
  • Go stronger, longer - It's viagra for the whole body.

Day 2
Because I already made a novel out of day 1 let me try and keep this short and sweet. While day 2 definitely was full of mental "sweets" it definitely did not come up short. Day 2 was more dedicated to assessing movement and then applying taping techniques in attempt to change movements.

Applying the spiral chain tape job to one of my athletes.
To start off Dr. Perry began with a segment on the importance of movement for life, how movement is a behavior, and how we all have our own unique movement habits or patterns. All things I whole-heartedly buy into and believe in. He then tied that part all together nicely by throwing this classic Gray Cook quote at us, "It took a habit to make that pattern, and it's going to take a habit to break the pattern."

Dr. Perry then had a great slide where he compared using the Snellen Eye Chart as a vision assessment to using movement as an assessment. He stated that if you weren't able to read the letters he knew you needed corrective lenses and if you can't move well then you probably need corrective exercise. Albeit he admits that some people can't reach perfect, whereas some only need a tiny tweak.

Let me outline the major areas of what we learned about on day 2:

  • Movement Science
  • Fascia and Fascial Anatomy
    • Big influences from both Schleip and Thomas Myers here...
    • Fascial Chains/Slings
  • Movement Assessment, Taping Movement, and applicable Rehab/Corrective Exercises
    • Maybe you don't like the SFMA or FMS...Doesn't matter, the importance of testing any motion that is used for ADL's or sport specific exercises is just as beneficial and vitally important.
  • The Importance of Breathing and the role of the diaphragm
    • Releasing the diaphragm
    • Taping the diaphragm
  • Tweak Taping
    • Process of testing and then taping various skin glides to improve movement or patient's asterisk(*) sign
  • Pregnancy Taping
    • A nice tape application to assist pregnant women with low back pain, etc.
  • & Performance/Sport Specific Taping

We were not discussing abstinence, yet.
There was a lot of discussion during these two days about the importance of the brain & nervous system and the role they play in both pain and movement. I really appreciated a lot of the theories that this course was basing its methods from. There was a very simple slide at the end of the first day that summed up the differences between FMT's theories and other brands or styles of taping:
  • Functional vs. Structural
  • Movement vs. Muscles
  • Sensory vs. Mechanical
  • Assisting vs. Resisting
  • Elastic vs. Rigid
  • Integrated vs. Isolate
There was a lot of SFMA/FMS type movement tests and many of Dr. Perry's own favorite movement tests thrown into this day. We discussed important aspects of the movements, potential compensations, movement lynchpins, and ways to approach correcting and taping said movements. There was a lot of moving and not a lot of sitting during this course.
Here I used the "Big Daddy" 4 inch tape, for posture.
Overall, I would say that I definitely enjoyed the course and I have found myself practicing a lot of what I learned in the clinic this past week. I don't think the tape is a be-all-end-all treatment and it is definitely not taught as one but it is another tool for the toolbox. I enjoyed the discussion and dissection of movement, nerves and the brain, and the implications of everything combined. Would I sign up again if I had to remake the decision? In an instant. Do I recommend it to others? Yes, but I feel like I definitely benefited from having previous exposure to the SFMA/FMS. There were a few massage therapists and personal trainers in the class and I couldn't help but wonder if they were able to digest everything as easily.

Day 2 Memorable Quotes/Knowledge Bombs:

  • The brain wants to feel safe, there is no safer place than the ground
  • "Pass your finger through the fuzz" - keep moving.
  • "If you don't own breathing, you don't own movement"
  • "The feet are the window to the soul/sole." - Karel Lewit
  • Flip them over and tape their yang.

Dr. Perry, Myself, and Dr. Nick...Both of them making me look tiny.

Jan 17, 2014

My SFMA: A Case Study - Multi-Segmental Flexion Breakouts

Today's post is the fourth part of my self-SFMA(Selective Functional Movement Assessment) case study series.  Specifically, We will look at and break out my dysfunctional Multi-segmental Flexion movement pattern from my SFMA Top Tier Post.  

I'm jealous of those that can do this.

Here are the links for the first three posts of this series:
SFMA Top Tier Pattern Assessment

The SFMA works by assessing 7 general top tier movement tests. All tests are rated and ranked by two broad categories of dysfunctional or functional, and then two sub-categorizations of painful or non-painful. This means there are four basic appraisals of FN, DN, FP or DP. From there you perform a "breakout" of each dysfunctional pattern to determine the cause of dysfunction. Dysfunctional movement patterns are broken down using an algorithm that funnels and filters the problem into either a mobility dysfunction or a stability &/or motor control dysfunction (SMCD). 

This video will look at the dysfunctional multi-segmental flexion pattern.  Here is the latest breakout video:


Multi-Segmental Flexion Top Tier = DN (Unable to touch toes. Why? We don't know yet. Other Criteria for passing: Uniform Spinal Curve, Posterior Weight Shift, < 70 degree Sacral Angle)
Single Leg Forward Bend Test = Bilateral DN, yet symmetrical (Still Unable to reach the toes or floor. Why? We don't know yet. Proceed to the next test.) 

This test helped to determine if the forward bend was an asymmetrical or symmetrical dysfunction…in the presence of pain with the top tier assessment we could also use this test to check for symmetry with pain provocation.

Long Sitting Test = DN (Still unable to reach toes. Why? I don’t know yet but we did pick up on a few things.)

We still do not have a clear cause of dysfunction yet, however we do know that I cannot touch my toes and I do have < 80 degree Sacral Angle. This would indicate limited hip flexion and/or limited spinal flexion, or both.

If I had been FN with this test we would have proceeded to the rolling patterns to check for a fundamental motor control dysfunction.

Active Straight Leg Raise Test: Right=DN, Left=DN (Looking for at least 70 degrees of Hip Flexion)

Passive Straight Leg Raise Test: Right=DN, Left=DN (Looking for at least 80 degrees Hip Flexion and to be within 10 degrees of the Active SLR)

It is observed that my passive SLR has more than a 10 degree difference from the active SLR. This would indicate a possibility of a core stability, hip flexion strength problem, excessive hamstring tone, guarding or a hip mobility dysfunction.

Supine Knee to Chest Holding Thighs Test = DN (Unable to bring knees and thighs to chest while supine.) This test is used to check the mobility of the hips while they are in an unloaded or non-weight-bearing position. Doing this also helps to differentiate a difference between hamstring mobility and hip mobility dysfunctions.

Breakout Findings: If we follow the breakouts one would deduce that I have a hip joint mobility dysfunction or a posterior chain tissue extensibility dysfunction or both…as well as a possible hip flexion strength or SMCD dysfunction. But that isn’t as important considering that we would need to treat the mobility dysfunction before addressing any SMCDs.

Do you have any ideas/suggestions/thoughts? Let me know in the comments below!


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