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!

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Please Leave Your Poor Hamstrings Alone!

"Tight Hamstrings, The Epidemic That Never Existed."

 -Dr. Erson Religioso, DPT

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.

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)

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.

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.

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.

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.

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