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.
Howdy again Readers! Today will be the first part of a series of posts that I am lamely labeling "My SFMA." Each post will feature a video related to my own personal Selective Functional Movement Assessment (SFMA). Today's video will showcase my own seven top tier SFMA tests. Each additional blogpost and video will showcase a single dysfunctional top tier test derived from this initial video. In those videos I will perform the appropriate breakouts according to the SFMA to determine the reason for failing each individual top tier test and will discuss ways of treating these issues.
The idea behind this came from the fact that I am going to start increasing my physical activity levels, getting into better shape, and eventually getting back to marathon training. Working on preventing injuries is always easier than taking time away from exercise or training to work on treating injuries.
I also thought that doing this would help me to practice more with the SFMA system and will allow me to receive guidance or feedback from others with experience using the SFMA. If you watched the video it is obvious that I have a lot of preventing...or maybe I should say correcting to do. To find out and discuss what/how I should address, don't forget to come back for part II!
Hey Everybody! Just wanted to take a moment to share a video that I recorded yesterday while in the clinic. If you have ever been here before you have probably heard me mention Ankle Dorsiflexion and I often find it to be restricted in a lot of people.
Well I use a lot of different techniques depending on the situation and I wanted to show you all one variation that I've been using with success.
The only separating factor with this technique is that I'm using two edge mobility bands simultaneously. Hope you all enjoy it!
Today's blog post is a tiny rant inspired by overhearing this conversation time and time again between runners...
"Yeah its about time for me to replace my shoes, my 'insert body part here' has been acting up lately and 'insert symptoms here'. I definitely just need to get some new shoes."
While I concede the fact that slowly overtime the properties of your shoe will change and that will affect the kinetics or forces acting upon your body during activity. However, it is inane to think the real problem is your shoes. More likely is the fact that you probably have an underlying dysfunction that becomes sub-clinical with rapid change in kinetics (new shoes) that can allow the symptoms to alleviate.
Some people may argue that if this system isn't broke then don't fix it. If you have the money to constantly spend on shoes for every fabled 300-500 miles then maybe this is your thought process. On the other hand, what about the possibility that this potential dysfunction or running form issue could be detrimental in terms of potential performance. Even worse, this true dysfunction could eventually manifest into a much larger problem that isn't easily fixed with a new pair of shoes.
Want to know what the better solution is in my mind? Find yourself a clinician (athletic trainer, physical therapist, chiropractor, or doctor) that is experienced with runners, running biomechanics and assessing the entire body. We don't want to find somebody that is going to point out that your shoulder blades are dysfunctional (maybe...we do!?) but perhaps you have a dysfunctional hip or back issue that is manifesting itself as pain or injury at the foot or ankle? There is also the potential for somebody to suffer from a general medical issue that is not musculoskeletal related or potentially related to nutrition/lifestyle choices.
Do yourself, your running performance and your wallet a favor and refrain from buying tons of shoes and save up to get yourself a consultation with an expert clinician. Don't just settle for anyone but ask around and find somebody that has some of the aforementioned qualifications. That is my rant of the day!
This past weekend I had the pleasure of attending the Selective Functional Movement Assessment(SFMA) certification course in St. Louis, Missouri. More specifically, the course was hosted on the beautiful campus of Logan Chiropractic College/University. Logan did a great job of hosting this seminar and they were very accommodating and even had snacks/refreshments/coffee available. The only thing I could think to gripe about was my poor cellphone service in the basement classroom that we used. ;)
I was first introduced to the SFMA by a mentor of mine during my senior year of my undergraduate when he attended an SFMA course himself. He gave me some background about what it was and what they were trying to teach and ever since then I had wanted to learn it myself. Reading the book Movement by Gray Cook and becoming FMS certified didn't help my anxiousness either.
For those of you that don't know what the SFMA is..."The Selective Functional Movement Assessment (SFMA) is a series of 7 full-body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known musculoskeletal pain. When the clinical assessment is initiated from the perspective of the movement pattern, the clinician has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main musculoskeletal complaint, but contribute to the associated disability. This concept, known as Regional Interdependence, is the hallmark of the SFMA. The assessment guides the clinician to the most dysfunctional non-painful movement pattern, which is then assessed in detail. This approach is designed to complement the existing exam and serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of movement into musculoskeletal practice. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain." -SFMA.com
(Disclosure: This was not a free item given to me for review. I paid for this on my own but I have learned a lot from the creator of this product and that information has helped me and my patients a ton so maybe that makes me biased. If that is a bias I hope I continue this bias for a long time.)
Today I will be reviewing the Edge Mobility Band which is part of the Edge Mobility System by Dr. Erson Religioso, DPT of The Manual Therapist. I have been following his blog for quite awhile now and from the start I was very intrigued by the magical blue bands that he kept using on his patients and in his videos.
I would watch his videos and read his blog posts about the increased function, mobility and decreased pain associated with using these bands as part of his treatment protocol. At the time I was unaware of the Voodoo floss bands so this was my first exposure to compression wrapping for anything other than edema prevention/reduction. I even tweeted at him back in April of this year to inquire whether a poor graduate student like myself could substitute a resistance band for his bands and get the same effect. He answered my tweet with complete honesty and told me that there was nothing magical about the Edge Mobility Bands. He stated that a simple resistance band should suffice.
While there may be nothing magical about these bands there is definitely something special about their construction and design considering that I wasted many hours trying to experiment with resistance bands instead of coughing up $24 bucks for two Edge Mobility Bands of my own. Most of those experiments led to cutting off the circulation of extremities, excessive body hair pulling, and the constant rolling and tearing of many thera-bands. It simply wasn't a feasible substitute for me but maybe it works or would work for somebody that is more coordinated, stubborn or cheap than me.
I recently got a new phone and I have been in the process of downloading new apps for it. This is my first Android phone so I am getting used to it but it has made me think about how much I use different apps on a daily basis in the clinic, on the field or in the classroom.
This also gave me the idea of telling you all about ten different apps that I find myself using quite frequently. I am always looking for more apps that will help keep me organized and productive so if you have any suggestions please feel free to comment below.
I have both an iPad and a Samsung Galaxy S4 so this list will include both android and Apple apps but many are available to users of many different devices. Now onto the list and in no particular order...
Therapeutic modalities had an entire course devoted to it in my educational curriculum and there is more and more research being done on the topic. There is plenty to learn about the theory and application of each individual type of modality from ultrasound to electrical stimulation and plain old ice.
I definitely learned a lot and the use of modalities has been definitely beneficial for me as a clinician, especially for acute injuries. However, I have found myself and others at fault for relying upon modalities too much. There are too many clinicians relying upon the "powers" of modalities instead of using the power of movement and rehabilitative exercises. I'm not saying that they don't have their place because they definitely do but they often are too heavily relied upon.
Somehow, someway during my initial years of schooling I
developed this idea that the profession of athletic training needed to compete
heavily with other professions. I used to think that I needed to boycott the
teachings of other professions like physical therapists, strength and
conditioning specialists and person trainers. I also had an urge to compete against others within my own
profession and try to be most intelligent or most competent clinician/academic. Finishing school and starting my professional career has definitely changed my thought processes.
While some level of competitiveness is necessary in a world
where multiple professions compete for patients or clients from the same pool
of people due to similar skill sets. However, I have begun to realize that this
previous thought process hurt three groups of people. Thinking and behaving the
way I did disadvantaged myself (the clinician), potential patients, and the
different professions.
Recently, I have worked to open myself up to the ideas of
others and other professions. Just think, where would human intelligence even
be now without the collective body of knowledge that is shared between
individuals? We might be able to think the same but the accumulation of
knowledge that is passed around and down through time is what makes it special.
I have been following Dr. Erson Religioso's blog, The Manual Therapist, for quite some time now. I also recently subscribed to his OMPT Channel section where I have learned quite a few evaluation and treatment techniques to add to my arsenal. Dr. E has training in a plethora of different schools of thought and one of them is the Mechanical Diagnosis and Therapy or MDT for short. Part of his MDT skill-set is a various amount of techniques that he refers to as "resets". He often uses them as part of his evaluation, treatment and home exercise programs. I hope I am saying all of this accurately, at least. Here is a couple videos of Dr. Erson Religioso III, DPT, FAAOMPT explaining the what, why and how related to these resets.
This is Dr. E's video highlighting the his favorite resets, and why they work.
An updated but longer video for Dr. E's favorite resets.
The Toe Pain:
I am currently pursuing a post-professional graduate degree so that means I am still a student (will be one for life) and that I still have finals. A couple Monday’s ago I was sitting around with a few of my classmates while waiting to take a final practical exam. One classmate mentioned that she had a very painful big toe on her right foot. She had been suffering this pain for a day or two since walking around Chicago the entire weekend while wearing ill-fitting footwear. She had only had the pain on one side without any direct MOI besides gradual onset related to the shoes and walking. She had pain with great toe extension when toeing-off in her gait cycle.
Dr. E’s videos had been on my mind and I was curious if his resets would really work because they were a foreign concept related to anything I had been taught. I had the idea of doing repeated-end range flexion of the great toe for about 20 repetitions and I asked her if she minded trying out the experiment. She obliged and we went to town with the repeated “resets”.
After I finished with the 20 or so repeats I asked her to stand up and walk around. Alas, she had no pain and no other complaints appeared. I told her that there was a chance that this would be a transient effect and that she may need to repeat this exercise about 10 times every hour. However, her pain never returned that day and hasn’t to date. I believe a week later when I inquired about her toe she mentioned that my “voodoo” had fixed the issue for good. While I don’t think I was doing any magic or voodoo I do think this highlights some merit to these resets on an n=1 level. Half of evidence-based practice is clinical experience and so far my “clinical” experience has been great; although I do wish I had some more extensive training or knowledge about MDT. I was impressed enough with these results that I tried using the repeated ankle plantar flexion reset for my girlfriend’s aunt who has had years of constant heel pain. This was just an offhand encounter at Mother’s Day brunch but it immediately took her symptoms from a wince-inducing 8/10 to a 4/10. I gave her instructions to continue these as a self-empowering home exercise and I hope she sticks to them. I really want to see how she progresses.
Conclusion:
My conclusion about these resets so far is that I like them but I don’t see them as a replacement to my current clinical skill set. I see them as being another tool and a great way to put responsibility into the hands of the patient. I understand the theory and concept as explained by Dr. Religioso. However, I definitely feel and want to learn more about this stuff before it starts to become a mainstay of my clinical practice.
Today I wanted to showcase a mini-case study of an athlete
that I consulted with recently. This was a 22 year old female collegiate track
and field athlete. This patient was a mid-distance runner that specialized in
the 800m event.
http://trialx.com/g/Calf_Pain-1.jpg
The athlete complained of chronic pain at the
musculotendinous junction of the Achilles tendon that had been recurrent at the
beginning of track season the previous two years. The athlete had a previous
history of turf-toe like symptoms in the ipsilateral great toe.
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Caution
All content on this blog is meant as instructional and educational. The author and guest authors of this blog are not responsible for any harm or injury that may result. Always consult a physician or another proper medical professional for medical advice.
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