Showing posts with label sports medicine. Show all posts
Showing posts with label sports medicine. Show all posts

Apr 25, 2014

It moves, it breaths...it LIVES!

I wonder if any of my blog readers are still "sticking" around?


Howdy Readers (if I have any left)!

I just wanted to take a quick moment to let you all know that I am still alive. I have so many post ideas, videos, and things that I want to share with you all. However, I am ashamed that I have let my dedication to posting slack so much!

I thought that this short post could be used to sum up some of the changes that are about to occur in my life and to state what I have been up to. First of all, I have now successfully defended my thesis and only have a few tiny edits and format changes to make before finally submitting it. Secondly, this means that I am only a couple of weeks from completing my Master's degree at Illinois State University. I had a lot of great classmates, and instructors with a variety of backgrounds and personalities that have helped me diversify how I think about, look at and treat my patients. I owe a huge thank you to all of them.



This also means that soon I will be finishing my tenure at Illinois Wesleyan University as a graduate assistant athletic trainer.  This is a bitter sweet feeling for me. I have made a lot of good memories, learned a lot, and met some great people over the last two years. I will miss working with the Men's Basketball team at Illinois Wesleyan. I had a great time working with them and it was a blast when they went to the NCAA Div. III Sweet Sixteen last year and the Final Four this year. They were the first team that I was solely responsible for after becoming certified as an athletic trainer. My interactions with the players, the injuries, coaches, fans and parents have been integral in influencing my clinical practice. Over the past few weeks I have received a lot of praise from them, their parents, and the coaches but the truth is I owe them just as much thanks.


What makes this even more bittersweet is the fact that they will be the first and last team that I solely work with for quite a while. This is because I have decided to accept a doctoral student position at the University of Miami (Florida) to get my PhD in exercise physiology. There, I will work as a research assistant instead of being a clinician like I did with my master's.

This is going to be a huge change of pace, culture, and life for me. I have lived in the midwest all my life, loved cold weather, and never attended a private college before. I am definitely in for some culture and climate shock when I get there. However, I do look forward to trying my hand at continuing my clinical skills in a non-traditional fashion for an athletic trainer. I don't have anything set in stone and who knows how busy I will be but I may attempt to do some small-scale concierge or private 1on1 work clients that will focus on injury prevention and performance enhancement. Coincidentally, there was a very fitting article related to this type of service over at The Manual Therapist today.


I am getting to the point of this post where I need to wrap it up, say good bye and get back to work. There is much to be done with moving, preparing my thesis for publication, scholarships, and getting back in shape myself. It is a very exciting time for me and I hope that from this point on I will be able to contribute to my blog more frequently than I ever have before since it's inception. In fact, this blog is now over a year old! I know this because I just received a domain renewal notice ;) I have received about 100,000 page views in the past year. I hope that I can increase that exponentially over the next 365 days! I wish you all the best.

Mar 3, 2014

Concussion, Cervical, TMJ/TMD or a Combination Thereof?

Myofascial Release of the Temporalis
Welcome readers! Today's post is about a very recent case of mine straight from the clinic! This is a mini case-study about a 22 year old male collegiate basketball player. This patient took direct blow via an elbow to the anterolateral aspect of the cranium during a basketball game on Saturday evening. After the game the athlete presented with several concussion symptoms as well as TMJ pain and a palpable and audible click with opening and closing of the mouth.

The patient presented with these findings during the assessment:
  • Cranial Nerve Testing all WNL
  • Dermatomes & Myotomes WNL
  • Concentration, Immediate Recall, Delayed Recall, Balance, and Orientation via the SCAT3 were all WNL
  • Patient Reported Concussion Symptoms
    • Headache, "pressure in head", "Not feeling right", Difficulty Concentration, and eventually added the symptom of difficulty sleeping the next morning.
  • Glasgow Coma Scale: 15/15 (WNL)
  • 1 Previous Concussion in the symptom prior where the patient suffered much more severely on the SCAT2 and had post-concussive symptoms for 2-3 weeks following initial injury.
Long before this case presented to myself I often wondered about possible connections between concussion symptoms, and temporomandibular joint(TMJ)/temporomandibular dysfunction(TMD)/ and cervicogenic headaches. I questioned whether a person could present with concussion symptoms due to potential muscle guarding/spasm and possible involvement of TMD/TMJ issues.

Obviously I still treated this patient as having a concussion and his symptoms had slightly increased the following morning(Sunday) as well. Nevertheless, despite the fact that I was treating him for a concussion and ordering complete neurocognitive rest (despite having perfectly acceptable objective test scores on the SCAT3) I decided to treat his TMJ and neck musculature using manual therapy. NOTE: Current policy with our team neurologist is to assume its a concussion and wait to imPACT test the patient with cessation of symptoms.



I only did a few minutes worth of manual therapy for this patient and they were done with very light pressure. I started with 1-2 minutes of light IASTM to the Masseter, and myofascial release of the Temporalis using my hands. (Both pictured in the above photos.) I followed these up with some light lateral mandibular glides bilaterally for about 30 seconds each.


Finally, I applied lateral-medial/posterior-anterior pressure with the pads of my second digit on both sides of the first palpable spinous process while the patient simultaneously performed an active cervical retraction or chin tuck, if you will. This was done in an alternating fashion with pressure on again/off again in 2-3 second cycles for about 30 seconds total.

The patient reported rapid improvement in their symptoms but not complete cessation and they started to slowly return about 40-50 minutes later...Which one might expect with a concussion...or with a rapid responding patient that wasn't given a HEP to perform after manual therapy. Which one is it? I can't be sure but I play on the safe side and assume the worst. Additionally, the click/pop of the TMJ was no longer present after treatment

The following day (Monday) the patient reported complete cessation of his symptoms and the TMJ issue had not returned. The patient underwent imPACT testing which came back normal and began the first step of a graduated return to play progression.

In conclusion, what does this all mean? I don't know. What if I wouldn't have chosen to treat the patient with manual therapy. Perhaps he would have awoken still with total cessation of symptoms and would have passed his imPACT as well. (This still doesn't even prove he didn't suffer a mild concussion!) Another potential alternative is that the patient could have continued to suffer from "concussion" symptoms for days at a time and perhaps this would have delayed his imPACT testing and subsequent return to play/activity/sport. 

This is not necessarily a bad thing because it is always best to play it safe. However, it also means that my patient/athlete would have had to suffer undue pain/discomfort related to his TMD/"concussion" symptoms. He also would potentially have to miss out on class/social activities/and experience a lot of undue psychological stress if I hadn't treated these findings. I am just curious if others if had these similar thoughts/case/experiences or what you all think of this? 

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 over...in 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."
  • "...you 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 1, 2014

A Year in Review: 13 Lessons of 2013


Happy New Year and welcome to 2014! This is my first post of the year and my 75th post overall.  This is going to be a reflection on some of the things that I learned in the previous 365 days. I was inspired to write this post after reading many of Mike Reinold's similar posts over the last few years. I guess I learned a lot this year because this turned into an epically long post. Sorry.

Dec 24, 2013

Top 5 Posts of 2013!


Happy Holidays and a Happy New Year to all of my readers! I'm not sure if I actually have any dedicated readers yet but happy holidays to any happenstance readers as well! This post is a highlight of my top 5 viewed posts of 2013. I know it isn't technically 2014 yet so maybe I will be proved wrong. However, if you are new to my blog or haven't read all of my posts then maybe this recap will enlighten you to a popular post that you missed.

Dec 16, 2013

My SFMA: A Case Study - Cervical Breakouts

Time to make an assessment of myself

Today's post is second part of my self-SFMA(Selective Functional Movement Assessment) case study series.  Specifically, We will look at the dysfunctional cervical spine movement patterns from my SFMA Top Tier Post.  In the first post/video, I was dysfunctional/non-painful (DN) for the Cervical Flexion Pattern, and the Cervical Rotation Pattern to both the Right & Left.  However, I was functional/non-painful (FN) for Cervical Extension. In case you missed it, here is the 7 top tier tests again.


The SFMA works by assessing 7 general top tier movement tests. From there you perform a "breakout" of each dysfunctional pattern to determine the cause of dysfunction. Dysfunction 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).

Assessment:
This video will look at the dysfunctional cervical spine patterns. Specifically, cervical flexion and cervical rotation to the left and right. I was functional for the cervical extension pattern so that pattern does not require a breakout assessment. Here is the breakout video:




Results:
Cervical Flexion Top Tier = DN (Unable to bring chin to sternum. Why? We don't know yet.)

Active Supine Cervical Flexion Test = DN (Still Unable to bring chin to sternum. Why? We don't know yet.)
If I was now FN we would know that there is a postural and motor control dysfunction or stability/motor control dysfunction...or both, affecting cervical flexion. This includes the c-spine, T-spine, and shoulder girdle postural dysfunction. Laying supine removed the postural and stability requirements of the gravity dependent/loaded standing position from the top-tier tests

Passive Supine Cervical Flexion Test = FN (Chin is now to sternum)
We can now assume the cause of the dysfunction was due to an active cervical spine flexion stability dysfunction or motor control dysfunction...or both. We know it is not a mobility issue because I had full motion when all stability and motor control requirements were removed and the movement was performed passively. If it was due to mobility reasons then my GF would not have been able to passively bring my chin to my chest. Mobility problems always present with consistent findings!

Cervical Rotation Top Tier = DN to the Left & Right (Can not rotate chin to mid-clavicle or at least 80 degrees, Why? We don't know yet)
This test no longer requires this degree of rotation and the ability to bring the chin to the clavicle, at least this is how I was instructed in October of 2013.

Active Supine Cervical Rotation Test = FN (At least 80 degrees of rotation bilaterally without a significant asymmetry)
We now know that the dysfunction was related to a postural and motor control dysfunction or a stability and motor control dysfunction...or both. This is why my top tier cervical spine rotation test was dysfunctional, not because of my perceived tissue "tightness."


Treatment:
It is said that there are many ways to skin a cat...that being said the SFMA is a tool or a system of assessment. It is not a specific approach to treatment. However, there are general guidelines based off of the findings and it also lays a road map of treatment for you(eg. mobility before stability, working your way down the top tier tests). Specifically, in my case I do not have any mobility dysfunctions within the cervical spine but if I follow the philosophy of the SFMA then I need to address the SMCD of the cervical flexion pattern before attempting to correct SMCD dysfunction of the cervical rotation.

There are many avenues for treating this dysfunction from dry needling to IASTM to MDT principles to using the 4x4 Matrix or etc. I can't advocate that one approach will be better for addressing my dysfunction than another...but I do have a system of assessment to judge the efficacy of each potential intervention. Perhaps IASTM and MDT combined will work great for 90% of my patients but I don't know that...all I need to know is how to assess-intervene-reassess. Oh and I should probably stay within my practice act, so use what tools you have and those that you are comfortable with.

Thoughts? Do you think my breakouts and assessment have been accurate so far? What would you do with me? I know what I would do....finish the SFMA breakouts, first. Come back as I continue to break out my many dysfunctional movement patterns.


Dec 10, 2013

My SFMA: A Case Study - Pt. I



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!

Nov 5, 2013

1 Month of The SFMA: My Reflections



It has now been exactly a month since I took the Selective Functional Movement Assessment certification course in St. Louis, MO. You can read my initial course review here. I have been trying to incorporate the SFMA into my clinical practice as much and as often as possible since then. I wanted to take the time to highlight some thoughts and self-reflections from this process so far.

Oct 18, 2013

Quick Video Update: Ankle Dorsiflexion Mobilization with Movement Variation.

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!



Oct 14, 2013

Is It Time to Replace Your Running Shoes...or Time To Get an Evaluation?



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!


Sep 8, 2013

Empathy: Better to Have too Much or too Little?



This is a short post today that I am typing up on my cell phone.  I'm on the team bus riding back from a football game where I just had to tell a college freshman that their first season of collegiate athletics was over after playing only one game.

This athlete most likely completely ruptured their ACL today and will probably need season ending surgery. This wasn't the first patient that I have delivered this news to and I'm sure it won't be the last. They took the news very well compared to others and didn't visibly weep.

Despite the athlete taking it so well I found myself trying to decide how empathetic I should be towards him. The mother of the athlete was openly weeping and so I tried to answer any questions that I could for the family and athlete.  I also tried to be as positive when discussing the future.

Seeing that this athlete is a freshman I have only known them for less than a month at this point. I don't have a lot of history with them and I don't know their personality very well yet. This will change as they will be forced to spend the next six months at least rehabilitating this injury after surgery.

I am writing this post because I find myself wondering if I was too cold, too invested or neither. Actually, I'm wondering if it's better to be one or the other? Maybe it's better for the patient to be overly empathetic and better for my own psyche to be a little desensitized.

The true answer probably lies somewhere in the middle and depends on the situation, the athlete's personality, and the severity of injury. I'm curious how others deal with these types of situations and thought processes. This isn't something that is explicitly taught or discussed in school. Perhaps this is related to why there is such a high rate of burnout in health care professions?

Thoughts or comments? I'd love to hear what y'all think.


Aug 26, 2013

Ten Handy Apps for In The Clinic and On The Field.


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...

Jul 20, 2013

Strengthen and Mobilize Your Feet!

I have put together a video compilation of some of my favorite mobility and strengthening exercises for the foot. The target of most of these will be for the intrinsic soft tissues of the feet but you can't fully target just one area or muscle of the body with an exercise. I didn't think of all of these ideas and I tried to give credit to those that I learned them from where I could!



These would be good for anyone with a history of ankle, lower leg or foot injuries. It doesn't matter if you wear Hoka One Ones or nothing on your feet because all of us should have strong and mobile feet. Your feet do a ton of work for you and are your main contact point with the ground. Take care of them!


Jul 17, 2013

Stay A-Head of the Game: Concussion Literature


Concussions are still a hot topic and will continue to be for the foreseeable future. The media loves to discuss them, coaches loathe them, parents fear them, and the research is still within its infancy. It isn't time for anyone to jump to conclusions or panic but it is definitely a good time to stay informed and properly educated on the topic.

This blog post came as a result of the latest edition of the Journal of Athletic Training, which had several concussion related articles. To begin the issue there was a special editorial written by concussion research expert, Kevin Guskiewicz, PhD, ATC, FNATA, FACSM. He is also the chair of the Department of Exercise and Sport Science at the University of North Carolina at Chapel Hill.
Dr. Guskiewicz recommends that sports medicine professionals stay informed on upcoming concussion research to be published within the next 6 months. 


This includes the ‘‘Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012’’ that was published in this edition of the Journal of Athletic Training and originally published in the British Journal of Sports Medicine in March, 2013. He advises that these documents "will define the standard of care for athletic trainers and team physicians for at least the next 4 to 5 years. These documents are very well prepared and will make significant contributions to the sports medicine community." 

He also had these three major closing points:

  1. Read these documents,
  2. Develop and implement a sound concussion-management program and policy
  3. Check the boxes each time you manage a patient with a concussion. 


Dr. Guskiewicz had one last closing piece of advice that is very important for concussion management but is applicable to everything we do as clinicians and arguable important for any person to learn. I know football season for me is fast approaching so I know I need to make sure I get caught up on my concussion literature.  I will leave you with his advice in quotes and a link to the latest journal issue!



"But just as important, be sure you go the extra mile to educate yourself and your athletes and to ensure that both you and your athletes are protected. "





Jul 14, 2013

Biphasic or Premod? Who cares!


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.

Jul 10, 2013

ATC Hacks Profiles Moi! And More!

I was recently asked by the guys over at ATCHacks if I was willing to answer some questions for their "In The ATR" series. I have been following @ATCHacks on twitter for awhile now and I love what they have been doing, what they are about and how they are doing good things for the profession of Athletic Training. Their "In The ATR" series features athletic trainers and asks them questions about their history, methods, tips and med-kits. 

I was not only honored to have them ask me to be part of In The ATR, but they have also asked me on to regularly guest blog for them about my experiences as a graduate assistant athletic trainer. This next year is going to be an exciting and fast paced time for me! Head on over ATC Hacks to see their feature on me and don't be afraid to register at their site to get full access to their information for free. They have some insightful articles for athletic trainers and aspiring athletic training students.

Jul 2, 2013

3 Lessons I Learned In My First Year As A Clinician


I am quickly reaching my one year anniversary since finishing my undergraduate education and becoming a certified athletic trainer. A lot has happened since then including starting work on my master's degree, my master's thesis and working with many different athletes and teams via my graduate assistant position. I have learned a lot and it would be impossible to list everything but I figured it would be a good idea to reflect back on a few major themes.

Disclaimer

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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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