Hey guys! Here is a quick video that I shot the other day while working with a patient of mine. I just wanted to share a technique for ankle mobility that utilizes the Edge Mobility Band (or a theraband).
Case: 21 year old male, collegiate basketball player, 4-weeks post ankle sprain. Imaging revealed avulsion fractures of the medial deltoid and lateral calcaneal-fibular ligaments. Patient was ordered by the team physician to be immobilized in a boot and on crutches for the first three weeks following injury. Initially coming out of the boot, dorsiflexion and plantar flexion were almost a zero for both active and passive ROM.
In the video, this obviously didn't return ankle ROM to normal ranges but definitely increases it with just one set. I often repeat this 2-4 times depending on the patient's tolerance to the compression. I often have the patient walk a longer distance if tolerated as well. It also substantially lowers the patient's perceived discomfort associated with ankle "stiffness" and "soreness". I use this in conjunction with several different mobility techniques but is nice because certain techniques like a traditional posterior glide are much too uncomfortable for me to use with this patient at this stage. This is a pain free alternative for him!
Hey everybody, today I wanted to take the
time and ask a fellow athletic trainer a few questions regarding challenging
beliefs and conventional wisdom. This post ties in perfectly with my last post when I interviewed Professor Timothy Noakes on challenging beliefs as well. I want to introduce you all to Joshua J.
Stone, MA, ATC, NASM-CPT, CES, PES, FNS. He is a fellow blogger at Athletic Medicine, and has been receiving a lot of attention
lately for taking a stance on the use of ice (cryotherapy) and NSAIDS in treating both
chronic and acute injuries. (Also see… Ice: The Overused Modality?)
Josh’s arguments are polarizing and have
definitely stirred some controversy on a topic that can invoke strong feelings
by many. However, the arguments that Josh puts forth are based on evidence,
logic, and an intellectual curiosity to question everything.
Welcome Readers! Today I have the privilege and honor of sharing a back and forth that I had with Dr. Timothy Noakes of Capetown, South Africa. If you are big into exercise physiology, running/endurance sports or high fat/low carb diets then you probably know of or have heard of Professor Noakes! Dr. Noakes is a brilliant man and when he speaks, I listen. He is a passionate man and has strong feelings but he is also passionate about science and is no stranger to challenging beliefs or conventional wisdom. He is infinitely curious and questions everything. Two hallmarks of a great mind. I hope you all enjoy the interview and are able to take one or two things from it! Me: Welcome Professor Noakes! I know you have been a man of many hats but could you give us a little background about yourself for the readers? Professor Noakes: I trained as a medical doctor at the University of Cape Town and during my training I realized that health, sports medicine and exercise physiology really interested me rather more than did the standard medical curriculum. So during my training I was more interested in how medicine related to sport rather than the information I was meant to be learning. I perceived that medicine was spending a lot of money on the management of chronic disease without appearing to be particularly successful. In addition, I realized that athletes were not getting much care from medicine and it seemed to me that the future of medicine lay more in prevention by promoting healthy lifestyles and exercise and, as a consequence, I realized that sports medicine would become increasingly more important.
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.
Today's post is kind of half personal story/half conjecture/half observation(wait, that doesn't add up!). To begin, I have now been wearing a minimalist/zero drop type shoe everyday for both casual use and exercise/running. The only time I wear a shoe that is not completely flat is when I wear my dress shoes with my suit for basketball games.
One of my current favorites
I am a huge proponent of wearing zero drop shoes with a wide toe box and the absence of a "toe spring". I feel this shoe design interferes the least with proprioception, normal foot mechanics, and proper tissue length. Think of non-zero drop shoes as being like a mini-high heel.
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
I am finishing up my last year of graduate school and for one of my courses we have guest speakers from other health professions come and present to our entire athletic training graduate program. This week we had a pleasure of a having a local Physical Therapist(PT) come and present to us on Dry Needling.
Dry Needling is a practice that is growing in popularity in the United States and more and more clinicians are getting trained in it. Athletic Trainers, at least in my state, do not have it in their practice acts to perform dry needling so we must refer out to others that are able to do so. I have referred a patient to this particular PT for dry needling in the past and they had great results from the treatment.
This PT presented on the background of Dry Needling and discussed how it differed from traditional acupuncture (local twitch response on trigger points vs. meridian therapy), and we learned how he incorporated this "modality" into his clinical practice. We also discussed related research to dry needling and it was a pretty informative lecture. Ultimately, he presented the case of undergraduate athletic training student (that is doing a clinical rotation at his clinic)and their chronic injury that coincidentally mirrored that of the patient's that I referred to him. He then went on to utilize dry needling on this student in front of us as part of his lecture, I whipped out my camera to get some video footage of it for all of you!
Before I show you all the footage I will present you with his case:
History: A 23 y.o. college student has been experiencing R side LBP that began
insidiously and has been progressively worsening over the past 2 years.
He also reports occasional
radicular symptoms to his R posterior thigh area. He rates the
intensity of his symptoms between 3/10 - 8/10 that worsen with prolonged
sitting in class and while driving. He also notes that he avoids heavy
lifting activities at the fitness center including
dead lifts and squats. His symptoms are generally decreased with
ambulation.
Imaging(who cares, right?): x-rays were unremarkable, L-Spine MRI revealed moderate disc bulge at L4-L5 level
Self-Report Measures: Modified Oswestry Disability Questionairre: 14/50 = 28% Fear Avoidance Belief Questionairre - Work Subscale: = 13
Significant Past Medical History: R ACL reconstructive surgery ('11)
Objective Findings:
ROM:
repeated trunk flexion = no change in sx,
repeated extension = pain that increased with repetition, repeated R side
gliding = no change in symptoms, repeated
L side gliding = no change in symptoms Sensation: B LE = intact to light touch and pin prick throughout MSR: B patella and B Achilles = 2+ Strength: R knee ext = 5/5, R knee flex = 5/5, R hip abd = 4-/5, L knee ext = 5/5, L knee flex = 5/5, L hip abd = 4+/5 Mobility: moderate thoracic spine hypomobility; moderate lumbar spine hypermobility w/ pain provocation Palpation: severe R glut max, glut medius, and piriformis hypertonicity w/ pain
provocation; elicitation of local twitch response w/ palpation Assessment: Myofascial Pain Syndrome related to poor strength and stability of lateral hip musculature and core stabilization and hypomobility of the thoracic spine.
Treatment:Dry Needling of the "trigger points" found in the gluteus maximus and gluteus medius. Followed with IASTM of the surrounding musculature and appropriate rehabilitative exercises for strength and stability. There wasn't a true home exercise program recommended to this patient but I would expect that he usually gives them one. I am curious how patients would respond to light IASTM prior to the dry needling instead of doing the opposite.
Here are the two videos! Enjoy! Anyone else have experience with dry needling via patients or personally? I haven't felt it but I am curious to how it feels! I have witnessed it to be an effective treatment but I am still apprehensive about "trigger points" as a topic or entity or our ability to detect them reliably.
Gluteus Maximus Dry Needling
Gluteus Medius Dry Needling (Really Long Needle!)Shorter Video
This weekend I am off to St. Louis to officially get trained in the Selective Functional Movement Assessment (SFMA) and I am very excited! I was introduced to this by my mentor during my senior internship as an undergraduate and have wanted to take this course since then. If you have read Gray Cook's movement you are probably familiar with the system but if you aren't then the simplest way of describing it is to call it a movement based evaluation system. System and movement are the keywords in that sentence. It is the medical professional evaluative half of the Functional Movement System (brother to the Functional Movement Screen). I will write a course review next week and post it here!
This is a quick video that I shot in the Athletic Training clinic the other day when working with a basketball player. This is a self-hip internal rotation mobilization that I have my patients perform on their own.
This helps to maintain the benefits gained from treatment and manual therapy when working with me in the clinic. Ideally, this would be done about once an hour for a single set of 10-20 reps but it can be hard to have a student-athlete comply with this and fit it into their busy schedules. I also have some of them do this before practice and lifting weights for temporary mobility gains.
This is done by the athlete applying an active-assisted hip internal movement while simultaneously providing slight distraction/traction. Check it out!
I have this athlete using an Edge Mobility Band in this video but they could also do this without the band. However, I feel that using the band is more efficacious due to the better hand-hold and compression provided by it.
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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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