Nov 12, 2014

Video Request: How To Tape Turf Toe

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Howdy Readers! After posting my latest Movie Monday video I was asked by an individual to post a video on how to tape the great toe when suffering from turf toe. First of all, turf toe is a forced hyperextension of the great toe or first metatarsophalangeal (MTP) joint which results in damage to the plantar aspect of the 1st MTP joint.

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Often times this can result in damage to a structure known as the volar plate. Due to the nature of this structure, this injury can be very debilitating for athletic activity and can even cause suffering with simple things like pushing off  with the foot while walking. This taping technique is commonly used by certified athletic trainers to allow athletes to return-to-play after minor or moderate injury and it can be used to protect, rest, and allow proper healing of the joint after initial injury.


However, this should only be used as an acute intervention and other rehabilitative exercises and manual therapies may be warranted. While limiting great toe extension may allow a person to remain physically active with such an injury or lower pain levels with activities of daily living...it is a necessary and crucial motion for the great toe joint to have. Therefore, it is imperative that pull pain free range of motion be restored after suffering a great toe injury such as turf toe.


Nov 10, 2014

Movie Monday: How To Tape a Sprained Thumb


Good morning readers! Another Monday and so I bring you another movie! This week's video is another how-to for taping but this time it is for your thumb. In this video I show two variations on how to tape an injured thumb with two different levels of support/restriction. There is one more modification that could be done with this tape job to take it to the ultimate level of restriction and that is called "The Hood". However, I thought the video was long enough as is and I reserve that for football lineman normally. Here it is! 


Nov 6, 2014

October Blog Traffic & Income Report

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Howdy Readers! I wanted to start a new tradition for the blog and it is something that I have long contemplated. As I have continued to blog over the last year or so I have gotten more interested in the  art, science, community/culture, and "theories" of blogging.

I have learned a lot from other bloggers by reading their content, seeing them lead by example, and I have also learned a lot from their advice/content directed at blogging specifically. My blog was started as a way for me to network with others, share ideas, practice my writing, and to hopefully help others.

I never started a blog with the intention of making any money and I didn't even know it was possible to monetize a blog in the beginning. I have watched others make life changing decisions as a result of their blogs and I have seen some people make substantial amounts of blogging. I do not make any substantial amount but none of us would make any money if it wasn't for the readers/traffic that we generate.

Therefore, I wanted to become more transparent with my blog and any income that it may generate. I want to focus on several key areas with this and these posts.

  • How I have done with traffic generation and revenue.
  • What has generated changes in the aforementioned
  • What I have learned from the changes.
I have seen others such as Lindsay & Bjork from Pinch of Yum and I think that it is an honest, open, and educational dialogue to have with you readers, the blogging community, and potential new bloggers. I am still learning a ton but I hope that I can share ideas or lessons learned along the way with others that may be curious. While I do not make much money from this endeavor (like I said this is not the goal) I think it is only right to stay transparent. Therefore, I will be sharing my monthly traffic and ad revenue reports with you in these posts.

So let's begin then...because this is my first post and there is nothing to compare it to - I will post the statistics from my previous 3 months.

Traffic

This sort of traffic is laughable by many in the blogging community. Some people average this many page views by the second  or minute. However, we must all start somewhere and it is a big increase from when I started blogging where I was happy to see 400 page views a month. Some additional traffic stats that I have to share are:

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I am encouraged by my relatively low bounce rate. The bounce rate is the % of people that leave my blog after visiting only one page. This is associated closely with the pages per session stat which is how many pages people view on average while looking at my blog in one viewing session.

So how much did I make? Well for one...I forgot to mention that these statistics are for my blog only and do not include my YouTube video stats. I will however include my earnings from my YouTube video ads. I have three sources of revenue that I use to monetize my content. Google Adsense for ads on my blog, YouTube (technically Google Adsense) for my videos, and Sovrn (formerly Lijit) for my website ads as well.
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So what is the breakdown you may be wondering? Well here it is by source:

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A couple of things stick out at me from the past few months when I look at this table:
  1. I had an error with my Sovrn Ads and I obviously wasn't very observant of this and it went quite awhile without me fixing it. Once I fixed it there obviously was a big increase. I am excited to see where this goes over the next year if traffic continues to increase.
  2. Secondly, I see a definite and consistent increase in YouTube ad revenue as I start to create more YouTube videos and increase the amount of subscribers to my YouTube Channel. I hope to create more YouTube videos that are of better quality with better content over the next several months so I am curious if this trend will continue in a linear fashion.
Well...There you have it folks. I will do this at the end of every month. I am definitely not bragging about these stats nor do I see my blog ever making me rich. Some people have made it rich from their blogs and that is impressive. Those scenarios took the right mixture of hard work, great content, dedication and the right niche of readers. I see quite a few flaws with how I run my blog to ever reach it big but fixing some of those flaws also creates a better overall experience for my readers and creates a better looking blog overall. So who knows...

Nov 4, 2014

Once a Student - Always a Student



So if you have ever read my blog before you probably know that I am a big fan of The Manual Therapist and Dr. Erson Religioso, III, DPT. Its true and I have learned a lot from him, his blog and his videos. One of his mainstays is the ability to be dynamic, open-minded, and ever evolving and that is why he calls the way he practices The Eclectic Approach.

These are great qualities for clinicians and I have tried to adopt this style of practice myself. I learned about basic resets and repeated movement exams/treatments from Dr. E's material. I thought I had a pretty good handle on the basics. However, ask any expert in anything...The basics are basic but they are not basic. What? I mean that even if you try or practice sometime a hundred times...there is still something new to be learned or nuance to be perfected over time. So what is the point?


Well I have been struggling with some neck pain and muscle spasm for the last week as a result of my brazilian jiu jitsu training. I hadn't really done much for it because most clinicians suck at self-assessment and treatment. I at least made sure that I didn't have any fractures or other major red flags which thankfully I do not. So instead I set up a consultation with Dr. E and I was able to learn a few things even though we technically didn't do anything that I didn't already know! Check it out!



So what did I learn about using repeated-motions that I didn't know before?

  • I wasn't aware that I was compensating out of fear-avoidance when attempting to treat myself using repeated-motions (specifically on repeated cervical extension with retraction)
  • I didn't realize how profound of an impact there would be by correcting this
  • A little bit of resistance while performing the repeated-motion like an active PNF can be immensely helpful for getting to end-range.
  • I was not aware of how quickly I was going with my repeated-motions. Slowing down the pace of movement seemed to help lower the perceived threat and opened up my range of motion.
  • I didn't think this had much an impact previously, I used to let my patients go to town doing their repeated motions as quickly as possible. There were some cases where the repeated-motions didn't net the effect that I was looking for and this could be why.
So what is the moral of today's post? Don't be afraid to get a second opinion or second set of eyes when trying to treat yourself as a clinician. Doing so doesn't make you a bad clinician, dumb, or incompetent...It just means you are currently a patient and not a clinician. Secondly and more importantly, ALWAYS keep an open mind and be prepared to learn something new every day, every hour, every minute. Lifelong learning = lifelong enjoyment.

This isn't quite what I had in mind.

Nov 3, 2014

Movie Monday: How to Buddy Tape Your Fingers!



Good Morning Readers! I hope nobody has a case of the Mondays...Today we have our second installment of Movie Mondays. This video will share with you a common, basic, easy but often screwed up taping technique. Athletic Trainers are pretty much the experts at taping athletes and have been for over a decade now.



However, some tape jobs like this can be done by individuals themselves. Which could obviously come in handy when an athletic trainer is not present or when you participate in a sport where it is not common for athletic trainers to be present. This is a great taping technique when a person has suffered an injury such as a minor interphalangeal or metacarpophalangeal (finger) sprain and needs additional support to allow participation while the injury is still healing. This could be done with several types of tape from light stretchy stuff, to somewhat flexible elastikon to a more restrictive but cheap and common athletic/white/coaches' tape. It just depends on the amount of support you want versus the amount of movement or function you want/need.

Additionally, this could be used prophylactically in sports where the fingers are at risk for injury when isolated...I'm looking at you football linemen, rugby & judo players, brazilian jiu jitsu athletes, or grapplers of all shapes and sizes.

There are a lot of taping techniques that an athlete could apply themselves and I hope in the future I can share some more of them with all of you. However, somethings like an ankle tape job are not very feasible for an untrained person to do alone. Especially when you could save time and money by getting a decent ankle brace instead. That sort of product or scenario doesn't exist for this tape job.

Oct 27, 2014

Movie Monday: The Vertical Compression Test


Howdy Readers! Today is Monday and hopefully the beginning of a new tradition here at Eat.Run.Rehabilitate.! I hope to continue to upload and post videos weekly and sometimes even biweekly if I get overly ambitious. I have been trying to take some time and pre-record some videos so that way when I do have time to do some editing and posting it will allow me to be more caught up on everything.


Anyways, today's video is going to be about the Vertical Compression Test. This is another test that I learned from Jay Dicharry's Anatomy for Runners book. I've said it before and I'll say it again...not a bad book to have around for reference! This is a great way to go about assessing a person's overal posture on their postural stability and its effect on the entire kinetic chain. Check out my video below!


Oct 25, 2014

What To Look for When Looking at Running Gait

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Howdy Readers! A lot of people like to talk the talk when it comes to assessing running gait/form. However, a lot of what people seem to say regarding gait sometimes boils down to just that...all talk. Some people look at a still frame or picture of an individual running and make claims based off of one moment in time. Somebody hook these people up with Miss Cleo because they must be able to look into the past and the future! Amazing!

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In reality, there are very specific things that you should be looking at from very specific reference points. Specifically, to best evaluate a person's running gait you would want to be able to evaluate their form from both frontal plane and sagittal plane views. Do you know what they are already? Well I didn't have this handy dandy knowledge until after I attended the Healthy Running conference (see my review here) and learned this from Dr. Mark Cucuzzella and Jay Dicharry, MPT, CSCS.

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 Before this I put most of my faith into my clinical assessments and often shied away from visual gait assessment. You shouldn't try to separate these two entities...they should be combined together to draw conclusions. There were two main reasons for this. One, I didn't have a nice high-speed camera for this. It is pretty difficult to be sure of what you are seeing unless you have the ability to record at higher frame-rates. Secondly, I didn't have this nice little handy-dandy checklist that I am about to share with you. Note: Please remember to compare left to right for these items when possible.

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Frontal View
Back when I first started running, on the left in the white.
Excessive Heel Strike!!

The Frontal View


  • Step Width
    • Narrow, Neutral, or Wide?
  • Arm Movement
    • Abducted, Cross-over, or In-line?
  • Trunk
    • Ipsilateral, Neutral, or Contralateral tilting/lurching?
  • Hip Stability
    • Adduction vs.  Abduction?
    • Internally vs. Externally Rotated?
    • Neutral?
  • Dynamic Knee Alignment
    • Valgus vs. Varus vs. Neutral?
  • Midstance Foot Position
    • Supinated vs. Pronated vs. Neutral
  • Cadence
    • Slow? Excessively Quick?
  • Other Abnormalities?

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The Lateral View.

The Lateral View


  • Vertical Displacement
    • <4cm li="" limited="">
    • 4-6cm = Optimal
    • >6cm = Increased
  • Arm Movement
    • Excessive anterior/forward motion
    • Neutral
    • Excessive posterior/backward motion
  • Torso Orientation
    • Anterior vs. Posterior vs. Neutral
  • Lumbopelvic Posture
    • Lordosis vs. Neutral vs. Flat
  • Hip Extension during Toe off
    • 15-20 degrees = normal
    • 5-15 degrees = limited
    • <0 degrees="severely" li="" limited="">
  • Knee Excursion during Stance
    • >25 degrees = flexed
    • 20-25 degrees = optimal
    • <20 degrees="stiff</li">
  • Foot Strike Pattern
    • Heel vs. Midfoot vs. Forefoot
    • Neutral Contact point vs. Foot contacts anterior to COM (Center of Mass)
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We all run different, but there are general things that we should look for and look to avoid for all running gaits!

Conclusion: There you have it folks! A simple check list to use for each view! I don't really use a posterior view anymore but you could still use the frontal view checklist for a lot of the same things that you might see on the posterior aspect. Additionally, don't assume that a duck is a duck when performing these analyses. Just because a person runs with zero hip extension does not necessarily mean that they have zero hip extension! Check their passive mobility! This could easily be a stability or motor control problem. 

Another example of this could be that just because you see something like excessive dynamic knee valgus don't assume they have a weak set of glutes! It could be due to poor ankle dorsiflexion that produces compensatory subtalar joint pronation and then causes compensatory knee valgus. Practice these assessments to work on being able to assess these things individually but quickly. You want to get to the point where you notice the "abnormal" instead of having to check for "normals" everywhere. 

Oct 13, 2014

Are Your Shoulders Ready for Brazilian Jiu Jitsu?

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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.

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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.

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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

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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.

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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.

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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.

!!Update!!
 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...


Sep 8, 2014

Three Non-Negotiables for Running

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Running a half-marathon indoors is as boring as it sounds.

Howdy Folks! Howdy? Why do I say that? I don't know but here in Miami everything keeps on thinking that I am saying "How ya doing", so perhaps I need to find a new greeting. Nevertheless, lets get back on track. Speaking of track...Do you run, work with runners, or want to run? I wrote today's post to share with you all some concepts that I learned from Jay Dicharry and Mark Cucuzzella at the Healthy Running seminar.

So guess what...? There is a lot more to running that going in circles around a track or bombing down trails in the woods. How about we break it down and discuss three critical components to running?These are critical for running "better" without taking a hit to your economy or risk of injury. I didn't say these three concepts will make you the best runner or prevent 100% of injuries. However, if you don't have these three things then you my friend are missing a few pieces of the puzzle.

1. Runners Need Mobility. Not More but Not Less.

What the heck does that mean? It means you need just enough mobility to move what needs to be moved without creating a compensatory movement pattern. It also means that going above and beyond that threshold may not be beneficial. We are talking Goldilocks here, not too tight and not too loose. We need you to be just right. The good thing here is that "just-right" probably fluctuates between body type, activity type (sprinter vs. distance vs. hurdlers), and running form. However, there are some minimums. We need enough mobility to allow our legs to extend behind us. This requires adequate hip extension, ankle dorsiflexion, and first ray dorsiflexion. We need other joints to be mobile as well but these are the essentials. How much? We are looking for 15-20 degrees of hip extension, 30 degrees of ankle dorsiflexion and another (ankle is already dorsiflexed to 30 degrees before measuring great toe mobility) 30 degrees of metatarsophalangeal (MTP) dorsiflexion of the first ray on top of that. These are not "normal" ranges of motion for these joints but these are the amount needed for running.

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2. Runners Need Stability.

If you try to drive a car with poor alignment very far then you are in for a hard a time. The human body is no different. You need a stable and properly aligned "chassis" for efficient energy transfer. This means you need enough "core" control or stability to maintain your alignment while running, for the entire run. You need to be stable from stride 1 through mile x/the finish. This requires stability in all three planes and not just the sagittal plane where many of us tend to hangout. I see poor stability as a common fault for many of us. It is challenging to have proper motor control, especially for long periods of time. We do not want unstable levers to interact with and try to control high/rapid forces.

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You need to be stable from beginning to end.

3. Runners Need Strength & Power.

You're a runner, right? The prime example of an "endurance" athlete. Pure cardio, pure aerobic metabolism, purely about getting in the miles or minutes. Wrong. Runners need proper levels of strength and power as well. There is plenty of evidence to show that weight training can be very beneficial to endurance athletes and runners! Your hips (glutes) need to be able to propel your entire body up and forward...very very quickly, many many times. In addition, vertical ground reaction forces (vGRF) in running peak at about 2.5x body weight! Think about that for a second...That would be the equivalent of a 150lb runner doing a single leg back squat with 225lbs on the bar for a total of 375lbs through one leg!

What about plyometrics? Economic running is very plyometric in nature...it is all about how well you can store and release elastic energy! If we are going to have stable levers from non-negotiable #2 then lets take advantage of that and apply some large forces through them!

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Gravity is relentless. You need to be strong because we are always fighting it.

In Conclusion
Take these three concepts in isolation and they make sense. Look at them in combination and they make even more sense! Hey wait a minute! How do these things even help runners? Well, overall these are needed to better our running economy and that is done by addressing two key concepts of economic running form.

  • Better Storage and Release of Elastic Energy
  • Minimized Loading Rates

Now we just need to take these conceptual ideas and put them into practice, right? Stay tuned for future posts where we will discuss how to evaluate and address these issues.

Disclaimer

Disclaimer: Please note that some of the links on this blog are affiliate links and I will earn a commission if you purchase through those links. I have used all of these products listed and recommend them because they are helpful and are products from companies that I trust, not because of the commissions that I may earn from you using these products.

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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