Intro to Hand Therapy Course Review

The hand has always been a weak area of mine, anatomy, treatment, the whole 9 yards. Thus, I was inspired to take an Intro to Hand Therapy Class taught by Patricia Roholt, a certified hand therapist (CHT) with 30+ years of experience.

 The intent of this class was to provide a broad overview of all things hand therapy.  We dove into hand anatomy, evaluation, treatment, splinting, and specific conditions.

My favorites parts were the anatomy, evaluation, and splinting sections. All of these areas were weak points of mine, and I definitely achieved quite a bit of clarity with these concepts. P-Ro is an absolute monster when it comes to splint making, and I loved all the tricks up her sleeve she had to make effective splints. It’s an area I’d like to dive into a bit more.

if the above areas are what you consider to be a hole in your game, I’d consider checking out her online offerings to see if her courses would be right for you.

Check out the full review in the video below. Once you got my final verdict, check out some of the meaningful highlights in the notes below.

Hand Anatomy

Let’s look at some of the fascinating anatomy that accompanies the hand.

The Carpal Bones

Laying your anatomy foundation starts with carpal bone appreciation, and the potential accompanying clinical problems.

‘ppreciate these bones, fam

As you can see, there are two rows of carpals. In the proximal row, the scaphoid and lunate articulate with the radius, and the lunate and triquetrum articulate with the ulna. The pisiform is in this row as well, but doesn’t articulate with any other bones. Its function is to allow for passing of the ulnar nerve and artery, and provide a distal attachment for the flexor carpi ulnaris (FCU).

The big red clinical red flag that can occur in this row is a scaphoid fracture. Because of poor blood supply to this bone, people often needed to be casted for 2-4 months to allow for healing.

Fractures in this region are often not immediately visible on imaging. Thus, a subsequent x-ray ought to be performed 2-3 weeks after the initial injury.

The second row of carpal bones consists of the trapezium, trapezoid, capitate, and hamate.

The trapezium is a bone of interest. In individuals undergoing surgery for thumb carpometacarpal joint (CMCJ) arthritis, part or all of this bone is often removed to increase space. Space is further increased by harvesting the palmaris longus tendon and shaping it into a pseudo-trapezium.

The Hand’s Retinacular System

The retinacular system ensures that tendons stay adhered to the hand while gliding, allowing for optimal hand function.

We can break up the retinacular system into three areas:

  • Extensor retinaculum – made up of six compartments (with first compartment potentially contributing to DeQuervains tenosynovitis)
  • Flexor retinaculum – Contain several synovial sheaths. Fingers II-IV all have their own sheath, whereas fingers I & V share a sheath.
  • Finger retinaculum

The most complex of these systems is the finger retinaculum. There are several pulleys that compose this system to adhere the flexor tendons to the finger: five annular pulleys (A1-A5) and three cruciate bands.

These pulleys are arranged in the following sequence:

Well I’m no Picasso, but do you like it?

For reference, here are the location of the Annular pulleys:

  • A1 – Metacarpophalangeal Joint (MCPJ)
  • A2 – Half the length along the proximal phalanx
  • A3 –Proximal interphalangeal joint (PIPJ)
  • A4 – Middle phalanx
  • A5 – Distal interphalangeal joint (DIPJ)

Trigger finger is a condition implicated within this system. Inflammation and swelling can adhere flexor tendons to the A1 pulley, restricting finger extension. Surgically, the A1 pulley is cut to alleviate this condition.

The Zones of the Hand

There are five zones of the hand to describe portions of the volar surface. It is important to know these zones from a surgical standpoint.

Pink = zone 1; black = zone 2; purple = zone 3; green = zone 4; blue = zone 5

 

  • Zone 1 – Proximal to Flexor digitorum profundus (FDP) insertion
  • Zone 2 – From Zone 1 to A1 (considered no man’s land due to poorest recovery times, as hand intrinsics reside here)
  • Zone 3 – From A1 pulley to volar carpal ligament
  • Zone 4 – Carpal tunnel
  • Zone 5 – Proximal to carpal tunnel up through forearm

Keeping flexor tendons healthy post-surgery involves differentially gliding their tendons. These movements help prevent flexor tendons adhering to the pulleys.

To understanding how to effectively perform these maneuvers, we need to understand flexor tendon muscles.

The big two that we are differentiating are flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP).

FDS primarily flexes the PIPJ…

Don’t stress about the FDS

 

…while FDP flexes the DIPJ.

You down with FDP? Yeah, you know me.

 

Thus, maneuvers must be performed to ensure individual gliding:

It is also important to note that FDP has two separate muscle bellies: one that goes to finger II, and the other that is shared by III-V. Thus, injuries along these particular areas require protection of all fingers, and may require joint blocking exercises to ensure tendon health.

The Extensor Mechanism

Whew, this part is a beast and very complicated structure. Let’s see if we can sift our way through it.

So gangsta that I grew up on that extensor hood, fam!

Here we see all the pieces that make up the extensor mechanism, which combines hand extrinsic and intrinsic muscles.

Let’s start with extensor digitorum communis (EDC), which acts to extend the MCPJ. This guy runs centrally along the finger, and splits off into sagittal bands that surround and stabilize the MPJ. In the picture, these would be a part of the “hood.”

Makes me think of that Wu-tang song every time

The EDC attaches to the middle phalanx, assisting with PIPJ extension. The fibers then split off into lateral bands, which are the criss crossed above past the middle phalanx. These bands are a merging with the hands intrinsic to perform DIPJ extension. The other muscles that would make up the lateral band insertion include the dorsal and palmar interossei, and the lumbricals—all helping to create DIPJ extension.

The Thumb

The big thumb intrinsic muscles are the called the thenar muscles, which help the thumb perform the important opposition movement. These include…

  • Abductor pollicis brevis
  • Flexor pollicis brevis
  • Opponens pollicis
Scalpel not included

These muscles attach proximally at the volar carpal ligament. This attachment is important to consider with someone who has a carpal tunnel release, as this surgery disrupts the thenar muscle attachment, potentially compromising thumb function.

Nerve Supply to the Hand

The big three nerves relevant to the hand are the median, ulnar, and radial nerve.

Yellow = Median; Green = Ulnar; Pink = Radial

The median nerve is the big dog when it comes to thenar muscles and first two lumbricals. Injury to this nerve will impact thumb opposition and sensation.

The ulnar nerve innervates many of the muscles of the hand, including lumbricals 3 and 4, all the interossei, and the hypothenar muscles. Thus, an injury to this nerve can have severe repercussions to hand function. Limitations could include inability to perform a lateral pinch (requires adductor pollicis activity), can’t abduct finger V (need abductor digiti minimi), and will have difficulty utilizing extensor mechanism.

The radial nerve is less of a big dog, predominantly responsible for sensation. There will be alterations in wrist and finger extension, but since hand intrinsics are innervated by the median and ulnar nerve, some finger extension is preserved.

Common Hand Pathologies

Ever seen a swan neck or boutonniere deformity before?

Finger 4 is a swan neck, finger 5 is a boutonniere

With a swan neck deformity, the proximal interphalangeal joint (PIPJ) upwardly displaces secondary to a disrupted  transverse retinacular ligament. These ligaments prevent dorsal displacement of the lateral bands.

With the boutonniere deformity, a PIP extensor tendon defect causes the proximal phalanx to migrate upwardly as the DIPJ extends.

The de facto treatment for the boutonniere is splinting the PIPJ in extension and the DIPJ in flexion.

Evaluation of the Hand

 

Most of this section was your typical evaluation fare: history, range of motion, posture, palpation, etc. But there were a few key pearls I gleaned.

Measuring Thumb Opposition

Measuring opposition according to this grading system is something I am employing much more. We measure opposition via a 10-point grading criteria:

  • Stage 0 – Thumb tip to lateral aspect of proximal phalanx of index finger
  • Stage 1 – Thumb tip to lateral aspect of middle phalanx of index
  • Stage 2 – Thump tip to lateral aspect of distal phalanx of index
  • Stage 3 – Thumb tip to index tip (considered early true opposition)
  • Stage 4 – Thumb tip to middle tip
  • Stage 5 – Thumb tip to ring tip
  • Stage 6 – Thumb tip to small tip
  • Stage 7 – Thumb tip crosses small finger DIPJ
  • Stage 8 – Thumb tip crosses small finger PIPJ
  • Stage 9 – Thumb tip crosser small finger proximal finger crease
  • Stage 10 – Thumb tip crosses distal palmar crease.

With stages 6-10, you want to make sure that the thumb slides down the small finger to ensure accurate opposition, as patients can compensate with thumb adduction, providing a false measure.

Sensation Return After an Injury

There are many ways to assess post-injury nerve function. One test used is tinel’s, in which you tap along the nerve to determine nerve regeneration. If you tap a portion of the nerve, it will produce an electric shock sensation to the point where the nerve has regenerated. This test can also signify potential nerve entrapment.

Based on how the nerve heals, constant and moving touch are some of the first sensations to return. Until these sensations are felt, true sensory re-education cannot be performed.

Wound Classificiations

 A weak spot of mine has always been wound care. Patricia helped stratify decision making for wounds in this class by classifying wound healing types. There are three.

First Intention

This type of wound is a sutured wound, in which range of motion across joints that may compromise the wound ought to be limited for 2 weeks after initial suturing.

Second Intention

This type of wound is an open wound, in which the treatment varies. The intent is to maintain a wound that is not too dry or wet.

Third Intention

This wound is intentionally left open at first to clean and debride, then is sutured and grafted once healed. Treat as a second intention wound until suturing/grafting occurs, then first intention once the wound is closed.

Scar Healing Times

 Scars have a specific healing times as well in the hands, which drive decision making in terms of progressing range of motion.

Coloring can be informative of how well the scar is healing. Typically, the redder the scar, the more immature the tissue is. Whereas white scars are a bit more mature.

Compared to normal skin, scar strength improves according to the following timeline:

  • 2 weeks:3-5%
  • 3 weeks = 15% (tolerates AROM)
  • 4 weeks = 30-50% (safe for most activities)
  • 2 months (70%)
  • 3-6 months (80%).

Splinting the Hand

 The splinting section was one of my favorite aspects of the course and really where Patricia shined.

The overarching goal of splinting is to give the hand what it cannot achieve.

Splints can be classified into three different types, either prefabricated or custom:

  1. Static – These splints lack moving parts, used for rest, protection, positioning, or function in some cases (e.g. nerve injury).
  2. Serial static/static progressive – These splints are used to increase mobility in joints and soft tissues via low load long duration stretching. The former requires therapist-remolding, whereas the latter is changed by modifying components (screw/Velcro)
  3. Dynamic – Splints that contain moving parts to compensate for motor loss, correct for contracture, protect tendons (by pulling in direction they cannot actively contract), or exercise muscles.

There were several different types of splints she suggested, but the real treat was watching her make splints. She had developed some pretty neat tricks to save on cost and maximize function. I don’t necessarily have any specifics, as the splints she makes were quite customized to the individual’s needs.

The Ideal Position to Splint the Hand

To illustrate important components of hand anatomy, it helps to look at how the hand is often splinted after an injury.

I’d rather some more IPJ extension, but like me, this splint is close to ideal, though not perfect #yesimsingleladies

The common position to splint the fingers in is with the MCPJ in flexion, and the PIPJ and DIPJ  in extension.

This position maintains tautness of all the collateral ligaments of each joint: the MPJ collaterals are taut in flexion, and the PIPJ and DIPJ in extension. This position also protects the volar plate, which is a ligamentous structure that limits PIPJ hyperextension. These structures must be preserved at all costs to avoid contracture in these areas.

Sum Up

There is a broad overview of Patricia’s Intro to Hand Therapy course. Though not perfect, it sparked many treatment ideas for me and helped me better appreciate the complexity of the hand.

To summarize:

  • Understanding hand anatomy is important in developing treatment paradigms
  • Flexor tendons must be differentially glided to ensure health post-surgery
  • Splinting acts to give the hand functions it cannot achieve on its own

What tricks do you have up your sleeve for assessing and treating hand complaints? Comment below and let us know!

Photo Credits

Anatomist90

Becguglielmino

Henry Gray

Wikipedia

Anatomist90

Anatomist90

Harrygouvas

Henry Gray

Henry Gray

Grant, John Charles Boileau

Grant, John Charles Boileau

Scoliosis, Morton’s Neuroma, and Just in Time Learning – Movement Debrief Episode 22

Movement Debrief Episode 22 is in the books. Here is a copy of the video and audio for your listening pleasure.

Here were all the topics:

  • Thoughts on Treating Scoliosis
  • Thoughts on Treating Morton’s Neuroma
  • Why I prefer Just in time vs just in case learning

If you want to watch these live, add me on Facebook, Instagram, or Youtube. They air every Wednesday at 8:30pm CST.

Enjoy.

                

Here were the links I mentioned tonight

Advanced Integration Day 4: Curvature of the Spine

PRI Advanced Integration

Ipsilateral Hip Abductor Weakness After Lateral Ankle Sprain

Method Strength – Dave Rascoe

Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

 

Check out the mentor program

Resilient Movement Foundations Course Review

I recently had the pleasure of attending a class put on by my fellas at Resilient Performance Physical Therapy.

A jolly old time with old friends and new

I went to this course for a few reasons. First off, I of course support the home team. I can’t even front, Douglas Kechijian, Trevor Rappa, Greg Spatz, and I go way back, and are very much related through IFAST family and directly (Doug is my younger older brother, Trevor is my son, and Greg is my stepson #dysfunctionalfamily).

That said, there is were a couple big things I wanted to take away from this course, which I did in spades:

  • Mastering basic movement
  • Program design

In these two areas, the Resilient fellas delivered in spades. Knowing what good technique is in the basic movement patterns, how to coach, and how to regress, are all underappreciated topics that these guys teach quite well.

So should you take this course? An emphatic hell yes. I give a more indepth review as to why in the video below, so go ahead and check that out.

Once you got the verdict, check out my favorite takeaways in the course notes, and then for the love of God sign up for a course of theirs!

Click here to check out the Resilient Seminar Page

Continue reading “Resilient Movement Foundations Course Review”

Thoracic Outlet Syndrome, New Grad Advice, and Interview Questions – Movement Debrief Episode 21

Movement Debrief Episode 21 is in the books. Here is a copy of the video and audio for your listening pleasure.

Here were all the topics:

  • The step-by-step process of treating someone with Thoracic Outlet Syndrome
  • How to leverage your strengths as a new grad searching for a job
  • Why new grads need mentors
  • My favorite questions to ask interviewers and to find out about a company

If you want to watch these live, add me on Facebook, Instagram, or Youtube. They air every Wednesday at 8:30pm CST.

Enjoy.

                

Here were the links I mentioned tonight

How to Design a Comprehensive Rehab Program

All About Jobs – Movement Debrief Episode 20

“The Briefcase Technique” by Ramit Sethi

Join my mentorship program, get a movement consultation, or let me design an online fitness program for you.

Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

 

Check out the mentor program

Knee Mechanics During the Bodyweight Squat

A Note from Zac

This week we have a guest post brought to you from my boi Benjamin Fergus, a Chiropractor friend of mine, who sent me an incredibly comprehensive video on squat mechanics.

I first met Ben at a DNS course way back in the day, and he was a pretty sharp kid then. Having watched this video, I can see that his knowledge base has only grown.

In this spot, Ben goes over the mechanics of the bodyweight squat, and I think you folks will tremendously appreciate his explanation of what is occurring at the knee.

Once you’ve finished watching the video, check his stuff out at GRIP Approach. You won’t be mistaken.

Enjoy!

~Zac

The Knee’s Position in the Squat

This overview of the ‘Complex Movements of the Knee Complex’ is not intended to tell you the right way to squat, but rather to show what is happening with the anatomy during movement and why. It also will show you how to read/name the movements with observation from the side and front.

Here on earth gravity is king in a squat. We like to keep the line of gravity and center of mass (COM/COG) situated over the midfoot. All variations of the squat can be seen as unique attempts to move our mass closer to the ground while keeping the COM over the midfoot.

There are no rights or wrongs named in this video, just a look at the possibilities of joint motion. What does ‘ knee internal rotation’ mean? We’ll look at that terminology and study what that translates to at the hip, femur, and shin in this biomechanics breakdown.

Benjamin Fergus, DC, DNS
Founder of GRIP Approach Educational Seminars
www.GRIPapproach.com

 @GRIPapproach on Instagram and Twitter

All About Jobs – Movement Debrief Episode 20

Just in case you missed Movement Debrief Episode 20, here is a copy of the video and audio for your listening pleasure.

Here were all the topics:

  • Pre-Job Preparation
  • Job Searching
  • The Interview Process
  • The Post-Interview Process
  • Negotiations
  • The Job

If you want to watch these live, add me on Facebook, Instagram, or Youtube. They air every Wednesday at 8:30pm CST.

Enjoy.

 

                

Here were the links I mentioned tonight

Resilient Performance Physical Therapy

“Here’s How to Really Prepare for an Interview” by Ramit Sethi

“The Briefcase Technique” by Ramit Sethi

Roger Dawson’s Secrets of Power Negotiating

Join my mentorship program, get a movement consultation, or let me design an online fitness program for you.

Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

 

September in Review

Every week, my newsletter subscribers get links to some of the goodies that I’ve come across on the internets.

Here were the goodies that my peeps got their learn on from this past August.

If you want to get a copy of my weekend learning goodies every Friday, fill out the form below.  That way you can brag to all your friends about the cool things you’ve learned over the weekend.

Biggest Lesson of the Month

Much of our successes and failures can be linked back to the habits we have. I noticed many times this past month that ineffective habits I had picked up were hampering my progress and productivity. One simple change (eliminating a to-do list, blocking out time to do things) was a complete game changer for me.

If you are doing something you don’t like, how do your habits keep you falling into that trap?

Quote of the Month

“Quality is not an act. It is a habit.” ~ Aristotle

Very much linked to the above lesson. We need quality to become automatic, and who better to illustrate this than an O.G. like Aristotle.

Hike of the Month

Pictures never do these things justice.

This was a tough decision to make on multiple fronts. This month I hiked four National Parks, saw a National Monument, and did all types of ill stuff.

Though Sequoia National Park will forever hold a dear place in my heart, Yosemite was hands down one of the most impressive things I’ve ever seen. The variety of terrain, the challenge of the 18+ miles I hiked, and the #views are hard to beat. I go back and forth on if I liked Yosemite or Zion better. But regardless, you should probably check it out.

Training

Quick Hit: Sprinting Tip

Here I discuss my favorite sprinting cue that I learned from my boy Derek Hansen. If there is one cue you could give to make your peeps faster, this is it.

Podcast: 20 Tips for Young Coaches

I wish I had this podcast when I was first starting out. My boi Mike Robertson lists several high quality tips that young coaches should apply to get the most out of many things–internships, networking, life. These tips are really good for anyone to apply in any situation.

Quick Hit: How to Lateral Shuffle

The lateral shuffle is a fundamental move that most any athlete ought to perform effectively. Here I provide my how-to’s and favorite cues…all in under 60 seconds #niccagestyle

Not to be confused with the equally impressive truffle shuffle

Article: ‘Science’ and the Barbell Hip Thrust

Doug Kechijian just continues to destroy the internet. In this article, he uses recent research on the hip thrust to critique a larger problem in science and performance–transfer-ability. Many times we argue about minutiae, when we really need to validate broader scope problems more effectively. Who better to discuss this issue than my buddy Douglas.

Quick Hit: Landing Mechanics 101

This past week’s quick hit goes into detail on how I coach landing mechanics, perhaps the most important piece to jumping safely and effectively. There are three keys to effective landing. What are those? Well, check out the vid.

Podcast: Bill Hartman on Building a Powerful and Pain-free Body After 40 

There is a reason why Daddy-o pops is such a huge part of my life. Besides being an incredible human being, every time I listen to him I pick up something new. In this podcast Bill goes into detail on the importance of routines, and he gives a sneak preview of his new book (out September 15th), going into detail on the principles he employs to building fitness post-injury. Also, if you want his book, click here.

 Quick Hit: Modifying Exercise Tip

If you hurt, the thing to do is to stop all movement right?!? WRONG.  A more prudent method is to find a different variation of a movement that gets the goal you want but doesn’t hurt. Here is an example

Rehab

Research: On the (f)Utility of Pain

After I finished this article I was like “damn.” I think so many times as clinicians we chase pain relief for pain relief’s sake, without considering if the patient is truly suffering. I think about how many times I’ve been a part of the problem, even when trying to provide the solution. This one will definitely make you think.

Blog: How to Read and Understand Scientific Research

Chris Kresser again with another gem (long road trips tend to have me consume a lot of info from one source). Here CK goes over many practical tips towards being an effective consumer and appraiser of the research. If you think research is tough to understand in rehab and performance, don’t even think about looking at nutrition. Yuck.

Podcast: Trever Rappa and Greg Spatz on Streamlining Rehab and Performance 

My two baby boys have grown up so fast! It is so refreshing to hear two well-respected physical therapists discuss expanding the PT scope into aggressive fitness. I love how both of these guys espouse not making injured people seem fragile, but always pushing intensity. The more you can expose someone to intensity, the easier return to performance becomes. We can’t just stop at success on the table.

You can see the family resemblance

Research: Nociception Affects Motor Output – A Review on Sensory Motor Interaction with Focus on Clinical Implications

This article was just absolutely awesome. In it the authors explain how nociception, both acute and chronic, impacts motor control both short and long term. They also sprinkle in some really cool things with the sympathetic nervous system and movement variability. These are all reasons why we cannot ignore nociceptive drive in chronic pain states.

Blog: Travel PT 101 – What is Travel Therapy

If you are a PT, unattached, have a crap ton of student loans, and like adventures, you should strongly consider travel PT. Traveling makes it feel like you are on vacation the entire time you are on assignment, and it feels good to actually make a dent on student loans. Here are all your questions, answered.

Health & Wellness

Podcast: RHR: All About Coffee

For those of us who are coffee lovers; you are welcome. In this podcast my man Chris Kresser discusses all the amazing health benefits of drinking copious amounts of coffee. Wait until you here him compare the antioxidant values to some of those highly touted antioxidant fruits. #mindblown.

Quick Hit: Travel Tips

While we can often talk about how to time sleep, supplementation, and such with travel, one thing often not discussed is what equipment you should bring when you travel. Having the right stuff can make travel much less stressful. What stuff? Check out the vid to find out.

E-Book: Genetics – The Universe Within

I’m excited for this read, as I recently got some genetic testing done. Going through this one to get some clarification as to what the results mean, but the folks at PN always do some good work.

Personal Development

Blog: 5 Time-Saving Productivity Hacks, Reviewed

This is a blog I’ve just been getting into, but they came through with a clutch post on ways to be more productive. Amazing how effective meditation was; something I may have to revisit.

Pointy hat a must

Podcast: Setting Goals, Making Money, and Overcoming Tough Times – Phil Hellmuth

This podcast took me back to the days I was obsessed with poker. In this wonderful Tim Ferriss podcast, world class poker player Phil Hellmuth discusses many of the trial, tribulations, successes, and failures he has come across in his life. Many words of wisdom were had. Making my goal sheet now!

Blog: Don’t Forget the Second Step

Seth Godin writes daily little blurbs that are often quite profound and helpful in terms of all things marketing, business, and life.

This post is no different. Here Seth talks about step one, which is learning how to do something. Most people get only that far, and never hit step two. What’s step two? Read to find out.

Blog: The Success is in the Struggle

This blog really hit home for me. After getting let go from my NBA gig, I spent a great deal of time evaluating things I needed to change about myself. This is a hard conversation to have with yourself, but can often by life changing. Here Eric Cressey talks about his life changing conversation that made him the great coach that he is.

Book: I Will Teach You to be Rich

Ramit Sethi does an excellent job providing simple, yet effective financial device. I’ve been reading this book a bit slow, but applying every single lesson he’s recommended in each chapter with outstanding results. I was able to convince my credit card company to up my limit, give me 0% APR for a year, and doubled my interest rate on my savings account just by following these steps. Definitely a worthwhile read.

Blog: The Top 5 Reasons to Be a Jack of All Trades

Tim Ferriss has really impressed upon me the importance of having a broad skillset. Mastery, or even competency, doesn’t take that long to achieve. A bit of focused study, and you will have most of what you need to be successful at your craft. This is why I am expanding my learning into areas such as sleep, nutrition, and more.

Blog: These 55 Productivity Tips Will Save You 1,000 Hours

Insidehook is a site I’ve been checking out for a good while, as it contains a lot of good things ranging from style to productivity. Many good gems in this post, especially the email stuff.

Music

Music: Incubus “8”

Incubus is one of my favorite rock bands, as I just love how diverse their sound is. And it seems like they rarely fail with their experiments.

This album goes a little back to some rock roots, and man does it have some heft to it. I trained to this when I first heard it, and I’m pretty sure my arm circumference increased by 3 inches…even though I was training legs!

Give “No Fun” and “Nimble Bastard” a listen

Which goodies did you find useful? Comment below and let me know what you think.

 

Photo Credits

Matt Brown

Sciencefreak

The Guide to Physical Therapy School

So peeps, I’m going on vacation this week.

So instead of a debrief, I present to you the first legit episode of the Zac Cupples show.

I’ll be putting these bad boys out occasionally when I have a topic that I feel would be better to riff on as opposed to discussing in a debrief or writing about.

Here’s an outline of the topics I discussed

  • Reasons to go into physical therapy
  • What to look for in a PT school
  • The goals of physical therapy school
  • What you should take away from school
  • What classes I recommend a student to take

Enjoy!

                

Here were the links I mentioned tonight

All Gain, No Pain

South College Physical Therapy Program

Bill Hartman

Continuing Education: The Complete Guide to Mastery

Explain Pain Course Notes

Therapeutic Neuroscience Education Course Notes

Lorimer Moseley Explain Pain Course Notes

Kettlebell Mashup

FMS Level 2

Ultimate MMA Conditioning

Dermoneuromodulation Course Notes

ART

Dry Needling Course Notes

Spinal Manipulation Institute

A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain

Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

Also, check out the mentoring, movement, and training services I offer:

Mentoring, Movement, and Training

All Gain, No Pain Foreword

All Gain, No Pain  releases today.

If you haven’t grabbed your copy of it yet, what the heck are you waiting for?

ALL GAIN, NO PAIN

 

I had the honor and pleasure to write the foreword for this excellent book, which Bill has so graciously let me reprint.

You can read it below, and if it doesn’t inspire you to grab Bill’s new book, what will?

Foreword

“Good morning!”

He had that shit-eating grin on his face. The type of smile you see when your parents found out something you didn’t want them to know. That smile you saw right before your untimely demise.

I knew damn well what that smile meant.

Back then I was Bill’s student. A quiet, shy, and uncertain kid. After doing a deal with the Mafia to find his email, offering up my future first born to learn from him, and signing a blood oath, I somehow convinced Bill to accept me as his physical therapy intern.

This was like meeting a rock star! Bill was all over Men’s Health magazine, T-Nation—the type of stuff young bucks like me were reading to get ahead of the curve. The last thing I wanted to do was let the guy down.

Then I overslept.

Well played alarm clock, well played indeed

Stressed, frantic, and brushing only my front teeth, I made it to the clinic 30 minutes late. Only to be absolutely destroyed by that smile—a look that will forever be burned into my brain.

I apologized, he mildly scolded me, and we moved on.

Working with Bill was an amazing opportunity for me. Day-in and day-out I’d see him help individuals who were in pain—we are talking years of pain—become pain-free in a matter of moments. He was changing lives and helping people both return to both work and high level performance.

Whenever we had a lull, Bill would either grab his Lacrosse ball or do some type of mobility exercise. The guy was in pain, and was doing whatever he could to provide some relief.

After barely passing his clinical, I would periodically come back to visit Bill and see what he was up to. Each time I returned he had re-invented himself. Fine-tuned his process. Mastered his craft. Found better ways to reduce his client’s pain so they could get their lives back on track.

Yet he still hurt.

I’ll never forget that day I met Bill up at a continuing education course. It had been a little while since I last saw Bill, and I barely recognized the guy. He was lean. Like, really lean. I’m talking 6-pack abs, veins on veins, absolutely shredded lean. At 50-years old no doubt.

What was really weird was he walked around shirtless all the time, but who am I to judge?

The coolest thing? He was in a lot less pain.

He rebuilt his body, reclaimed his health, and most importantly, restored control. Control for a time I’m sure he felt lost.

As incredible as Bill’s transformation was, I’ve continued to see him do this over and over and over again with clients who have been in pain.

Bill is simply one of the smartest and hardest-working individuals I know, and to see this continual evolution and drive to help people is inspiring. It is this drive that instilled greater confidence in my life, pushed me to write, fueled my discipline at continual self-improvement, and landed me an opportunity to work with the high performers in the NBA.

The fact that the man who I look up to more than anyone, the man who adopted me as his son, is asking me of all people to write a foreword for his book, is surreal. It feels like that moment in Star Wars where Obi Wan gave Luke his first lightsaber. Ready to carry the torch of the Jedi for the future.

Though let’s be real, I’d totally be turning to the Dark Side. Black is a much more slimming color.

Way cooler capes too

Unlike Obi Wan, this Jedi master still has a lot of life left in him, and I am beyond excited for you to be learning how he helps people in pain stop surviving, and start thriving.

And there is no better time.

Chronic pain is a widespread epidemic. In the United States alone, 25.3 million adults suffer from daily pain, with 23.4 million reporting that pain as severe¹. This is a problem that costs the United States economy $635 billion dollars per year².

The things people do to become pain-free are numerous. Many times, these treatments are passive—massage, injections, icy hot, ultrasound, magnets—intending to provide some semblance of relief.

Too bad this stuff doesn’t work.

When comparing passive treatments to active approaches, such as exercise, there is no contest. Exercise wins, time after time³. Both aerobic exercise and weight training have been shown to help increase pain tolerance and brain function4,5. In fact, a lack of exercise may be the primary cause of most chronic diseases, as well as the cure6.

But how can I start exercising when I’m in agony just sitting here? How can I reap the benefits when my back hurts just looking at weights? You want me to walk for how long?!?

There exists no one better to answer these questions other than Bill Hartman.

If movement is the solution, then All Gain, No Pain is the guide.

In this book, you will find strategies to restructure your life in such a manner that reduces pain, improves fitness and health, and builds you to better withstand life’s stressors. Simply stated, you’ll be able to live the life you thought was once gone.

Bill has spent countless hours researching and experimenting with various methods; figuring out what methods work, and which one’s do not. He’s eliminated the unnecessary and ineffective strategies that many people try and fail with, while providing you strictly the essentials. The stuff that works.

His No Pain Principles will aid your quest in pain freedom, and his All Gain Principles will build the fitness necessary to keep persistent pain at bay. As for those movements that bother you in the gym? Bill has designed wonderful workarounds that can still drastically improve your fitness.

What makes this book different than the rest is that it comes from an author who has dealt with chronic pain himself. Bill understands the trials and tribulations you have and will go through. There simply is no better guide out there for your journey to rediscovering you.

And I must say, the strategies outlined in All Gain, No Pain flat-out work. As I was reading and editing this book, I adapted many of the principles myself. Over the course of three months, I dropped 25 pounds and was below 10% body fat for the first time in my life. Moreover, I’ve established rituals and habits that have increased my work output, energy levels, and overall satisfaction with life. You may have come to this book because you are in pain, but I promise you will leave with so much more.

If you stick with the principles, you’ll get results. You’ll look better, feel better, and move better. Most importantly, you’ll be you again. Not the old you. Not the you in pain.

But the best version of you.

Sum Up

Again, this book is an excellent read, regardless if you are in pain, wanting to perform at the highest level, or wish to understand stress.

Get your copy by clicking here.

References

Pixabay

BagoGames

Scars, Hands, and Handling not Getting Jobs – Movement Debrief Episode 19

Just in case you missed last night’s Movement Debrief Episode 19, here is a copy of the video and audio for your listening pleasure.

Here were all the topics:

  • Is treating scars essential?
  • My thoughts on what hand therapy should look like
  • How to act and react when you don’t get a job you think you want
  • The R&B concert I went to…yes we riffed on that for awhile

If you want to watch these live, add me on Facebook, Instagram, or Youtube. They air every Wednesday at 8:30pm CST.

Enjoy.

 

 

                

Here were the links I mentioned tonight

Three Dimensional Mathematical Models for the Deformation of Human Fascia

Camp Lo – Luchini

K-Ci & JoJo

Ginuwine

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