Impingement, Trusting Your Assessment, Noncompliance, and the Off-Switch – Movement Debrief Episode 15

If you are beyond sad that you missed last night’s Movement Debrief, number 15, I got your back. This time both audio and video are available #growing up.

Here’s what we talked about:

  • What impingement is
  • How to treat impingement at any joint
  • When do local inputs matter?
  • Trusting your assessment process
  • When to go beyond your assessment process
  • Why context matters
  • Making the most of noncompliant people
  • Dealing with bad situations
  • The importance of having an “off switch”

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 some of the links I mentioned in this Debrief.

The 3 Biggest Basketball Conditioning Mistakes

Practical Basketball Conditioning

How to Treat Pain with Sitting – A Case Study

Neurocoffee

 

How to Fix Neck Pain After Lifting – A Live Treatment

While in the Hamptons, my main man Cody Benz started developing some neck trouble.

We thought it might be helpful for y’all to see what I would do to help a cat like him.

Here you will see me go through an entire treatment session with Cody, while I do my best to explain every decision I make. A major kudos to Daddy-o Pops Bill Hartman for asking some great questions throughout the treatment.

Instead of the typical transcript I provide for these longer videos, I decided to write this up similarly to my neck pain with sitting case study format. I reflected on this case while editing the video, so you’ll see some added thoughts I had while you read through. I would recommend watching the video and reading the case study to get the most out of the material.

Enjoy watching the session.

Continue reading “How to Fix Neck Pain After Lifting – A Live Treatment”

Workers’ Compensation, Dealing with Late Patients, Fall Prevention, & More – Movement Debrief Episode 9

Episode 9 was a long one, and I’m so sad if you missed it live.

Here were some of the topics:

  1. The necessary organizational fix to worker’s compensation
  2. Ways physical therapists can have patients simulate work
  3. Targeting educational-specific impairments
  4. The need to expand scope or collaborate to help clients thrive
  5. How to deal with patients who are always late and don’t do their exercises
  6. Working on getting up off the ground after a fall

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

Enjoy.

Return to Play after a 5th Metatarsal Fracture – Case Report

I was recently featured on my buddy Scott Gray’s podcast,  a great clinician in the Florida area who I have a lot of respect for.

Before we dive into the podcast, let me tell you a bit about why I like this guy so much.

It’s not just because he is a part of the IFAST family.

I’ve been going back to the basics as of late, reviewing concepts such as tissue pathology, anatomy, surgical procedures, and the like.

If there is anyone who has the fundamentals down savagely well, it is Scott Gray.

He put out an Ebook called “The Physical Examination Blueprint”, which you can download by subscribing to his newsletter. Here he details all the essentials on screening your patients.

To me, the most important aspect of patient care is knowing who you can and cannot treat. Stratifying your patients based on who needs to be referred out, and who you can help is essential to providing the best care.

Quite simply, there are few better resources out there that outline how to do this than Scott’s ebook.

In it, he delves into what relevant questions to ask, tests to perform, and establishing a relevant diagnosis. Often underlooked, yet exceptionally important components of the clinical examination.

Again, I cannot recommend Scott’s ebook and site enough. It’s a great resource for many things PT, including many of his eclectic and unique manual therapy techniques. Definitely check this guy out.

Rehabbing a 5th Metatarsal Fracture to High Level Basketball

In this podcast, I outline a case I worked on back when I was in the NBA D League. 

This kid suffered a distal 5th metatarsal fracture with only a couple minutes to spare in a game. It was a brutal injury after one of the worst games in my life that I experienced, namely because we had three guys go down in one game.

Talk about awful.

I outline my entire process and every detail of what I did to get this kid back to high level basketball. A process that started with a fracture and ended with him establishing a franchise rebounding record the last game of the season. Pretty spectacular to say the least.

I feel very fortunate to have worked with such a driven and hardworking guy, and ultimately that was what his success hinged upon. Though minor, it was an honor to be this guy’s guide back to high level performance.

In this podcast, we dive into the following topics:

  • Immediate post-injury rehabilitation
  • Post-surgical care
  • The non-weight bearing phase
  • The weight bearing phase
  • Return to play Criteria
  • Return to performance criteria
  • Acute:chronic workload monitoring

Again, thank you to Scott Gray for featuring me on the podcast. I had a blast doing it.

If you’d like to download this podcast and get my free acute:chronic workload calculator that I used with this patient, subscribe to my newsletter by clicking here or simply fill out the form below.

Join the email list

Join the email list to get exclusive updates as well as free instant downloads.

How to Treat Pain with Sitting – A Case Study

Case studies are much more valuable than many give credit for.

It is this type of study that can often lead to sweeping changes in how further research is conducted, often create paradigm shifts in their own right.

After all, there was only one Patient H.M.

One thing that I wish I saw more in case studies was the clinician’s thought process. Why did they elect to do this treatment over that, what were they thinking when they saw this? How do they tick?

I was fortunate enough to have an online client of mine suggest to that I make her a case study, and it was a very rewarding experience on both fronts.

My hope is that you can see how a clinician thinks first-hand, and see the challenges a clinician faces…

When you can’t work with your hands.

Continue reading “How to Treat Pain with Sitting – A Case Study”

Change The Context: 3 Tools to Treat Neck Pain

Basket Case Study

The other day I woke up with some right-sided neck pain. I had some discomfort and slight limitations rotating or sidebending right.

Now I’ve already completed many systemic-oriented treatments, and don’t really have a go-to non-manual for the occasional crick in the neck. I was unable to get any manual therapy, nor were self-mobilizations effective.

What’s a guy to do? Continue reading “Change The Context: 3 Tools to Treat Neck Pain”

The Road to an Alternating and Reciprocal Warrior: Wisdom Teeth Extraction

This spans an entire treatment over a year’s time.

Here’s part 1

Part 2

Part 3

The Saga Continues

I’ve been through vision, I’ve had dental integration, I’ve put in the PRI activity homework, maximized my PRI testing, and feel a new man.

I know frontal plane
I know AF IR

Yet neutrality eludes me. It is a state of mind I could once feel by the power of glasses and splints, but the nervous system learns and accommodates. I topped out.

But of course, I knew that would be the case from my very first session with Ron.

“You gotta get those wisdom teeth pulled.” ~Ron Hruska

By virtue of the dentist I integrate with, the time came. And here are the results.

Extract time.
Extract time.

Zac B.E. (Before Extraction)

So at this point in my life the large HRV gains I initially had were dropping and I was still having some neck tension. Training was feeling so-so.

Test-wise, the videos below show what I look like.

Here’s my squat

And my toe touch.

Upper quadrant tests

And lower quadrant tests

Mandibular movements

And some cervical movements

My pelvis is consistently neutral and I can shift and squat with the best of ‘em. But I still present with restrictions in my thorax, neck, and mandible (BBC/RTMCC).

These limitations are likely present because of a  bony block called wisdom teeth.

The enemy reveals himself
The enemy reveals himself

As you can see, the maxillary (top side) wisdom teeth limit the excurision of my lateral pterygoids for lateral trusive movements. My hope is by removing these guys I will get access to more frontal plane, which should clean, up my remaining tests.

Operation Extraction: 1/30/15

By the way, 3D CT machines are the coolest thing out there. Definitely putting on my amazon wishlist.
By the way, 3D CT machines are the coolest thing out there. Definitely putting on my amazon wishlist.

I enter the room to get prepped for surgery, and the worst possible thing occurs.

Country music is playing.

7529bed6557dc022221851f82c0a8a52
Immediate amygdala hijack

And I can’t have that!

So I politely ask one of the workers there if we can play something a bit more soothing prior to my surgery.

2pac “I ain’t Mad at Cha” begins playing.

That’s more like it.

Could not think of a better way to reduce threat.
Could not think of a better way to reduce threat.

I get the IV put in, hear some Juicy by Biggy, and pass out from the Mind Eraser anesthesia. Yes, it was actually called “Mind Eraser”, and yes, I remember nothing.

Like this happening

Evidently I really wanted this picture taken
Evidently I really wanted this picture taken

And definitely not this

But I do remember looking like Marlon Brando for a period of time

What was really cool about the whole experience is how little pain I felt. I probably took 2-3 pain pills at most. I think this is because I was actually excited about having this surgery done, and the reward I was hoping to get far exceeded the nociceptive information I would inevitably receive.

Just goes to show it’s all about threat perception.

#explaindentistry Should I pitch this to Adriaan?
#explaindentistry
Should I pitch this to Adriaan?

Zac A.E. (After Extraction)

I waited to re-measure and assess until 6 weeks later. This way I had to some time to heal and adjust to this new sensory experience. My exercise program basically consisted of squatting, alteranting activity, and mandibular lateral trusion to feel my pterygoids.

The cons are I no longer looking like Marlon Brando, but the pro’s are the mobility gains. Check it out in the vids below.

Here are the standing tests

My upper quadrant tests

Lower quadrant tests

Here are my mandibular movements

And lastly, cervical

Since surgery I’ve been hovering between a right BC and superior T4. I consider myself no longer a TMCC patient because mandibular movement is now fully restored. The thorax position can limit cervical axial rotation.

In terms of how I feel, neck tension has been significantly reduced, especially with jaw movement. The only time I get the tension is when I am training hard or if I am reading/sitting for a real long time.

I also produce a crap-ton more saliva, which comes back to the very first question Ron asked me when I started this process. You don’t know what this stuff will affect.

Me like all the time now
Me like all the time now

Consequently, I have noticeably much more phlegm in my saliva and feel way more congested than ever. Sleep quality does not seem as good, as I have generally felt a bit more tired throughout the day.

So what gives? My thought was the wisdom teeth would be the final piece of my PRI quest, but I did not get all the changes I was hoping to get. Was Ron wrong? Did I get less wise for nothing?

I did not lose my wit and charm though. Sorry Ron, better luck next time.
I did not lose my wit though. Sorry Ron, better luck next time.

The one consistent thing that I am still limited in is the cervical rotation and shoulder horizontal abduction. I am hesitant to perform any pec inhibitory activities because I have been neutral in the past. I don’t want to “stretch” something that doesn’t need stretching.

I look over my 3D CT scan that I got at the dentist office, and one thing stands out. I find my limiting factor:

Not your run-of-the-mill tissue extensibility dysfunction
Not your average tissue extensibility dysfunction

The journey continues.