Category: All Things Rehab

Teaching Movement, Expanding PT, Embracing Failure: Movement Debrief Episodes 2 & 3

Here are this week’s Movement Debriefs. I’m hoping to get on a regular schedule once I get settled into my new gig as a PT Mercenary, but hope you enjoy. Anchoring Old Movements to New, Prioritizing PT’s Professional Needs In Episode 2,  we discuss the following concepts:  Visit 2 & 3 of our patient with the lumbar fusion Using familiar concepts from old exercises in new exercises Strategies to enhance learning. Prioritizing Problems in the Profession. Embracing Failure and The Dunning-Kruger Effect In Episode 3,  we discuss the following concepts: My Failure The Dunning Kruger Effect – and how to hack it Embracing Failure Learning from Failure Anchoring Old Movements to New Movements Expanding PT Embracing Failure

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The Squatting Bar Reach: A Movement Deep Dive

Aka How I Mastered the Sagittal Plane In our first episode of “Movement Deep Dive,” we go over one of my favorite moves, the squatting bar reach. It’s an excellent technique and I hope this video explanation is helpful. If videos aren’t your thing, I’ve provided a modified transcript below. I would recommend reading and watching to get the most out of the material. Learn on!  

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Movement Debrief Episode 1: Meet the Patient at Their Story

A Live Movement Video Series Hey party people. I recently started doing some live feeds on the interwebz. You can check me out on Facebook and Youtube if you want to see me live. Otherwise, I thought I’d share with the very first episode of “Movement Debrief.” Here we dive into the following topics: The importance of reflection Using similar language to the patient. De-threatening that language Restoring sagittal plane control A case for manual therapy Enjoy!

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The Ultimate Guide to Treating Ankle Sprains

A Humdinger No Doubt Ankle sprains. Such a bugger to deal with. Ankle sprains are one of the most common injuries seen in basketball. The cutting, jumping, contact, fatigue, and poor footwear certainly don’t help matters. Damn near almost every game someone tweaks an ankle. Treating ankle sprains in-game provides quite a different perspective. Rarely in the clinic do we work with someone immediately post-injury. Instead, we deal with the cumulative effects of delayed treatment: acquired impairments, altered movement strategies, and reduced fitness. The pressure is lower and the pace is slower. You shed that mindset with the game on the line. You must do all in your power to get that player back on the court tonight, expediting the return process to the nth degree. I had a problem. Figuring out the most efficient way to treat an ankle sprain was needed to help our team succeed. I searched the literature, therapeutic outskirts, and tinkered in order to devise an effective protocol. The result? We had 12 ankle sprains this past season. After performing the protocol, eight were able to return and finish out the game. Out of the remaining four, three returned to full play in two days. The last guy? He was released two days after his last game. It’s a tough business. The best part was we had no re-sprains. An impressive feat considering the 80% recurrence rate¹.    Caveats aside, treating acute injuries with an aggressive mindset can be immensely effective. Here’s how.

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Starting from the Bottom (Now We Here): When General Physical Preparation Matters

Professional Nihilism? After wiping the tears and coming to the stark realization of our (ir)relevance in performance, we must ask where do we fit in? Do we matter? I’ve asked myself this question many times. It is hard to answer when tactical over-utilization begets repetitive stress injuries; a poor night’s sleep, Slurpees, and donuts make someone ill; or a contact play ends a career. What could I have done differently? What was my role? Though these questions have required skill development in special physical preparedness, sports science, and stress management; improving general qualities is pertinent in certain scenarios. It is these times in which rehab and training are of utmost importance, and we regain our relevance. When GPP Matters Our skills shine in the following instances:

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Start at the End: A Case for Special Physical Preparedness

“I need to get my wind back.” Every time I heard this I cringed. I did all the right stuff returning guys back to sport. I’m talking getting guys more neutral than Ron Hruska on a tropical island, FMS scores that Gray Cook would be ‘mirin’, hop tests that Kevin Wilk would foam at the mouth over, and high intensity continuous training sessions that would make Joel Jamieson say “really?” Yet as soon as they got onto the court, they’d be smoked. I’d hear that cursed phrase over and over again. What was I doing wrong? I thought we address all of their performance needs, yet we would continually run into the same problem. It wasn’t until I learned the following axiom that we broke this pattern:

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Course Notes: PRI Postural Visual Integration: The 2nd Viewing

Would You Look at That It was a little over a year ago that I took PRI vision and was blown away. A little bit after that, I went through the PRIME program to become an alternating and reciprocal warrior. I had learned so much about what they do in PRI vision that I was feeling somewhat okay with implementation. Then my friends told me about the updates they made in this course. I signed up as quickly as possibly, and am glad I did. This course has reached a near-perfect flow and the challenging material is much more digestible. Don’t expect to know the what’s and how’s of Ron and Heidi’s operation. And realistically, you probably don’t need to. Your job as a clinician is to take advantage of what the visual system can do, implement that into a movement program, and refer out as needed. This blog will try to explain the connection between these two systems. If you want more of the nitty-gritty programming, I strongly recommend reading my first round with this course. Otherwise, you might be a little lost. Let’s do it.

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Course Notes: Cantrell’s Impingement and Instability, 2015 Edition

Third Time’s a Charm  A trip home and hearing Mike Cantrell preach the good PRI word? I was sold. Impingement and Instability is one of those courses that I could take yearly and still get so many gems. In fact, I probably will end up taking it yearly—it’s that good. I took I&I last year with Cantrell (and the year before that with James), and the IFAST rendition was a completely different course. Cantrell provided the most PRI clinical applications I have seen at any course, which is why he continues to be one of my favorite people to learn from. Basically, if you haven’t learned from Mike yet, I pity you. Get to it! I have way too many gems in my notes to discuss, so here are a few big takeaways.

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Course Notes: Explaining Pain Lorimer Moseley-Style

Why Weren’t you Here??!?!?!?!?! A late addition to the yearly course list, but a decision I will never regret.   Lorimer Moseley is one of my heroes in the pain science realm and I’ve always wanted to hear him speak. His teaching style—slow paced, humorous, filled with story, and unforgettable—really resonated with me and made his material so easy to understand. My admiration for him tremendously grew because he was readily admitting if he didn’t know something, critical of his own body of work, and very open to what we we do clinically. I got the impression that he was okay with us practicing how we wish, as long as our treatments are science-informed and coupled with an accurate biological understanding. I left the talk validated, reinvigorated, and better adept at educating patients. He put on one of the best courses I have been to. If you haven’t seen Moseley live or had the chance to interact with him, please do so. Let’s go over the big moments.

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Manual Therapy Musings

When I think About You… Prompted by some mentee questions and blog comments, I wondered where manual therapy fits in the rehab process. To satisfy my curiosity, I calculated how much time I spend performing manual interventions. Looking at last month’s patient numbers to acquire data, I found these numbers based on billing one patient every 45 minutes (subtracting out evals and reassessments): Nonmanual (including exercise and education) = 80% Manual = 20% Modalities = 0%!!!!!!!!!!!! Delving a bit further, here’s my time spent using PRI manual techniques versus my other manual therapy skill-set: PRI manual = 14% Other manual = 6% As you can see, I use manual therapy a ridiculously low amount; skills that I used to employ liberally with decent success There’s a reason for the shift I want my patients to independently improve at all cost and as quickly as possible. The learning process is the critical piece needed to create necessary neuroplastic change; and consequently a successful rehab program. Rarely is learning involved in manual therapy.

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