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:

  1.  Visit 2 & 3 of our patient with the lumbar fusion
  2. Using familiar concepts from old exercises in new exercises
  3. Strategies to enhance learning.
  4. Prioritizing Problems in the Profession.

Embracing Failure and The Dunning-Kruger Effect

In Episode 3,  we discuss the following concepts:

  1. My Failure
  2. The Dunning Kruger Effect – and how to hack it
  3. Embracing Failure
  4. Learning from Failure

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!

 

Continue reading “The Squatting Bar Reach: A Movement Deep Dive”

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:

  1. The importance of reflection
  2. Using similar language to the patient.
  3. De-threatening that language
  4. Restoring sagittal plane control
  5. A case for manual therapy

Enjoy!

 

The Ultimate Guide to Treating Ankle Sprains

A Humdinger No Doubt

 

Ankle sprains. Such a bugger to deal with.

Worse than childbirth, as David Butler might say.

 

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. Continue reading “The Ultimate Guide to Treating Ankle Sprains”

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”

How to Design Your Learning Program

Thanks Buddy

The other day I was texting with a friend and writer I respect dearly, Seth Oberst, and he asked me an excellent question regarding the reading process:

How do you determine what you read next though? ~Seth Oberst

I answered him then, though it felt brief and inadequate. His question inspired me to reflect on how I design my learning process.

Though I’ve mentioned my learning philosophy, it may be fruitful to delve into the details. Seth, I hope I don’t let you down. Continue reading “How to Design Your Learning Program”

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?

TheRockPoint
IT DOESN’T MATTER IF 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, Slurpies, 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 is of utmost importance, and we regain our relevance.

When GPP Matters

Our skills shine in the following instances: Continue reading “Starting from the Bottom (Now We Here): When General Physical Preparation Matters”

Movement Chapter 7: SFMA Introduction and Top-Tier Tests

This is a chapter 7 summary of the book “Movement” by Gray Cook.

Intro

The SFMA’s goal is to assess functional capabilities. This system is based on Cyriax differentiation and grading principles. Instead of describing things as strong, weak, painful, or painless; the following descriptors are utilized:

  • Functional nonpainful (FN): Unlimited movement and able to complete a breath cycle at end-range. Called the dead end.
  • Functional painful (FP): Called the marker, reassessed.
  • Dysfunctional nonpainful (DN): Limited, restricted, impaired mobility, stability, or symmetry. Labored breathing with movement also implicates this choice. Called the pathway, where treatment occurs.
  • Dysfunctional painful (DP): Called the logical beehive because we do not know if pain is causing poor movement or vice versa. It is an unreliable place to work unless acute situations.
Cee Lo is still pushing for the FU to get recognized in the SFMA.

SFMA corrective and manual therapy lie in treating the FP’s and DN’s. The order at which things are treated also matters, so the order listed below for the top tier tests is also typically where treatments should hierarchically begin.

  • Cervical spine patterns (CSP)
  • Upper extremity patterns (UEP)
  • Multi-segmental flexion (MSF)
  • Multi-segmental extension (MSE)
  • Multi-segmental rotation (MSR)
  • Single leg stance (SLS)
  • Overhead deep squat (ODS)

We then operate the SFMA in the following fashion:

Movement Chapter 4: Movement Screening

This is a chapter 4 summary of the book “Movement” by Gray Cook.

What Be the Goal?

Movement screening’s goal is to manage risk by finding limitations and asymmetries via two strategies;

1)      Movement-pattern problems: Decreased mobility and stability in basic movements.

2)      Athletic-performance problems: Decreased fitness.

But movement ain’t one.

The FMS razor, akin to Occam’s razor, is to determine a minimum movement pattern quality before movement quantity and capacity are targeted.

Movement patterns are lost by the following mechanisms:

Ideally, the FMS would be part of the basic tests performed when one is looking to participate in sport. Prior to any athletic engagement, a medical exam is performed to clear someone to participate. This exam is often followed by performance and skills tests. Gray feels that the FMS belongs between these two tests, as there is an obvious gap from basic medical screening to high performance.

Oh gosh that hurdle step is going to be awful after this.

It is not to say that we must only train movement patterns. Rather, all the above qualities can be trained in parallel. The real goal is to manage minimums at each level and make sure improving one does not sacrifice quality at the others.

Movement Chapter 3: Understanding Movement

This is a chapter 3 summary of the book “Movement” by Gray Cook.

You Down with SOP?

Unlike many other areas, movement does not have a standard operating procedure and is thus very subjective. Since movement is the foundation for all activity, it is important that we develop some type of standard for good movement.

Good thing we haven’t heard this point before.

Changing Compensations

Movement compensations are often unconscious, thereby making these patterns difficult to be cued away.  It may be the case that less threatening movements and corrective exercise could be utilized to change undesired patterns.

When designing exercise, it is important to make them challenging as opposed to difficult. Difficulty implies struggling, whereas challenges are what test one’s abilities. Anyone can make something difficult, but not all can challenge.

Function of the FMS and SFMA

The goals of the functional movement systems are as follows:

1)      Demonstrate if movement patterns produce pain within accepted ranges of movement.

2)      Identify those without pain that are at high injury risk.

3)      Identify specific exercises and activities to avoid until achieving the required movement competency.

4)      Identify the best corrective exercise to restore movement competency.

5)      Create a baseline of standardized movement patterns for future reference.

The difference between the FMS and SFMA is that the FMS assesses risk whereas the SFMA diagnoses movement problems.

No treaties for crappy movement. Puns through the roof today.

The FMS operates in the following manner:

1)      Rates and ranks nonpainful movements based on limits and asymmetries.

2)      Identifies pain.

3)      Identifies lowest ranking or most asymmetrical patterns; most primitive pattern if greater than one.

4)      Find activities that may perpetuate the problem and take a temporary break from said activities.

5)      Start a corrective strategy.

6)      Reassess the test.

7)      If improved keep strategy, if not recheck FMS.

8)      Check exercise performance.

9)      Use effective and properly paced progressions.

10)   If changes occurs, retest FMS to establish norms and change corrections.

Whereas the SFMA operates as such:

1)      Find dysfunctional nonpainful (DN) movements (the path) and functional painful movements (FP), which are the markers. Work on DN before FP.

2)      Don’t breakdown functional nonpainful movements (FN).

3)      Only breakout dysfunctional painful movements (DP) if other breakouts can’t be performed.

4)      DN’s should show mobility or stability impairments that need to be addressed.

5)      Check these impairments.

6)      Check FP’s in loaded and unloaded positions; noting the lowest level in which pain is present.

7)      Form working diagnoses based on info from DN’s.

8)      Check for functional activities that could perpetuate the current complaint.

9)      Treat.

10)   Reassess impairments.

11)   Reassess pain breakouts. If changes occur at the lowest level, move up through the breakouts.

12)   Reassess dysfunctional breakouts.

13)   If baseline changes positively, keep chosen strategy.

Once the SFMA is clear, FMS at or near discharge.