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:
Read MoreStart 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:
Read MoreHow to Approach Learning
It’s Been Awhile Hasn’t it? I was in a place where I couldn’t get much writing done. I got out of the groove, out of taking one too many con ed courses. It’s times like this where you have to look somewhere for inspiration. For me, I looked toward Arnold Schwarzenegger. I was watching “The Terminator” the other day with my aunt; an incredibly good movie, as all Arnold movie are. Picture the iconic scene where the T-800 is looking for Sarah Connor in the police station, but the officer refuses to let him in. It is then when he drops that iconic line:
Read MoreCourse 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.
Read MoreCourse Notes: The Val Nasedkin Seminar
A Long Lost Love Strength and conditioning is a guilty pleasure of mine. One I love to indulge in from time to time. There is something about the training process that excites me. So when I heard Val Nasedkin was speaking in the US, I jumped on the opportunity. Val is the brilliant mind behind the Omegawave, a device which I have been experimenting with in my own training and hoped to learn more about. I left with a greater appreciation not only for what Val’s system intends to do, but the way he coaches and programs. If you get a chance to hear Val or Roman Fomin speak, take up the opportunity. These guys are both revolutionaries in their respective fields. Here were a few of the big takeaways. Ze Goal Val created the Omegawave to provide a framework and determine appropriate timing for our current performance methodologies. Most training and rehabilitation processes are chosen based on results. focusing here, however, neglects individual responses to inputs. Great results can come at a great cost to an individual. If biological cost of training can be measured, there is potential to maximize an individual’s health, long term potential, and work capacity, while still achieving desired results.
Read MoreCourse 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.
Read MoreCourse 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.
Read MoreManual 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.
Read MoreCourse Notes: Spinal Manipulation Institute’s Dry Needling 1
You Mean Zac Didn’t go to a PRI Course? Yes. From time to time I occasionally take a gander at what else is out there in PT land. It was probably about time I check out this whole dry needling thing and see what the fuss is about. I took the Spinal Manipulation Institute’s version based on some recommendations from a few colleagues I trust. Ray Butts was MC’ing for the weekend. I know needling is quite the controversial topic, but I was amazed at the sheer quantity of evidence supporting this modality. Like, an insane amount. I am not sure what the “haterz” found their criticisms on, so please comment if you have some ammo (I am a noob to this after all). And Ray’s lecture on dry needling mechanisms? Oooohhh lawwwwd. Easily one of the best foundational science lectures I have ever heard. Period. The passion this group has not only for science but the physical therapy profession is inspiring. They made me excited to be a PT. Perhaps even inspired me to contemplate the PhD route. All that said, I am unsure as to where needling will fit into my practice. The assessment that would point you toward needling someone was sorely lacking. I’ve noticed this problem to be quite common in manual therapy courses. It’s pretty much you hurt here/have this diagnosis, then use this protocol.
Read MoreCourse Notes: PRI Cervical Revolution REMIX
Note: I made some errors on the first rendition of this blog that were corrected after speaking with Eric Oetter. Courtesy to him, Lori Thomsen, and Ron Hruska for cleaning up some concepts. Four Months Later When the Lori Thomsen says to come to Cervical Revolution, you kinda have to listen. I was slightly hesitant to attend since I had taken this course back in January. I mean, it was only the 3rd course rendition. How much could have changed? Holy schnikes! It is simply amazing what four months of polishing can do. It was as though I attended a completely different course. Did I get it all figured out? No. But the clarity gained this weekend left me feeling a lot better about this very complex material. This is a course that will only continue to get better with time; if you have a chance to attend please do. Let’s now have a moment of clarity. Biomechanics 101 The craniocervical region is the most mobile section of the vertebral column. This mobility allows regional sensorimotor receptors to provide the brain accurate information on occipital position and movement. The neck moves with particular biomechanics. Fryette’s laws suggest that the cervical spine produces ipsilateral spinal coupling in rotation and sidebending. The OA joint, on the other hand, couples contralaterally. C2 is the regulator of cervical spine motion; much like the first rib regulates rib cage movement. C2 is also important for the mandible, as it balances the cervical spine during mandibular
Read MoreCourse Notes: BSMPG 2015
#Bestconferenceevaahhhhh I shipped off to Boston to attend my first ever BSMPG summer symposium. And it was easily one of the best conferences I’ve ever been to. There was an excellent speaker lineup and so much of my family. Art Horne really put on a fantastic show. If you haven’t been to BSMPG before, put it on your to-course list. It is one of the few courses that has a perfect combination of learning and socializing. I hope to not miss another. Instead of my usual this person talked about that, let’s look at some of the big pearls from the weekend. Why Sapolsky Doesn’t Get Ulcers In one quote Robert Sapolsky summed up my current foundational premise to rehabilitation and training: “The stress response returns the body to homeostasis after actual or potential threats.” ~ Robert Sapolsky Regardless of what your malady is, it can probably be linked back to the stress response gone awry. The specifics become irrelevant because the stress response occurs nonspecifically. This response works best against acute crises. Guess how we screw it up? Chronic stressors. Human stressors are quite different from other species’ as we have the capability of inducing this stress response psychosocially. Gazelles on the Serengeti don’t have to worry about student loans. We can see how chronic stress becomes an issue when you look at what occurs in the stress response: Glucose travels to the bloodstream to mobilize energy. Increased cardiovascular tone, heart rate, and blood pressure. Decrease long-term building projects such as
Read MoreCourse Notes: PRI Interdisciplinary Integration 2015
A Stellar Symposium Back in April I had the pleasure of finally attending PRI’s annual symposium, and what an excellent learning experience. The theme this year was working with high-powered, extension-driven individuals. The amount of interdisciplinary overlap in each presentation made for a seamless symposium. Common themes included the brain, stress response, HRV, resilience, and drive. These are things altered in individuals who are highly successful, but may come at a cost to body systems. If you work with business owners, CEOs, high-level athletes and coaches, high level positions, straight-A students, special forces, and supermoms, this symposium was for you. And let’s face it; we are both in this category! There were so many pearls in each presentation that I wish I could write, but let’s view the course a-ha’s. The Wise Words of Ron Ron Hruska gave four excellent talks at this symposium regarding high performers and occlusion. Let’s dive into the master’s mind. People, PRI does not think extension is bad. Extension is a gift that drives us to excel. Individuals who have high self-efficacy must often “over-extend” themselves. This drive often requires system extension. Extension is a consequence, and probably a necessary adaptation, of success. If this drive must be reduced to increase function and/or alter symptoms in these individuals, we have to turn down the volume knob. How can we power down these individuals? Limit alternate choices – These folks take a wide view of a task Set boundaries – These folks attribute failure to external factors Making initial
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