Top 10 Posts of 2017

At the end of each year, I like to see what you beautiful…sexy…outstanding people liked the most from the jazz I be putting out.

I want to understand you. Let me in!!!!

While most of the top 10 were in the exercise-specific realm, I didn’t really see a common trend. It seems as though my fam have eclectic tastes.

It’s probably why we get along so well!

I want to thank you, the fam, for making 2017 an outstanding year. It has been all the comments, questions, stories, and praise that keeps me outputting content for you.

I got some big things planned for 2018, and we may mix up the format a bit, but I think you will like the changes.

But enough rambling. Let’s check out the top 10. First off…

10. Resilient Movement Foundations Course Review

Squat game on point, fam

One of my favorite classes of the year,  put on by my fam from Resilient. Here we learned all the fundamental keys to effective movement, how to perform the big lifts savagely well, and how to use specific movements to improve joint position in these lifts.

Follow these guys, they are some of the biggest stewards of the profession.

9. Practical Pain Education

Chinese version

My thoughts on pain education have morphed a substantial degree over the past year. While I think my understanding of pain’s complexities have enhanced, I’ve worked on simplifying my education paradigms.

I’ve often found that going down the neurophysiological rabbit hole is completely unnecessary, and providing simple examples has led to substantial changes in buy-in and client understanding.

Check this talk out to understand the process, and get my updated thoughts.

8. Recommended Resources

The most thugged out library in physical therapy

Man, fam. I literally just posted this and am amazed to the extent that this post skyrocketed.

Pretty much everything I discuss is not original, but my interpretation of what other incredibly intelligent individuals are saying.

Here are resources that I draw from, and something I hope to continually update and refine.

7. Continuing Education: The Complete Guide to Mastery

This is about as artsy as I get.

When approaching continuing education courses that you really want to learn and understand, there are key processes one must undergo to maximize the learning experience.

Consider this the guide.

6. How to Deadlift: A Movement Deep Dive

Nothing like hitting that 115# 1-RM

Deadlifting is one of my favorite moves for getting all types of gainzzz in the gym. It also happens to be one of my favorite exercises to coach.

When I am thinking deadlift, I am thinking of particular biomechanical processes, coaching cues, and programming tips.

In this deep dive, I highlight all of those pieces to provide my understanding of what is going on with the deadlift.

5. How to Treat Pain with Sitting – A Case Study

Planking was so 2013. Starting the Copenhagen revolution.

I’ve done quite a few online movement consultations this year, and this case study highlights that process

Here, I outlined the entire treatment process and post-treatment reflections. You get a glimpse in terms of what presentations lead me to making particular clinical decisions. If you can understand what compensatory strategies to look for, and what movements can drive favorable change, you can accomplish a lot without even touching someone.

4. The Squatting Bar Reach: A Movement Deep Dive

Not a shorty, but can get low

If there is one thing I’ve improved upon over the last year, especially with working with basketball cats, it’s been squatting.

Squatting is a great fundamental movement that ought to be mastered, and here you’ll learn the art of changing levels.

No vertical tibias here, fam!

3. The Ultimate Guide to Treating Ankle Sprains

Pulling your leg from the beginning.

When you work in basketball, ankle sprains are more the norm than the exception. The sooner you can get the players back on the court, the better chance you have at winning.

I developed a pretty successful protocol to doing just that. Treating acute ankle sprains in this fashion got most peeps to return immediately.

2. 90/90 Hip Lift: A Movement Deep Dive

The amount of photoshopped horrors that could be created from this picture.

If breathing is a part of your program, you probably should have this basic position down pat. If it’s not, srsly?!?!

In this post, I outline the rationale behind the 90/90 hip lift, relevant testing that would implicate it’s usage, and a few different variations you can use with it.

1. He Sleeps He Scores: Playing Better Basketball by Conquering Sleep Deprivation

Much needed after 2017

I guess you guys need some help with sleeping (don’t we all). This post was by far the most popular.

This article discusses my sleep problem that I had with my fellas in the NBA D League, and it was a big one. With early flights and poor travel conditions, sleep was a luxury.

How do you make the most of a terrible situation? Read on to find out, and see the amazing results.

Final Remarks

I want to thank everyone for making my return to blogging a joyous occasion. 2017 was a mixture of failures and successes for me, and you wonderful people have made this transition back to the blogosphere so smooth.

I am forever grateful that you have decided to become fam to this blog, and I look forward to seeing you here next year!

Stay hungry, stay learning, stay moving,

Zac

Practical Pain Education

I gave a talk on how I approach pain education in the land of China, and yes I finally got around to re-recording it.

Here were some of the topics I discussed in this talk:

  • The history of pain education
  • The difference between the three pain mechanisms
  • What the current research suggests regarding pain and threat
  • The 14 most common maladaptive pain beliefs, and how to squash those thoughts via education

If you want immediate access to the remainder of the 1 hour and 49 minute talk, and a FREE 21 page PDF file of my talk notes, fill out the form below.

Without further adieu, here is the first 20+ minutes of the talk.

How to Design a Comprehensive Rehab Program

Just when I thought I was out, the clinic pulls me back in.

Though I’m glad to be back. There’s just a different vibe, different pace, and ever-constant variety of challenges that being in the clinic simply provides. This has been especially true working in a rural area. You see a much wider variety, which challenges you to broaden your skillset.

I’m amazed at how much working in the NBA has changed the way I approach the clinic.

Previously, I was all about getting people in and out of the door as quickly as possible; and with very few visits. I would cut them down to once a week or every other week damn-near immediately, and try to hit that three to five visit sweet spot.

This strategy no doubt worked, and people got better, but I had noticed I’d get repeat customers. Maybe it wasn’t the area that was initially hurting them, but they still were having trouble creep up. Or maybe it was the same pain, just taking much more activity to elicit the sensation.

It became clear that I was skipping steps to try and get my visit number low, when in reality I was doing a disservice to my patients. This was the equivalent of fast food PT—give them the protein, carbohydrates, and fats, forget about the vitamins and minerals.

If fast food PT fits your macros tho right?!?!

Was getting someone out the door in 3 visits for me or for them? The younger, big ass ego me, wanted to known as the guy who got people better faster than everyone else. Yet the pursuit became detrimental to the patient’s best interest. There were so many other ways I could impact a patient’s overall health that I simply sacrificed in place of speed.

I only got them to survive without pushing them to thrive.

I see a lot of individuals proudly proclaim how many visits it takes for them to get someone out of pain, but pain relief is only part of the equation. There are so many more qualities we can address before we consider a rehab program a success.

This stark realization has reconceptualized how I structure a weekly rehab program. I now emphasize all qualities necessary to return to whatever task the patient desires, and attempt to inspire them beyond those initial goals.

You want to know what my visit average is right now?

I stopped counting, and started treating.

Let’s look designing the rehab week to take your clients to the next level.

Continue reading “How to Design a Comprehensive Rehab Program”

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.

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!

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”

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.

Regret? You serious?
Regret? You serious?

 

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. Continue reading “Course Notes: Explaining Pain Lorimer Moseley-Style”

Come Hang With Me: Courses At My Clinic

Dear Readership

 We are hosting several courses at my clinic this year, and we would love to have you, the readers, attend.

We...The readership
We…The readers

The three courses that East Valley Spine and Sports will be hosting are all excellent courses. I have taken two of these classes prior, and the third I have taken a prior rendition of. And let me tell you, these courses are boss.

Aside from us bringing some excellent content, you will also have the opportunity to hang out with a good group of people, and imbibe in some good beverages with me.

Class is next, the course is nice, and we can talk neuro all night.
Class is next, the course is nice, and we can talk neuro all night.

Here is what we are bringing.

PRI Pelvis Restoration: March 28th-29th

 I took this course a little over a year ago (read the review here) and I am very excited to be learning from Lori again. She presents this very complex material in a systematic and understandable fashion.

Most importantly, she’s funny!

Thank you, she'll be here two days.
Thank you, she’ll be here two days.

Signup for the course here.

ISPI Therapeutic Neuroscience Education: Educating Patients about Pain: June 6th-7th

Adriaan Louw is one of the best speakers I have heard, and the material is priceless (read my review here).

10% chance Adriaan will wear this outfit at the course. 100% chance the class will be stellar.
10% chance Adriaan will wear this outfit at the course. 100% chance the class will be stellar.

This course gives several practical insights as well as easy-to-learn neuroscience education that will help you become adept and educating patients on pain.

Signup for the course here.

ISPI Neurodynamics: The Bodies Living Alarm: October 17th-18th

 I took a version of this class when Adriaan spoke for the NOI group, and I am excited to see what tweaks have been made since. This time we are bring Louie Puentedura in to teach the class. I am excited to hear his perspective, as I have never seen him talk. Adriaan speaks highly of him, so he’s okay in my book!

And it's not an easy read.
And it’s not an easy read.

Signup for the course here.

 

We look forward to seeing you. Come learn, laugh, and party with us in lovely AZ.

The Post Wonderful Time of the Year: 2014 Edition

And That’s a Wrap

It’s that time of the year that we get to look back and reflect and what posts killed it (and which bombed).

It seems as though my fine fans be on a pain science kick this year, and rightfully so. It’s some of the best stuff on the PT market right now. It’s definitely a topic I hope to write about more in the coming year, and one I will be speaking on at this year’s PRC conference.

But without further ado, here are the top 10 posts of 2014.

10. Treatment at the Hruska Clinic: PRI Dentistry and Vision

Lift scores 6/5 with the Bane mask on. #alternatingandreciprocalwarrior
Lift scores 6/5 with the Bane mask on. #alternatingandreciprocalwarrior

Going through the treatment process as a patient has really upped my game in terms of knowing when to integrate with my patients. It has also been a life-changing experience for my health and well-being. Learn how they did it for me.

9. Course Notes: THE Jen Poulin’s Myokinematic Restoration

She's a myokinematic beast!
She’s a myokinematic beast!

So much fine tuning occured the second time around. I love how Jen acknowledged the primitive reflex origin of the patterns, as well as fine tuning both lift tests. She’s an excellent instructor (and fun to party with)!

8. Treatment at the Hruska Clinic: Initial Evaluation

Producing so much saliva
Producing so much saliva

The start of my alternating and reciprocal saga. Made for one of the most fascinating evaluations I have ever experienced. Ron Hruska is otherworldly.

7. Course Notes: PRI Postural Respiration

Chiari malformation waiting to happen.
Chiari malformation waiting to happen.

I love a good foundational course taught by the Ronimal. You always get a few easter eggs that allude to higher level courses and concepts. A must-take course.

6. Course Notes: PRI Craniocervical Mandibular Restoration

Ron looks even better in person with the meat suit.
Ron looks even better in person with the meat suit.

One of the most powerful and humbling courses I have ever been to. Ron goes all out on this course, as it is his baby. What dental integration can do to a system under threat is a concept that I hope is further explored in medicine. We can’t do it alone folks.

5. The End of Pain

Still verklempt by the overwhelmingly positive response.
Still verklempt by the overwhelmingly positive response.

This post marked a shift in my thought process and a realization of the possibilities that an integrated health system can accomplish. I have high hopes for our profession, and feel excited that an original post had so many views.

4. Course Notes: PRI Pelvis Restoration

A good group to learn from and with.
A good group to learn from and with.

It seems that with each PRI course you take you go another layer down the rabbit hole. Pelvis is a great course to link up Myokin and Respiration; especially with Lori and Jesse at the helm.

3. Course Notes: Dermoneuromodulation

Diane is bullseye with her neuroscience.
Diane is bullseye with her neuroscience.

Couple the best manual therapy explanation I have come across and a gentle technique and you get a rock solid course. The only downside is that now Diane has tarnished any other manual therapy course for me, as I can’t rationalize any other explanatory model given.

Fine by me.

2. Course Notes: Therapeutic Neuroscience Education

Stayed hungry to learn ever since this course.
Stayed hungry to learn ever since this course.

I love Adriaan’s practical application of pain education to patients, and he is one of the best speakers in the biz. There’s a reason why I am hosting him again next year.

1. Course Notes: Explain Pain

A legend
A legend

A great neuroscience course, a great practical course, and getting to learn from a PT legend? Sign me up.

Game Over!

And that marks the last post of 2014. Which were your favorites? Which are you hatin’ on? Comment below and let’s hope to even better content in 2015!

496d30611f94277eee71b80e3cd0f24cb9

Pain Language and other Jive Talk

To All My Clinicians in the Struggle

It was all a dream, I used to read ortho magazines.
It was all a dream, I used to read ortho magazines.

 I struggle with patients.

Those patients that I am having trouble with are who I study the most. It’s that whole learning from your failures thing.

In studying these folks, I have noticed an interesting trend.

It doesn’t involve movement.

It doesn’t involve medical history

It doesn’t involve stress (though it always involve stress)

Instead it involves language. I have noticed a few commonalities in how those patients who are either not improving or have been in chronic pain for some time talk. There is one shift, however, that I notice more often than not.

Disembodiment from Your Sports Team

 I don’t really watch a whole lot of sports; I’d rather play them.  Sports fans however, interest me. It’s fascinating how much ownership a sports fan takes in his or her team.

Fascinating creatures indeed
Fascinating creatures indeed

This ownership is especially noticeable when things are going well.  Think of the language one may use during the following instances:

  • Huge victory – “We finally beat the Packers.”
  • Draft Picks – “Our team got some huge prospects.”
  • Championship win – “We are the champions….my friends.”

Notice though, how oftentimes language may shift when a team is not doing so well.

  • Huge loss – “The Bears lost…Again.”
  • Draft flops – “I can’t believe they chose Steve Urkel first round!.”
  • Championship loss – “They blew our chance of winning.”

Robert Cialdini discusses this concept in his book “Influence: The Psychology of Persuasion.” When our team is winning, we manipulate our association to said team to improve our self-image. On the flip-side, when our team is losing, we will do things to distance ourselves (you can read an interesting study on this here). Perhaps it switches from  “we win” to “they lost.” Or perhaps we wear team jerseys after a victory and regular clothes after a loss.

Or perhaps he's wondering why he'd determine a structure at fault, before considering it's the brain....Yes, this just happened. Gratefully accepted by Bill Hartman, I did need it.
Or perhaps he’s wondering why he’d determine a structure at fault, before considering it’s the brain….Yes, this just happened. Gratefully accepted by Bill Hartman, I did need it.

This same concept seems to apply to pain states. Think about those folks in acute pain/injuries:

  • My neck hurts.”
  • “I tore my ACL.”

Compared to those who perhaps are in more chronic pain states, or at least those folks who I have noticed are not doing well.

  • “It hurts in the neck.”
  • “It must be that bulging disc.”
  • “I have the neuropathy.”

The former examples still have ownership with their problem, while the latter distances themselves. They become disembodied from the perceived affected area.

They lose the area’s image. They no longer love their team. That shoulder jersey they used to wear stays in the closet.

What the zaccupples.com team jersey is.
What the zaccupples.com team jersey would be if the skeleton was actually asymmetrical.

I’m going to quit using my arm.

I’m going the start calling my arm “the” arm.

I’m going to start saying the arm is killing me (to which I ask the patient if I should call the cops).

I’m going to persist in a chronic pain cycle.

 What to Do What to Do

 A patient’s descriptors and metaphors can play a critical role in how the pain experience is perceived. If thoughts and beliefs are what seem to impair one’s function, then it is those impairments that must be addressed.

Your goal is to get the patient to fall in love with the affected area again.

In order to play neurological cupid, shifting a patient’s language can have profound effects. It may be as simple as just making them aware of how they are describing the affected body region; relating these descriptors to brain smudging. You could also use the sports fan example above:

“Your perception of pain has led you to become a disgruntled fan of your shoulder. You need you [notice how I frame the needs to what they need to improve] to become a super fan of your shoulder again. It is your shoulder; take ownership in it. I’m going to show you some gentle exercises that will give you that winning streak you need to start cheering for your team again.”

This will happen in your educational conquest I can promise you that.
This will happen in your educational conquest I can promise you that.

Regardless of what direction you choose to go, you have to do all that is possible to change your patient’s perceptions, thoughts, beliefs, and fears regarding the pain experience.

It’s one of the hardest things we have to do.

What are some of your tips, tricks, phrases you notice?

New magazine I may start??
New magazine I may start??