SI Joint Pain, Slideboards, and Bulging Discs – Movement Debrief Episode 31

Movement Debrief Episode 31 is in the books. Here is a copy of the video and audio for your listening pleasure.

Here is the set list:

  • How does pelvic position influence SI joint pain?
  • Is there a difference between right and left SI joint pain?
  • Where do slideboard variations fit into the program?
  • When are bulging discs relevant?
  • When is flexion vs extension warranted in treating bulging discs?
  • When ought to neurodynamics be performed with disc bulges
  • Who are my top R&b artists

 

If you want to watch these live, add me on Facebook, Instagram, or Youtube. They air every Wednesday at 7:30pm CST.

Enjoy!

 

Zac Cupples iTunes                

Here were the links I mentioned:

 

Michael Shacklock

Clinical Neurodynamics

Book Notes Clinical Neurodynamics

BJ the Chicago Kid

blackbear

Anderson .Paak

Musiq

KCi & Jojo

Ginuwine

Case

Joe

R. Kelly

Enhancing Life

Method Strength

Andy Mccloy 

Trevor LaSarre

Here’s a signup for my newsletter to get nearly 3 hours and 50 pages of content, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

 

Check out the mentor program

Recommended Resources

I oftentimes get asked what resources I recommend. The resources listed below have been essential at putting me down the path that I am currently going, and have shaped how I practice today.

Trips = reading opportunities.

The cool thing about this list? None of these are set in stone. If I find a better resource, or one of the blogs I recommend starts to resonate with me less, it leaves the list (no pressure).

I want to give you guys the most up-to-date resources as humanly possible, so please check back here frequently.

If you’d like articles and such that are tripping my trigger as of late, you may want to sign up for my newsletter. You’ll also get some access to almost 3 hours and 40+ pages worth of exclusive content on pain and breathing.

Here are my resources:

Foundational Sciences

Video series

Makemegenius – A youtube page dedicated to explaining scientific concepts that a kid could understand.

Crashcourse – Another series of short videos explaining complex scientific topics and more in 15 minutes or less. I wish I had this in undergrad.

Books

Gilroy Atlas of Anatomy – Easily the best paper anatomy atlas you can find in the land. The angles drawn, the clarity of pictures, this atlas has it all. Wait until you see the subocciptals from the side. #mindblown

Guyton and Hall Textbook of Medical Physiology – Easily the best and most comprehensive physiology textbook in the land, the depth at which this book dives into with concepts is otherworldly. If I need clarification on a physiological process, this is my go-to.

Physiology of Training for High Performance – Easily the best exercise physiology textbook I’ve come across. Very few explain the energy systems with such depth, and I absolutely love the sections on the stretch shortening cycel

Kinesiology of the Musculoskeletal System – Neumann is the gold standard for explaining how each joint works in the human body. There is simply no more of a comprehensive resource on movement than this book.

The Physiology of Joints Volumes 1, 2, & 3 – If you want a more thorough understanding of joint structure and function, look no further. Just good luck finding copies that won’t cost you an arm and a leg.

Why Zebras Don’t Get Ulcers – The classic written by the master himself, Robert Sapolsky. This is the gold standard text on all things stress. His writing style makes a normally boring topic exciting to read.

Principles of Neural Science – Prepare to have your mind blown. The depth at which the neurology goes within this book is incredibly challenging, but if you need to reference something neuro-related, this is the book to have.

Apps & Technology

Visible Body Atlas – The gold standard 3D anatomy atlas. The visuals are stunning, and it is incredible to see how the anatomy looks from multiple angles.

Visible Body Muscle Premium – Yes, you need this too. Seeing how muscle contract to move the bones is worth the price of admission.

Rehabilitation

Blogs & Podcasts

Bill Hartman – Daddy-O Pops Bill Hartman is the cat who I look up to the most, not just in the PT realm, but in life. His blog consists of neat little tips to improve multiple aspects of your life, and he is the go-to-guy when thinking about developing your system or model. I appreciate his systematic approach.

Resilient Peformance Physical Therapy – My boys, Doug Kechijian, Trevor Rappa, and Greg Spatz, put out a lot of great content. These guys do such a great job of putting problems of the profession into perspective, and looking at things with as little bias as possible.

Doug also host a wonderful, eclectic podcast, where he interviews many people within and outside the profression, drawing comparisons to things we experience in performance and rehab.

Mike Reinold – Mike is who I look to for all things post-surgical, pathology, and PT research. I admire his breadth of knowledge base in these areas, and his Ask Mike Reinold show is full of great pearls.

Charlie Weingroff – Charlie is one of those cats who does a good job bridging the gap between rehabilitation and performance. Though I know we practice differently, I find myself nodding my head a lot when he discusses systems and principles. I appreciate his ability to integrate multiple thought processes into his own approach.

Modern Manual Therapy Blog – If I want to learn about manual therapy, TMJ, and more, Erson is my guy. I took his course many moons ago, and admire how well he assimilates multiple systems into his own approach.

Seth Oberst – I love how Seth integrates meditation, interaction, threat reduction, and many other aspects into his approach. When it comes to stress mitigation, Seth is the guy.

Scott Gray – Scott is a PT I admire when it comes to evaluation, testing, and diagnosing conditions, definitely not my strongest suit of things.

Healthy Wealthy & Smart – A podcast put on by a physical therapists named Karen Litzy, Karen goes around interviewing physical therapists from all walks of life. I’m always getting an inspiration to study something further or a pearl of clinical application every time I listen to her interviews. Her advocacy for the physical therapy profession is admirable.

The Ca$h Based Practice Podcast – Jarod Carter was the early pioneer regarding building a cash based practice. Business was never my strong suit, so getting access to the information in this podcast has been clutch.

PT Adventures – How do I learn about contract negotion? What do I look for in a recruiter? OMG where was that picture taken?!?! These guys know all the ins and outs when it comes to travel PT, and are by far the foremost experts on the topic. Their complementary E-book is an absolute must, even if you aren’t considering travel.

Apps & Technology

A Manual of Acupuncture – I was taught dry needling through somewhat of a medical acupuncture lens, and if you dive into the literature you’ll need to know the acupuncture points. I would be lost if it weren’t for this app.

Recognise Apps – Essential for graded motor imagery retraining. This app not only has graded left/right discrimination challenges, but also tracks accuracy and timing. The best on the market, and has all body parts available.

Books

Diagnosing & Assessment

Differential Diagnosis for Physical Therapists – Do no harm is priority number one. This book is your guide that ensures you keep people in your clinic who you can help, and refer those who you can’t.

Primary Care for the Physical Therapist – If we push the physical therapy profession to first line providers, this text will become more and more essential. This book teaches you the things you need to know to become a primary care provider.

Orthopedic Rehabilitation Clinical Advisor – When it comes to specific orthopedic diagnoses, this is by far the most user friendly. This book gives you ideas in terms of differential diagnosis, testing, prognosis, and so much more.

Netter’s Orthopedic Clinical Examination – Want to know which tests are most accurate and effective? This text is the one for you then. Love how they look at multiple different assessment pieces, and use evidence to either support or refute their utility.

The Malalignment Syndrome – Want to understand and appreciate asymmetry in the human body? Then this is the resource for you. This book shows many of the common restrictions seen in our movement assessment, and explains from an osteopathic standpoint what is going on.

Pain & Nervous System

Why Do I Hurt – The essential book for understanding basic pain neurobiology in the easiest way.  I absolutely love Adriaan Louw’s analogies and examples for explaining pain to patients. It’s a quick read well worth the time.

Therapeutic Neuroscience Education: Teaching Patients About Pain – In the explosion of pain science books, this one is by far the most practical. Here Adriaan Louw simply explains how pain works, and provides excellent strategies for educating patients with easy-to-understand language.

The Sensitive Nervous System – This is the heavy version of understanding how this whole nervous system and pain works. David Butler discusses the nervous system, central sensitization, neurodynamics, and so much more. Fantastic read.  [read the book notes here]

Clinical Neurodynamics – Michael Shacklock looks at the concepts of neural mobility through a more anatomical and physiological lens, and taught me how to appreciate the neural container (the tissues surrounding the nerve).  [read the book notes here]

Topical Issues in Pain Volume 1 – Louis Gifford is all about not getting too sciency and more about practically applying this pain science stuff. His early work is essential reading.

Treatment

Recognizing and Treating Breathing Disorders – If you want to know all the essentials in applying breathing to treatment, this is the gold standard. Anytime I go to review physiology of breathing, this is my go-to text. [read some of the book notes here]

Region-Specific

The Pelvic Girdle – Diane Lee provides the go-to resource for learning all things about the pelvis. The first half of the book is gold—anatomy, kinesiology, etc. The treatment half? Well, it’s not what I would do, but whatever 🙂

Orofacial Pain – This book is incredibly dense, and surprisingly one of the best pain science texts around. But if you want to learn the ins and outs of orofacial pain, it’s a must.

Hand and Wrist Rehabilitation: Theoretical Aspects and Practical Consequences – To go-to for all things hand and wrist. The graphic showing wrist kinematics are like nothing I’ve ever seen, and worth the price of admission.

Courses

Spinal Manipulation Institute – These guys are the go-to for learning dry needling. I’ve also taken their extremity manipulation class, which was nicely done as well. The consistent theme with all of their coursework is evidence. They do a great job outlining what the research says, and even what it doesn’t say. I appreciate them attempting to minimize their biases.

Active Release Technique – I only took these because I was able to go on someone else’s dime, and I was pleasantly surprised. The preparation and execution of the class greatly improved my understanding of anatomy and movement. The technique and concept itself is simple, yet quite effective. Especially considering the short amount of time it takes. It’s a great soft tissue technique, though pricier than necessary.

Johnny Owens Bloodflow Restriction Training – I thought this was a gimmick at first, then my boy Johnny Owens dropped research bombs on me left and right. I was amazed at how effective this was, and I’ve personally seen some nice changes both in myself and clients with utilizing BFR. Johnny hosts the gold standard class.

Postural Restoration Institute – A good way to get you started thinking about the movement system as a whole, and seeing how exercise selection can impact multiple areas. I typically recommend the following class order: Myokinematic RestorationPostural Respiration → Pelvis Restoration → Impingement and Instability. I would cap it at that. I’ve found if you have a good understanding of these courses, and enrich your understanding with similar sources, you’ll rarely if ever need to explore the more esoteric routes.

Dermoneuromodulation – ART is a bit more aggressive of a manual technique, DNM is much much lighter and quite effective. Diane also has the best explanation on manual therapy mechanisms I have ever come across, and that is worth the price admission alone.

Explain Pain – When I took this class by David Butler, I was absolutely blown away. Easily one of the best classes for understanding pain mechanisms, and some of most helpful metaphors you will find for education.

Therapeutic Neuroscience Education – Whereas Explain Pain is more science-heavy, Adriaan Louw’s iteration is all about practical application. He has some of the simplest and most effective ways to explain how pain works to clients. A must take.

A Study of Neurodynamics: The Body’s Living Alarm – While I haven’t taken this class formally, Adriaan’s version of Mobilisation of the Nervous System had way more practical applications that other iterations of the class I’ve taken. When it comes to neurodynamics, you need treatment ideas. Adriaan is the guy who I got that from the most.

Graded Motor Imagery – What do you do when all movements hurt? That’s where GMI comes into play. This class takes you through introducing someone into movement by teaching left/right discrimination, visualization, and mirror therapy. I use this quite a bit in early phases of rehab; especially if someone is not allowed to move the affected area.

Performance

Blogs & Podcasts

Mike Robertson – Mike was one of the first dudes that got me inspired to dive into this field. He has some of the most in-depth coaching posts like ever. Period. We also think very similarly from a coaching standpoint. Head to his site if you want to learn how to design a comprehensive strength training program for general population to athletes alike.

Mike also hosts one of the best podcasts in performance, in which he interviews a bunch of people in the fitness industry, including this joker. 

Eric Cressey – Been a big fan of Eric for a very long time. His book, Maximum Strength, was one of the first training programs I used that led to appreciable gains in strength. His knowledge of the upper extremity and shoulder is unparalleled, and that includes the rehabilitation

Darkside Strength – This is a good compilation site for a wide variety of performance topics. Ranging from med ball throws, to thorax rotation, to posture, you’ll find just about anything you’d like to learn about on this site.

YLM Sports Science – Yann Le Meur is awesome. What he does is takes important research articles, and disseminates them into useful infographics. If you want to get a quick summary of relevant research articles, here’s the site.

Joel Jamieson – Joel is the foremost expert on all things conditioning. I love how he integrates sports science (namely heart rate variability) and many other measures to make logical programming decisions.

Lance Goyke – Lance is one of my dear friends who writes on a wide variety of topics; ranging from building mass, to how overrated stretching is, to excellent physiology lessons. I love his 4 point Friday that he sends to his newsletter peeps, as he exposes you to very cool reads and listens on a wide variety of topics.

TD Athletes Edge – The place my boy Tim Difrancesco built. Here, Tim discusses all factors that are relevant to performance, such as diet, sleep, stress management, and movement. I really like the stuff Tim puts out because we have very aligning philosophies.

Tony Gentilcore – Tony is a guy who I refer to quite a bit regarding coaching cues and the like. Cat has one of the prettiest deadlifts in the game, so have to throw mad respek his way.

Dean Somerset – Dean is my go-to guy for post-rehab training. Love how he incorporates a wide variety of things into his training, and he always writes posts that make me think.

Bret Contreras – I admire how much Bret is a steward of the science and all things evidence-based. He’s also the guy who pioneered the hip thrust exercise. While not something I incorporate much in my training, definitely a great move if gluteal hypertrophy is your goal.

Chaos & Pain (NSFW, or most anyone) – With many of us emphasizing recovery, high/low methods, and not going too hard, sometimes you need a swift kick in the teeth and someone to tell you to get after it. That’s why I go to Jamie Lewis. The guy is also an encyclopedia when it comes to old time strength people and cooking stew. Definitely an underrated site.

Apps & Technology

Polar Beat – If you play with heart rate training, this app is a must. Here it’ll track your heart rate, time spent exercising, and so much more.

Tabata Pro – My favorite app for interval training. Simple, easy to use, and effective in both visual and auditory cues for when to go!

Books

All Gain, No Pain – Yeah, I’m a little biased (I did write the foreword after all), but Bill Hartman’s first book is an instant classic. I love how all-encompassing this book is. You’ll get an understanding of pain, stress, performance. But most importantly, you’ll be able to design a program that is specifically built for you. If you are post-rehab and looking for a way to get back into training, this book is a must.

Ultimate MMA Conditioning – Aka energy systems and application made ridiculously simple. Joel Jamieson’s classic book teaches you most of what you need to know when designing effective conditioning programs. It’s an essential read.

Starting Strength – If you want to enhance your understanding of the mechanics of basic lifts, this book is essential. My favorite section is the squat chapter.

New Functional Training for Sports – Mike Boyle has some of the best progressions that are simple and easy to execute. I like this book a lot because it is all practical application. His jump progression makes up a bulk of how I introduce the concept of jumping to my clients.

Essentials of Strength and Conditioning – Yeah, the exercise and nutrition sections are lackluster, but you’d be hard pressed to find a better overview of all things S&C. Some of the basic science chapters are easy to understand, which is incredibly valuable to me.

Spark – This book will make you rethink just how powerful aerobic exercise is.

Courses

Resilient Movement Foundations – An essential class to attend if you want to master the basic movements. I also like how if a movement cannot be performed, the boys at Resilient give you methods to assist in performance.  If you want an overview, check out my course notes.

FMS Level 2 – While I’m not an avid FMS/SFMA practitioner, I thoroughly enjoy their intelligent exercise progressions and coaching styles. Some of the variants taught at the level 2 in particular are things I readily incorporate into my practice.

Derek Hansen – One of the best sprinting coaches I’ve ever come across. His seminar that I attended was all about practice application, and his simple coaching cues to improve sprinting have made a huge impact in my clientele. Want to learn sprinting? Here’s the guy.

Tim Gabbett – The acute:chronic workload is a fundamental principle that we must all consider in both the rehabilitation and performance realms. No one teaches it better from an application standpoint than Tim Gabbett.

ALTIS Apprentice Coach Program – How does getting to learn from the likes of world class track coaches Dan Pfaff and Stu McGill for a week sound? One of the best investments I’ve ever made, you learn basically what you want to learn from this apprenticeship program. The biggest takeaways I got involved the art of coaching, resiliency training, plyometric programming, and that’s just a small taste.

Certified Speed and Agility Coach – Lee Taft is the foremost expert when it comes to multidirectional training. This online cert provides a great overview of all the skills one must possess when playing a multidirectional sport.

Nutrition, Functional Medicine, Sleep, & Wellness

Blogs & Podcasts

Mike Roussell – Mike is one of my favorite nutrition peeps in the land. Responsible for the great book the Metashred Diet, a diet I used to drop my first 20 pounds, Mike is all about practical application in regards to dieting. His steps are simple, easy to use, and require easy changes in behavior. Definitely a guy to learn from.

Chris Kresser – Chris hosts one of the most comprehensive functional medicine combined with ancestral diet resources I have ever seen. Many of the things he has posted on my site have helped me a great deal with some of the health issues I have experienced, and his practioner program is very intriguing to me. You will not be disappointed by what he has to say.

The Paleo Solution Podcast – Hosted by Paleo extraordinaire Robb Wolf, I amazed at how well versed he is in the wide variety of topics discussed in this podcast. Whether he’s interviewing a sleep expert, paleo enthusiast, or

Rhonda Patrick – RP (#bae) has gotten me so much into genetics, fasting, sauna use, and many other topics.  The papers she puts out for her newsletter peeps are beyond comprehensive. Definitely check out her site, listen to her podcast, and consume as much as possible.

Peter Attia – This blog is technically retired, but Dr. Peter Attia is a wealth of information when it comes to all things functional medicine. I admire his approach and emphasis on blood sugar management, hormones, and many more things. If I were ever to go to medical school, I’d want to turn out like this guy did.

Apps & Technology

Zero – This is the go-to app to use if you are experimenting with fasting. It times how long you’ve gone without eating, and keep you on target with the desired duration you wish to fast.

The Oura Ring – By far my favorite tracking device, and I’ve experimented with the best of them. The Oura ring is by far the most accurate sleep tracker you can buy. It also measures HRV, body temperature, activity levels, and the newer model do things for finding your circadian rhythm. All within a sleek looking ring. You’d be amazed at what you can learn from wearing this ring, especially in terms of what late night behaviors can impact sleep.

BrainWave – The best white noise app in the land. Also combines calming sounds with various waves that supposedly stimulate various brain states. Does it work? Who knows, but I’ll hedge my bets.

F.lux – An app that blocks blue light, the stuff that keeps you awake at night, on your screens. Essential for anyone who has to work on their computer late.

Books

The Metashred Diet – Just do it. That could be the mantra for this great read by Mike Roussell. Here, he just lays out a plan of attack to execute an all-out war on fat loss, and it is quite effective. I was able to drop close to 20 pounds staying militant on the 56 day plan, and I’ve kept up with many of the principles on a consistent basis.

Sleep Smarter – A little bit heavier on the esoteric sleep strategies, but I was blown away by how effective implementing these strategies have been. The biggest takeaway for me from this book was the importance of light exposure. A great read.

Take a Nap! Change Your Life – Who knew effective napping could be so scientific? If you want to get the most out of your naps, or question just how important napping is, let this be the answer.

Sleep for Success! Everything you Must Know About Sleep but are Too Tired to Ask – This book provides a little bit of background knowledge regarding sleep, and some easy strategies to implement to enhance your sleep quality. It’s a little salesman-heavy at times, but still a solid read nonetheless.

Courses

Precision Nutrition Level 1 – An excellent combination of overview, depth, and application of nutritional coaching. The emphasis on behavior change is critical, and I admire how that makes up the backbone of this great certification.

Personal Development & Entrepreneurship

Blogs & Podcasts

Barking up the Wrong Tree – Probably my favorite blog on the internet. Like…for real. Why are you still here??? Eric Barker is a guy who researches many different topics, and breaks down the information into 3-5 applicable points. My favorite? How to be James Bond of course!

The Tim Ferriss Show – One of the most popular bloggers of all time, Tim goes around interviewing a wide variety of people, seeking answers on how to get the most out of life in the fastest manner possible.  He also has great q&a’s and talks on building business and more. An essential listen.

Jocko Podcast – The podcast of former Navy Seal Jocko Willink. My favorite podcasts are his Q&As, where he problem solves listener questions with incredibly practical advice that you probably don’t want to hear, but need to hear. Definitely a life changing person to learn from.

Seth Godin – He writes a short blog every day that will either inspire you, make you rethink what you are doing, or be just the thing you need to hear.

I Will Teach You to Be Rich – Ramit Sethi promotes a message that really resonates with me. He writes profoundly on topics ranging from personal finance, entrepreneurship, and marketing. Definitely check this cat out.

Books

Extreme Ownership – One of the most impactful books I have ever read in my life. Consider it the practical guide for controlling the things that you can control. You’ll be amazed at what making this shift in mindset can do for you.

The Obstacle is the Way – I read this book during a rough patch in life, and it helped me appreciate how impactful adversity can become. It can break us or shape us. Use those hard things in life as opportunities to grow. This will help you along the way.

The Ego is the Enemy – Something I’ve struggled with through much of my life is squashing ego. This book was essential for doing that. Realize that you aren’t that important, keep a beginner’s mindset, and be humble. Understanding these three concepts will get you far in life.

The Subtle Art of not Giving a F*ck – After you’ve squashed your ego, read this bad boy to bring it up to appropriate levels. This book is essential in helping you understand just how frivolous most things in life are. I sweat so many fewer things thanks to this phenomenal read.

The Millionaire Fastlane – This book will forever change how you think about running your business, running your life, and why it is important to strive for a business that makes you millions. It’s more of a selfless reason than you think.

Unscripted – Another great in-your-face book by MJ DeMarco. This one makes you really think about striving for that 40 hour work week until your dead. Another life changing book.

The 4-Hour Work Week – Elimination, automation, and many more outstanding principles occur in this book. The biggest key I got from this was a guide on streamlining many of the processes I have in place from a business standpoint. It’ll definitely make you think about how you are currently running your life.

Discipline Equals Freedom Field Manual – On those days you lack motivation, or when you feel like blaming others for problems, or are experiencing tough times, just read one page. Never did a book exist that helped me refocus as well as this one.

The Definitive Book of Body Language – Nonverbal communication is essential to effectively communicating with a wide variety of people. You will be amazed at some of the relative nonverbal “mistakes” we make when interacting with others. Mastering this book will enhance your relatability to a high degree.

How to Talk to Anyone – Another great key read in maximizing verbal and nonverbal strategies to  become an effective communicator. One of my favorite tips? Taffy eyes. Get it to learn more.

Apps & Technology

Evernote – My go-to note taking app. Syncs with most every tech device you own, and is pretty easy to use. Love how easy it is to categorize things, and you can even copy paper notes onto this bad boy. Essential for tracking many of my upcoming projects.

AllTrails – If you are an avid hiker, this app is a must have. I can’t tell you how many times this app saved me on questionable hikes, or given me access to hikes that I didn’t know about. In a class of its own.

Freedom – For those times you need to be immensely productive and the internet does nothing but distract you. This app will kick you off the internet for however long you so desire.

Deathclock – Another procrastination killer. Download this Chrome extension, and each time you open a new page you’ll see how many days you approximately have left to live. Morbid? Yes. Effective? Absolutely.

Photo Credits

Pixabay 

 

 

Scoliosis, Morton’s Neuroma, and Just in Time Learning – Movement Debrief Episode 22

Movement Debrief Episode 22 is in the books. Here is a copy of the video and audio for your listening pleasure.

Here were all the topics:

  • Thoughts on Treating Scoliosis
  • Thoughts on Treating Morton’s Neuroma
  • Why I prefer Just in time vs just in case learning

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 the links I mentioned tonight

Advanced Integration Day 4: Curvature of the Spine

PRI Advanced Integration

Ipsilateral Hip Abductor Weakness After Lateral Ankle Sprain

Method Strength – Dave Rascoe

Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

 

Check out the mentor program

Thoracic Outlet Syndrome, New Grad Advice, and Interview Questions – Movement Debrief Episode 21

Movement Debrief Episode 21 is in the books. Here is a copy of the video and audio for your listening pleasure.

Here were all the topics:

  • The step-by-step process of treating someone with Thoracic Outlet Syndrome
  • How to leverage your strengths as a new grad searching for a job
  • Why new grads need mentors
  • My favorite questions to ask interviewers and to find out about a company

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 the links I mentioned tonight

How to Design a Comprehensive Rehab Program

All About Jobs – Movement Debrief Episode 20

“The Briefcase Technique” by Ramit Sethi

Join my mentorship program, get a movement consultation, or let me design an online fitness program for you.

Here’s a signup for my newsletter to get a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

 

Check out the mentor program

Death of Vertical Tibia, Usain Bolt, Complex Patients, and More – Movement Debrief Episode 13

Movement Debrief Episode 13 yesterday involved quite a few rants. Must’ve been the ketones talking.

Here’s what we talked about:

  • Restoring sensation with my patient with low back pain
  • Why it’s okay to have an angled tibia during squatting
  • Would any intervention help/hurt Usain Bolt?
  • The complexity of Usain Bolt
  • Struggling with a complex patient
  • Dealing with uncertainty
  • Embracing the struggle

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

Enjoy.

Here were some of the links I mentioned in this Debrief.

How to Deadlift – A Movement Deep Dive

Squatting Bar Reach – A Movement Deep Dive

The Sensitive Nervous System – Read my book notes here

Clinical Neurodynamics- Read my book notes here

A Study of Neurodynamics: The Body’s Living Alarm

Mobilisation of the Neuroimmune System – Read the course notes here

Explain Pain– Read the course notes here

Extreme Ownership

The Obstacle is the Way

Ego is the Enemy

The Subtle Art of Not Giving a F*ck

Master the Fundamentals of PT, Neurodynamic Tricks, & Check Your Ego – Movement Debrief Episode 7

Episode 7 of the Movement Debrief (aka The Movement Awakens) occurred last night.

I can only imagine how devastated you are that you missed it.

But hey, though I think it’s way more fun live, I have a copy of the video below, where we discussed the following topics:

  1. Why fundamental PT skills are still relevant
  2. Why the basic clinical exam is incredibly important
  3. Determining if you can or cannot help your patients
  4. A simple trick to making any movement a neurodynamic test
  5. Doing what is best for the patient, not your ego or agenda

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

Enjoy.

Master Sagittal Plane, Coaching Progressions, Detaching, & TFL Inhibition – Movement Debrief Episode 5

Did you miss Movement Debrief live yesterday? Though much more fun live, I have a video of what we discussed below.

This debrief was quite fun, as we had an impromptu viewer q&a. Thank you Alan Luzietti for the awesome questions! If you follow along live on Facebook or Youtube, I will do my best to answer any questions you ask.

Yesterday we discussed the following topics:

  1. Why you should emphasize sagittal plane activities longer than you think
  2. How to coach exercises to maximize client learning and compliance
  3. Why detaching from your client encounters makes you a better clinician
  4. Viewer Q&A – “centering from the chaos” & TFL Inhibition

Lastly, if you want the acute:chronic workload calculator I spoke about, click here.

Without further ado:

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”

9 weeks with Bane, I mean Zac…Oops Sorry Wrong CI

Only one wears glasses but both are alternating and reciprocal warriors.
Only one wears glasses but both are alternating and reciprocal warriors.

Note from Zac: This is my first guest post, and to start things up is the one and only Trevor Rappa. Trevor was my intern for the past 9 weeks and he absolutely killed it. Here is his story.

It’s very exciting for me to get to write a guest post for Zac’s blog that I have read so many times and learned so much from. The experience I have had with him over these past 9 weeks has been incredible and I hope to share some of it with all of you that read this.

He challenged me to think critically in every aspect of patient interaction: how I first greet them, which side of them I sit on, the words I use, and how I explain to the patient why I chose the exercises they’ll go home with. All of this was to create a non-threatening environment to help to patient achieve the best results they can.

He also taught me how to educate patients with a TNE approach, incorporate other interventions such as mirror therapy into a PRI based treatment model, and deepened my understanding of the neurologic concepts behind performance.

Therapeutic Neuroscience Education

Perception of threat can lead to a painful experience which will cause a change in behavior. It’s the PT’s role to introduce a salient stimulus to attenuate the perception of threat in order to cause a positive change in experience and behavior (Zac and I came up with that, I really like it).

Pain is not the enemy. Teaching patients that their pain is normal and it doesn’t always mean that they are damaging themselves can be challenging as pain is often the reason patients seek out or are referred to PT. Some of the points we tried to teach patients were

  • Pain is there to keep you safe, which is good
  • Pain does not equal tissue injury
  • No pain, no gain is not what we’re looking for
  • Discomfort is okay
  • Knock on the door of pain, don’t try to kick it down

A large part of educating patients is helping them re-conceptualize why they are having pain. Most patients think of pain in terms of a pathoanatomical model (ie tissue abnormality=pain) and this is perpetuated by a lot of members in the medical community. The pathoanatomical language often causes a higher perception of threat and induces greater feelings of being broken, hopeless, and unfixable.

Re-educating the patients that what they are experiencing is normal and teaching them why it is normal helps decrease their perception of threat. We do not want to use language that will make patients more threatened, like telling a 20 year old that they have the spine of an 80 year old (numerous times our patients have been told that by other medical professionals). Getting them out of a mindset that if they move a “faulty tissue” they will make their situation worse is one step in this process.

Regardless of whether the patient is dealing with a more acute injury or one that has become chronic, there are three things we taught each patient that we would do in PT to help decrease some of the sensitivity they may be dealing with. Those three things are movement, space, and blood flow. These three things require the patient to be active in their therapy which gives them control.

Many of the patients with chronic conditions had stopped doing the things they enjoyed. Giving them activities which they can do without perceiving pain, or that can help decrease their pain, shows patients that they do not need to rely on external passive interventions to feel better. Getting patients to believe/understand that they have the control and power to make themselves feel better is one of the most important things a PT can do.

Mirror therapy, sensory discrimination, and PRI

Learning how to use different interventions to help decrease sensitivity and pain was huge for me. We used mirror therapy with different types of patients whether they had chronic pain or were post-surgical. The mirror activities usually started with the patient moving their unaffected limb while watching their affected limb move in the mirror. For example, if you right arm hurts you’d move your left arm while looking at the mirror because it would appear that your right arm is moving. We would progress patients to where they were moving their affected limb behind the mirror while still watching the reflection of their unaffected limb moving in front of the mirror. With the example above, you would still be watching the reflection of your left arm in the mirror making it look like your right arm is moving but would also be moving your right arm behind the mirror. This helped introduce patients to moving a sensitive area without experiencing pain, thus decreasing the threat of movement.

Numerous RCTs have shown this to be true.
Numerous RCTs have shown this to be true.

Another intervention I had not used before was sensory discrimination. We used this mostly in our post-surgical or more acute population to help decrease the local sensitivity after an injury and to try de-smudgify (that may or may not be an actual word) their homunculus [note from Zac: Totally is].

Sharp-dull discrimination was used first, then we progressed to two-point discrimination and usually ended with graphesthesia. The progress for patients from not being able to discriminate between sharp-dull to having graphesthesia showed me how powerful the role of the somatosensory homunculus is in the pain experience.

And of course, I learned more PRI from Zac. He challenged me to use more integrated non-manual techniques with patients while also limiting the number of cues I used. This was great because it is very easy for me to over coach these techniques. He also gave me a better understanding of some of the big concepts in PRI, such as neutrality.

Neutrality vs Hypofrontality

Neutral is a huge word in PRI that is often thought of as the end game when in reality it is just the beginning of a PRI treatment. The end goal is to get someone alternating and reciprocal. The idea of neutral always made sense to me as a good goal for performance as “neutral” joint positions is where the greatest force would be able to be produced. Talking to Zac about this he brought up what Bill Hartman Grandpa 🙂 has said: Neutral is a neurologically prefrontal state in which learning can occur, as the prefrontal cortex (PFC) is active during tasks that require attention. However, this is not a state you want an athlete performing in.

An active PFC is good when athletes or patients are in rehab because their cerebellum and basal ganglia are learning new movements that can then be used with less activity from higher cortical areas during performance. The movements used during these activities can become reactive after enough learning, practice, and repetition (those 3 things go hand in hand).

During performance or training we would not want an athlete using the higher cortical areas that elicit attention as this would make them slow and inefficient. Instead, we would want them fast and efficient (ie reactive and reflexive). A transient state of hypofrontality allows an athlete to reach a state of “flow”, which Mihaly Csikszentmihalyi describes in his book Flow, which is where the highest levels of performance occurs. This would allow the lower reactive (cerebellum and basal ganglia) and reflexive (brain stem) centers of the brain to essentially take over making them fast and efficient.

So from a theoretical neurologic stand point you do not want an athlete in a prefrontal state during performance. Good rehab and programming can help them become alternating and reciprocal through graded exposure and relearning of certain movement patterns in a neutral (prefrontal) neurologic state. Once this foundation is there, power and capacity can be added through training (which Zac talks more about here ). This may allow an athlete to stay alternating and reciprocal during transient states of hypofrontality when performing, not “neutral”.

Another concept that stood out to me from talking with Zac is the difference between extensor tone and extension. Extensor tone is necessary for power production during performance but it does not necessarily mean that the athlete is going into a position of extension. When someone is in extension they limit their degrees of freedom for movement and thus their movement variability. Using extensor tone from a neutral position, for lack of a better term, would allow them to display power while maintaining their potential movement variability (be alternating and reciprocal). This idea was something that made things click for me.

In summary…

I learned a lot from Zac and want to thank him for all his help and time he spent teaching me. Needless to say, this was an amazing clinical internship for me and I cannot recommend enough that other students should try to get Zac as their CI or for patients to get treated by Zac. He is the real.

Zac Cupples and Iron Sheik same thing
Zac Cupples and Iron Sheik same thing

And now what everyone has been waiting for… Zac quotes

Help for cueing exercises

  • “Shakin’ like a polaroid picture”
  • “We don’t want Fat Joe and the lean back”
  • “Do you remember the three little pigs? I want you to be the big bad wolf and blow their house down”
  • “Do you have the big 3? Jordan (L abs), Pippen (L adductor), and Rodman (L glute med)?”
  • “We like a tight right butt and we cannot lie, the other therapists can’t deny”
  • “I’ll start calling him Buffalo Bill, cause he’s abducting like crazy”
  • “We don’t want you to have hamstrings like Goldmember”
Hamstrings like Goldmember = POTS
Hamstrings like Goldmember = POTS

Zac after getting his wisdom teeth out, he doesn’t remember saying these things

  • “I have lateral trusion!”
  • “Check out this IR” and then he self-tested his own HG IR
  • “I ain’t got time to bleed”
  • “Nobody makes me bleed my own blood”

Other favorites

  • “If you ain’t assesin’ you guessin’”
  • “There’s 45 miles of nerves in the human body if you put them all in a straight line, but don’t try it at home cause you’ll die.”
  • “…hmm..interesting” in Bill Hartman Grandpa’s voice
  • “…sure about that?” in grandpa’s voice
  • “Her teeth told me she had bunions”
  • “I don’t know why he told us the same diagnosis five times.”
  • “Breathing is really important. The research has shown if you don’t do it you will die”
  • “How about this word, variability. How about this word, salience. How about this word, anti-fragile. How about this word, POTS.”

Trevor Rappa is a student at Columbia University and will graduate this May with his DPT. He has clinical experience with Lori Thomsen at the Hruska Clinic and with Zac Cupples at East Valley Spine and Sports. Upon graduation, he will be working at Peak Performance in NYC. You can get in touch with Trevor by email at trevor.rappa@gmail.com or on twitter @TrevorRappa.

 

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.