Tag: physical therapy

When Can I Run Again After an Ankle Sprain?

Ankle sprains are such a bugger and take some time to heal. But once you’ve let swelling and such run it’s course, when is it safe to run? We answer that in the video below. Here, you’ll learn my criteria and progression that I look for when having someone safely return to running. Watch and learn! Ankle sprain red flags The first thing you have to do after an ankle sprain is make sure you don’t have a fracture. There are these rules to follow called Ottawa Ankle Rules, which are a cluster of findings that would indicate getting some imaging done. These findings include: Inability to weight bear Pain within the viscinity of either malleolus If you have these findings, you most definitely need to get some imaging. Do not pass go, do not collect $200. But if you do not have these findings, move along to the next part 🙂 Returning back to running after an ankle sprain Running is merely a series of bounds (jumping from one leg to the other) for an extended period of time, so after an acute ankle sprain, we have to make sure components leading up to this go okay without any issues. To determine the course of action for this return, we can start from the most fundamental actions of the bound, then build our way up. The steps below are the progression that I use. You want to make sure that you have minimal increases in pain/swelling before moving onto

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A Narrow Infrasternal Angle with Right Oblique Tilt – Case Report

What do you do if you have someone who is a narrow infrasternal angle, stiff as all hell, with some glaring asymmetries? Check out this video below, where a colleague and I walk through a case who presents in this manner. It in, you’ll hear about the following: How to test shoulder flexion more reliably How to build someone into half kneeling Moves to utilize for this type of individual Watch the video to learn what we did!

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Bridging the Gap Between Table Testing and Training

Many of the moves we use to improve range of motion are a little weird. What if I have a client who wants to lift them heavy-ass weights? They want to feel like they did something. How can we bridge this gap? Watch this video to learn how. Applying the movement model to fitness Don’t underestimate the power of some of these simple breathing moves. When coached well, your clients will shake and get absolutely cooked. It’s a beautiful sight. Often, the key differentiator between feeling nothing and feeling a whole lot with some of the simple breathing moves is the stack. Make sure you have the stack. But remember folks, these moves are not something we just throw into the program willy nilly. These moves are merely regressions of the common moves that we perform in the gym. The Lewitt position is a regression of your midrange depth of the squat. If we understand the different positions we need to utilize to improve various ranges of motion, we can pick common gym moves to get range of motion changes. For example, if someone has a loss of external rotation, we might choose a 2 kettlebell front squat: If I need internal rotation in the arms and legs, pushups could be MONEY: Need to rotate like a boss? Well fam, a 1 arm press could change da game!

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The Best Position for the Stack – A Case Report

Many times if you don’t get the result you are looking for movement-wise, it is often related to losing the stack (and not talking to Zac). How do you know where the failure occurred? That’s exactly what we sift through in this video. In it, we walk through a failed case, and look at where tweaks could be made to improve the outcome. Watch it to learn more! Looking at each component of the stack In this case of a person with shoulder pain, we look at some of the big limitations this person had: Decreased shoulder internal rotation biliaterally Decreased left shoulder external rotation Narrow infrasternal angle From here, you then need to look at each piece of the stack to determine how to design the activity with the best possible chance of success. What are those components? I’M GLAD YOU ASKED!! Here are the pieces we focus on for the stack in order of importance (though fam, you need to build it all!): Pelvic positioning Full exhale Pause and inhale with ab tension and relaxed upper thorax Reach without crunching Now based on what we need to maximize this person’s movement options, we can then engineer exercises with a high probability of increasing available movement. The keys we need to respect are restoring external rotation before internal rotation, respecting their anthropometric structure, and address asymmetry (shoulder rotation limitations indicate this person has a right rotation bias). Therefore, we can engineer activities that can create high odds for success:

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Improving Hip and Shoulder Internal Rotation WITHOUT STRETCHING!

Having shoulder and hip internal rotation is kind of a big deal. What if you could get it as quickly as possible without a single stretch? That’s exactly what we did in this case. I work with someone who is unfamiliar with my techniques, and in 3 moves (1 of them a failure), we were able to increase shoulder and hip internal rotation. Watch the video below to learn what we did. Case overview The “patient” is my nephew, Brad. He’s a football player and wrestler who is just a stiff bro. No pain. Objective findings Brad’s main initial findings were the following: Test Left Right Infrasternal angle narrow Shoulder flexion 155 155 Shoulder external rotation 95 95 Shoulder Internal rotation 90 50 Hip flexion 95 95 Hip external rotation 60 60 Hip internal rotation 10 10 Straight leg raise 65 65 Intervention selection Given the findings above, are major keys to focus on were making the infrasternal angle dynamic and restoring internal rotation. Brad appears to be a classic narrow infrasternal angle. Lewit tilt I chose this move because the 90 degree angle at the hips biases internal rotation. The supine position promotes lateral ribcage expansion, which is great for narrow infrasternal angles. If you want a super in-depth reasoning for this move, check out this post. After performing this move, B’s test results were as follows (improvements are bolded): Test Left Right Infrasternal angle narrow Shoulder flexion 155 155 Shoulder external rotation 95 95 Shoulder Internal rotation 90

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Movement Analysis and Breathing Strategies for Pain Relief and Improved Performance

Chris, a high level mountain biker, at first didn’t believe someone could help him move better over the internet. He had back issues for a hot minute, what the heck was an online consult going to do? A couple consults later with me, and Chris is pain-free, back to doing all the wild and crazy things he was doing before without issues. Chris was so juiced up about his results that he wanted to learn more about my thought process and what I do that he had me on his podcast. Chris Kelly is the owner of Nourish Balance Thrive, a really cool site that brings several great practitioners together to help clients remotely with whatever their goals are. Despite Chris technically not being in the field, he’s one of the best interviewers I’ve had the pleasure of podcasting with. He asked some great, unique questions, and we got into a wide variety of topics. Here are some of topics we discussed on the podcast: Ben House and Flō Retreat Center in Costa Rica How I got into physical therapy. The influence of Bill Hartman. Working with NBA basketball players. The influence of Dr. Bryan Walsh. Sleep and performance How to treat pain Assessing movement Movement variability The online assessment process Pain vs. tissue damage How we improved the host’s chronic lower back pain The importance of the pelvic floor What is considered normal breathing How to promote behavior change in our clients Applying the principle of minimal effective dose

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Wrist Pain, Dry Needling & Taping, and Should I Become a PT? – Movement Debrief Episode 90

Movement Debrief Episode 90 is in the books. Below is a copy of the video for your viewing pleasure, and audio if you can’t stand looking at me. Here is the set list: Why does wrist discomfort occur with weight bearing? What limitations could contribute to wrist discomfort? What modifications can I make to improve wrist discomfort? What regressions are useful for wrist discomfort? Do I use dry needling or taping? If and when do I find these modalities useful? Is it worthwhile becoming a physical therapist? What is it really like being a PT?

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