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

July 2017 in Review

Every week, my newsletter subscribers get links to some of the goodies that I’ve come across on the internets.

Here were the goodies that my peeps got their learn on from this past July.

If you want to get a copy of my weekend learning goodies every Friday, fill out the form below.  That way you can brag to all your friends about the cool things you’ve learned over the weekend.

Biggest Lesson of the Month

Maximize proximal before spending time distal. I’ve just seen too many patients where we applied some type of axial intervention, which led to profound changes distally. Position governs all. Thank you for making me realize this daddy-o.

Quote of the Month

Only those who dare to fail greatly can ever achieve greatly. ~Robert Kennedy

Rehabilitation

Blog: What is the Best Test to Discern an ACL Tear?

My boy Scott Gray put together a rock solid post on diagnosing an ACL tear. I’ve been very big as of late on filling the differential diagnosis hole in my game, and this one was beyond helpful. I wish I had heard of the lever test last year when I had a guy pop his ACL in-game.

Blog: The Quadruped Rockback Test: RIP

My buddy Doug Kechijian ever so succinctly puts this dated test to rest. There is so much more that goes into deciding squat depth than can be accurately accounted for with this test.

never question a guy with a loaded gun.

Performance

Research: The effects of two different recovery postures during high intensity interval training

I’m still making my way through this beast. It’s a thesis, but the references and explanations of the science behind breathing, position, and recovery is outstanding. Not only that, but changing your recovery position has had a profound effect on improving my clients’ conditioning.

Video: Lateral Lunge Quick Hit

This was a promo I put out for my 5th Metatarsal RTP podcast. It’s a nice little cue to drive greater frontal plane activity on the non-working leg.

Research: The athlete monitoring cycle: a practical guide to interpreting and applying training monitoring data

So proud of my guy Eric Oetter, who put this incredibly practical guide to load management together with the brilliant Tim Gabbett. EO is doing phenomenal things with the Grizzlies, and this provides a small insight into his process.

Nutrition

Podcast: Does Meat Consumption Cause Cancer? 

Short answer – It depends. I have a coworker who I discuss with the problems of this argument. I’m an avid meat eater because gainzzz, and it turns out that makes the difference. If you aren’t listening to Ronda Patrick by the way, you’re welcome.

Yeah, I’m a meat eater #dealwithit

Podcast: How to Tell if You Have a Leaky Gut

Chris Kresser is a cat I’ve been really getting into as of late. I think there are a lot of cool things within functional medicine, and this guy is one of the most evidenced-based out there.

I think the gut microbiome is a vastly underappreciated area to intervene on. But how do you know if you have a problem? CK tells you how to find out.

Video/podcast: George Brooks, Ph.D on Lactate

This Rhonda Patrick joint talks about all the wonderful things lactate does for us. This molecule always gets a bad rap, but did you know in brain injuries (concussions, TBIs, etc), it’s one of the few substrates that is capable of providing our brain fuel? This was a very fascinating hour in which I learned a great deal.

Research: Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan

Supplemental Podcast: Satchin Panda Interview

What if I told you that there was a way you could keep eating what you are eating yet still lose fat and gain muscle. Would you do it?

If so, then this is your study. By simply restricting the eating window to 9-12 hours in mice, and having them eat earlier in their day, these bad boys lost some major weight. He did a similar study in humans as well. He goes into detail about this and more. Both the paper and the podcast are quite interesting

Sleep

Video/Podcast: Dan Pardi on Sleep

I’ve been on a little Rhonda Patrick (#bae) kick as of late. In this interview, Dan Pardi talks about all things sleep, circadian rhythms, and more. If you can maximize sleep duration, intensity, and timing, you are winning at life. Never thought of sleep described in this manner.

Quick Hit: Tips for a Better Sleep Environment

Here are some of my keys to creating that ideal sleep environment. There might be a few in here that you didn’t think about. What are your keys?

Finance

Book: The Four Hour Work Week 

An oldie, but a goodie. I’m taking my time with this one because it’s a big book and filled with so many practical applications. This book inspired me to check my email, and respond, less frequently. He’s given me so many ideas on streamlining my life. You’ll love the tips he has for elimination and automation. Incredibly practical.

Blog: Student Loans? What Student Loans? 

Given that I’m pretty green at being a PT mercenary, this website has been gold for me. If this doesn’t inspire you to consider travel PT, nothing will. The money is real, and it seriously feels like I’m on vacation all the time.

Me on the left by the time my student loans are paid off

Book: Roger Dawson’s Secrets of Power Negotiating

I recently had to prepare for a salary negotiation, and just reading a few chapters from this book made the process go exceedingly better than I anticipated. Negotiating, like many things, is a skill. This book will teach you the fundamentals to a skill that will benefit so many aspects of your life.

Miscellaneous

Music: “Handshakes with Snakes” by Apathy (NSFW, and likely offensive to most everyone)

As y’all probably know, I am a major hip hop head. Like, pretty much all that I listen to. I found this cat on Spotify while at the gym, and was blown away. Has fire lyrics over insane samples. Listen to the joint called “Moses” which features Twista and Bun B. Un…be…lievable

Current Book: What If

I’ve lately been trying to read something a bit less technical right before bed to help me fall asleep (which has been working well btw). First book I chose was this gem by the creator of XKCD, Randall Munroe. He basically goes through and answers ridiculous questions in the most scientific manner possible. It’s a brilliant combination of interesting and funny.

My favorite so far? “What would happen if you had a mole of moles?” #deep

Photo credits

Air National Guard

Karim benzeoona

DonkeyHotey

 

Stress Response, Proximal First, Sensation Loss, and Your Health – Movement Debrief Episode 12

Let me guess, you are devastated you missed last night’s Movement Debrief.

You should be. It was by far the most interactive debrief we had yet. Loved how active everyone was, and definitely some people help me get better.

Kudos to Steve, Jo, Yonnie-Pooh, and the many others who commented on today’s Debrief.

Here’s what we talked about:

  • How the stress response impacts many areas
  • Treatment hierarchies
  • How to restore sensation loss post-surgery
  • Functional Medicine
  • Why taking care of your health helps others

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

Enjoy.

How Sleep Saved the D-League – Resilient Podcast

Sleep is a big deal.

Not only has a lack of sleep been linked to many big bad diseases, it also contributes to poor performance.

Behavior change through education and persuasion is hard enough as is. We are all resistant to change, namely because our current habits and routines require Herculean willpower efforts to break. This problem  is especially true in non-conducive environments.

It’s hard to eat healthy when your family cooks fried foods and orders pizza for dinner every night.

It is these situations where we just have to make the most with what we have, and that’s exactly what I spoke about on one of my best friend’s podcasts, Doug Kechijian.

Before we go into the content, let me tell you a bit about Douglas, my younger-older brother.

Doug and I first met way back in 2013 at a PRI course in Phoenix. 

So young. So youthful. So of poor quality of a photo. Doug is 3 people right of me

I was the first person who arrived in town, and it was up to me to take care of the rental car.

We had five bros to get to the class, so I needed to find something cozy that could fit everyone and their luggage to and from the class and Phoenix airport.

So I’m looking at some midsize SUVs, a couple sedans, trying to find the right car that I could fit everyone in.

Then I saw this:

So…fast…now my realistic dream car.

Doug and I had never met before, and he was the first person I had to pick up. He asked “what will you be driving?”

I said “you’ll know.”

So there I am, picking Douglas up in this Dodge Challenger flarin’, hip hop blarin’, shade-wearin’, and straight up stuntin’ in that AZ heat.  The car was a great ice breaker towards realizing how likeminded we both were.

All the other guys we had to pick up were flying into town every couple hours. For the hell of it, we made the 20 minute drive back and forth to the airport in that Dodge Challenger. We ended in clown car fashion, but it was totally worth it…Well, for me at least. I got to drive that beast!

It was in those hours, that weekend, that coziness, that these two cats who didn’t know each other developed a long lasting friendship. I am fortunate to say that about every single one of those guys in that picture.

Doug is simply one of the most intelligent, grittiest, interesting, and eloquent individuals I know. He is without a doubt a thought leader in the fields of physical therapy and performance. Each time we hop on our 2+ hour call to catch up, I always become a better clinician, coach, and person. He is a wealth of information, served our country with distinction, and a great human being. I am honored to call him my friend, and you guys should know who he is.

He’s also a really good agent, as he’s gotten me two of my most recent jobs!

So please, check out his site, follow his killer twitter, watch him demonstrate exercises shirtless on Instagram,  see him in NYC, and do all you can to learn from this guy.

On a side note, he and his two partners, Trevor Rappa (aka my son)and Greg Spatz (aka my step-son), put on seminars periodically throughout the year.

One class I want you to know in particular is at Move-SF in San Francisco on October 1st. 

Why am I pointing this one out? Because I’m going to be there. I want to learn all that I can from these guys. As should you.

So if you are a reader of mine, go to this seminar and we can get together for some grub and discussion. I plan on being around the Bay Area for a little while (there’s National Parks to be hiked after all), so please attend and support my dear friends.

 Improving Sleep the Easy Way

I was recently featured on Doug’s podcast where we discussed my sleep initiative that I executed when I was with the Iowa Energy of the NBA D-League.

While the article covers logistics, this podcast details the why’s, how’s, when’s, etc.

If you missed my original article, click here to read it: “He Sleeps He Scores: Playing Better Basketball by Conquering Sleep Deprivation.”

Here were the topics that we discussed:

  1. The challenges a pro sports medical and performance staff faces
  2. Why I started my sleep initiative
  3. The sleep initiative details
  4. How I persuaded the coaching staff to break sacred traditions
  5. How better sleep benefitted the team
  6. Sleep science resources
  7. Eliciting organizational and individual behavioral change

If you want to download this podcast or many of the other amazing podcasts Doug has put out, subscribe to him on Itunes. 

Some of my favorites include the podcasts he did with Daddy-O Pops Bill Hartman, David Epstein, Brett Bartholomew, Dr. John Childs, and of course, the one and only James “The Thinker” Smith.

How to Treat Pain with Sitting – A Case Study

Case studies are much more valuable than many give credit for.

It is this type of study that can often lead to sweeping changes in how further research is conducted, often create paradigm shifts in their own right.

After all, there was only one Patient H.M.

One thing that I wish I saw more in case studies was the clinician’s thought process. Why did they elect to do this treatment over that, what were they thinking when they saw this? How do they tick?

I was fortunate enough to have an online client of mine suggest to that I make her a case study, and it was a very rewarding experience on both fronts.

My hope is that you can see how a clinician thinks first-hand, and see the challenges a clinician faces…

When you can’t work with your hands.

Continue reading “How to Treat Pain with Sitting – A Case Study”

Sleeping Tips for New Parents & Patients Owning Their Care – Movement Debrief Episode 6

If you missed yesterday’s Movement Debrief live, you missed a doozy.  We discussed the following topics:

  1. What strategies new parents can use to maximize the little sleep they get
  2. Ways to give patients ownership in their care

There are a few products I mentioned or are relevant that you may want to check out:

Recommended Relevant Resources

Take a Nap, Change Your Life

Metashred Diet

Found My Fitness Podcast by Rhonda Patrick

Tim Ferriss Podcast featuring Rhonda Patrick

Meditation Apps

Headspace

Calm

Insight Timer (free)

Nootropic Supplements for Alertness

Foursigmatic Mushroom Coffee

Teacrine – Shoot for 150mg/day

Blue Light Blocking Systems

blue light blocking glasses

f.lux – a blue light blocking app for your computer. Syncs with sunrise and sunset

Circadian Rhythm Devices

NatureBright Sunlight Plus Light and Ion Therapy Lamp – For use when you live in an area with poor sunlight. Helps stimulate alertness. Also shoots negative ions, which has a bit of research, at least with earthing, to favorably impact heart rate variability.

Zero (free) – An app that promotes circadian fasting. Ensures you stop eating before sunset.

 

 

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

A 16 game losing streak. Worst record in the league. 8 rookies. We were in dire straights.

Could we fix it in 2 hours?!?

The NBA travel schedule is one of the hardest in pro sports. 82 games in a season plus playoffs. Several back-to-back games that require time zone changes, late nights, early mornings, and playing nightly at a high level.

And a high level of sleep deprivation.

Fortunately, many NBA teams, including the one I worked for, take whatever measures possible to ensure our guys get enough sleep. They modulate flight times, stay in the best hotels, and use their unlimited budgets to improve sleep quality.

We call that soft where I come from.

My domain—the NBA D-league. Home of the worst schedule in professional sports.

I can’t even call it a nightmare because you don’t sleep enough to hit your REM cycle.

Let’s take a look at this disastrous schedule.

Continue reading “He Sleeps He Scores: Playing Better Basketball by Conquering Sleep Deprivation”

Continuing Education: The Complete Guide to Mastery

75

That’s my number.

No, not that number.

 

Pervert

75 is the number of continuing education classes, conferences, home studies, etc that I’ve completed since physical therapy school.

Though the courses are many, it was probably too much in a short period of time. When quantity is pursued, quality suffers. Sadly, I didn’t figure out how to get the most out of each class until the latter end of my career.

Two classes in particular stand out: Mobilisation of the Nervous System by the NOI Group, and ART lower extremity.

Yes, the content was great, but these classes stood out for a different reason. You see, instead of just doing a little bit of prep work, I kicked it up a notch. I extensively reviewed supportive material, took impeccable notes, and hit all the other essentials needed to effectively learn.

I was prepared, and because I was prepared I got so much more out of these classes than my typical fair.  The lessons learned in those courses stick with me to this day.

For the stuff you really want to learn, I’ll encourage you to do the same. Here is the way to get the most out of your continuing education. By the time you are done reading this post, you’ll understand why I now recommend a more focused learning approach and fewer courses.

Let’s see how to do it.

 

Continue reading “Continuing Education: The Complete Guide to Mastery”

Course 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.

And we grow more everyday.
The League of IFAST grows stronger every day.

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.

what your symptoms are.
what your symptoms are.

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.

 

I have thought about it on more than one occasion
I have thought about this viable option on more then one occasion

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 digestion, growth, and reproduction.
  • Increase immune system activity
  • Sharpen cognition, alertness, and pleasure

If the stress response perpetuates, other systems fail and break down to continue to support the need to reduce potential threats. We see a shift in the homeostatic set-point toward elevated levels of the above.

Although we all must deal with stress in some way, why is it that some people tolerate chronic stress better than others? It’s all in how one copes. The following is needed to successfully deal with stress:

  • Need an outlet for stress.
  • Have predictable information.
  • Have a sense of control.
  • Have a healthy social circle.
  • Perceive that life is improving.

 

Stress Antifragility

Per the book of Sapolsky:

 

Optimal stress = moderate severity + shorts duration/amount + safe/benevolent environment.

 

Aka good training. But how do we build up individuals to continually better tolerate further challenging stressors?

Here is where my man Eric Oetter dominated the conference.

My 2 favorites from the weekend.
My 2 favorites from the weekend.

When chronically stressed, the aforementioned stress response takes high priority in all our systems, including nervous. Immune molecules smudge our various homunculi, dopamine floods the system to reward outputs, and myelin solidifies neurological pathways to perpetuate it.

Breaking a chronic stress cycle involves habit alteration.

To be able to effectively create newly favorable habits, movements, or pathways, attention is key. This piece is something we lose in a stressed state; as prefrontal cortex activity decreases. This is why salience is so important.

To return to a favorable homeostatic environment, we enlist Eric’s three P’s:

 

#Prime

 

Both prime and Prhyme are essential
Both prime and Prhyme are essential

Prime brain activity via the aerobic system. It boosts brain power, especially if done before an activity.

 

How: Work between 120-150 bpm for 15-30 minutes prior to motor skill learning. Do something you enjoy so you do not become overly stressed by the activity itself.

 

#Prune

And helping you learn since 10000 BC
And helping you learn since 10000 BC

Sleep is a big deal. According to one of the speakers, Vincent Walsh, we sleep 37% of our lives. Yet we only work 19% of them. We sleep so damn much that it should probably be taken seriously.

Sleep helps us remember by helping us forget things. The sleep cycle replays our day; keeping the important pieces and discarding the unnecessary.

This discarding is the pruning that Eric referred to, and it occurs by glial cells. Glia is what smooths out new neural connections.

How do we get good sleep?

  1. Respect the chronotype – keep your normal sleep-wake cycles.
  2. Take naps – 26 minute naps are bomb.
  3. Banish blue light – cut out 1-2 hours before bed, as blue light from electronics tells the suprachiastmatic nucleus in the brain that it is light out.
  4. Become a sleep environmentalist – No caffeine after 12, no meals 3 hours before bed, sleep in a cool room, etc.

 

#Prefrontal

If you can’t access to the prefrontal cortex, you will never hit the cognitive stage of motor learning.

Chronic stressors inhibit access to the PFC. The PFC is the doorway to variability, which is something unwanted during a stress response. Automaticity is king.

Getting the PFC allows all systems to be freely expressed. How do we do it?

  • Mindful meditation.
  • Monitoring (omegawave, bioforce HRV, etc).
  • Remove the “neurolock” via redirection and respiration (hint hint– PRI)
  • Energy systems development.

 

Respect the Thorax

 This section will channel my homie’s James Anderson and Allen Gruver. Can’t go a place without getting a PRI fix.

It's quite uncanny actually
It’s quite uncanny actually

What keeps the spine and sternum oriented right despite the thorax counter-rotating to the left? The answer would be airflow. A hyperinflated left chest wall pushes these areas to the right.

Thoracic movement is determined by this position as well as timing/coordination of gross movement patterns. We can observe how the thorax is driven through what the extremities are doing.

If you look at the baseball throw, we ought to see alternate positioning on each arm. For example, if the right forearm is in supination during a part of the throw, the left arm ought to be in pronation. This reciprocal arm function promote the thorax rotating in one direction. It’s a PNF thing.

Do you even PNF bro?
Do u even PNF bro?

If the arms go in the same direction, the thorax must extend or flex. Since sport is usually extension-driven, we can guess which direction one will go.

 

The Decision

Vince Walsh gave an excellent talk on the brain. He thinks we miss lots of talent because we look predominately at physical prowess.

Physicality is only one piece of the puzzle. Some individuals may develop excellent decision-making skills later on in their careers that may trounce athleticism.

Your ability to make right choices and avoid wrong ones is necessary for success, and is a trainable skill.

To know how to train it, it is important to understand the three types of decision-making:

  • Physical – What to do and not do (e.g. gun slinging)
  • Mental – e.g. poker playing
  • Temporal – e.g. playing chicken

Vince predominately used computer simulations to train these decisions, but it seems plausible that these tests could be applied to any type of training. Perhaps something like a reactive agility test could help improve physical decision making as an example. You just have to be creative.

 

For example
For example

A Cautionary Note on Data

Al Smith said some of the most profound words this weekend. He spoke to caution us on data.

Data does not always tell the individual story, as it can lead to less individualized training or rehab. It dehumanizes both our clients and us. This statement made me think quite a bit to those folks who champion evidenced-based everything.

Perhaps instead of measuring everything, one must first ask if there is a problem with what one is thinking of measuring.

Cynefin

Another cool thing Al Smith showed us was the cynefin framework; a sense making model in which acquired data precedes framework.

download

Depending on what a situation can be categorized in, one would expect to utilize different thought processes.

Simple – predictable relationship between cause and effect (use best practice)

 

Complicated – predictable relationship between cause and effect that’s not self-evident (use good practice)

 

Complex – A system without causality (use safe-fail experiments)

 

Chaotic – A completely unpredictable system (Use novel practice)

 

Where does training fit? Where does rehab fit? We may be using incorrect methods in particular situations.

You can learn more about the framework here, it’s definitely something I hope to explore more in the future.

Weekend Quotes

  • “Too much exercise is not normal hominid behavior.”
  • “This CT scan was not drawn by a commissioned artist.”
  • “If you think that’s a tight pec you better check pressure in the air.”
  • “10,000 hours can’t always undo 100 dumb ones.”
  • “Frank Netter shut down the left AIC.”
  • “Deny PNF and you are messing with the system.”
  • “We’re all barking down the same tree. We just like to complain.”
  • “No plan survives the first contact with the enemy.”
  • “Changing the answer is evolution; changing the question is revolution.”
  • “If you live in mediocrity you eventually think it’s good. You don’t know what good is.”
  • “It’s not normal to fart all day.”
No more complaining or whining. There is no bathroom.
No more complaining or whining. There is no bathroom.