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:

90/90 Hip Lift – A Movement Deep Dive

The Fundamental Rehab Technique

It’s a classic that does so much more than the naked eye can see. This round of “Movement Deep Dive” focuses on the 90/90 hip lift, and some of my favorite variances off that move.

I hope you have your pen and paper handy to take notes, because this video is a long one.

If videos aren’t your thing, I’ve provided a modified transcript below. I would recommend both watching the video and reading the post to get the most out of the material.

Learn on!

Continue reading “90/90 Hip Lift – A Movement Deep Dive”

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”

The Sensitive Nervous System Chapter X: Neurodynamic Tests in the Clinic

 This is a summary of Chapter X of “The Sensitive Nervous System” by David Butler.

The Tests

When assessing neurodynamics, there is a general system that is used including the following tests:

  • Passive neck flexion (PNF).
  • Straight leg raise (SLR).
  • Prone knee bend (PKB).
  • Slump.
  • 4 different upper limb neurodynamic tests (ULNT).

I will demonstrate these tests for you in later chapters.

Many clinicians when discussing the lower extremity-biased tests deem that maybe only one or two of the tests need to be performed, however this assertion is erroneous. Slump, SLR, and PNF all need to be tested as a cluster. The reason being is that the clinical responses may often differ.

This difference is especially noticeable when comparing the SLR and the slump. These two are not equal tests for the following reasons:

  • Components are performed in a different order.
  • Spine position is different.
  • Patients may be more familiar with the SLR, therefore give more familiar responses.
  • The patient is in control during the slump, not in the SLR.
  • The slump is more provocative.
Slump ≠ SLR, and SLR ≠ Slump. New product name?
Slump ≠ SLR, and SLR ≠ Slump. New product name?

Rules of Thumb

When testing neurodynamics, here are the following guidelines:

1)      Active before passive.

2)      Differentiate structures – add/subtract other movements to see if symptoms can change.

3)      Document the test order.

Positive Test

The positive testing here is a little dated based on what Butler’s group and the research says as of right now. Based on what I have learned from Adriaan Louw, having any of the following is what constitutes a positive test.

  • Symptom reproduction.
  • Gross range of motion asymmetry between sides.
  • Gross sensitivity asymmetry between sides.

Source Identification

There are several pieces to look at when determining potential sources of neural findings.

  • Area: Cutaneous zones generally nerve trunk; dermatome generally nerve root.
  • Motor loss: Reflex loss is usually the nerve root; specific motor loss can be the root or trunk.
  • Patient history.
  • Palpation: Generally how to find AIGS.
  • The movement exam: Good at showing neural container dysfunction.

Unexpected Responses

There are several unexpected responses that often have very rational explanations.

  • Release worsens, addition is better: Likely a neural container problem.
  • Ulnar symptoms with ULNT1 (a median nerve test): Tests are crude, and could have an anatomical variance.
  • Bizzare pain responses.
  • Multiple positive tests: Generally treat the least sensitive.