Help Any Client Achieve Their Goals

I recently did a little spot on IFAST University regarding how I approach, assess, and progress people along the physical activity continuum. Read the little intro  below, and if you want to watch the video, click on the picture or the link.

As a bonus, I put together a little PDF outlining how I improve the movement variability side of physical activity. If you sign up for IFAST University, you’ll get access to it.

Without further adieu, here is the post.

The Four Step Process to Address Movement Limitations

I’m in the business of creating change, but — as you know — that stuff is HARD TO DO.

How do you simplify the process?

I like to outline things. When thoughts have a directional flow, it’s easier to keep everything straight. So I have to ask myself questions about each and every situation.

What kind of person is in front of me? And what am I going to do with him or her?

In this post, I’ll outline my process of helping people achieve their health and performance goals. We’ll discuss:The 4 areas where we can start creating change

    • My main area of focus: physical activity
    • The 4 steps physical activity
    • Each step from my physical therapy view
    • Each step from my performance coach view
    • My progression for mobility
    • The 3 active mobility tests I use
    • Testing for arm motion with lower body tests
    • Runners who get pain after they run 5 miles
    • Patients who get back pain after they sit for 4 hours
    • Athletes who can’t play the whole game without pain
    • …and a bunch of other short examples to relate this system to your own clients

Click below to watch the video.


Help Any Client Achieve Their Goals

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:

 

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Resilient Movement Foundations Course Review

I recently had the pleasure of attending a class put on by my fellas at Resilient Performance Physical Therapy.

A jolly old time with old friends and new

I went to this course for a few reasons. First off, I of course support the home team. I can’t even front, Douglas Kechijian, Trevor Rappa, Greg Spatz, and I go way back, and are very much related through IFAST family and directly (Doug is my younger older brother, Trevor is my son, and Greg is my stepson #dysfunctionalfamily).

That said, there is were a couple big things I wanted to take away from this course, which I did in spades:

  • Mastering basic movement
  • Program design

In these two areas, the Resilient fellas delivered in spades. Knowing what good technique is in the basic movement patterns, how to coach, and how to regress, are all underappreciated topics that these guys teach quite well.

So should you take this course? An emphatic hell yes. I give a more indepth review as to why in the video below, so go ahead and check that out.

Once you got the verdict, check out my favorite takeaways in the course notes, and then for the love of God sign up for a course of theirs!

Click here to check out the Resilient Seminar Page

Continue reading “Resilient Movement Foundations Course Review”

D League Readiness Measures, Navigating Flare-ups, and Should I get the OCS? – Movement Debrief Episode 16

Just in case you missed last night’s Movement Debrief Episode 16, here is a copy of the video and audio for your listening pleasure.

Here’s what we talked about:

  • What readiness and performance measures I used in the NBA D League
  • What I would’ve done differently?
  • How to navigate a pain flare-up
  • What are the pro’s and con’s of becoming a clinical specialist

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 some of the links I mentioned in this Debrief.

How to Design a Comprehensive Rehab Program

How to Treat Pain with Sitting – A Case Study

Services sign-up

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

 

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”

Post 100: Sexifying Upper Quadrant Post-Op

I Wrote a Lot

It’s interesting to think how much this blog has changed since I started writing in February 2013.

We’ve gone from cliff notes of books, to cliff notes of courses, to the occasional self-musing.

 

The blog. She is my muse, my flame.
The blog. She is my muse, my flame.

While I still plan on reviewing and assimilating courses I take, my hope is to expand and reflect upon whatever is in my brain a smidge more.

It makes sense to start this trend with post 100.

And today, postoperative care is piquing my interest.

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Yes, post-op intervention is a guilty pleasure of mine. And it’s not because it’s easy.

Far from easy.

Post op treatment gives you a license to create under various constraints. Meaning you have to dig a little deeper to achieve desired goals.

I think it can be way sexier, and effective, than your typical post-op protocol BS. So let’s create some successful post-op fun.

In post op, not sure if it was ever there.
In post op, not sure if it was ever there.

The First Constraint

Before we even talk about specific patients, we have to first look at the largest constraint yet: available tools.

At my current digs, I don’t have much of anything in terms of heavy weights. So here is what I have at my disposal that I can implement:

  • 1-on-1 care for 60 minutes
  • Kettlebells: 10, 15, 25 pounds
  • Therabands and theratubes of various sizes
  • Cook bands of various resistances
  • PRI trial orthotics (mouth splints, arch supports, reading glasses, yada)
  • Steps
  • Tape
  • IPAD
  • 3D stretch cage (aka very expensive equipment to tie therabands to)
  • Access to higher level brain centers
  • Heart of gold

We keep things simple at EV.

All day every day at EV
All day every day at EV

Early Stages

This is every clinician’s favorite rehabilitation stage, namely because it is incredibly boring.

That is, boring if said clinician has absolutely zero temporal wobble.

You can be amazed at what the patient can actually be do at this stage to expedite the rehab process once movement constraints are lifted.

The most common upper quadrant restriction involves no movement of the involved extremity.

The goals during this stage ought to include:

  • Promote a safe healing environment – reduce fear, pain, swelling, etc.
  • Restore local mobility
  • Restore system variability
  • Remap affected regions in the somatosensory homunculus
  • Challenge the aerobic system

Let’s take a patient I am seeing post-rotator cuff repair on his right arm. He cannot move his arm for 6 weeks.

Top priority of course is restoring range of motion, so session bulk was spent on pain-free manual therapy and passive range of motion. For home he gets elbow/wrist ROM and nerve glides.

But there is no way in hell I am doing that for 60 minutes.

In the outfit I would say it in...
In the outfit I would say it in…

There are many other things that this fellow can work on aside from basic range. Let’s address the other qualities.

Restore System Variability

In PRI-land, this gentleman was a PEC/RBC/RTMCC. We began to address this protective pattern day 1 after surgery.

Reduce sympathetic tone, reduce threat perception, promote a safe healing environment. Everybody is happy.

Since I knew he would be living in a recliner for the forseeable future, we kept things simple by blowing up a balloon.

One week later our guy came in as a LAIC/RBC with decreased left hip internal rotation, so we shifted our emphasis towards improving right apical expansion while shifting into his left hip.

With this strategy, we were able to maximize system variability within the confines of his restrictions. Gaining apical expansion on the right side was a nice way for the patient to relax the shoulder tissues while keeping the repair intact.

Remap Affected Regions

Use it or lose it reigns king in post-op land. But how can we get this gentleman to use his arm while respecting the passive-only barrier?

Here is where I love graded motor imagery the most. The shoulder’s motor pathways can still run while the repair stays intact.

So day one, we assessed our guy’s left/right discrimination using the NOI Recognise app.

He ended up blowing this stage out of the park, so once we went through all the different challenges this program allows we went straight to explicit motor imagery.

Most of my imagery is explicit...
Most of my imagery is explicit…

I asked our guy to visualize what his shoulder looked like without the brace first. Once he was able to do this, I had him imagine moving his arm in various movement planes, to progress to envisioning ADL performance with his affected extremity.

In the clinic, I would teach him push/pull movement on his left arm while he imagined performing those actions on his right.

Once he mastered imagery, we began to implement mirror box therapy.

We first started out by just watching him move his “right” arm in the mirror, which he said was very freaky.

Grab a mirror box...and perhaps some Chardonnay.
Grab a mirror box…and perhaps some Chardonnay.

Despite the freakiness, it blew him away how much this technique reduced his pain and stiffness.

Once he could do basic movements no problem, we had him work on push/pull movements using his left hand while watching his “right”arm.

His most challenging piece? Open loop arm movements. This task was a beast for his mind:

Combining GMI with working the non-affected extremity tremendously expedited re-learning basic movements on his affected extremity as we progressed later into postoperative care.

Challenge the Aerobic System

 Our guy is in his 50’s and a blue collar worker, so we aren’t getting super wild and crazy here.

Day one we emphasized nice easy walking 20-30 minutes per day to increase circulation and promote healing.

Clinic-wise, we taught him squatting, deadlifting, pressing, and rowing. To emphasize the aerobic system, we kept things at tempo pace to emphasize slow-twitch hypertrophy and aerobic development.

Tempo lifting

  • 2-4 sets of 10-12 reps
  • Pace 3 second eccentric—no pause—3 second concentric. I tell patients to say this mantra slowly – Screw…you…Zac (eccentric) Screw…you…Zac (concentric). This mantra also helps boost the immune system because patients find it funny. Two points for me!
  • 30-40 seconds rests between sets.

Later Rehab Stages

 The later rehab stages look somewhat similar to typical fare, though I do not emphasize isolated strengthening so much.

Once the active assist/active unresisted phase is allowed, we switch to that stuff. Shoulder remapping becomes a greater active process, so most of GMI is stopped. Let’s get him moving.

Fortunately he does.
Fortunately he does.

Our program also shifts toward him using his right extremity to aide in variability restoration. He has limited flexion, so I like a doorway lat stretch:

[side note: amazing that most comments I’ve heard on this vid involve my glutes and not the technique. Upon reflection of most of my life, this probably is not as surprising]

I also like him doing unresisted reaching:

We still emphasize challenging the aerobic system and the unaffected extremities, but this usually accounts for about 20% of the session at this time.

Once we can start resistance training the extremity, we keep things simple. I like push/pull movements and static/dynamic motor control exercises. So we teach our guys armbars, get-ups, carries, crawling, etc.

I don’t use a whole lot of isolated cuff work during the rehab process. The cuff doesn’t really work as a prime mover, so unless the goal is cuff hypertrophy (aka gettin’ Swolebodan Milosevic), I don’t do it.

 

Do some homework if you don't know who he is
Do some homework if you don’t know who he is

In the cases that I have scrapped cuff isolation exercises, I still saw manual muscle testing improve just the same. So let’s teach the cuff to be a cuff.

We finish the rehab process by making it look a lot more like fitness. By the end, the hope is to have system variability restored, local mobility in the clear, and strength up to snuff. Teach your guys and gals the basic movements and emphasize patient-specific functional activities, and you are in the clear.

Final Thoughts

 That’s where I am right now with upper quadrant post-operative care. There is a lot that these folks can be doing, and my challenge to you is to make those early stages of rehab some of the most exciting for the patient.

Now go and create!

Even if it's something like this.
Even if it’s something like this.