Last Blog Ever! (on this site)

Posted: January 30, 2013 in Uncategorized

Hi all,

I just wanted to take the time to let you all know that I have officially moved over to a new site.

It is appropriately titled drjustinrabinowitz.com and hopefully will be more awesome than anything ever created! 

Thank you all for following me and reading my stuff! It’s nice to know people can actually benefit from something I wrote on the web. 

As a thank you for your continued support, a free gift waiting for you on the new site. Just leave your Name and Email, and the gift is yours!

Thanks again,

Justin

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Some Running Links…

Posted: January 7, 2013 in Uncategorized

Recently, I had the chance to do an informal lecture at the local running store in town. In the short talk, I tried to emphasize a few things runners (and most people, for that matter) usually neglect. Namely, soft tissue work and stability training.

The first thing we spoke about was foam rolling as either a warm-up or cool down (or both). Dr. Jeff Cubos designed a great 6 minute run prep:

http://www.jeffcubos.com/2010/04/13/the-6-minute-run-prep/

For some thoughts on stability or core training for runners, Dr. Cubos posted a great article, ‘Injured? Take a Break!’

Finally, here is a quick stability exercise that requires minimal equipment and even less time to perform.

Happy Running!

In what has turned into an unintentional series of articles, today will be Part III of the New York Jets injury problems. And no, I’m not talking about Rex’s tattoo

Part I occurred very early in training camp when the Jets mysteriously suffered a rash of soft tissue based injuries.

Part II occurred as the season was coming to a close and the Jets decided to take a step in the right direction and evaluate the reason behind these injuries.

And finally, Part III is the latest in the soap opera. Apparently the Jets decided that the strength and conditioning staff was the reason.

Remember, this is only Year 2 of this S and C staff as the first staff got fired for this…

sorry, I could not resist

I’m a little late to the party, but there is never a bad time to share a few more lessons from 2012…

1) Show by doing, not by saying– I think we are all guilty of this is one way or another. We all have grandiose plans that are harboured in that bizarre place we call our minds, yet living it out is a different story. I know personally, I am guilty of this just like the next guy. Whether it’s a treatment plan that I want to try, or a business venture that I should explore, the thought vs the action are two totally different steps. Rather than saying you are committed or that you will change, show it. Or as the E-Myth states,

The difference between creativity and innovation is action

2) The plan is only as important as the action that follows This is the same idea as #1. Or, as Dan John would say,

The details matter far less than the violent application of the plan

In order to take action steps, we must first have a plan of attack. BUT, be warned that if the plan is too complicated, it will be impossible to act on, and usually nothing will get done. Rather than spend so much time articulating a complicated and hard to complete idea, plan something simple and act on it.

3) Everyone should report to SOMEONE– I truly feel the most lethal situation for some people is being their own boss. Whether it is an internet business, a training business, or even a personal workout program, having nobody to report to is often a huge problem. Like it or not, deadlines and consequences are great motivators for all of us. Find people you can report to who will hold you accountable.

Obviously, many do in fact work for themselves. I’m not saying sell your business, but I am saying set up your systems so that you are accountable to someone other than yourself.

4) Criticism is a gift, treat it that way– For most of us, when faced with critique,  we get defensive and immediately brush off what was said. Instead, take everything said to heart, evaluate and process it, then make the decision if the critique is valid and if changes needs to be made. Rather than thinking of criticism as a curse, take it as a second chance or  a Do over to Do better.

5) A little fear goes a long way- Fear is a great motivator. Waking up every morning with a bit of trepidation that you may fail is not the worst thing in the world. As an athlete, when I felt like I wanted to sit at home and watch tv, that little bit of fear that an opponent was out- working me, got me off of the couch and to the gym. The same applies to business and work. The idea that someone out there is working harder at their craft than I am is a scary  thought and something that goes a long way as I try to always push to be better.

2012: My Year in Review

Posted: December 26, 2012 in Uncategorized

Today I wanted to share 3 big events in my life from the past year. Some good, some great, and some not so great… Enjoy!!!

1) I’m a Doctor-  The biggest change that 2012 brought was the transition from student to doctor. Initially, this was a change I took lightly. I kept telling myself that just because I crossed the stage and received that Doctoral degree, it didn’t  mean I changed as a person. What I failed to realize was that people now look at me a little different. Parents trust me with their kid’s health. Others hope I can do SOMETHING to help them get out of the pain that every other doctor told them would not go away.

This is truly humbling. Because of this, I certainly need to hold myself to a higher standard. Crossing that stage did in fact make me a different person. It did give me more responsibility and it did change the way others view me and how I need to view myself.

2) People Actually Read My Stuff-  Another huge change in 2012 has been THIS BLOG. Quite frankly, it started because I enjoyed reading other blogs, was really bored in student clinic, and thought I had some things worth putting on paper. 80 blog posts later, I am in the process of some big moves and hopefully some more useful content. The cool thing about my blog (other than the fact that I write it) is that hopefully people, who read it, can see me grow as a student, a doctor, and as a person throughout the journey. As I stated above, this blog started for me as a student and many of the posts are clinical thoughts or ideas I may have had at the time. Being able to look back 80 posts to see what I was thinking about a year ago is a pretty cool thing.

Make no mistake, as much as I love this blog and the feeling of putting out a quality post, it is hard freakin’ work!! After experiencing it myself, I can say I have a new-found respect for those who write their blog as a ‘side-job’ and consistently put out new, quality content.

When I asked Dr. Kathy Dooley, my former professor, and current Wonder Woman, how she finds time to post a new “Dooley Noted” everyday, she had this to say, ” The subway…I spend copious time on he subway.”

I responded by saying, “I gotta to get one of those.”

In all seriousness, maintaining a blog is no easy task. There are times when I feel like I have nothing to say and that nobody really cares. It seems that whenever I have that thought, someone sends me a really nice message with a compliment and tells me to keep up the good work. That’s what keeps me writing. So if you are one of those people, thank you.

3) I Failed- Yeah, I said it. It’s not the first time and it won’t be the last. Last year, while doing my student internship, I applied for  a program that would let me work within another chiropractor’s office rather than in the student clinic. An ‘Honors Program’ if you will. Well, as you may have guessed, I was not accepted. Not only was I not accepted, but I was the only one who applied. Basically, the doctor chose to have nobody instead of me.
I think it would be easy to sit here and tell you everything was peaches over the last year, but that sure isn’t reality. With an effort to be transparent, I think it is important to share some good and some bad, as nothing is perfect.
Or, as Dr. Tom Lotus says, “Everyone that posts on Facebook tells me about their success. I want to know about your failures.” In the end, this is what we learn from.
It did not take me long to realize that I needed to learn from the experience, rather than just be pissed. And as a former athlete, there is no better motivation than being told you aren’t good enough. Just in case I ever forget, I keep my application on the Desktop of my computer. Sort of a friendly reminder, I guess.
I’d be lying if I said that experience didn’t leave a HUGE chip on my shoulder. In the end, the people I am lucky enough to treat in practice will be the ones to benefit because I will always try to prove that doctor made a mistake by not choosing me.
Without failure, there is no success.

More Soft Tissue Injuries…

Posted: December 20, 2012 in Uncategorized

Earlier this season I posted a blog titled, Our athletes are pulling muscles. All we need to do is stretch more, right? The premise of this was based around my beloved (yet awful) New York Jets. This article talked about the rash of soft tissue injuries that occurred earlier in the season for the troubled New York squad.

Not surprisingly, injuries became a theme of 2012 Jets. It has gotten so bad that they will be conducting an internal study to see why they have been plagued. Check out the article here .

Tragedy and bELieve

Posted: December 17, 2012 in Uncategorized

As you all know, our country has suffered another unexplainable tragedy. I don’t think there is anything I can say on this blog that will change the situation. I also do not want to use this blog as a platform for political filibustering on my thoughts concerning gun control. Quite frankly, I think that attitude is one that takes away from honoring the victims lost in Newtown, Connecticut.

As much as we now question the values of current society, I think we can all take solace in the fact that there are many, many  more people in this world doing unbelievably good. People who continue to inspire us by their attitude, actions, and overall positive spirit are not hard to find.

For an example of this, look no further than New Jersey’s own Eric LeGrand. Eric, a former Rutgers football player, was tragically paralyzed during a college football game. He has since become a national hero because of his attitude and a smile that lights up a room.

I mention this because I recently had a chance to read Eric’s autobiography, Believe: My Faith and the Tackle that Changed My Life. 

At times like this, when we really can’t understand why things happen, we have to turn our focus to people who inspire us to be better. Eric certainly does that. Because of this, I certainly recommend you check out his book and story.

As I spoke about earlier in the week, I have been finding some pretty interesting things involving the FMS Active Straight Leg Raise (ASLR) and the SFMA Multi-Segmental Flexion (MSF), particularly as they involved headache patients.

Today I wanted to share some corrective exercise solutions as well as an observation or two:

The first comes from Dr. Jeff Cubos. This is Supported Leg Lowering,  generally the go-to for a Mobility Restriction:

One thing that I have found to be helpful with this exercise upon initiation is to physically act as the support at least to start. For a visual aid, this means that in the above video, I would take place of the chair. What I have found is that by acting as the support to start, I can feel how easy or hard the patient is working to simply lift the opposite leg. Specifically, the supported leg will push down into the support in order lift the opposite leg. A finding like this may lead you into looking further into core efficiency and/or hip flexor weakness.

In this video, Phil Plisky uses a core activation technique along with a Gray Cook band for Leg Lowering Progressions. This is for both a mobility/stability fix.

Finally, here is a demonstration of Unsupported Leg Lowering, again courtesy of Dr. Jeff Cubos. This is primarily used for a stability fix.

Hope you all find this video helpful!

In the hierarchy of movement dysfunction, “by the book” correctives will tell you to first fix a dysfunctional ASLR (Straight Leg Raise) before moving on to fix the rest of a dysfunctional screen.

For a great tutorial on the Active Straight Leg Raise Test (FMS), here is a quick 6 minute video from Lee Burton:

From a clinical perspective, the ASLR is also part of the assessment. Most are familiar with using an ASLR for nerve tension signs, but it is also used as part of the breakout assessment for MSF(Multi-Segmental Flexion) as per SFMA protocol.

Recently, I have had a string of adolescent male patients (most often athletes) who present with a chief complaint of headaches. Upon assessment, they have had  a bilateral (1/3) in the FMS Active Straight Leg Raise and a DN (Dysfunctional Non-Painful) with MSF.

Is this purely a coincidence? If you are a believer in Anatomy Trains, then most certainly not.

As this picture illustrates, this  Superficial Back Line of fascia runs from the bottom of your feet up through the calves, hamstrings, low back, neck, and finally attached onto the skull. And, when you talk to these patients about how their headaches manifest and feel, they often describe it as starting in the back of the neck and working its way up behind the skull while they literally feel as if something is tugging on the back of their neck.

From a treatment approach, I have found that while initially treating the neck specifically, taking a more global approach can yield some pretty fantastic results.

First, starting with the manual treatment: I was treating an MMA fighter who was dealing with post concussive symptoms and presented to the office with a headache. Like I described above, he was also on a corrective program for ASLR and had a DN MSF. It is interesting to note that after his recent concussion, his MSF regressed a considerable amount from when I initiated treatment for a different complaint. I started by addressing his neck specifically, and his within session audit revealed a slight decrease in headache but still a DN MSF. Then, I decided to go south and address the rest of the Superficial Back Line. The result of this was pretty substantial. Not only did the headache almost vanish, but I saw a great change to the MSF. It seemed that addressing a larger portion of the fascial line made the biggest change.

His corrective exercise/homework was to simply continue with Leg Lowering Progressions with the goal of improving MSF and ASLR all while continuing to monitor the post concussive symptoms.

Later in the week, I will have a nice compilation of videos with some variations of Leg Lowering Progressions.

Stay Tuned!

I am lucky to have to some really smart, dedicated, good-looking friends who also happen to amazing strength coaches. Not only do I often get to talk shop with them but I actually spend weekends with them learning how to pick up and put down heavy things. It’s funny, the first time I went to one of these “strength and conditioning” seminars, I jokingly said, “I am going to a powerlifting seminar. I’m sure nothing I learn this weekend will be applicable to clinical practice.” You see where this is going. (I was obviously very, very wrong)

I recently attended Supreme Strength 2.0 put on by my buddies Todd Bumgardner and John Gaglione. At the start of the day, everyone in attendance introduces themselves and talks about what he/she wants to get out of the day. When it came to me I said (or at least, I tried to say. Ok, this is what I was thinking and maybe a few of these words came out in a coherent sentence.)

I have found very quickly, especially when dealing with athletes that when they come in complaining that they have low back pain while deadlifting or shoulder pain while overhead pressing, that it is best to examine their technique first and foremost. Most of the time, I have found that fixing their technique is just as effective to decreasing their pain as any manual therapy technique in my tool box.

Whether you follow Craig Liebenson’s “Bridging the Gap” between rehab and training or Charlie Weingroff’s “Training= Rehab Rehab = Training” philosophy, you are well aware that the lines have become very blurred. The benefit here is that everyone gets better and learns from each other. Most of all, it benefits the client/patient because we as professionals now have a greater ability to give each individual what is best for them rather than what is best for them (so long as it fits within our tool box of what we prefer to do). Hopefully, this will end the insanity of Mrs. Jones going to a chiropractor with back pain and being told she needs and adjustment, going to the physical therapist and told she needs exercise, and finally going to a massage therapist and being told she needs soft tissue work.

I digress….

The following are two situations in which a strength and conditioning background  helped patients in a way I would never have been able to without the knowledge imparted on me by some really smart friends.

1) The technique of a muscle up (quite frankly, what a muscle up is)– I had an athlete come in with low back and shoulder pain. She said that her coach was intent on her doing a muscle up on a straight bar. Here is a video for those unsure of this exercise…

He makes it look easy. Trust Me. It’s Not.

Not only that, but check out the shoulder elevation and internal rotation needed to complete this exercise. It’s shoulder impingement waiting to happen. Couple that with the fact that someone doing this needs to absolutely own a regular pull-up and we can now start to see how/why this athlete has shoulder pain.

Ironically, a few weeks prior to this encounter I had a chance to attend Chad Waterbury’s Rings and Power Tour at Ranfone Training Systems. The first exercise Chad taught was the muscle up. Among the keys to this exercise: 1) A False Grip 2) The ability to pull yourself up into the mid torso region of your body, making the transition easier 3) a crazy amount of strength required to make numbers 1 and 2 possible.

I had this conversation with the athlete and she quickly realized that 1) she was not ready for this exercise and 2) attempting this exercise was aggravating her shoulder.

Finally, I showed her the video of Chad Waterbury doing a muscle up:

2) In- season plyometric training for a basketball player is not how he should be spending his time in the weight room Any plyometric training for an athlete with movement and strength deficiencies is a problem, but that’s for another post. This particular conversation occurred with a high school basketball player’s father. He was talking about plyometric training for his son continuing throughout the season. On the surface, it makes sense. Basketball is a plyometric sport where jumping and change of direction are paramount.

However, to put it simply, we need our athletes to focus on the things they don’t do in their sport. For basketball players (and most athletes) plyometric training and conditioning is the basis of what they do every day. Therefore, strength training and corrective work should be how they are spending the majority of their supplemental time in the weight room.

Again, our ability to communicate with the client is often just as important as physically treating their injuries. It’s impossible to have one without the other.