Archive for January, 2012

This was the headline that I woke up to this morning. With the Super Bowl about a week away, the talk is centered on New England Patriots All-World tight end, Rob Gronkowski and his bum left ankle. Injured in last week’s AFC championship game, Gronkowski’s ankle is and will be the most talked about injury of Super Bowl XLVI.

Adding to the drama, Gronkowski’s dad Gordy ruffled some feathers last week as he revealed to a Buffalo newspaper details of his son’s injury. Bill (I only wear hooded sweatshirts) Belicheck, New England demi-god and Head Coach is classically tight-lipped with all injuries especially during playoff time so this obviously did not go over well in the Patriot locker room. (Can you fine a player’s father???)

The reason why what Gordy Gronkowski’s dad revealed is so important is because of the type of ankle sprain that Rob has. Unlike a classic ankle sprain, Rob suffered a high ankle sprain and is generally much more serious. As sports fans,we hear this term thrown around a lot. We hear how bad it is and how hard it is to heal but what exactly is it? Glad you asked…

Traditionally, a high ankle sprain has a much different mechanism of injury than a classic ankle sprain(technically it’s not really called a classic ankle sprain, but for the purpose of this article it makes it easier to delineate than just ‘ankle sprain’). A high ankle sprain usually occurs when an athletes’ foot, ankle, and lower leg are externally rotated (think toes pointing out).

This is the moment before Gronk’s injury. As you can see, the Raven player is just about to fall onto Gronk’s left ankle as the foot is already externally rotated.

This differs from your classic ankle sprain in which the usual mechanism is “plantar flexion-inversion.” We all know this as “rolling your ankle.”

Furthermore, the tissue that is injured is different. A high ankle sprain are usually an injury of the syndesomosis or interosseous membrane between the tibia and fibula of the lower leg. This is a direct connection between the two bones.

A classic ankle sprain is most commonly an injury to the outside portion of the ankle and generally below the level of a high ankle sprain. The ligament most often damaged is the Anterior TaloFibular Ligament (ATFL).

Again, you are probably still wondering why a high ankle sprain is such a pain to deal with? (Get it, haha) The most common answer you will get from experts in the field is due to the lack of blood supply to the area that is injured in a high ankle sprain. Injuries need a steady blood supply to repair damaged cells and without it, healing time is delayed. In fact, it is generally thought that a high ankle sprain can have a healing time that is almost double that of a classic ankle sprain.

The point of this article is pretty simple. I hope for those of you reading, this is a vehicle allowing  you to sound really smart around your friends come Sunday. I imagine it going a little something like this…

You walk into the room, middle of the first quarter after downing your 17th chicken wing just in time to see Gronk catch another touchdown. As everyone cheers, (or if you are from the tri-state, everyone curses) you casually say aloud, “Wow, nice catch! Good to see Gronk healthy. That interosseous membrane really healed nicely. You know, a high ankle sprain is a tough injury to come back from? Glad to see the Patriots training staff doing a great job!!”

even the cat will be impressed!

Please, if anyone does this let me know! It will make my Super Bowl enjoyable rather than being bitter that the Jets are at home.

Thanks for reading!


My good friend Todd Bumgardner has recently released his first ever e-book. I can tell you first hand that Todd has been working on this for almost a year now. As someone who has just started a blog, I can’t even imagine the work that went in to writing a freakin’ book. One blog post a week is hard enough! 

Let me give you 5 good reasons why you may want to go over to his site and check it out:

1) For any of you out there who are sick and tired of the same old boring workouts, the Pull-Up Manifesto has more Pull-Up variations and  challenges than anyone could ever imagine. In fact, I dare you to find anything on the internet that is a more complete guide to any single exercise!

2) As Todd will tell you in the e-book, the Pull-Up is the most useful upper body exercise on the planet. You might as well learn why! Todd not only gives exercises, but gives rationale behind them in a manner than people can comprehend.

3) The Pull-Up Manifesto is FREE!!!!!! If you are anything like me, you are probably saying, “Here is another guy on the internet trying to sell me something.” Not so fast!!! You read it correctly, the Pull-Up Manifesto is free to download here at . All you need to do is sign up for free email updates from the guys at BSP and the e-book will be there for you to download! 

4) Did I mention it was free?!?

5) Yep, its’s still free.

As many of you may have read here, I have spent the last 3 weeks attempting to get myself healthy by making it a habit of eating ‘clean’. This usually consists of fresh fruits, veggies, and lean protein. That being said (and I think anyone who has been on a diet can relate) eating clean can become terribly monotonous and boring.

I feel your pain kid

One of the ways to make things more interesting is to take recipes that you know and love and substitute healthy alternatives. A perfect example of this is what we did at my house yesterday with spaghetti squash. For years, people(including myself) have been thinking up ways to go ‘low carb’ but until recently, I had never explored the wonderful world of spaghetti squash.

My family generally eats pretty healthy as for years we have eaten turkey meatballs over a bed of spinach rather than your typical pasta and meatball dish. This is a great healthy alternative although certainly leaves something to be desired in the texture category and flavor (flavour for you Canadians out there) category. However, since being introduced to the world of spaghetti squash, I can honestly say it makes me miss pasta a little less.

From a health standpoint, spaghetti squash completely blows typical spaghetti out of the water. Not to bore you with a ton of numbers, but here are a few important ones: (all values are per 1 cup)

  • Carbs: Spaghetti-42 grams   vs  Spaghetti squash – 10 grams
  • Calories: Spaghetti -220        vs Spaghetti squash – 42

Note: this nutritional information was taken from your typical processed, enriched white flour spaghetti

So without further ado, here is how you can make spaghetti squash and use it as a substitute for your favorite pasta dish. The preparation is so simple it’s almost silly.


Spaghetti squash (really, that’s it)

  • Note: I would recommend buying the smaller spaghetti squash because the bigger they are, the harder to cut in half. Seriously, it’s like trying to juggle cats.  
  • As far as portions go, 1 small(ish) spaghetti squash is more than enough to feed 2 people


1)Wash the spaghetti squash and cut in half, long ways.

2)Place on a baking sheet, face down. (you do not need to spray the sheet)

3)Bake at 375 degrees for 60 minutes. When it comes out of the oven it will look like this…

4) Allow to cool until it can be handled.Please don’t burn yourself! 🙂

5) Take a fork and scoop out the middle section (seeds and all) and discard.

6) Finally, separate into strands by running a fork through the squash, long ways.

finished product

From here, the squash is your oyster (see what I did there?). Use it any way you please. Yesterday, we (my Mom) made turkey meatballs and marinara sauce and had a healthy version of spaghetti and meatballs but just like with pasta, their are literally endless possibilities.  

I hope you enjoy my first attempt at recipe sharing via the blog-0-sphere!

Thanks for reading! Have a great day!

80/20: Learn it, Love it, Use it

Posted: January 19, 2012 in Uncategorized

As poor graduate school students, my roommates and I decided upon moving into our house on Long Island that we would do the incredible. The unthinkable. The absolutely insane. We decided to NOT purchase cable tv!!! I could only imagine doing this 15 years ago, my world would have ended.

thank you, I will

Anyway, this decision has led me to a whole new world of which I actually enjoy. It’s called books. I know, I know, how could I even say something like that?!?!? Admittedly, I still do drive home on weekends in order to watch football. (Go Jets!! O wait, they are probably watching at home on the couch just like me.)

Most recently, I have been reading Tim Ferriss’s book called The 4-Hour Work Week. This is not my first experience with Tim Ferriss as I have also read The 4-Hour Body  and The Blog of Tim Ferriss. Instead of giving you an in-depth analysis of all he does and writes about let me just say this: Tim basically takes things that are common, turns them upside down, beats the crap out of them, and then gives you his take on it. These topics include fat loss, time management, and even medical testing. I think most importantly, Mr. Ferriss walks the walk. Everything that he talks about, he has done in his own life. This kids, is what we call street cred.

Yup, I got it

Finally, what I respect about Tim is that he doesn’t want or expect you to do/agree with everything he does. He simply tells you what he has done and asks you to pick one thing that resonates and apply it to your life.

One of the themes that  I wanted to expand upon today (and hence the title of this post) is the 80/20 rule. I had recently read this in Tim’s book but it is not the first time I heard it. I go by a general rule of thumb: If I hear the same concept from a bunch of really smart people, then it must be true, and so the 80/20 rule fits this category.

Before I actually explain what the 80/20 rule is, I wanted to point out that it can be applied to just about anything. I think as I develop my blog, the topics may seem strictly medical/health/student/chiropractic related but I hope that the general concepts can be applied to everyday life.

The 80/20 rule as Tim writes (also known as Pareto’s Law, if you get this right on Jeopardy please make my check out to “cash” ) in its simplest terms: 80% of the outputs result from 20% of the inputs.

Some real life examples (I will use 4  to keep with Tim’s theme)…

1) Think about your life as it stands right now. Specifically, think about the things/people who cause you the most stress. I can bet that 80% of your stress is caused by 20% of the people in your life. Of close relationships, this may only be 2 or 3 people you are close to. It may be time to either cut them out of your life or have a tough conversation with them. You may have to say, “I can not be around all the negativity anymore, so if we are going to continue our relationship I need it to be positive in my life.”

2) For my friends out there that are students… Think about how many hours you spend studying for tests/boards. Now, imagine how much of that “study” time is spend texting/facebooking/playing with your iPhone/checking your email/playing video poker/playing words with friends. If all of that was cut out, you would probably be left with about 20% of your time that is actually spent learning the material that will yield at least 80% of your knowledge.

3) A place where I first learned about the 80/20 rule is the business world. Specifically to chiropractic, I have read that 80% of our business income comes from 20% of our patients. The article was written by Dr. Anthony Lombardi a Canadian chiropractor and can be found here. If you didn’t want to click the link just read on —> Basically, the message is to spend time cultivating relationships with the 20% of patients that will bring most of your business through their own care or referrals. Think about those blanket emails that we often receive from doctors or companies of whom we are now on their mailing list. It is suggested that rather than sending one huge blanket email about who-knows-what (usually something interesting enough to warrant a quick delete) to your entire mailing list, select that most valuable 20%  and write them each individual emails. Not only does this show that you actually care, but when is the last time you received a personal email from a doctor of yours just asking how you are doing?? I would assume the answer is somewhere between Never and Are you crazy?!!?

4) The final example is specific to manual therapy but I think future practitioners, current practitioners, and patients can certainly learn something from this. One of my main goals as a future practitioner is to be good enough to know exactly what my patient needs in their care. This will not only save time but increase results. From my experience so far as an intern, I have learned that many patients perceive the value of care strictly by the amount of time spent. Often, their idea of quality is strictly quantity. They like the “kitchen sink approach” where we use every laser, stim machine, hot pack, cold pack, and manual tool in the clinic and just hope that something makes them feel better all while increasing their treatment time. Using the 80/20 rule would shift this thought process. Taking the time to assess the patient to find out exactly what is going on and then to apply the one or two treatment modalities along with the one or two most valuable corrective exercises may cut the visit time by more than half. However, we have now established the most valuable 20% of the treatment which will yield at least 80% of the results. Rather than worrying about the pebbles (small) dysfunction, Dr. Brett Winchester calls it “finding the rock (big) of dysfunction.”  Say it with me, the most valuable 20% of the treatment will yield 80% of the results.

So, as you can see this 80/20 rule really does apply to all aspects of life. I have had some really good comments and feedback from some other posts and would certainly like to hear from you all on this. Let me know how the 80/20 rule applies to your life and what you can do to make it work for you.

I look forward to hearing from you!

Like most people out there, I have New Year’s resolutions. This year in particular, my resolution was to finally try a cleanse/detox program in order to jump back on the health wagon. 

Admittedly, a big reason for my cleansing decision was to give myself a kick-start back into healthy eating and simply not to just “detoxify.” Maybe that is not the best reason, but somebody told me honesty is the best policy so what the hey?! Therefore, please forgive me if the rest of this article seems to intertwine the whole dieting/detoxing idea.

Between Thanksgiving, Christmas, Hanukkah, Festivus, and New Year’s my food choices have been sub-par to say the least. If those were the only days that  I let myself go, I would still be doing ok, but my life since then has become one giant cheat meal. Therefore, drastic measures had to be taken.(cue the scary music)

As I started researching cleanses or detox programs, I had one rule: I will not starve myself. We have all seen those cleanses that consist of water, honey, cayenne pepper or like two shakes a day for two weeks and no real food. While these may help the body cleanse and help people lose weight, it just seems a little over the top for me and quite frankly not my cup of tea (although this is the only form of caffeine I am allowed to have, #godimisscoffee!!!)  <——— yep that’s a hashtag

I think part of that comes from when I was in upstate New York in chiropractic school and a bunch of my classmates decided to cleanse. They were doing the two shake per day cleanse with little to nothing else. And, while they all claimed to “feel great” I have to say, they looked less than stellar.Yes, it could have been the combination of 1)no sunshine in upstate ny for about 8 months 2) the fact that they were all working on 4 hours of sleep while studying for exams and 3)they were living in upstate ny (did I mention that already?) but honestly they just did not look healthy to me.

Because of this, I really wanted to find a program that allowed me to eat a normal sustainable amount of organic fruits, veggies, and lean proteins while also “cleansing” with fiber, probiotic etc. Better yet, I wanted a program of which I could continue with the healthy eating program even when the actual cleansing process was over. I wanted something that I was going to invest time and money in to make it worth my while.

I know what many of you might be thinking. Justin, why don’t you just take fiber and eat healthy? That would probably save you some money rather than wasting it on a fancy cleansing kit. Trust me, I thought of that. However, if I was being honest with myself, I knew that it would not work. If nothing else, I needed a built-in excuse. I needed to be able to say, “I can’t eat that, I’m on a cleanse.” Rather than, “Eh, one slice of pizza won’t kill me.”

Also, I NEEDED to invest money into this because just telling myself to eat healthy was not going to work. Now that I have something invested, I have a greater incentive to follow and take care of my body. It’s kind of like those guys who park their fancy cars in the corner of the parking lot (I hate this) so god-forbid anyone sneeze on the bumper and leave a dent while the guy with the ’92 Chevy takes up two parking spots and really doesn’t care if somebody takes a bat to the side view mirror. The guy with the fancy car invested a lot of money and therefore is taking better care of his investment.

So in review:

1) I fell off the healthy eating wagon.

2) I decided to try a cleanse program in which I would not starve myself.

3) I used a hashtag while not on Twitter.

4) I needed a built-in excuse so I could not be guilted into eating pizza.

5) I invested money into my diet/detox therefore making myself more accountable to follow.

6) And, don’t be that guy that parks your Beamer in the corner of the lot because I really hate that.

Thank you for reading! Have a great day!

This past weekend I completed my Active Release Technique Full Body Certification. It was a long weekend in which I learned a lot.

That being said, I am not here today to give a review of the course, tell you what I learned, or explain how learning A.R.T. can help save the world.

save the world, just like this???

What I wanted to talk about today was something I experienced early on in my education and have since spoken to many fellow students who feel the same way. It’s what I like to call the learn more= feel dumb phenomenon. Makes no sense, right? You would think that learning more about a topic or trade would make you feel smarter.

On the surface, learning more makes us smarter, more competent, and more confident in our craft.

However, something happens when we try to expand our knowledge: We lose confidence by comparing ourselves to the teachers/instructors. 

Early on, I would attend seminars and after the weekend was over, I would have this feeling that compared to the instructor, I knew nothing and was totally worthless. The instructor just had so much knowledge to give and watching them work on a patient was an art (get it? art. A.R.T, Active Release Technique???) in itself. In fact, I once had a conversation with another student at a seminar who I look up to and who has taught me a ton himself. He said, “This guy is so smart, I feel like  I am doing my patient’s a disservice by even treating them.”

I used to share this sentiment. But, I got to a point where I realized I needed to flip the switch. I needed to leave a seminar empowered with the knowledge I learned. To be frank, I had to learn to be more selfish. I realized that it isn’t about me compared to the instructor. Really, it’s me compared to me.

This paradigm shift if you will, most definitely changed my outlook and has since left me leaving seminars happy and empowered. Now it’s easy. When I step back, all I need to do is ask myself two simple questions:

1)Do I know more now than I did before this weekend?


2)Will my patient’s benefit from what I have learned?

If I can answer “yes” to these two questions, everything else can be thrown out the window because I am satisfied. Satisfied until the next seminar…

Until next time, have a great day!

Today I wanted to take the time to share my favorite way I have ever heard pain explained. Like most good things in life, the genius is in its simplicity. It comes from a brilliant chiropractor and soft tissue specialist Dr. William Brady.

I think one of the most challenging aspects of transitioning from a student to a practicing clinician is explaining to the patient what you are treating and what their problem is. Students go through school and have to learn a different language (medical-ese) but once in practice have to take that language and translate it so that the patient understands. Because really, telling a patient they have an “acute tendonopathy of the gastroc-soleus complex with concomitant flexor hallicus longus fibrosis” sounds really smart but explains nothing to a patient.

Ok, enough with the jokes (maybe, no guarantee) and let’s get to the explanation.

The following is the chart Dr. Brady uses to show a patient why they are in pain in the absence of traumatic injury (i.e. getting hit by a MAC truck). These are classically referred to a cumulative trauma injuries. Really, it’s just a fancy way of saying your body is a mess and now you are paying for it.

ps: it took me 45 min to figure out how to get this from my phone, cropped, edited, and finally on to the page  so I hope everyone really, really enjoys it.

Now for the explanation:

Let’s say one day you wake up and the bottom of your foot hurts. You have been training for a marathon for a few months, doing fine and then slowly you start to feel “something on the bottom of your foot.” Most importantly, you can’t remember falling, tripping, or doing anything that you think would cause the pain. You may be a classic example of the graph on your viewing left.

On the top of the graph you see “pain threshold.” This means, you woke up saying “ouch” and now you are in the office for treatment. Your body has finally reached a point where it is bad enough for the brain’s alarm to go off.

On the ‘x’ axis, the label is dysfunction. In previous posts I have spoken about dysfunction. This graph does a great job of illustrating the ” building blocks of dysfunction leading to pain.”

Let me quickly explain the numbered blocks:

“1” might be a core instability issue that has been lingering for years. With only this issue, you have been able to compensate yet still function at a high level

“2” may be a weak Glut Medius muscle. This helps to stabilize the hip as well as many other functions. Still, no pain.

“3” could be a lack of hip extension due to tight hip flexors. Again, you are building dysfunction, but in your case those three dysfunctions on top of one another still have not caused pain.

“4” is a tight Achilles tendon leading to decreased dorsiflexion of the ankle.

“5” is a plantar muscle overworking. Finally, the alarm goes off in the body, and you have pain.

If you look at these 5 dysfunctions, something becomes evident. 4 out of 5 problems are not on the bottom of the foot. Only after building dysfunction in 4 other sites, did you actually reach threshold. Yes, it hurts in your foot, but there are many other issues that need to be addressed.

Another point that needs to be discussed piggy-backs on my last article on Functional Screens found here. I think this graph does a great job of showing the need for functional screens. In a case like we showed above, treatment may be applied to the bottom of the foot and the pain may go away. We have simply addressed dysfunction number ‘5’ and this got you below the pain threshold. However, we have done nothing to fix dysfunctions 1-4, so we are still very close to pain. One more small problem could cause the same pain.

As Dr. Brady says, his job is to “chip away” at each dysfunction, slowly unbuilding (My word, not his. In fact, not a real word at all.) those blocks that have led to pain. This will give a person more wiggle room, or room for error so they can go about their daily activity or training schedule without the inconvenience of pain.

Thank you for reading. Have a wonderful day!