Archive for November, 2012

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.

1) This past weekend I had a chance to connect with some old friends for a day of learning courtesy of the guys behind the Supreme Strength program.

Specifically, John Gaglione and Todd Bumgardner were the gentleman presenting this event. Furthermore, I was humbled to be able to help out, offer an opinion, and answer questions from some of the coaches and trainers in attendance.

One of the many highlights of the day was when Coach Chris Merritt (Todd’s business partner) began talking about his experience working with MMA athletes. Coach Chris has carved a niche in this arena and does a damn good job. You all may be familiar with his star athlete, Dustin “The Disciple” Pague who fights in the UFC and was also casted for the reality series The Ultimate Fighter. What people seem to get a kick out of (myself included) is when Coach Chris talks about some of the weight cuts and experiences he and his athletes must go through in order to fight. Just to give you a brief idea, many UFC athletes walk around and train 30-40 lbs heavier than the listed fighting weight. And just using Dustin as an example, if you have seen videos of his training, you see he is in no way fat or remotely out of shape during any of his training. This truly is an unbelievable and un-natural thing to do but something that is accepted and expected within the sport.

All this leads me to my next point…

2) Last night I was listening to a podcast put together by the gentleman of myfatfact.com  in which they interviewed one of my former professors, Dr. Russ Ebbets. The topic was Sports Chiropractic, however much of the discussion is relevant to anyone who deals with athletes in any capacity.

One of the main things that Dr. Ebbets preached (in school and within this podcast) is the idea that training to be a world-class athlete is not and should not be considered ‘normal’ human physiology. Whether it is running 26.2 miles or getting in the octagon with someone whose intention is to snap off your elbow, we as exercise or health care providers must realize the demand on these athletes is above and beyond what our general population of clients must be able to withstand and accomplish.

Have a great week everyone!

Oh Sandy…

Posted: November 5, 2012 in Uncategorized

As most of you know, I reside in the great state of New Jersey which was recently ravaged by Hurricane Sandy.

Just to give a quick update:

Myself and family are safe and sound and have no serious property damage to report. A week later, we are still without power but lucky enough to have neighbors who have invited us into their home. Today (Monday) is the first day I am back to work and treating patients.

Many others are not so fortunate. Some have a house but no heat, while others literally have nothing as Sandy washed away much in its path of destruction. Most of you already know this, as I have been told our state has made national and international headlines of late. It is a bit of surreal feeling when you live through something but because of the circumstance, the people outside the community have more access to what happened than you do. Other than the local newspaper, and a less than stellar 3G connection from my phone, I have not really seen the true damage that occurred predominantly down the Jersey Shore. As I write this at the office, I am experiencing my first internet connection in over a week.

Again, I am super fortunate to have come through this ok, but as someone whose family has lost everything in the past (a house fire) I guess maybe it hits a little closer to home.

Much of what we in New Jersey have grown up with, may never be the same. Vacation spots at the beach may be merely just a memory now. In fact, some of you may have read this post I wrote this past summer. The video in this shot was taken at the Belmar boardwalk. From what I hear, the boardwalk is no longer standing.

The truth however is that for me these are just memories. For many, what was lost was a livelihood, a lifetime of savings, or a home. Worse, some people lost their lives.

All this does is offer us a little perspective.

That gas line I had to stand in for 3 hours? Not a big deal.

The extra long commute many of us now face because of the storm? Not so bad.

No cable tv or internet for a while? We should probably do that more often. (by choice)

Finally, I just want to thank all of my friends who have been consistantly checking in on me and my family. Having good friends is…. good!