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!

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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!

fact

Today I will be sharing Part II of the my three part series concerning some of the lessons I learned from a seminar I recently attended. In short, it was quite the experience. In long (if that’s a phrase), just read Part I, here

Lesson #2

Educatate people about their pain, don’t scare them.

The message that was preached at this marketing seminar was pretty clear.

Make people believe something is wrong with them

The basic premise is that everyone has aches and pains and it is our job to convince them they have a serious problem that needs to be treated in our office.

In order to do this, you sometimes have to make an emotional plea that can get very personal. I can’t remember exactly how they worded it but something along the lines of,

And most of all, you owe it to yourself and your family to at least come to the office for a consult

Again, educate, not scare. (my opinion)

An example:

A person who seems to be experiencing tension headaches.

Rather than scare the person, simply explain the rationale:

Many times headaches can be multi-factorial. They can be from a bad reaction to certain foods, hormones, stress levels, or maybe something so simple as muscle tension. In many cases, it is a combination. If you have never had anyone assess you before or look into your situation, I would be happy to help.

…..

On the other end of the spectrum, I certainly do believe there is a time and place for helping people understand that pain is not normal.

This is most relevant when going through the SFMA Top Tier assessments. Often, I go through the ranges with a patient, and ask if they have pain. A very common response is,

No not really, nothing more than the normal pain

Excuse me?!?!!?

There is certainly something to be said about educating a patient to believe that pain is a problem and that in fact, “normal pain” is not normal.

Again, there is a fine line between scaring a patient and making them understand that they should not have to live with pain.

I gues to reiterate my last post, I believe as much as we must practice our diagnostic skills, practicing the way in which we educate and communicate with our patients’ is paramount to the success of our clinical practice.

1) I FINALLY got to attend the SFMA (Selective Functional Movement Assessment) seminar this weekend in Philadelphia.

As I have stated before, I had already been using the Top Tier assessment with my patients, and I was super excited to get the ‘full package’ so I could begin to use the system as it was designed. I have to say, I don’t know if I have ever left a seminar more excited.

I’m a systems guy, they fascinate me. This system is totally based on common sense (don’t mistake this for being easy to learn and master) and gives us the groundwork to truly figure out what is going on with our patients’. On this blog, I always talk about patient empowerment and home care, and I feel the SFMA is Doctor/Therapist empowering in the sense that we are no longer throwing darts and praying we hit a bullseye.

To me, there is something very powerful about breaking down a MSF (Multi-Segmental Flexion) pattern and finding that you can have a true tissue shortening on one leg and a stability problem on the other AND be able to prescribe and treat the patient accordingly. I think the only way we can truly empower our patient is if we are empowered ourselves and believe and understand, to the best of our ability, what is truly going on with each patient encounter.

2) On a similar note, I was talking to a Physical Therapist this weekend and he was excited to learn the SFMA because he felt he now has a system to do wellness or movement checkups. He talked about being able to assess someone who may not have pain and still be able to find dysfunction, give them some corrective work and then send them off for a few months to work on those patterns. Considering I wrote about this  awhile ago in Why your dentists shouldn’t be the only one doing yearly check-ups, I obviously agree with him and feel it is certainly another viable option in which we can help people.

3) Finally, I think something that is generally overlooked (at least by me) during a Reverse Lunge pattern is Anterior Core Strength.

We have all had clients who only ‘feel it’ in the quads as this is usually the limiting factor. In the past when cueing this exercise, I would often tell a person to push-off the heel and not let the knee completely migrate over the toe. While these are certainly valid, I found that during my experimentation today (my workout), the biggest change occurred when I made a conscious effort to not let me anterior core buckle (resisting spinal flexion and an accentuated anterior pelvic tilt) and actively bracing. I automatically felt more upright, and the stress of the exercise moved predominantly to the posterior chain.

Today will be Part I of a 3-part series from a seminar I attended this past weekend. As you will soon read, I thought the seminar was horrendous with a bit of sleazyness sprinkled in. However, there is always a lesson (and an ensuing post) that follows.

I was invited to a chiropractic marketing seminar this weekend. For my friends out there who know about this side of things, it was the type that certainly gives our profession a bad name. Some may call it a ‘Come to Jesus’ chiropractic meeting (maybe I just call it that). For me, it was important to attend because I believe it is hard to comment or have an opinion unless you have been intimately involved within the situation. Also, I always try to be the type of person that learns from every situation of which I am put. I would always get frustrated when after attending a seminar, many people would simply focus on what they didn’t learn rather than what they did. Not to get too much off the topic, but this is more so a mentality in life, rather than an isolated incident.

On a similar note, one of my mentor’s Dr. Jason Brown wrote something similar in this article: Lemons and Lemonade.

So, the point here is that there is always a lesson. Sometimes, it just takes some critical thinking to flip the lesson into a context in which it applies to you.

Lesson #1

Make Contact and Communicate: Much of the seminar this weekend dealt with attracting new patients to the office. Quite frankly, many of the ways they promoted were sleazy (I was trying to think of another way to describe it so as not to use the same adjective over and over, but this is all that came to mind) but the message rings clear. My friends, we can all wax poetic about the best 4×4 matrix progressions, packing the neck on a kettle bell swing, using scratch off scented kinesio tape (I don’t think that exists but it would be cool) but the reality is that we need people to come in and out of our practice in order to, you know, practice. Now, how to do this is certainly up to you. I would give suggestions, but I haven’t mastered it yet. Not even close. At this seminar, they made it a point to go out and meet people. This is step one. In my short time in practice, I can tell you it will not pay the bills to simple sit in the office and hope and pray that people will magically walk through the door.

just because you build it, does not mean they will come

And once you meet people, Step 2 is how to communicate what you do with the public. This is especially important. If you are reading this blog, there is a good chance you are doing something out of the norm. You are defying industry standards, and making things better. Whether a therapist or a trainer, you are giving clients an experience better than the guy next door, but also very different from the guy next door.

Two quick examples:

1) At the gym setting I work, many potential clients come in, and the first thing they ask is, ” Where are all the machines.” This is simply the opinion of many as to what a ‘good’ gym has. Lots of brand new, shiny leg extensions, and treadmills with the ability to rub your neck as you run and a personalized a/c unit, because god-forbid someone actually sweats while working out.

2) Many new patients who come into the office often end up asking if I am chiropractor or physical therapist because they don’t understand how/why I am teaching them to hip hinge, or why, as a chiropractor I am ‘training’ them with leg-lowering progressions.

The bottom line is that we must be masters at communication. We must explain to people why we don’t use machines and treadmills and that yes, in fact I am a chiropractor who does exercise with my patients because it is what I believe is best for them. I want them to know that the days of them walking in the door and plopping themselves facedown on the table for a 3 minutes adjustment are over. And most importantly, I need them to know why. I need to educate them so they understand, which hopefully makes their experience better. Now, hopefully they will ‘get it’.

In closing, I have found that the patients who ‘get it’ become our biggest advocates. They can’t wait to tell a friend or family member about the ‘chiropractor’ in town who assessed movement and gave them exercises to do at home. In the end, I think the people who ‘get it’ help build our practices just as much as any contact out there.

Since it’s October and I haven’t done a random article in a few months (see what I did there, it’s random and no correlation between October and a random article??) I figured it would be a good time to post a few thoughts that seemingly have nothing to do with one another.

1) As someone who is unbelievably new into practice, I think one thing that resonates with me is the idea of creating an ‘experience’ for a patient rather than just a treatment or treatment plan. Obviously, school can teach us technique, but that is not the entire story. In the simplest of terms, our patients (or clients) need to like us and they should get something more than simply an adjustment and soft tissue treatment when they come to the office.

Here is an experiment: Go ask a family member who is the best doctor they know. Once they give you a name, ask them why. I would bet one of the first few attributes that comes out of their mouth is, “He is a really nice guy and he cares.” Rarely will you hear, “I love him because his shoulder stability tape job is awesome.” (Funny that my last post was about a shoulder stability tape job)

Honestly, I have shadowed almost 20 doctors. In my opinion all of them were not fantastic clinicians. BUT, the ones who were successful were all genuinely nice people who their patient’s loved. They took the time to educate their patient’s, asked about their lives, remembered small details about the personal life, and smiled. ALOT.

There is something to be said about that.

2) I got an email a few days ago from a friend/colleague asking for some advice about his younger brother concerning a training program. He said his brother is a really good up and coming basketball player with a desire to play at the next level and was wondering what type of training and or supplementation he should use.

Here is what I told him:

I think the key to whatever you want to do in athletics is all based on proper, healthy movement patterns and also simply getting strong. Before speed and agility, if it were my athlete, I want to make sure he knows how to hip hinge with weight (deadlift), do a real pushup and pull up. You show me an athlete that can do all those things, I bet he is also one of the fastest and most athletic. If you think about what speed and agility really is, it’s simply force production off of the ground. This is on the basis of strength, all of it.
As far as protein supplements… I wouldn’t start with it, although a good, high quality protein is certainly not a problem.
(about the supplements)… It should be just that, a supplement. I would start with a rough idea of what he is eating everyday. I would guess, his protein from whole foods is pretty low and he can increase size and strength just by eating more. Most kids that are “hard gainers” simply don’t understand how much and how often they need to eat. Sometimes it’s downright uncomfortable and a pain in the ass but that’s what it takes.

I also referred him to this fantastic article from Eric Cressey, Make My Kid Run Faster. Much of what I told him, I learned from this article, so it may be best going right to the source.

As some of you may have seen on Facebook, I had the opportunity to be a part of the medical staff at the USGA Senior Amateur Championship which was played at Mountain Ridge Country Club in West Caldwell, New Jersey.

For the majority of the day(s), I had my treatment table set up in the woman’s locker room (no, woman were not allowed in the locker room during the tournament) and was there to perform manual therapy for the golfers. Needless to say, it was an honor and pleasure to be part of the event and most importantly, the golfers seemed extremely happy with our work.

All that being said, I just wanted to share some notes and observations that I made from this past weekend.

1) These guys are freakin’ good! Just to give you an idea, through the first two days of the tournament, the leader was at 5 under par. And maybe even more amazing is the fact that scoring in the high 70’s is considered a poor round. For you non-golfers out there, an everyday golfer is considered good in my eyes if they can consistently shoot in the high 80’s.

2) Hydration seemed to play a huge factor with these guys. This became evident with simple manual muscle testing as many would begin to cramp while on the table. Since this was a national tournament, it seemed as if many of the athletes from warmer climates were cramping the most. I think this was due to the fact that the climate was actually much cooler than they were used to. Counterintuitive, I know. Because of this, these guys did not feel like they were ‘thirsty’ or that they were sweating and did not hydrate properly.

Or maybe as one guy told me,

It’s because they all drink beer every night.

Touche, sir.

3) Before treating, I put each athlete through the Top Tier assessments of the SFMA. Consistently, most had similar FN’s (functional/Non-Painful) and DN’s (dysfunctional/Non-Painful).

MSF (Multi-Segmental Flexion) was surprisingly and consistently FN. Remember, these athletes all need to be over 55 to qualify for this tournament so compared to the general population of similar age, these guys had much better mobility in this range.

MSE (Multi-Segmental Extension) was consistently DN or DP. Of note, they were generally hanging on their low back for extension with limited anterior translation of the hips and extension in the thoracic spine.

SLS (Single Leg Stance) was also consistently DN. I found that most players lacked the proper hip stabilization required to balance on one leg.

All in all, it was a great experience and can’t wait for a chance to do it again.

A few days ago, a new interview was posted on movementlectures.com where Craig Liebenson interviewed Gray Cook. Generally, the discussion involves both the FMS and SFMA, but that is just where it begins.

In short, this is must listen. For my friends in chiropractic school, save your $5 that you would have spent on 5 beers (yes Seneca Falls, NY is the only place in America you can still get $1 beers) and purchase this lecture. It is absolutely fascinating.

As I was listening, I took down a few notes and figured I would post them on the site. Obviously, you would do a huge disservice to yourself by only reading this. Seriously, go listen to it (after reading this, of course).

Like usual, Gray Cook is a one-liner machine as his responses to Dr. Liebenson’s questions are highlighted below.

ENJOY!

The FMS is not an evaluation, it’s not an Orthopaedic assessment… if the screen was more complicated, the reliability would plummet.

-1’s and asymmetries are a red flag because they interrupt the primitive reflex stabilization responses.

-Core performance testing (McGill’s side plank hold) vs baseline stability and function (rolling patterns)- the core performance tests are conscious but our stability in everyday life is unconscious.

90% of our core runs of reflex stabilization.

Can test things with isolation (inclinometer, dynamometer) but that is not how you train it. 

-Gyms and many strength and conditioning programs lean on the hypertrophy model (biological structure), but neural changes are first.

-Movement competency or lack therefore of (inappropriate stiffness, abnormal muscle tone) = High threshold strategies (Over-abbing your way through life).

-The most violent contraction occurs following extreme relaxation (think Bruce Lee).

– The SFMA is a consistent way of looking at movement so you can see when something is inconsistent.

– The intention of the SFMA was never to have someone hold the flow chart in practice. You can skip steps but don’t you dare miss one.

 – The FMS is not designed to specifically catch a foot, hand, wrist, or C-spine. The screen gives a provocation, but doesn’t tell you everything.

-SFMA tells us exactly which exercise will reload the system.

-SFMA is the diagnosis at the point where you have managed pain while the FMS is the prognosis. It helps the trainer develop a program to manage the dysfunction.

-Think of the FMS as movement vital signs. It is a baseline, but not the only thing you are going to do.

If you have symmetrical 2’s across the board on the FMS but I can hear you running from a mile away… Maybe its your friggin’ running mechanics!!!

-If you can’t memorize the flexion breakout (SFMA), make your own. It will look the same as ours.

– Without a proper and thorough assessment you are essentially spraying bullets and hoping one works. With a good assessment, you may only need to take one shot.

Accidently Getting to Active Care

Posted: September 24, 2012 in Uncategorized

Sometimes it’s better to be lucky rather than good.

I happened to stumble upon this clinical tidbit a few weeks ago and just wanted to share.

It involves kinesio tape. You know, the stuff that every single Olympic athlete had on…

water matches tape which matches swimsuit…I see what you did there

For most of us, kinesio tape is another tool in the tool box used to help decrease pain, give the patient a soft barrier of support, and act as a ‘treatment while out of the office.’ I consider it a passive modality (although one in which the patient can be active while wearing, which is awesome), and one that, just like anything else, can be overused and relied upon once it is no longer needed.

More recently however, I used kinesio tape and it became as much of a diagnostic tool as a passive care modality. (hence the reason for this post)

……….

I was on my way out of the clinic the other day when one of our trainers came up to me and mentioned his shoulder has been bothering him. He is currently training for a bench press competition and just felt like his shoulder was not right. Because I had somewhere I had to be, I asked the trainer if I could just tape him to see if that offered him some relief until I could really spend some time to figure out what was going on.

I used this tape job, which I got from Dr. Greg Doerr. It has become my go-to for many shoulder issues.

I saw the trainer a few days later, and he told me the tape did help his shoulder feel about 20% better. Obviously, it was just a band-aid to get through the workout, but it gave me a great idea of where to go with my treatment.

Now, what I needed to do was almost re-create what the tape did with exercise.

My go-to has become HA (Heavy ASS) Kettle-Bell carries. Along with a plethora of other benefits (grip strength, anti-lateral flexion training, sweating, and grunting) HA Kettle-Bell carry does wonders for patients presenting with bench pressing/impingement/meathead syndrome. Interestingly, I think most people think that when someone is in pain, heavy training should be avoided. However, many times heavy loading is EXACTLY what they need.

If you don’t believe me, check out this post from Dr. Jeff Cubos.

To give people an idea of the weights we use in the office, I usually start with around 40lbs and have worked my way up to 70lbs. Keep in mind, all patients I have used this with so far are what I would consider ‘in shape’ with years of training experience under their belt.(this is not a requirement) Also, I usually don’t even tell the patient how much weight I am giving them, because I know that some would get nervous to be lifting something so heavy while they are in pain. After the exercise, once they are feeling better, I then tell them how much they are carrying.

For the visual learners…

So what did the tape actually do in the first place?

In my eyes, when that specific tape job makes the shoulder feel better, it simply tells me that I need to get the shoulder “back and down.” The patient needs upper trap, levator scap, and the pectoralis muscle to take a chill pill all while waking up middle trap, lower trap, and the rest of the scapular stabilizers.

All in all, this exercise has been a great find for me and my patients. In fact, I would go out on a limb and say it has been the most effective way to decrease shoulder pain in the quickest amount of time.

Are We Creating Monsters?

Posted: September 18, 2012 in Uncategorized

Some horrible news over the past few weeks really made me stop and think…

For those of you who have not been following, it was these two stories that honest- to- god made me question everything I know.

Oakland A’s pitcher Brandon McCarthy, taking a line drive off his head can be found here.

Tulane football player Devon Walker, fracturing his spine during a game can be found here.

I guess I need to tell you my story so you can see where I am coming from…

For as long as I can remember, sports has been something that literally controlled my life. Nobody forced me to play, and I know my parents would have been just as happy if I decided to join the debate team, computer club, or the band (I actually was in the band from 4th-12th grade, but that’s neither here nor there).

In kindergarten, I was with my mother at the grocery store and being, well, in kindergarten, I decided that it was a good idea to casually take a handful of gummy worms out of the candy dispensers, bypass the weigh machine, and stick the candy directly into my mouth.

Yes, this is stealing. (I was 6, let me live)

Well, my mother saw this and certainly was not happy. I obviously needed to be punished. So, how do you punish a 6-year-old so he really, really gets the point?

Take away his toys? Nope.

Take away television? Negative.

No dessert? Not enough.

Not letting him go to recreation soccer practice? Damn, mothers always know how to make a point.

This crushed me. As a 6-year-old, soccer practice was my life. It was like telling Snookie she can’t go to Bamboo.

The point here is that I really, really love sports.

…….

In high school during my senior year, I went to throw a cut block on a defensive lineman. He tried to hop over me, but didn’t jump high enough. His knee caught my low back pretty good. I thought it was bruised, so I kept playing. This went on for another two quarters until I collapsed on the field because I simply couldn’t run anymore.

The team doctor took me back to the locker room and we found blood in my urine.

From there, I was sent to the hospital and stayed overnight. They found that I had bruised my kidney and fractured the L4 and L5 Transverse Process vertebrae.

I was told that I would need to be in a back brace for 6 weeks in order to let the injury heal.

I was crushed. 6 weeks in a high school football season is over half the year.

During my 6 weeks away from the field, my coach decided to put me up in the coaches booth with head phones so I could help call both the offense and defense. Staying involved with the team was something I NEEDED.

After 6 weeks of inactivity and in a brace, I removed the brace and without any Physical Therapy (the doctor said I didn’t need it, and amazingly I believed him) I returned to the field after 1 day of practice.

This was really dumb and I payed for it a bunch of years later with surgery.

But you know what?

I wouldn’t change any of it. 

The fact that I was able to go back on the field and play again was worth it, in my opinion. Just that one last chance to get out there  is something you never, ever get back.

The point: I really, really love sports.

…….

Since that time I went on to play college baseball. Ironically, my career ended there with a torn labrum on a hook slide into home plate during the 2nd week of my junior season.

…….

I tell these stories because I think before I go on, everyone must understand where I have come from. I come from a place in which I believe in building tough SOB’s with a no-nonsense attitude toward sports and training. Neither is/was something I did to hang out with friends, or build a social group. To me, it was ALWAYS serious business. Luckily, for most of my career, school came a bit easier for me so I in turn, spent 98% of my time focused on sports. Simply put, sports was never what I did, it was who I was. Quite frankly, it’s who I still am.

So that brings us back to the present.

I am now a chiropractor with a fascination in rehab and human performance. One who is always reading the research, going to seminars, and always looking for that ‘edge’. That ‘edge’ is generally anything that pushes human performance to another level.

Essentially, we all want to know (myself included) how to make our athletes bigger, faster, and stronger all while trying to keep them healthy.

But the question is when is enough, enough? When have we taken it too far?  What needs to happen for us to make drastic changes?

Think about the situation with Brandon McCarthy. Yes, I understand this was more of a freak injury. A line drive directly back at the pitcher’s head is not common. But, at some point it comes back to simple physics. The pitchers are continually throwing harder, the batters are getting stronger and subsequently hitting the ball harder. The pitcher’s mound has not moved back at all. So, what’s left is simply less reaction time and a higher velocity of which the ball is reaching the mound.

And then we look at the football situation. Trust me, I am well aware that poor technique can cause a freak injury to happen. But, no technique in the world can stop 250 lb. men from running at each other at freakishly high speeds literally trying to take each others head off.

As an industry, we are in the business of making better athletes. By doing this though, are we making these sports more dangerous?

At what point is it too much?

How far will we push the limits of human performance until we truly regret it?

As the title states, I am truly afraid we are creating monsters and I’m not sure where it ends.