The Art of Recovery (Part 2 of 2)

Part I went over stress, tissues, the nervous system, and many of the factors that are involved with recovery.Throughout a PT session there are many opportunities to influence the patient's health; both for the immediate and long term effects.  This post will go over the 4 factors of recovery that I often try to discuss with patients before they are discharged from Physical Therapy.

4 Factors of Recovery

Each of these 4 factors could be a book on its own, let alone a blog post.  To save myself some of the mental stress of going over each of them in-depth, I'll just briefly describe the factors and some methods for improvement.Before you start educating patients, it's important to follow the golden rule:

• Don't prescribe anything you haven't tried yourself

This goes not only for exercises, but the lifestyle changes as well.  If you don't sleep well, have never meditated, and eat bad food, then you shouldn't try to influence other people.

Sleep

Sleep is a difficult one.  Going to bed at a descent hour is extremly difficult these days.  Youtube, reddit, twitter, league pass, and Netflix (how can you just watch 1 episode of House of Cards?).  But it's one of the easiest ways to improve recovery.Sleep gives us the lowest level of stress (internal & external) on the body.  This low level of stress allows us to get out of the red and into the black.  It lets us recover.  Both mentally and physically.The science behind sleep (and why we need it) is still not conclusive.  But we do know that sleep plays a huge role in hormone regulation (melatonin, GH, TSH, testosterone, cortisol, etc.), augments immune system function, improves cardiovascular function, increases cognition, and improves neural function (stimulate oligodendricytes, myelin, neural development/repair).  Plus, the supine position puts the lowest load on the body.Sleep expert at NIH, Dr. Michael Twery, sums up these benefits of sleep nicely; "Sleep affects almost every tissue in our body."So even if we don't know all the reasons behind why we sleep, we at least know that it's good for you.Most experts agree that you need at least 7 hours of sleep a night.  Of course it varies from person to person, but if you're getting less sleep than 7 you might have trouble recovering from the day's cumulative stress (especially if you've put extra stress on it; i.e. workout, injury).

Improving Sleep

 

Mental Stress

Today's culture creates quite a problem.We have these bodies that were developed from over 6 million years of evolution.  This slow, progressive, evolution of our physical body has given us the genes we have today.  Even though we've become a different species than our ancestors, we still share many of the same genes.  Thus, we share a similar body type as our ancestors.On the other hand, our cultural evolution has skyrocketed in the last 10,000-50,000 years, leaving our physical bodies way behind.  And this cultural evolution continues to progress at an exponential rate.  The Agricultural and Industrial Revolution were the first big events that changed the way humans live.  Now we have the Information/Telecommunications Revolution. We are spending more time plugged in and less time present with our bodies.  From this cultural evolutionary perspective, we don't share much in common with our ancestors.This creates a mismatch between the environment we live in and our physical bodies.  In other words, our bodies are not made to live in today's cultural environment.The result of this, and the fact that we often treat the symptoms instead of the cause, is what Daniel Liberman refers to as dysevolution.  A product of this dysevolution is the increasing amount of mental stress/disorder and physical dysfunction.Luckily for us, there is a method to help prevent or decrease this mental burden - Meditation.

Meditation

Meditation has been around for possibly 5,000 years.  Needless to say, it has some empirical evidence.I have taken UCLA's on-line meditation course with mindfulness expert, Diana Winston.  While this by no means makes me an authority on the subject, it has educated me on some of the science behind meditation and how to apply it.The benefits of meditation are incredible and the profound effects cannot be overstated.  Many people talk about the life changing effects of this practice.  Even some of the most successful people in our society have credited meditation as a big part of their growth and accomplishments.But even if empirical evidence doesn't convince you, modern research has shown many positive effects.

Research Has Shown That Meditation Can

• Improve Physical Health (e.g. cardiovascular, immune system)
• Improve Mental Health (e.g. anxiety, depression)
• Improve Emotion Regulation
• Decrease Sympathetic Drive
• Improve Attention (e.g. conflict attention, improve flow)
• Improve Brain Function (e.g. neurodevelopment, gyrification)
• Decrease Pain
• Improve Well-Being

Sounds pretty good, right?And did I mention that it's free and easy?  Well...it's free and physically easy.  Developing your meditation practice is a process and requires some motivation and mental effort.  But don't take that as a deterrent, it's not exhausting or mentally fatiguing.  In fact, most people feel energized after meditating.  The most difficult part is getting started and developing the habit of meditating.I think one of the best places to start is with Diana Winston's 5 minute breathing meditation (YouTube).This is a great place to start for 3 reasons:

1) Everyone can perform 5 minutes

2) It goes over the basics and gives you a standard guideline for future meditations

3) The diaphragm is the only voluntary muscle that can directly influence the autonomic nervous system.  Breathing augments the parasympathetic response of meditation.

It's important to note that I don't immediately jump directly from discussing a painful shoulder to giving them a 5 minute meditation recommendation.Before I prescribe meditation to a patient, I first educate them on the autonomic nervous system continuum (sympathetic vs. parasympathetic).  Then I begin to explain some of the benefits of meditation and how it can aide in their recovery.  If they are receptive, I simply write down my meditation recommendation (above), tell them to type it in on google, find a quiet place, and try the 5 minute meditation.One benefit of our accelerated cultural evolution is that there are now plenty of meditation guides, timers, apps, and techno-bio-feedback devices that give people an easy way to stay on top of their meditation practice.

Diet

Bringing up diet is a lot like bringing up politics.  Everyone has an opinion and no one knows what's really going on.Do we eat nothing but bacon?  Is carbohydrate a bad word?  Is there a chocolate diet?However, more science and less propaganda has allowed for a recent paradigm shift in diet.  We're only scratching the surface and the answers will vary per person and per culture.  But it has gotten a lot better than that terrible food pyramid we were taught to believe.Trends will come and go, but I feel that there are 5 facts that would help most people.  Of course there are a lot more to these "facts" than a simple sentence, but hopefully it'll give some direction for nutrition choices.

5 Nutritional Facts

1. Avoid Processed Foods
2. Eat More Vegetables
3. Avoid Simple Carbohydrates
4. Fat is Not Bad for You*
5. Stay Hydrated

I don't think these 5 Facts will change as they seem to be backed up by basic physiology, logic, and evolutionary medicine.  We may learn more about the specifics of each category, but the basic principle shouldn't change.  For example, it is now well known that fats are good for your health, but research is finding out which specific types of fats are healthy and which are detrimental (i.e. trans fats).

Exercise

The benefits of exercise are enormous.  Exercise improves the musculoskeletal system, controls weight, increases life span, reduces diabetes risk, improves mental health, reduces risk of some cancers, improves cardiovascular fitness, and improves sleep.Exercise is also beneficial for recovery both:

• Immediately following a bout of stress

• For the long term ability to adapt to stress.

The immediate beneficial effects of exercise for recovery should be focused on the circulatory system.  The goal is simply to get blood and fluids moving around.  This should include some active dynamic stretching, mobility work, light stabilization, and/or light aerobic exercise.The long term effects of exercise are much more complicated.  This requires specific individualized programming that involves periodization and deloading.  People should have a normal overall fitness and exercise routine to help stress the body for an individualized adaptation.  Because in the long run, the body can only handle what the body is adapted for.There are many great articles regarding the physical aspect of recovery.  Check the references provided below for more detailed information.

Bottom Line

It's often not the over-training, as much as it is the under-recovery.You can have the greatest training program and the best workout session from the best coach in the world.  But unless you are able to recover from it, it won't matter.Bernard Hopkins, record holder for chronologically oldest boxing champion, sums this series it up nicely:

• "Lifestyle is the make or break of any athlete."

I would even go one step further and say that lifestyle is the make or break of anyone's health.

Disclaimer

Now I'm not saying you should go out and give your patients a full nutritional prescription or start discussing their childhood to determine why their boss stresses them out.  Instead, you should just be assessing the factors that influence their recovery and offering some general advice (if you are educated).  Anything more than this would be beyond health promotion and fall out of the scope of your practice.If someone is interested in a more in depth answer, you should refer out.  The patient will benefit from a greater health "team" and the person you refer out to may even start referring in to you.

Dig Deeper

Signs & Symptoms of OvertrainingChen, Jui-Lien, Ding-Peng Yeh, Jo-Ping Lee, et al. "Parasympathetic Nervous Activity Mirrors Recovery Status in Weightlifting Performance After Training." Journal of Strength and Conditioning Research25.6 (2011): 1546-552.Porges, Stephen W. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. New York: W. W. Norton, 2011.Walter, Chip. Last Ape Standing: The Seven-million Year Story of How and Why We Survived. New York: Walker &, 2013Lieberman, Daniel. The Story of the Human Body: Evolution, Health, and Disease. New York: Pantheon, 2013. PrintNutritionSugar is a Drug - Rejection of Low-Fat Dogma - Kris Gunnars Science - 11 Problems with the Modern Diet - Don't Fear the FatsPrecision Nutrition - Boosting Recovery, All About RecoveryHydration - Len KravitzBulletProof - Diet Infographics -SleepInfoGraphic - NIH - 11 Benefits of Sleep - Neural Repair - Sleep "Hacking" - Supplements (1, 2) - How Athletes Sleep - FatigueScience - Study on Performance - James Clear's Informative Sleep Guide - Farnam Street Shane Parrish's Science Summary - NYTimes Schwartz - Sleep & Pain Correlation - Healing Power of Sleep - NeuroSleep InfoGraphic - 10 Reasons Why Sleep is Good - GMB - Sleep Deprivation = Cell Damage - Fix Circadian Rhythm - 2015 National Sleep Foundation Recommendations (Hours Per Night) - TNP on Sleep & Pain - Non-Obvious Sleep Solutions - Wear Sunglasses at Night (here & here) - Scientific American How to Be A Better Sleeper - Sleeps Role in Obesity & Psychological Disorders - 7 Steps to Better Sleep - Body in Mind's Sleep, Pain, & Recovery - Eric Barker 5 Ways to Sleep Better - Sleep is good for learning and memory - The New Yorker "Why Can't We Fall Asleep" - Relationship Between Sleep and Pain - Understanding Sleep - Sleep Builds Good Hearts - Optimizing Sleep for Memory - Sleep Restriction Therapy - Nick Littlehales 90 minute cycles and Ronaldo - National Institute of Health: Why Sleep is Important - Sleep removes neurotoxic waste from the brain - NYT Sleep. Clean. - NYT Sleep Problems and Type 2 Diabetes - Sleep & Recovery from YLMSportScience - The Sleep Judge on the Health Benefits of SleepReimund, E. "The Free Radical Flux Theory of Sleep." Medical Hypotheses 43.4 (1994): 231-33.

"Removal of excess free radicals during sleep is accomplished by decreased rate of formation of free radicals, and increased efficiency of endogenous antioxidant mechanisms. Thus, sleep functions essentially as an antioxidant for the brain."

MeditationUCLA Mindfulness Awareness Research Center - Mindfulness Research Summary (Flock L, Flaxman G) - Gyrification - 7 Myths of Meditation -23 Ways to Reduce StressUCLA  - Mindful Awareness Practices (MAPs) I for Daily Living (On-Line).  2013.ExerciseCDC - Harvard - Exercise & the Brain -Mike Robertson - 6 Tips for Recovery , Aging AthletesEric Cressey - 3 Tips for Aging AthleteChris Beardsley - RecoveryKevin Neeld - Post-Game Sympathetic Dominance, Overtraining & RecoveryDan John - Recovery TipsPatrick Ward - Rest, Recover, Regenerate Part 1, 2, 3, 4, 5Seth Oberst - RecoveryEric Bach (via Dean Somerset) - Recovery - Deloading 

Blair, S.  Physical inactivity: the biggest public health problem of the 21st century.  BJSM.

Fountain of YouthThe 23 Hour Plan--The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

 [subscribe2]

Course Review - StrongFirst Kettlebell Workshop

On June 1st I had the pleasure of participating in a StrongFirst Kettlebell Workshop with Phil Scarito.  It was a 1-day course that went over the intricacies of the basic kettlebell movements (Deadlift, Swing, TGU, Goblet Squat, Press).  The theory is that it's better to master the fundementals than to be average at a bunch of different lifts.  Plus, it's these basic KB movements that that have the greatest impact on improving one's physical abilities and movement patterns.Phil Scarito was the instructor for the course.  He is extremely knowledgable on many levels and was able to translate his concepts to everyone from physical therapists to personal trainers to your average gym rat.  Phil is able to go into the greatest details of each movement to truly help you understand the movement at a different level.  He has a great YouTube page with tons of detailed instructional videos.Along with some posterior chain soreness, I learned quite a few things.  Here's some things I learned in one day with Phil Scarito and the StrongFirst instructors.

General

1) Your clients/students/patients will do what you do.  Make sure you can execute the move perfectly and they will too.2) Training barefoot is extremely important.  It allows you to maximally "root" your feet into the ground and give you more power.  Shoes deprive you of that important sensory information.3) Lose big toe contact = lose power4) Fast & Loose - keep moving during your training and use active rest5) Tactical Frog is a great mobility warm up6) Fix the deadlift.  When someone is having difficulty with a movement, often times going back and fixing their deadlift will resolve the problem.  "Don't fix the swing, fix the dealift" - Brett Jones7) "Try to make the light weight feel heavy, and make the heavy weight feel light" - Marty Gallagher8) Breathing is extremely important to develop stability.  Coordinate breathing with movements (biomechanical breathing).9) Think about driving your feet into the ground and pushing the earth away.10) Active Negatives are a great way to learn movement.  It also spares the agonist of eccentric load, allows for successive induction, trains the antagonist, and helps to "grease the groove".11) Always keep the wrists in neutral.  Don't let it bend to accommodate the bell.12) All you need for programming is TGU's and Swings.  Do those everyday and you will make tremendous gains.  (paraphrased Pavel advice)

Hip Hinge/Deadlift/Swing

1) The hip hinge is the basis for the deadlift.  The deadlift is the basis for the swing.2) "Rooting" feet into the ground is extremely important for power transfer.3) Reach down and stay tall before you pick up the bell.  This packs the shoulders while maintaining proper posture.4) It's important to start the swing off right.  This helps activate the lats to develop tension, increases power generation, and properly starts the movement with the right momentum.5) If you let the weight go at the bottom of the swing it should fly backwards, not down.6) Avoid the "high hip hinge".  Don't get lazy and start doing partial range swings.7) Timing is extremely important.  There should be a delay going up (KB "float") and a delay going down ("playing chicken with the KB").8) Don't over think quick lifts.9) Don't be so afraid of flexing your trunk forward.  Many people will bend at the knees to try to keep their torso upright instead of hinging at the hips.10) Make sure to "snap" your hips forward.  Finish the lift tall.http://www.youtube.com/watch?v=_z3T1CwP5bg

Turkish Get-Up (TGU)

1) You can take the TGU and turn it into a million different exercises.  Break it up, practice small parts of it, add a few TGU movements into other exercises.2) The TGU takes you through a full neurodevelopmental progression.  No other exercise can do that.3) Starting position will determine the success of the rest of the movement.4) The legs and arms should be parallel in the starting position, much like a starfish (or at 45 degree angles).5) You should be "rolling" to your elbow, not sitting up to it.6) When you get to your hand "think of wedging yourself between the bell and the floor" - Phil Scarito7) The "2 Lines" to look for:

• In Sitting Phase: Hand, Hip, and Oppoite Foot in line

• In First Kneeling Phase: Hand, Knee, and Foot in Line (same side)

8) Most people do the TGU too fast.  Should be a slow movement with at least a couple seconds in between movements.http://www.youtube.com/watch?v=RkVaQMi9wTQ

Goblet Squat

1) After your hips go below your knees it is all on the glutes to get back up.2) Don't get out of the bottom position too fast.  You want to go slow to prevent the hips from shooting up.3) Pull yourself into the bottom position with your hip flexors (active negative).4) Keep your feet pointed straight ahead and the exercise will naturally prevent valgus collapse at the knee.5) Don't sacrifice form for depth (avoid excessive lumbar flexion).6) A common fault is sitting forward into the knees.  Most people will need to focus on sitting back into their hips.http://www.youtube.com/watch?v=ZnG3Z7Zgpzs

Strict Press

1) You can't press with a hyper-extended wrist.  There's no power.2) Don't reach up.  Instead, think of pushing the whole body away from the KB.3) The plank and the military press are very similar exercises.4) Don't let the ribs flair and hyperextend the lumbar spine.5) Actively pull the bell back down (active negative).http://www.youtube.com/watch?v=WTmR-Qr32dg

Summary

More and more people are becoming interested in kettlebells.  As a clinician this means we have to have a better baseline level of knowledge so that we can assess, train, or refer out when we have patients that are using this equipment.Remember the rule with all exercises:

• Make sure you are competent with the movements before you prescribe or assess someone else.

The kinesthetic learning of this course cannot be matched by anything other than performing the movements while being coached by professional.  I highly recommend taking one of these workshop courses with StrongFirst if you have any interest in kettlebells.

Dig Deeper

Strong FirstPhil Sacrito - Website - YouTubePaul GormanGray Cook & Brett JonesKettlebell Studies

McGill

Jay K

Jay K et al

 --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

 [subscribe2]

Basic Hip Strengthening

Chubbs was right.  It’s all in the hips!Hip strength is extremely important for your musculoskeletal health.  The hip muscles are connected from your pelvis to your femur.  This connection means they will not only have an influence on your hips, but also effect your back and your knees.  In other words, your hips help stabilize and translate forces from your legs to your trunk and vice versa.  In addition to this anatomical/biomechanical relationship, our society has a very high prevalence of back and knee pain.  So maybe instead of another "core" program or a new squat technique we really just need some hip strengthening.  This post will discuss the importance of hip muscles, the effects of hip strength, and how to start strengthening them.

It’s Hip to be a Glute

When it comes to preventing injuries and increasing athletic performance, the hip muscles are hard to beat.  They have a great influence on 3 planes motions and are heavily used in everything from walking to hitting a tennis forehand down the line.  The Gluteus Maximus and the Gluteus Medius are the 2 main muscles of the posterior hip that can easily be strengthened to improve performance and prevent injury.

Gluteus Maximus

This muscle is the most powerful external rotator of the hip and has a major role in controlling the hip as a pivot in the sagittal plane (hip hinging).  Because of the size and orientation of this muscle it is very important for supporting the hip in all planes of motion.

• Primary - Hip External Rotation, Hip Extension
• Secondary - Hip Abduction

Gluteus Medius

This muscle is essential for controlling the hip and trunk motion in the frontal plane.  It prevents the trendelenberg gait pattern (walking like a penguin).

• Primary - Hip Abduction
• Secondary - Hip External Rotation, Hip Extension

Hip Muscles Importance

These muscles preventing your hip going into a flexion/adduction/internal rotation moment.  When this position occurs with movement it is often called Dynamic Valgus.  Throughout the day (walking, sit to stand, stairs) and in athletic activities (agility tasks, jumping) your hips are at a great risk for this movement dysfunction.  Failure to have adequate hip strength to prevent dynamic valgus can potentially lead to various injuries (IT Band syndrome, ACL tear, hip impingment, low back pain, etc.).

Effects of Decreased Strength/Motor Control of the Gluts

At the Knee

The knee is basically a simple hinge joint.  It flexes and extends.  If your hips aren’t strong enough to support the reactive forces that accompany movement it will compensate with excessive motion at the adjacent joint.  This means that when your hips fail you begin to introduce rotation and side bending into a hinge joint (the knee).  Once a joint begins to function in a different way than its structure it is just a matter of time before it breaks down.

At the Back

Think of the pelvis as a shelf for the lumbar spine.  If that shelf is tilted one way (from weak hips) then your spine will have to compensate and bend to maintain an upright posture.  This leads to excessive compression on the spine and prevents its normal motion.  You cannot have dynamic trunk/core stability without dynamic pelvic stability.

Why Hips Are Weak

Don’t take it personally.  You can blame it on the most probable reason why your hips are weak - our society.  The increased amount of time in the static sitting posture puts the gluteal muscles in a lengthened position.  This position stretches the muscle out, thus causing decreased contractile potential (decreased strength).  In other words, your gluteal muscles go from tight effective movers to a thinned out weak tissue.The problem is further worsened because your body is much smarter than you are.  It adapts and begins to compensate with other muscles to achieve the necessary movement.  This is a natural survival mechanism.  However, once this compensation is set in, you will be strengthening the compensatory muscles instead of your gluts every time you exercise.  Add this to the fact that most of our motion occurs in the sagittal (front-back) plane and you've set yourself up to turn your strong gluteal muscles into soft cushions.

How to Strengthen Them

Here are 4 basic hip strengthening exercises.  This is a good base to start from before progressing to intermediate/advanced exercises.  Never sacrafice quantity for quality.  Perform exercises in a slow, controlled manner.  Stop immediately if you experience any pain.http://www.youtube.com/watch?v=9zzts_Ojrso&feature=plcp

References

Powers, Christopher M. "The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective." Journal of Orthopaedic and Sports Physical Therapy (2010)Nadler SF, Malanga GA, Feinberg JH, Prybicien M, Stitik TP, DePrince M. Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study. Am J Phys Med Rehabil (2001)

Equipment

You can get the exercise bands here.  Start with green and work your way up.[subscribe2] --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

 [subscribe2]

What I Learned from Running a Half-Marathon

On June 9th I went to Chicago, IL to run in a half-marathon with my brother and girlfriend.  Prior to this I had never ran more than 6 miles at once and had spent my time playing sports and lifting weights as opposed to endurance training.  I trained for 3 months, ran the half-marathon, and learned a lot about myself and running.

7 Things I Learned From the Half-Marathon

10% Rule is No Joke

The 10% rule implies that you should never increase your duration, frequency, or intensity by more than 10% per week.  The only time I had pain during my training was after I violated this rule.  It was early in the training when I went from running 3 miles, 3 times a week to all of a sudden doing 3 consecutive 3 mile runs.  I was feeling great, getting addicted to the gratification, and feeling overly ambitious.  I went from 9 miles in a week to 9 miles in 3 days.  I strained my left calf and had to spend a lot of time managing the injury early on.  I quickly learned that running 3 times a week (non-consecutively) and progressing by 10% per week is more than enough.

Know Your Limitations

It helps that I’m a physical therapist and I see injured runners everyday.  So I knew what the common injuries were and how to prevent them.  More importantly, I also knew what my own impairments were.  I had tight hip flexors and calfs and a tendency to overuse my hamstrings over my gluts.  Knowing this helped me to focus on resolving this impairments early on and afforded me a more efficient running gait.  Any time I had some soreness or if a run was difficult, I would just put some extra time into my personal impairments and the next session would be much easier.

Running Gait

In the past decade the opinions and “facts” on running gait have really gotten out of hand.  Everyone from your personal trainer to the guy bagging your grocieries has an opinion.  A bigger problem is that some people subscribe to these types of running techniques like they're joining a cult.  All of a sudden you have someone who knows nothing about your body or running gait giving you advice about how you should run.  I think that unless you are a very competitive endurance athlete you should not spend too much time worrying about your stride.  I just focused on 3 simple things:

1. Land Softly - the less impact on the body the better
2. Don’t Over Stride - the best advice I received was when someone told me you should increase your stride in the back, not in the front
3. Run Tall - posture plays a big role in running economy and proper muscle activation sequencing

Running isn’t a Workout, You Have to Workout to Run

I see alot of injured runners in the clinic who only run during their training.  They don’t stretch, they don’t strengthen, they only run.  Repetitively working the same muscles in the same manner in only one plane of motion is a formula for failure.  It’s important to supplement your endurance training with stretching and strengthening.I designed my workouts to help me run more efficiently and to prevent injuries.  I included alot of stretching and mobility exercises, balance training, and hip and core strengthening.  This gave me more stability and prevented compensatory motion.  It also allowed me to strength train without impacting my run the next day due to soreness.

Nutrition (Goo)

Prior to this half-marathon I always though the goo packs and running with water around your waist was for lunatics who live, eat, and sleep in their running shoes.  This quickly changed after I started running over an hour.  I distinctly remember a 11 mile run that lasted about 1:40.  I had no food and no water.  The last few miles were hell.  I had nothing in the tank.  Every step was difficult.  I felt nauseous.  I had hit “the wall”.  It took me a full day to recover from this session.  The next run I took one of those disgusting goo packs (never take vanilla) at 55 minutes and the rest of my run was much easier.  There is a big correlation between nutrition and physical performance.

Don’t Get Competitive

Many people told me to start out slow, run negative splits, and to wait for my legs to get under me.  However, when the race started and the adrenaline hit things changed.  I started to be concerned about separating from “the pack” and passing people that didn’t look like they trained appropriately.  At the 4 mile mark I was running a minute faster pace than I had during my runs while training.  I dialed it back and tried to settle in to a good rhythm, but the last few mile markers seemed much longer than the first few.  A couple of the people I was passing in the beginning came back around to pass me during the last few miles.  My advice would be the same as all the people I mentioned in the beginning - start slow, run negative splits, and wait for your legs to warm up.  I just hope you listen better than I did.

Treat Yourself

I had muscle soreness and some ITB pain after the race.  After stretching, foam rolling, a 2 hour nap, and going for a short leisure walk I was feeling fine and ready for the celebration to begin.  At the end of the day I did the same thing...after several celebratory beers.  I woke up on Sunday without any problems.

Bottom Line

• Use the 10% Rule to prevent overtraining and injuries
• Know your body and its limitations
• Don't obsess over running gait - focus on a few simple corrections
• Workout to supplement your running efficiency and to prevent injuries
• Nutrition is very important
• Run your race - don't get competitive
• Take care of yourself after the run

 --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

 [subscribe2]

Constructive Rest / Passive Alignment / 90-90 Position

When prescribing home exercises for my patients I often try to keep it to a minimum of 3 exercises.  I understand it's the last thing people want to do at the end of a long day, especially when they require great effort and concentration.  Luckily for those of us that experience pain and discomfort there is an exercise that is easy to perform, doesn’t require a great deal of mental energy, and gravity does all the work for you.This exercise (seen below) has been called many different things and has been claimed to be an innovative technique by many different people.  But the truth is that people have been putting their feet up at the end of the day long before any clinician could coin it as their own.  While each individual may have a different rationale and name for this exercise, the principle and basis are the same regardless.

Rationale

• Allows for passive re-alignment of spine and posture (Pete Egoscue)
• Decreases the tension of the psoas muscle to allow for “constructive rest” (Liz Koch)
• Puts the low back in the position of the least load on the discs
• Reduction of lumbar lordosis
• Increases the posterior separation between the vertebrae and facet joints
• Reduces pressure on the nerves

How to Perform

1. Lie on ground
2. Put feet up (on an ottoman, chair, coffee table, dog, significant other, etc.)
3. Make sure your hips and knees are at 90-90
4. Aim for 15-20 minutes per session
5. Enjoy

Cognitive Connection

Many practitioners advocate conscious awareness of your body in this position (e.g. where do you feel  pressure? tension? stress?).  Some believe this is also a great position to exercise your diaphragmatic breathing.  Others recommend simply focusing on allowing your body to relax and to let your body adapt to gravity.  Try a combination of these approaches to find what works best for you.90-90 Position, Constructive Rest Position, Egoscue Static Back 

References

Peterson MD, Nelson LM, McManus AC, et al.  The effect of operative position on lumbar lordosis. A radiographic study of patients under anesthesia in the prone and 90-90 positions.  Spine 1995 20(12):1419-24Koch, Liz.  The Psoas Book 2nd Edition.  Guinea Pig Pubns, 1997. --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

 [subscribe2]

Protect Your Neck

October is always one of my favorite times of the year.  The weather gets a little cooler, the football season is in full swing, pumpkin flavored food is available, Oktoberfest beers are on tap, and most of all Halloween is right around the corner.  Before the time comes for ghouls, ghosts, and demons, it is important to prepare and protect your neck.Using these 6 tips to protect your neck will help prevent you from becoming one of the undead and drastically improve your neck health.

6 Ways to Prevent Neck Pain

1. Posture

As with any spinal pathology, posture is the most important variable.  In our technology dominated society we spend much of our time with our necks flexed down or lurching forward.  These gravity dominating postures can add up over time and cause great damage to your neck and shoulder muscles, vertebrae, neural tissues, and circulatory system.  It is of grave importance that we maintain good neck posture when ever we can.Of course it’s impossible to sit and stand straight up ALL the time.  The research has shown signs of maladaptive connective tissue response occurs after 20 minutes.  So doing a “postural reset” every 20 minutes will reverse gravity’s damaging forces, activate muscles to prevent atrophy, and most importantly, allow you to heighten your senses to view any potential vampires in your environment.  Ensuring that you have the correct ergonomic set up is also a key factor in maintaining proper posture.Postural Reset - Stand with feet straight ahead, keep knees straight but not locked out, slightly contract glut muscles, gently tense stomach muscles, slide shoulder blades back and down, stack head back on top of shoulders, and hold for anywhere from 30 seconds to 5 minutes.  Even if you can't stand up (in a meeting, class, auction, getting your hair cut, etc) then you can still benefit from a postural reset from the waste up.  Here's a video of a useful postural exercise: The Da Vinci

2. Face Forward

If your head is down and buried into your book, smartphone, or laptop you will be leaving the back of your neck wide open for a vampire to feast on.  It could also cause long term damage to your neck (spinal stenosis, disc herniation, muscle atrophy, etc.).  So even if a vampire doesn’t make you the next meal, you’ll still be in trouble later on in life.A simple fix is to bring objects to the level of your face (or at least higher than your waste/lap).  This will place your spine in a more neutral position and significantly decrease the stress on your neck.  Making it a habit to use your arms instead of your neck will save you in the long run.

3. Sleep With One Eye Open...On Your Back

Night time is when vampires are most active.  Unfortunately for us humans, it is also the time when we are usually sleeping.  This is why it’s important to sleep on your back.  It puts your spine in a neutral position and doesn’t place an uneven load through your neck (like sleeping on your stomach or side).Sleeping on your stomach is the worst.  It just torques your neck all night and gives vampires easy access to your nape without worrying about any resistance.  If you can't sleep on your back at least try to sleep on your side.  Having the proper pillow makes a big difference as well.  You don't want one too firm that places your neck into too much flexion and you don't want one too soft that puts you into extension.  You need a pillow that will support the natural curve of your neck.

4. Carry with Caution

Often times the baggage you carry can also be one of the main stresses on your neck.  Try to be more aware of the load you are placing on your body when you are carrying things.  It’s best to have the forces as symmetrical as possible and as close to your body as you can.  This is why backpacks are much better for you than purses or messenger bags.   If for some reason you cannot use a backpack, make sure you switch sides often.  Habitual one sided carrrying will lead to uneven muscle tone throughout the body, possible scoliosis, and set your shoulder and neck muscles up for failure.

5. Stabilize Below the Neck

While your neck may be the target, it is important to keep everything below the collar protected as well.  Giving your head a stable support surface to function off is very important in preventing chronic neck pain.  I've seen too many cases where weak shoulder/scapula muscles force the neck musculature to compensate and overwork.  So stabilizing your shoulders will help to decrease your neck pain as well as increase the amount of force you can use to put a wooden stake through a vampires heart.2 Shoulder/Scapula Exercises

1. Seated Row - Hold each rep for 10 seconds, start with 10 reps comfortable weight to start
2. Prone I's - Start on stable surface, do 1 side at a time, make sure to go slow on the way down, emphasize using your lower scapula muscles

Often times patients with chronic neck pain have imbalances and impairments much further down the chain.  The thoracic spine, lumbopelvic mechanism, and hips should be assessed by a professional if your neck pain is not getting better over time.

6. Stay Loose

Dealing with the stress of living in a world with vampires can add up.  Many people hold this tension in their neck.  Couple this with maladaptive postural positions and you have a very dysfunctional tight neck.  Stretching a couple key muscles throughout the day can have a dramatic effect in reducing/preventing neck pain.Start with a very gentle stretch to make sure this doesn't aggravate your neck.  If it causes any pain do not perform this stretch and see your local physical therapist or physician.  These stretches should be held for 30 sec to 1 min.  Emphasize keeping the stretch side shoulder down throughout the stretch.

1. Trapezius Stretch
2. Levator Scapulae Stretch

Bottom Line

Vampires can be a real pain in the neck (sorry, couldn't resist).  Following these 6 tips will help you prevent the affliction of cervical dysfunction and immortality.  Remember to seek out a healthcare professional if you have pain with any of these movements or postures and if you are not getting better.

• Obsess over your posture
• Bring objects to your face level, instead of trying to bring your face to your hands
• Sleep on your back
• Try to carry symmetrically, or at least change side every 20 minutes
• Stabilize below the neck - strengthen shoulders/scapula
• Stretch out your neck muscles to increase tissue extensibility

  --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

 [subscribe2]

Links

It doesn't take a subscription to a peer-reviewed medical journal to gain knowledge and understanding in the orthopedic world.  Today there is a plethora of websites and blogs with so much free information that you can practically get free continuing education online.  Here's a list of some helpful sites.  I've tried to focus on the ones that are more focused on concepts and education instead of product placement and marketing.  Let me know if there is anything I'm missing.

Websites

Physical Therapy

Physiotherapy Site, Local Physiotherapists, Qualified PhysiotherapistCyber PTShoulder DocYouTube - OptimumCareProviders's ChannelTrigger PointsFMSPostural Restoration InstitutePosture, etiology of a syndromeAPTA Learning Center: HomeThe DonTingy Method - SIJ and Low Back Pain websiteMy Physical Therapy SpaceInternational Spine & Pain Institute

Orthopedic

eOrthopod.com | Orthopedic Information, News, Patient Guides, FAQs and moreMedScape - News, Reference, EducationOrthopedic News | ORTHOSuperSiteMedlinePlus: Videos of Surgical ProceduresAAOSSpineUniverse.comCyriax Orthopaedic MedicineStone Clinic :: Welcome

Training

TESTOSTERONE MUSCLE | Unapologetic Muscle-Building ElitistsExRx (Exercise Prescription) on the NetPersonal Training Programs - Exercise database, muscles, equipment ACE Fitness - Health and Fitness Information

Endurance

Endurance CornerSlow TwitchThe Science of SportCoachr.org | Latest information for Track and Field - AthleticsCrossfitNatural Running Center  

Pilates & Yoga

Balance Body - PilatesFull Fitness - PilatesYoga JournalYoga BasicsBandhaYoga

Anatomy / Kinesiology / Pathology

Muscle Atlas — Musculoskeletal Radiology — UW RadiologyAnatomy Trains | KMI | Welcome!Kinetic ControlKinesiology, NTUPTNeurokinetic Therapy - David WeinstockHand KinesiologyAnatomy and Physiology Functional KinesiologyGetBodySmart: Interactive Anatomy & Physiology TutorialsMaster Muscle List Home PageAnatomy LessonHumpath.com - Human pathology - Photos - pictures - videosMuscle PhysiologyANATOMYReal BodyWork | MusclesRunning Barefoot: Home

Neuro

Body in Mind - Brain & Mind in Chronic PainNOI - Neuro Orthopedic Institute (David Bulter)

Blogs

Physical Therapy

MikeReinold.com - A Blog for Physical Therapy, Athletic Training, and Sports MedicineBill HartmanThe Sports PhysiotherapistGray Cook, Physical Therapist, Lecturer, AuthorGreg Lehman - The Body MechanicPhysiodigest - David FitzgeraldMark Perren-Jones - Neck Pain and ExercisesThe Athletic Development BlogThe PT ProjectMyPhysicalTherapySpace.comPT Think TankPhysiotherapy Info » Research Analyzed by Clinicians, For CliniciansFITS TorontoErson Religioso - The Manual TherapistLeaps and BoundsCharlie WeingroffSherry McLaughlinNeil Poulton - PhysiobloggerRon HruskaKelly Starrett - MobilityWODSomastruct - James SpeckMyRehabExerciseRehabEducation (NASMI)Seth Oberst

Chiropractors

Craig LiebensonJeff CubosPerry Nickelston - Stop Chasing PainDr. Andreo Spina - Functional Anatomy Seminars -Ryan DeBell - The Movement Fix

Orthopedist

Shane Mangrum - The Back Exercise DoctorDr. Mazzara - Patient Information and Surgical Procedures

Manual Professionals

Leon Chaitow - Complementary health careSports Performance Coach and Licensed Massage Therapist — Patrick Ward, MS CSCS LMTErik Dalton Myoskeletal Alignment Techniques BlogSave Yourself

Training & Fitness

XLathleteEric CresseyMobilityWOD - Kelly StarrettRobertson Training Systems | High Octane Corrective Exercise & Performance EnhancementStrength Coach.com - Mike BoyleNick Tumminello Fitness | Baltimore MD Personal Trainer | Sports Performance & BodybuildingJohn Izzo's Trainer AdviceReality-Based Fitness - Keats SnidemanKelvin Miyahira - Golf Swing Analysis Paul Ingraham - Save Yourself from Aches, Pains & InjuriesPilates Teacher Tips | information and ideas to keep it freshNerd Fitness - Steve KambCharles PoliquinEliteFTS8 Weeks Out - Joel Jameson Breaking Muscle

Endurance Athletes / Running

Chris JohnsonBruce Wilk - Running Rehabilitation & Physical Therapy for MiamiJay DicharryRunningPhysio

Ergonomics / RSI

Ergomatters

Pilates, Yoga & Other

Liz Koch - Core AwarenessPilates Teacher Tips | information and ideas to keep it freshThe Daily BandhaDr. Weil 

Neuro & Pain

Better MovementHealth Skills - Behavior, Psychology, Chronic Pain ManagementMichael Shacklock's Neurodynamic Solutions (NDS)BBoy Science - Tony Ingram Louis Gifford

Bottom Line

Keep in mind that some of these websites/blogs have been around for a long time and have a tremendous amount of information in their archives.  Be sure to take your time and thoroughly explore these sites to get the maximal benefit from them.I think it's important that healthcare professionals continue to progress in the on-line world.  It improves the quality of our services, raises the standard of care, and delivers useful information to people who need it.

The Big 10 Percentowski

The 10% Rule

A common rule that has become widely accepted is the 10% rule.  This is a general guideline to help prevent injuries.  The rule simply states that you should not increase your duration, frequency, intensity, or load by more than 10% per week.  Failing to abide by this rule can lead to maladaptive compensations, tissue overload, subsequent injuries, and a possible loss of that rug that really ties the room together.

Just Take it Easy, Man

Whether you’re trying to increase your bowling average or how much you bench press, you need to first break down (stress) your muscles before you they build back up stronger.  This is pretty much the basis behind the Physical Stress Theory and the SAID principle.  To make gains you have to push hard enough to where the body is forced to adapt to the new demands placed on it.  The problem comes when people push too far and are out of their element.  The body cannot adapt and injury occurs.  This is a bummer, man.

How to Apply it

Using the 10% rules helps to ensure that you won’t push yourself past the adaption stage and into the injury stage.  Examples of ways to use it:

• Running 20 miles a week, increasing to 22 miles the following week
• Bench pressing 15 reps of 135lbs, increasing to 17 reps of 135 the following week
• Practicing guitar for 40 minutes, increasing to 44 minutes the following week
• Drinking 10 White Russians a day, increasing to 11 White Russians a day the following week

Don't Let This Aggression Stand

Of course this is just a simple guideline.  Everyone has different thresholds and tolerance levels.  Depending on your level of experience with the task you are performing you can adjust your progression accordingly.  If you’re looking to break records, the 10% rule may be too conservative.  However, if you’re just looking to stay injury free, then the 10% rule is a great guideline to abide by.Also note that this isn’t a 10% increase between sessions, it assumes you are performing the activity a couple times a week.  The Dude wouldn’t be rolling straight if he didn’t build his tolerance throughout the week.  And keep in mind that if you are having pain during or after the activity you are already in the overload-injury level and probably need to dial it down some.Even though this is a simple rule and seems like common sense, I have clinically seen more patients injure or re-injure themselves by doing too much, too soon.  The classic example is the knee patient that is feeling much better and decides to increase from 1 mile to 2 miles in just one session.  This is a 100% increase!  Like Donny, this patient is out of his/her element and are most likely overloading the tissues too much.So next time try not to be an overachiever and just abide by the 10% rule, man. --The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

 [subscribe2]

Ice: Nature's Miracle Healer

Ice is good for more than just keeping your favorite cocktail cold.  It can have a profound effect on preventing and healing injuries.  In fact, it’s been used as a healing modality (cryotherapy) for centuries and continues to be one of the main methods for reducing pain and accelerating tissue healing.Knowing how to properly ice is very important skill set to have.  This article will go over the reason for icing, benefits, physiological effects, methods, and protocols.  If you're only interested in the "how to" feel free to scroll down and skip the logic and reasoning.  

Reason for Icing

After an injury the body responds to injury by trying to protect itself.  This is good news...to a certain degree.  The body tends to over compensate during the acute healing process and you are left with residual inflammation and edema.  This extra fluid in a focal area causes an increase in pressure which can compress nerves that signal pain and decrease your functional movement.  This can create a viscous cycle as decreased and compensated movements may cause further injury and prevent proper healing.  Icing after an injury can help to control the edema, inflammation, and pain that results from an injury, thereby limiting the loss of function and movement.  Simply stated, icing can accelerate healing. 

Benefits of Ice

1. It's Cheap - a one-time fee of less than $40 can give you unlimited cryotherapy for years
2. Very Easy to Use - all you have to do is apply it to the affected area and relax
3. Convenient - it only requires a freezer and 10-15 minutes

What Ice Can Be Used For...

• Acute and Chronic Musckuloskeletal Injuries
• Prevention and Reduction of Delayed-Onset Muscle Soreness (DOMS)
• Inflammation and Edema Reduction
• Pain Control (increases pain threshold)

Physiological Effects

Blood Flow (Hemodynamic ) Effects

◊ Vasoconstriction of blood vessels (reduces blood flow, limits internal bleeding)◊ Increased blood viscosity ( increased the resistance to flow)◊ Reduction in the circulatory rate◊ Reduces the chemical reactions and vascular permeability that occur during acute inflammatory responseIce can help control and limit the inflammation process through the circulatory system.  Reducing the amount of blood to the area will lead to a decrease in the amount of residual inflammation and edema.

Neuromuscular Effects

◊ Decreased Nerve Conduction Velocity (sensory and motor)◊ A-Delta fibers (pain transmitting fibers) have demonstrated the greatest decrease in conduction velocity in response to cooling◊ Increased Pain Threshold (decreased pain sensation)◊ Reduction of muscle spasm (via the gate control mechanism)Ice can help to reduce the body's ability to send pain signals to the brain and thereby having an analgesic effect.  Since muscles require a signal from the nervous system to contract, a decrease in conduction velocity can lead to a reduction of a muscle spasm.

Proper Icing Protocol

When to Ice

◊ After an acute injury◊ Throughout a chronic injury◊ After any activity that aggravates the musculoskeletal systemUse your hands.  If the tissue has an increased local temperature, there is most likely an acute inflammatory process occurring and ice would have a great benefit on the healing process.

Where to Apply

◊ Depends on the type of injury and tissues involved.◊ For Joint Injuries – put the joint in a comfortable relaxed position, wrap the ice pack around the entire joint (360° coverage)◊ For Muscle Injuries – place the muscle in a gentle stretch, wrap the ice on top of the location where it hurts

Duration

◊ 10-15 minutesAfter 15 minutes the smooth muscle of the blood vessels becomes “fatigued” and loses their vasoconstriction abilities.  This could negate the beneficial effects of cryotherapy.

Frequency

In the acute stage it’s important to ice as often as possible.  I usually tell patients to try to aim for at least 3 icing sessions a day, even if it means bringing an ice pack to work. But make sure you wait an hour in-between icing session to allow the tissue to return to normal temperature.It’s important to stay consistent with icing.  Don’t give up after one day of icing an injury.  Make sure you keep icing on a daily basis until all the pain and inflammation is gone.

Positioning

◊ Try to use RICE protocols when you can◊ Take advantage of gravity with elevation and use compression when possible◊ As mentioned early, put joints in a comfortable position, put muscles on a gentle stretch

How to Ice: Methods

Ice Cup Massage

• Fill paper/styrofoam cup with water and freeze (don't fill to top, leave some room)
• Tear top layer off cup
• Use small circular movements over the affected area
• Apply for 5-10 minutes or until you experience analgesia/numbness
• Best for small areas (lateral knee, plantar fascia, tennis elbow, etc.)

Ice Pack (Gel)

• Gel packs can conform to the effected area and provide 360° coverage
• Apply for 10-15 minutes
• For best results apply with RICE protocol (Rest, Ice, Compression, Elevation)

Important Considerations

What to Expect

Ice isn't the most pleasant modality.  For this reason, many people often make the mistake of choosing heat instead.  Heat is not good for acute injuries and can increase blood flow to the area, which in turn would increase the amount of inflammation and edema.Normal sensation when icing occurs in the following manner: intense cold, mild burning, aching, then analgesia and numbness.  So expect a little discomfort before you reap all the benefits of icing.

Pre-Cautions & Contraindications

◊ Over superficial main branch of nerve (should not cause tingling or numbness further down the extremity)◊ Hypertension◊ Over an open wound◊ Cold hypersensitivity and intolerance◊ Over an area with circulatory or neurological compromise◊ Be cautious when applying to the spine, in my clinical experience necks and low backs don't always react well to ice

Considerations

◊ Icing sessions should be at least 1 hour apart◊ Don’t ice before exercise or activity◊ Limit icing sessions to 15 minutes

Bottom Line

Icing is one of the most important aspects of accelerating recovery from an injury.  Proper icing technique is paramount to attaining the maximum benefits from cryotherapy.  It also will prevent any harmful side effects.

• Icing helps to control the edema, inflammation, and pain that results from an injury, thereby limiting the loss of function and movement
• Icing can be used for both acute and chronic musculoskeletal injuries, as well as a preventative technique
• Cryotherapy causes changes in the circulatory and neurological system to produce it's physiologic benefits
• Protocol - cover the entire injured area (360° if it's a joint), for a duration of 15 minutes, with RICE protocol, until the inflammation and pain has ceased
• Methods - Ice Cup Massage, Ice Pack

References:

Cameron J.  Physical Agents in Rehabilitation: From Research to Practice.  Philadelpha, PA:  Elsevier,  2003--The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

 [subscribe2]