Posts

Foundational Philosophy & Principles: Finding The Big Why & How

Young coaches and clinicians are overwhelmed with information and ideas. There is so much stuff to wade through these days.  (Here is a thought: instead of constantly crying out for "more" research, how about firmly eliminating and deleting the piles of myth and bad information out there that clutter the landscape? How about refining our processes of implementing the good knowledge that is already out there? Listen to the The Knoweldge Project podcast episode 42 with Atul Gawande -- love his thoughts on medical ignorance vs ineptitude, along with the problems of autonomy/assumptions of mastery afforded medical professionals after completing formal training and acquiring titles/letters.) Part of maturing as a professional is building a solid bullshit filter and the confidence to say "No" to methods or tools that do not serve you well. This comes from making your own mistakes and learning from the mistakes and experiences of others. Shout out to all the mentors.  Eli...

Another New Distraction: Neurocog

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Knee rehab is rife with shallow work. Historically, we have been distracted by the idea of "neuromuscular control" -- people standing on unstable surfaces with a 30 deg knee flexion angle, being perturbed, in search of the holy grail of hamstring co-contraction. And we forgot to ask people to bend and straighten their knee. To develop knee extensor strength -- THE KEY TO KNEE HEALTH. We now (again) have to use isokinetic devices to tell us what the knee extensor strength is because we have lost the skill and ability to program and observe movement that develops and is indicative of that strength & capacity. Note: I am not saying it isn't important to inform RTS with objective measurement. I am saying that many clinicians now rely on those occasional measures solely because they do not have the ability to design in session challenges / progressions that ask the patient to demonstrate and express the necessary capacities and movement competencies.  Now, there is a new d...

Strength: Overcoming Tradition & Assumptions

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The term "strength" comes with many images and stereotypes. The most common stereotype usually includes intimidating men who look like action figures, in spaces that look like iron jungles. Strength is associated with mass gain, limb girth increases, muscle hypertrophy and maximal force production against an external load. With regard to lower body strength, we speak in terms of multiples of bodyweight (BW), with the ratio of 2x BW historically viewed as necessary and desirable. We have historically trained in terms of 1 RM. There has been a trend recently to adopt a VBT (velocity based training) approach, as we know 1 RM changes on a daily basis and technology now allows us to more finely tune things with velocity as the target within each set. These things can be helpful as we initially learn to measure and document progress. But I think it is important to step back from this narrow outlook, because this view of strength does not serve all of us well, in either the rehab or...

Warm Up: Repetition & Intention Matter

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2015. Chloe Kim warms up for a commercial video shoot at 11 pm. It is 20 deg F. I talk explicitly with my athletes about warm up and the importance of taking it seriously. This is specific work that gives us information and it forms the foundation for that particular session. It is not just about raising body temperature or sweating. Nor is it a time for mindless busywork. There will be general things that work for an entire team; but there will also be things that are specific to the individual athlete. It is important to allow each athlete to have input into their warm up. Personal accountability here helps develop good overall habits and lays the foundations for a lifetime of using movement for self-care. Intentional effort is important. This is the time where one learns to become "in tune" with the body and its potential physicality. The only way to do this is to work through a variety of movements, repeatedly, over time. These experiences allow you to choose those moveme...

Rewind: Foundational Leg Strength in Rehab

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I am reviewing things for a new project and this blog post from April 2020 has some things I want to keep in mind. Thought I would share it again. Might prompt some good reflection for the physio crowd. ----- Last week Donie Fox had a great article for HMMRMedia --  "Using Foundational Legs Exercises as the Cornerstone of Rehabilitation."  Check it out if you haven't already. Donie's article is important in my mind because it addresses a critical issue in the rehab world. There is a serious lack of appreciation for and mastery of the use of basic movements (squats, lunges, step ups) to build foundational lower extremity strength. Donie and I have decided to go into more depth on this topic in our next few podcasts. We will also hopefully touch on return to running programming criteria. Here are some barriers, in my opinion, to rehab professionals adopting a "foundational legs" approach. I'm not trying to be overly critical or a curmudgeon here. I am simp...

Pearl for Practice: Overhead Work with the Barbell

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  I don't ever remember being intimidated by overhead lifting. I was lucky to get expert instruction early in my career. But there are many sport and medical professionals who are unsure of the safety of lifting overhead. Some are adamantly against it. Bilateral work with a bar, overhead and behind the head, is advanced and demands full ROM. It doesn't require extra ROM, but it does require normal, full ROM. Athletes and non-athletes who do not have normal, full shoulder ROM clearly need to do more remedial, single-arm overhead work. Everyone needs to earn the right to do advanced movements. Many just need to take some time to find the motion they actually have; if you haven't put your hands over your head very often, you probably don't know what you are capable of doing. But let me be clear: I've worked with many people who never ever need to use a barbell. I did what was appropriate and necessary for their needs, not my ego or somebody else's idea of what...

Practitioner Reboot: The Outdated Concept of "Core" Work

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 "We did core today."  That phrase makes me furrow my brow and chuckle at the same time. I suppose it is a vestige of bodybuilding and assigning body parts to workouts. We can do better for our athletes if we evolve our mindset and programming to think beyond the isolated torso. And that black hole of training called "stability." If you must give a session or a part of a session a name, I'd like to suggest an alternative framework. We'll stay on the "c" theme, but start from a foundation of movement, not stillness. To do this, I ask you to leave behind ideas of isolating and activating torso muscle groups. Embrace the terms connection, coordination and control. --- Most of life (and sport, for that matter) are not still.  In archery, biathlon, gymnastics or rowing, the stillness we observe is part of one or many transitions from one posture to another. The athlete demonstrates significant control and coordination for a relatively short time; moving...