It's About Preparing People, not Preventing Injuries

ACL injuries do not happen in a void. People sustain injuries when their infrastructure is unable to manage a specific set of physical circumstances. To describe the mechanism of the injury without the context of the person and their level/type of sport, is to miss valuable insight. In sport, we prepare the person, to the best of our understanding, to meet the physical demands of that sport. We do not just work to prevent one particular injury; we prepare athletes to navigate the total sport physical environment. By "we" I mean the coaching and support staff -- specifically the athletic development staff.  Athletic development (AD) coaches prepare athletes through the development of physical literacy and movement competencies via movement progressions. It is more than strength, power, agility; it is the acquisition of knowledge, skills, abilities and behaviors to manage themselves within the entire sporting environment. At the higher levels of sport, AD coaches coordinate wit

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

  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 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. Now, there is a new distraction: Neurocog!! We are going to enhance your RTP journey by distracting you with visual and auditory tasks while you bend and straighten your knee. We might even have those fancy lights! To me, it looks like we are going down a very similar path of not doing the work that needs to be done. We latch onto a term and task that sounds clinical and sciency

Strength: Overcoming Tradition & Assumptions

The term "strength" comes with many images and stereotypes. These unfortunate stereotypes usually include intimidating men who look like action figures and act like jackasses, playing in spaces that look like iron jungles -- but that's for another discussion. An important discussion, but I'll save it for later. Strength is associated with mass gain, limb girth increases, 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. Then we train in terms of 1 RM. I ramble about the challenges of that here. 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 performance world. Much of how we "do" strength and measure i

Warm Up: Repetition & Intention Matter

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

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

  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