Category — Continuing Education/Product Reviews

My friend and Doctor of Physical Therapy Charlie Weingroff just did an awesome podcast interview on Super Human Radio.

Charlie talks about, amongst other things:

- Some of the main issues with the current state of physical therapy and patient treatment being doled out in private PT clinics around the country

- Counterintuitive Therapy

- Movement Dysfunctions

- Shoes that put you into a more anterior/forward base of support (high heels, running shoes with built up heels, and rocker bottom shoes)

- The importance of learning to deadlift properly with load/intensity for patients who have shoulder pain/issues

- Flat feet – “Do people really have feet, or do the feet GET flat?  Maybe we need to rehab properly and prescribe orthotics less?”

Aside from the above, Charlie goes over a number of other key topics and gives a lot of nuggets of information that you can take away and start considering with your patients/clients TOMORROW!

This interview is great!

Patrick
patrick@optimumsportsperformance.com

I attend a lot of workshops and continuing education courses every year, and I always take something away.  I come home with some new ideas, new ways of looking at things, or potentially new tools to put in the toolbox.  The whole goal of attending workshops is to sharpen your skills and get something new to “play with”.  I can’t remember the last time I attended a workshop that I didn’t at least take some of the ideas or concepts and try them out. 

Unfortunately, I feel like most people attend workshops, listen to what is being said (often times they are very excited with the information presented), and then get back to their facility on Monday and just do the same old thing, or worse yet, they try and apply a few of the concepts in a haphazard manner, leading to undesirable results and the feeling that “this just doesn’t work for me.”.

I find there is a big difference between understanding and applying, and it is the middle ground between those two words that people often get Lost In Translation.  Most people understand what is being said in the courses they are attending, but when it comes to the application of things, the get caught with this deer in the headlights look.  Some of this may come on the part of laziness from the attendee, who does not want to spend sufficient time thinking about how what they just learned fits into their overall philosophy.  And some of it may come from the fact that the individual may not have a strongly rooted philosophy in the first place.

That being said, I have decided to put together some of the tactics I use after attending a workshop that have really helped me “own” the material (so to speak) and put it into something useable that fits into my overall methodolgy.  I should note that the proper application of new ideas doesn’t happen overnight, and I am always re-evaluating and refining things to try and get a better outcome.

Have a philosophy first

Before you start to try and apply things, get your bearings straight by developing some sort of thought process for why you do what you do.  If it is exercise, think of how you set up programs (either training or rehabilitation) with regard to:

• Exercise selection - What exercises make up the “rocks” of your program?

 

• Exercise progressions – How do you get from one place to another?  How do you progress and/or regress the exercise?  How do you decide when the individual is ready to progress to a more advanced movement?

 

• Program order – The order of things is very important.  To often I see trainers or therapists just throw together programs and have people do things in a random sequence.  Perhaps results aren’t as good as they could/should be because you haven’t developed an order/hierarchy for doing things?

 

• Goal – What is the overall goal you are trying to achieve and how are you going to get the client there?

Re-read

Re-read your notes before adding things in.  Make sure your ducks are in order.  Can you explain what it is you are trying to do with this new concept?  Where exactly in your philosophy (see above) does said concept fit in?

Create a spreadsheet

This one can be time consuming but I have found it to be one of the best way for me to put my ideas in order.  After a workshop, I try and sit there with a blank piece of paper and write out a spreadsheet of what I learned and how the ideas fit.  I want to know what all the progressions/regressions are and how I can use this new concept to the best of my potential.  Having a spreadsheet also helps you refine your thought process and makes things streamlined and systematic, so you don’t have to waste as much time sifting through notes and material to get the information you are looking for – the spreadsheet has already put things in order for you!

Discuss and Teach

Finally, after a new conference I try and solidify the information by discussing and teaching what I learned to someone else (another colleague).  I have found teaching to be one of the best ways of learning the material.  If it is concepts of exercise you are trying to work into your thought process, taking a colleague through the movements, refining your coaching skills on the movements, and getting their feedback about what you are saying can be very helpful in solidifying the material and will ensure that you don’t make mistakes and bumble around when trying to teach the movements to clients/patients.

Conclusions

Don’t just attend workshops.  Really try and grasp the concepts and connect the dots.  The material is only as good as the person using it and the better you can develop this stuff into your own thought process the better your results will be when applying it to clients/patients.

Patrick
patrick@optimumsportsperformance.com

When Anatomylinks.com became available I was extremely eager to check it out, as Willem Kramer has been a huge influence on me.  After several months of poking around on the website, here is my review!

Who

Willem Kramer is a Dutch trained physical therapist, licensed massage therapist and Certified Strength and Conditioning Specialist.  For those that don’t know, it is because of Willem that I attended massage school in the first place.  A few years ago Willem was working for the Arizona Diamondbacks as their manual therapist and I happened to be hanging out in the training room watching him work magic on a few players.  I was intrigued by what he was doing and started asking him questions about were I could learn the type of soft tissue therapy he does.  He told me that I should just go to massage therapy school, get a massage license, and then start putting together ideas on how to treat people based on my knowledge of anatomy.  I was sold!  Two weeks later I signed up for massage therapy school.

Hopefully more people will hear about Willem in the future, as he is one of the smartest people I have had the opportunity to speak to and learn from.  His knowledge of anatomy is top notch and the way he applies this knowledge in his manual therapy approach is very unique.  You can hear more from Willem in his interview with Carson Boddicker on the Sports Rehab Expert Podcast.

What

First and foremost, Anatomy links is not the same as Anatomy Trains.  Anatomy Trains is a great product and Tom Myers is someone I have a lot of respect for.  While Anatomy Trains looks at the fascial system Anatomy Links goes beyond that.

The Anatomy Links approach honors the statement “Everything attaches to everything”.  With this in mind, Willem shows us the possible connections for one single structure, which he refers to as an Anatomical Unit.  While most people think in terms of muscles, bones, and joints, Willem challenges us to open up our minds and and consider everything else as well: skin, fascia (superficial and deep), tendons, ligaments, nerves, and blood vessels. 

I am going to be totally honest when I say it is overwhelming to think like this.  I told Willem after the first few weeks of using the site that I felt like a quarterback who’s playbook went from 12 plays to 50 plays overnight.  Willem is honest and says that it takes time to consider all of this.  At his clinic in the Netherlands, Veel Beter Fysiotherapy, clinicians are asked to sign a minimum of a 3 year contract in order to immerse themselves in the system and take the appropriate amount of time to think about all the possible links.

Willem has a number of examples on his website.  Here is one example showing you what the Anatomy Links screen looks like and the information contained in each column:

Most people will watch this video and wonder where to go from here.  I know I did!  This is where the vast number of possibilities start to come into play.  I’ll give a simplified explanation of how I use the information contained in this site by using the above example of the Fibula.

If we determine that the Fibula is something that needs to be treated (perhaps in a situation of ankle sprains, restricted ankle mobility, or problems with the proximal tibiofibular joint) we would type “Fibula” in the search box at the top and get the above page with the column on the far left giving us a detailed anatomy of the structure in question, the Anatomical Unit.  In the middle column we see all the things that make up the structure we are looking at – arteries, bones, deep fascia, joint capsules, ligaments, muscles, and nerves.  In the case of the fibula, there are 51 structures that are part of this anatomical unit.  By selecting one of the tabs in the middle column, the column on the right will give us the structures contained in that specific category.  It is in the right column where we look at the links to the Anatomical Unit (in this case the fibula).  These are the structures that we want to evaluate and if necessary treat in order to get a favorable response in the Anatomical Unit that is determined to be dysfunctional.  Furthermore, rather than limiting ourselves to the right hand column, we can click on each one of the structures in this column making them the new anatomical unit (left column) and creating a new list of connections that need to be evaluated. 

Through this system, we may start at the ankle with the distal tibiofibular joint and end up working all the way up to the lumbar spine when our assessment is comprehensive and honors the links found to be dysfunctional.  The way that we get to the lumbar spine can be through any one of the links that are affecting the anatomical unit – bones, joints, muscles, skin, fascia, nerves, blood vessels, etc.

If this seems overwhelming, don’t worry…it is!  Like I stated earlier, grasping this system in its entirety will not happen overnight.  That being said, you can easily begin to use the system and start considering various links to the Anatomical Unit you are trying to affect/treat and as you get better at putting things together and connecting the dots, more options will open up for you. 

One way to simplify things is through the “settings” tab at the top right of the page, which allows you to control the structures that show up in the middle column.  For example, if you want to start simple and only look at bones and muscles, you can unselect everything else, making only those two structures viewable, and allowing you to build your links from there.

Currently, the Anatomy Links site is complete through the lower extremity.  Willem is working on adding in connections for the upper extremity and torso but I am not certain when this will be complete as it is an enormous task to try and put all this stuff into the system.

Why

I cannot recommend the Anatomy Links system enough as it has opened up my mind to different ideas and strategies when working on clients.  I find myself thinking about people that I work on and looking through the site and considering new connections that I may not have previously considered. 

Many have heard the term Regional Interdependence, which in a nutshell tells us that the pain or dysfunction you are experiencing in one area may be created by or related too dysfunction in a region of the body remote to the location of the current complaint.  Anatomy Links takes this concept to the next level tying together all of the systems of the body, not just the musculoskeletal system.

I highly suggest checking out the Anatomy Links site as Willem has several other tutorials explaining how to use the site besides the one posted here.  The site also has a blog section were Willem occasionally writes ideas and concepts to consider.  Willem’s personal blog also has additional articles that reflect his Anatomy Links thought process.

I hope you take the time to investigate the Anatomy Links site and consider the vast possibilities in your treatment approach.  Hopefully we will hear more from Willem Kramer in the future, as I believe that he has a lot to offer the industry.

Patrick
patrick@optimumsportsperformance.com

Every year I try and attend the NSCA National Convention.  As a professional in this industry, I feel it is important to attend lectures and conventions to not only advance your knowledge, but also meet with other professionals and colleagues.

Every year there are a few people slated to speak that I am excited to see and from there I just sort of pick and choose based on the titles of the lectures and hope that I catch something noteworthy and interesting.  Aside from reviewing a few of the talks enjoyed from the week I also want to talk a little bit about some of the differences I noted between the American and the European strength coaches.

The event kicked off with Todd Wright’s Vertical Core lecture.  For those that don’t know, Todd is the head strength and conditioning coach for University of Texas Men’s Basketball.  Todd’s methodology embraces the teaching of Gary Gray, and it really came through in his lecture.  I am familiar with Gary Gray’s work and own one of his DVDs, but seeing how Todd integrates this into a sports performance atmosphere was something I was really excited to see.  Todd talked mainly about training the core musculature in the standing position by utilizing trasformational zones via the lunge matrix, and using arm drivers to further enhance core function in all three planes of motion.  The big take home from this lecture for me was how I can integrate this into fascial lines to enhance movement and drive proprioception following soft tissue therapy.  There were a few movements that didn’t gel well with me, but there were concepts that I will definitely steal and think about how I can work them into my overall training methodology.  I have been using the lunge matrix in warm ups for some time, as well as the arm drivers, but there was a lot more dynamic ideas that Todd offered, which i will absolutely be thinking about and considering over the next few weeks as I think about how this stuff fits in.

On day two, the highlight for me was seeing Dr. Ken Cieslak.  I was first introduced to Dr. Cieslak by his webinar on Sports Rehab Expert were he discussed various soft tissue strategies – ASTYM, Graston, Gua Sha, ART – and looked at some of the science behind them.  Dr. Cieslak’s presentation looked at some of the latest research on overuse injuries and offered practical applications for strength and conditioning professionals.  I found the talk to be a refreshing look at regional interdependance, and Dr. Cieslak attacked some common overuse injuries as well as sound information on stress fractures.

Day three was the strongest of the weekend.  The day started with a talk from Indianapolis Colts Strength Coach Jon Torine, who went over how the team uses the Functional Movement Screen and Undulating Periodization to develop their overall training program.  Coach Torine showed a few corrections that can be used to improve poor performance on some of the Functional Movement Screen tests, and then talked about how they integrate that back into their strength program. 

Next I headed over to hear Ian Jeffreys speak on coaching game speed and reactive agility.  Ian is a lecturer and performance enhancement coach out of Wales.  I have enjoyed his lectures in previous years, and this one did not disappoint.  Ian went over various ideas about open vs. closed loop drills for team sport athletes and delved into the brain and how we learn.  I found the talk to be a good blend of both science/research and practical application.  Ian finished with some videos of him coaching a group of soccer players in Norway and it was great to see some of the drills he was talking about in real time.

After Ian’s lecture I went and heard Dr. William Kraemer speak about the physiology of American football and the implications this has on strength and conditioning.  Dr. Kraemer has done a ton of research in the field of Exercise Science and Strength and Conditioning and whenever I have the chance I like to see him speak.  He is one of the few researchers, in my opinion, that can offer practical recommendations rather than just reading stats off of powerpoint slides.  Additionally, he is a great lecturer and teacher.  So, no matter what, I always go and listen to Dr. Kraemer.

My day wrapped up by sitting in on a lecture by Jon Goodwin, who was representing the UK Strength and Conditioning Association.  The title of Mr. Goodwin’s lecture was Sprint Mechanics: Combining New Insights and Old Ideas to Refine Our Physical Preparation.  This was by far the best lecture of the weekend!  The only complaint I can make about this lecture was that I wish it were in one of the 90min. slots as you could tell he was really rushing through the last 20 minutes or so to try and get all of his information in.  I jotted down notes the entire hour.  Jon preached the importance of getting stronger and being able to apply more force into the ground.  He also talked about how quick feet drills have the opposite effect, as the athletes are trying to move quickly to get off the ground rather than focusing on trying to apply more force into the ground.  I am definitely going to spend more time looking at my notes from this lecture and checking out some of the studies he cited.

I walked in and out of several other sessions over the three days, but the ones above were the ones that were the most exciting for me.  Another reason I like attending the national conference is that I get to spend time hanging out with friends from around the country and this year was no different.  I spent a good portion of the day hanging out and talking shop with Steven Bubel and Charlie Weingroff.  Both guys have a lot of information to offer and it is always a pleasure for me to listen to them speak and learn from them.

A word on coaches from different countries

After having attended the national conference the past several years one thing I always make note of is the difference between coaches from America and coaches from Europe.  I’ll preface my thoughts by saying that I don’t think either wasy is better or worse, just that they are different.  Additionally, I would add that I think the “best of both worlds” approach would be ideal.  Unfortunately, coaches tend to be very “one side or the other”, with very little middle ground.  Finally, this is by no means implying that all the coaches from these regions fall into this model.  This is just generally what I have observed.

American coaches tend to be more basic – “We lift Monday, Wednesday, Friday and we condition on Tuesday and Thursday” – while the European coaches seem to be more thought out in their approach looking at various energy systems and training objectives and spreading them out through the 7 day work week.  American coaches tend to focus on the strength aspect of things (squats, bench, power cleans, etc) and for the most part train all athletes the same way.  On the other hand, European coaches seem to get really into breaking down the sport in question – understanding the energy systems involved, how much work each athlete in each position does during a match, the joint angles and movements of the sport, etc.  They tend to be more immersed in “sports science”.  When the European coaches lecture these ideas come through and they have a specific explanation of how the training program will support performance in a given sport, while the American coaches tend to be a little more general.  The American coaches appear to put more stock in cleaning up poor movement, performing some sort of qualitative movement screen, and trying to improve the athletes general movement qualities.  The European coaches seem to be more into improving the movements of the sport, but don’t appear to have a way of evaluating qualitative movement, operating more on the idea that increasing strength, power and movement in the specific sport will take care of any general movement deficits.

Like I said, I don’t think one is better than the other, just different.  I think being somewhere in the middle is the way to go.  If you qualitatively screen your athletes’ movement (as those who read this blog know I favor the FMS) and rule out potential risk, then you can place them in a more aggressive training program (and if they fall into a higher risk category, you can hold them back a little and work on more foundational tasks).  Having a deeper understanding of the movements needed in sports and the energetic demands will help you create a comprehensive program that not only addresses the athletes’ strength but also enhances their sports preparation.

Learning is fun and attending lectures, workshops, and conferences is a great way to expand your knowledge and expose yourself to other ideas.  Hope to see you at the next event!

Patrick
patrick@optimumsportsperformance.com

Because my blog contains my ideas on both strength and conditioning and soft tissue therapy, I tend to get a lot of emails from trainers and strength coaches about massage therapy.  Either they want to know how they can go about doing soft tissue work on their athletes/clients or they want to know what to look for when trying to establish a partnership with a soft tissue therapist.  In this article, I’ll address the former.  In a future article, I’ll address the later.

Getting a License

First and foremost, before you start putting your hands on people and manipulating soft tissue, you are going to want to cover your butt and get licensed in your state.  Every state has different regulations regarding what it will take to obtain a license, so do your homework.  Typically a google search consisting of “your state” and the terms “massage license state board” should pull up a website with the information you are looking for. 

Different states will have different numbers of classroom hours required to get your license.  Additionally, some states will also require you to complete a state exam or will require you to take the National Certification Board for Therapeutic Massage & Bodywork Exam (NCTMB).  Another thing to keep in mind is whether or not you will be moving from the state you are obtaining you license in, as there may be additional requirements to obtain licensure in the state you are moving to.  For example, in Arizona you are required to attend a state accredited school, which has a curriculum consisting of 700hrs.  There is no state test at this time in Arizona if you graduate from a state accredited school.  However, if you are moving to Arizona from out of state, they want you to have taken the NCTMB exam. 

Choosing a School

Look for three things:

1. That the school is accredited in the state.
2. The total cost is reasonable.
3. Ask to transfer in as many credits as you can if you already have an undergraduate (or higher) degree in a physiology or an exercise related field.

School accreditation is very important, as you don’t want to waste time and money attending a program that amounts to absolutely nothing!

With regard to cost, price out the schools in your area.  Don’t waste any more money than you need to.  There are several massage schools around the country and in most major cities that deal with only teaching a massage curriculum, like a vocational school.  Additionally, look at your local community colleges, as several community colleges now offer massage therapy programs.  Look around and find the best price possible.

Transfer in whatever physiology credits you can!  This will help not only bring the cost down, but also decrease some of the time you have to be there attending class.  At the risk of sounding rude, if you already have a degree in a physiology based field and you know your anatomy and physiology really well, there is nothing that you will learn in massage school that will be earth shattering for you.  For the most part the education in massage school is pretty watered down and the only reason you are going is to get the license.  You will have time to learn all the good stuff you want to learn once you have that license in hand.  The goals in massage school are going to be to learn basic body mechanics (so that you don’t hurt yourself) and to just get your hands on people and get experience palpating structures, as most of the anatomy you have learned so far has been straight out of a book and has not dealt with actually trying to palpate the structures you are memorizing.  This is another reason to shop around for the best cost.  You aren’t looking to get a Harvard level education here.  The whole purpose is to get the license. 

Some of the schools you run into will be a little more, what I call, “granola” in nature (IE, a little more on the mystical side of bodywork).  Do your best to find a program that has as little of that as possible.  However, keep in mind that massage therapy tends to attract this kind of crowd, so all schools have a little bit of that and a little bit of the spa nonsense.  You’ll have to just bite the bullet and keep the goal in mind – LICENSE!

Other things to consider

• Massage therapy, and manual therapy in general, can be an incredibly brutal job.  The average professional life of a massage therapist is 3-5yrs.  So, there is a relatively high rate of burn out due to the amount of hands on work you have to do.  Keep that in mind, as doing this is not for everyone, and some will do better with finding a therapist to team up with and establish a referral business back and forth.

 

• Teachers in massage school wont know what to do with you because they wont understand what it is you are trying to do.  For the most part, they are massage therapists (obviously) and don’t have as much of a background in exercise, so it may be difficult for them to see where you are coming from.

 

• Massage therapy school teaches you to be a massage therapist!  They teach you to do 60-120min total body massages.  One of the questions that people in the field of strength and conditioning have when they finish their massage license is, “How do I go about applying this?”  This is where developing a system and thought process will come into play.  It is rare that I do 60min. total body massages (actually, I don’t ever do it), but rather, I have established a thought process that governs what I do and how it blends in with the training that we do.  This is a topic for a whole different blog though and I may touch on this in the future.

Hope that helps!

Patrick
patrick@optimumsportsperformance.com