Category — Assessments

Yesterday’s blog about getting a massage license brought on some great comments, concerns, and questions from colleagues in the field.  Rather than answering them in the comments section, I decided to start a new entry pertaining to their thoughts as I think they are important and others may benefit from reading them as they may have some of the same questions.

Patrick
patrick@optimumsportsperformance.com

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Hi Patrick, 

Very interesting blogpost about massage therapy, answered a lot of questions I’ve had.

Regarding “getting the license”, is it really just a case of going to any suitable MT school, making the grade, and then after that is when you can start adding to your skills with things such as Graston techniques, Gua Sha etc.?

Or do you have to pick a direction you want to go with first e.g. NMT, SI etc.?

Thanks
Cedric

Cedric,

The Latissimus dorsi is a rather large muscle with several attachments making it an important muscle in both upper and lower extremity function.

Anatomy

Latissimus dorsi attaches to the spinous process of T6-12, the thoracolumbar fascia (creating an anchor on the sacrum and lumbar vertebrae), the posterior iliac crest, ribs 9-12 and the crest of the lesser tubercle of the humerus.  Occasionally Latissimus dorsi can have an attachment on the inferior angle of the scapula as well.  Its innervation is from the thoracodorsal nerve (C6-8) and it functions to produce internal rotation of the shoulder, and extension and adduction of the humerus.  Additionally, the latissimus dorsi is one of four muscles that play a role in force closer of the SI-joint – the erector spinae, gluteus maximus, and biceps femoris are the other three.  Finally, there is a noted connection of the Latissimus dorsi on one side of the body with the gluteus maximus on the opposite side of the body via the thoracolumbar fascia.

Considerations for treatment

It has been my experience that the latissimus dorsi often goes overlooked in soft tissue therapy sessions.  While not intended to be an exhaustive list, below are some of the times when it may be helpful to investigate the latissimus dorsi. 

• Trigger point referral patterns - Latissimus dorsi trigger points refer to the back of the shoulder blade, the back and outside of the shoulder, down the back of the upper arm (in the region of the triceps), down the ulnar side of the forearm and into the pinkie and ringer finger.  Additionally, some of the trigger points in Latissimus dorsi may refer into the lateral abdominal region, in the area of the obliques.
• Potential satellite referral patterns – If the Latissimus dorsi is found to have trigger points (either active or latent), it may create satellite trigger points in antagonistic muscles or in muscles that lie within its referral zones.  For example, because the internal obliques reside in the referral zone of the Latissimus dorsi, they too can develop trigger points of there own, which may refer down into the groin area, and cause the client/athlete to complain of groin and lower abdominal pain (which often gets diagnosed as “sports hernia”).
• Brachial plexus complaints - Because the Latissimus dorsi can internally rotate the shoulder and depress the shoulder girdle (as well as placing the shoulder in extension), it can place greater amounts of tension on the brachial plexus and cause clients/athletes to complain of shoulder or neck pain with movements of the arm.  Additionally, this position of the shoulder may impact lymphatic drainage in the axillary region.
• Anterior pelvic tilt - When an individual is in an anterior pelvic tilt, the Latissimus dorsi will be placed in a shortened position (due to its attachments to the posterior iliac crest and thoracolumbar fascia).  This may be one potential factor in some of your client/athlete’s lower back, sacral, or pelvic issues, and is worth investigating along with your normal soft tissue treatments.
• Breathing and rib function – Because of its connections to ribs 9-12, Latissimus dorsi is an accessory muscle of breathing.  With the arms elevated overhead it assists in inhalation, and with the arms down it can assist in exhalation.  When breathing patterns are not properly observed, Latissimus dorsi may become more active to help assist, creating tension and potentially trigger points.  Knowing that the Latissimus dorsi is an accessory breathing muscle when the arms are overhead (inhalation) is important to remember when working with overhead athletes.  Knowing that Latissimus dorsi is an accessory muscle of respiration when the arms are down (exhalation) is important as I have seen a number of runners, especially distance runners, complain of shoulder pain or pain down the arm when running (all of which are common trigger point referral patterns for this muscle, as well as common complaints given when the brachial plexus is being put under stress/tension).

Conclusion

While there are many things to consider with regard to soft tissue treatment, I feel that the Latissimus dorsi is overlooked when clients/athletes present with some of the common complaints highlighted in this article.  Above are a few situations where you may want to consider evaluating the Latissimus dorsi as part of your treatment approach.  Finally, once soft tissue treatment is completed, be sure to include appropriate exercise progressions to ensure that the client is brought back to normal function.

Patrick
patrick@optimumsportsperformance.com

What is the point of an assessment?  We know that pretty much everyone needs the same things:

• Hip mobility
• Core strength
• Thoracic spine mobility

This is a common argument made by those who don’t do any assessment.  They rationalize their thought process by stating that everyone is pretty much in the same boat, so they will all need the same things.

While I wont disagree that the above three areas are key points that many people need to work on, I will disagree whole-heartedly with the fact that we should stop assessing because people are all pretty much alike.

Unfortunately, one size does not fit all, and people can not be grouped into protocols.  While there may be normative data that we can look at on athletes of different sports or individuals of different ages and genders, it doesn’t mean that everyone will fit the bill.  If we base our training only on the “trends”, what about the people we miss?  They are paying customers too!  Do they not deserve to have their needs individually addressed?

A lot of clients may have similar needs, but the reason for those needs may be vastly different.  The assessment allows us to properly determine the starting point for a given client and develop a program that fits those needs.

A thorough assessment is critical to both our training and soft tissue therapy clients, as what is common in one person may not be in another.  The devil is in the details, and the more details you can collect about each one of your clients, the more effective your program will be.  Don’t go into it blind!

Patrick
patrick@optimumsportsperformance.com

Today, Physical Therapist and Strength Coach, Charlie Weingroff had a great post in his BLOG about a discussion he, Carson Boddicker, and I had regarding program design. 

Check it out HERE.

The discussion started with me questioning the need to add extra mobility work into the actual training session since it should have been addressed properly in the warm up.  My idea was that we often throw so much at a client in the way of exercise intervention, that it may be better to just have them work on getting really really good at a few things.

Basically, Charlie’s reply was, “it doesn’t matter”, as long as people are moving well, and that may mean that not everyone needs to be doing extra mobility work.  I can respect that answer and it falls right in line with my overall philosophy on training:

1. Move Well – Improve your overall movement and be able to own basic/fundamental patterns.
2. Train Correctly - Use proper lifting technique and establish a program that allows for appropriate progression in exercise difficulty, volume, intensity, and frequency.
3. Get Fit - This can mean different things to different people.  To some it may mean losing body fat, while to others it may mean improving their vertical jump and sports performance. Honestly, whatever get fit means to you, it doesn’t really matter if you can’t grasp the previous two points, as you wont be able to get there without good movement and a sound training program.

Charlie went on to give some program design examples, and the thing that is most important to me is where he places the word need in the training program.  This “need” is based on the individual and will depend on what you have determined – based on your assessment - that the individuals weakest link is.

In my opinion, this is the most important part of Charlie’s post, as it plays to the importance of individuality in a training program.  One size does not fit all, and understanding your clients abilities are important.  Many develop their training programs in a general way that has every client performing the same mobility drill (be it hip mobility, t-spine mobility, ankle mobility, etc).  I have done this same thing before in the past as well and the most important thing I learned is that, when I did it this way…I missed people!  People may all have the same general needs – hip mobility issues, t-spine mobility issues, etc – but the reason those areas are problems may be different for each person.  Having our assessment govern the clients need is a better way, in my opinion, to get that client moving as best they can.   After all, you have to move well first!

This leads nicely into a blog that I should have posted next week titled, “Why Even Bother Assessing?”

Patrick
patrick@optimumsportsperformance.com

Two days ago I posted some of the pearls of wisdom that Gray Cook laid on us at the FMS Course this past weekend in Phoenix.  Below are some of the other notes I jotted down in my notebook during the two day seminar.

Gray’s Pearls Part 2:

- If you have an issue with your active straight leg raise or shoulder mobility, you don’t have the right to go anywhere else in a corrective strategy.  Don’t worry about your squat, clean up active straight leg raise and shoulder mobility FIRST!

- If you leave out one of the seven tests because of your own bias, your data will be flawed and you wont get the same result.  There are seven tests for a reason.  They are all important!

- After you clean up your active straight leg raise and shoulder mobility, shoot for cleaning up rotary stability, as this is a true test of “soft core” function.

- Pain is not a signal we can train through.

- You need to get your clients to stop doing negative activities that will hold back their progress in your program.  Once movement clears up and is above a minimum standard, they can work back to doing what they like to do.  If they aren’t willing to give these things up, the results of the program will always make you look bad, as they wont improve.  For example, the best back surgeons will not operate on smokers because smoking delays the healing process and their results will not be as good, making the surgeon look bad.  You wouldn’t ask your mechanic to run along side you car and fix the engine WHILE YOU ARE DRIVING IT!

- Don’t be ready to add a positive (corrective exercise/strategy) to a training program.  First try and remove a negative! 

- Any movement that you cannot score at least a two one means that you can’t do any conditioning or strength work on that movement.  You must meet the minimum standard.

- The definition of corrective exercise is move well and then move more.  Most people just want to move more.

- The best way to get your core to work right is to correct your worst movement pattern.  If you can get mobility back, your core will turn on automatically and do what it needs to do (mobility before stability).  Your core may not be able to work properly right now because your ankle is locked up, or your hips don’t move well, etc…Doing all the core work and plank exercises in the world wont fix this problem.

- Work backwards to the crib for correcting movements!

• This was one of my favorite comments of the weekend.  You can read more about how developmental kinesiology applies to the FMS in my article HERE.

- If you don’t move well in a pattern, don’t move often in that pattern until it improves.  For example, if the squat pattern is bad, don’t worry about doing plyos or jumping activities until it is better.

- It disappoints me to see research that tests stability without the researchers clearing mobility first.  Stability is driven by optimal mobility, as mobility improves mechanoreceptor stimulation.  Poor mobility = poor mechanoreceoptor function = poor stability.

- A higher center of gravity will make you authentically stabilize.  Seek to use a higher center of gravity in some of your exercises/movements.

- If you go into a movement pattern and the muscles that are being lengthened contract and push you out of the pattern, THIS IS NOT TIGHTNESS.  This is actually a contraction, even though the client describes it as tightness.  A good example of this is clients who can’t touch their toes and claim that their hamstrings are tight, when in reality, the hamstrings are turning on (when they should be lengthening) during the movement to provide stability to the pelvis since the core is not doing what it needs to do.  This is muscular contraction and not hamstring tightness.

- Inconsistencies in the FMS are usually stability problems, while consistencies are typically mobility problems.

- If you want to see your abs eat better.  If you want your abs to work better, move better!

- The definition of functional exercise is what it produces, NOT what it looks like.

- You gotta break a pattern before you can make a pattern!

- We’d like to think that we can verbalize to people how they can move better, but we can’t.  Try and tell someone who has never rode a bike how to do it and see if they can go out and reproduce it.  They can’t!  They have to actually go out, get on the bike, and try it out a few times to under stand what it feels like.  Exercise is the same way.

- You can’t motor learn authentically in a painful pattern.

Hopefully you found these notes useful and they made you think a little bit.  As I said, the course is excellent and I highly recommend it to anyone.

Patrick
patrick@optimumsportsperformance.com