Most trainers, massage therapists, and strength coaches do not possess an adequate skill-set when it comes to screening and assessment. This isn’t necessarily their fault as it is poorly taught in most of these profession’s educational curriculum. In fact, so many people get very nervous and almost paralyzed by the idea of having to do some screening or evaluation that they do choose to do nothing instead. Some people get so carried away with ridiculous assessments that are practically meaningless that its easy to see how one could get a nasty case of “paralysis by analysis!”
Yikes..not a Goniometer!
However, having a basic evaluation system for things like full-body mobility and movement capacity (including stability) will really set you apart from other professionals and allow you to be more effective at your job. The key is to stay within your specific scope of practice and realize that as non-medical professionals, we cannot “diagnose” anything and are simply obtaining information on each client to guide their safety and effectiveness in movement/exercise. It is especially helpful to know when to refer out when you arrive at red flags. Red flags are things like pain or strange or unexplained symptoms that would be better carried out by licensed medical professionals that are trained to look and treat these types of things.
Here is short list of potential red flags to watch out for:
Red flags for spine fracture
Deep Back/Spine Ache that doesn’t fit usual back ache
Major trauma such as vehicle accident or fall from a height
Minor trauma, or even just strenuous lifting, in people with osteoporosis
Red flags for cancer or infection
Flags from medical history
Age over 50 years and new back pain, or age under 20 years
History of cancer
Constitutional symptoms, e.g. fever, chills, unexplained weight loss
Recent bacterial infection (e.g. urinary tract infection)
Intravenous drug abuse
Immune suppression
Pain that worsens when supine; severe night-time pain; thoracic pain
Flags from physical examination
Structural deformity
Red flags for cauda equina syndrome or rapidly progressing neurological deficit
Flags from medical history
Saddle anesthesia
Recent onset of bladder dysfunction (e.g. urine retention, increased frequency, overflow incontinence)
Recent onset of fecal incontinence
Flags from physical examination
Severe or progressive neurological deficit in the lower extremities
Unexpected laxity of the anal sphincter
Perianal/perineal sensory loss
Major motor weakness: knee extension, ankle plantar eversion, foot dorsiflexion
Beware of Red Flags!
In this blog Keats Snideman is going to take Bret Contreras through a basic length-tension (mobility/flexibility appraisal) screening system that he uses to evaluate his clients. This screen is used in addition to more dynamic movement screening that includes the FMS (Functional Movement Screen) as well as some basic table assessments. This blog will show videos outlining his table assessments.
The Functional Movement Screen (FMS)
Before we move onto the table assessments, it is important to have a basic understanding of the FMS. The FMS is a 7 test screen developed by Gray Cook and Lee Burton used to evaluate fundamental movement patterns. The screen will assess risk and can identify situations where the client experiences pain and should be referred to a specialist, situations where a client needs to work on balancing out asymmetries, situations where a client needs to work on increasing mobility, stability, or motor control to improve a particular pattern prior to engaging in various activities. The 7 tests include the deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability push up, and rotational stability. The FMS is a very valuable assessment tool that every trainer should incorporate into their arsenal.
Basic Table Assessments
The table assessments that Keats uses consists of a breathing pattern assessment, a head & neck mobility assessment, a t-spine mobility assessment, a shoulder mobility assessment, and a hip, foot & ankle, and big toe mobility assessment. These basic tests are assessing what is called ”passive movement testing” (although they can all be done actively as well). Passive movement can be further broken down into what is called “physiologic motion,” which is what we are going to be demonstrating, and “accessory jointmotion” (joint play, component movements). Accessory movement testing is beyond the scope of testing for the intended audience of this blog so those tests should be left to licensed professionals trained in orthopedic manual assessment.
Breathing Pattern Assessment
In this video, Keats takes a look at my breathing patterns. He’s looking for natural diaphragmatic breathing that involves breathing into the belly prior to breathing into the thorax.
Head and Neck Mobility Assessment
In this video, Keats takes a look at Bret’s neck mobility from various directions. Normal ranges include 0-80-90 degrees of cervical flexion, 0-70 degrees of cervical extension, 0-30-45 degrees of cervical lateral flexion, and 0-70-90 degrees of cervical rotation.
Thoracic Spine Mobility Assessment
In this video, Keats takes a look at Bret’st-spine mobility from various directions. Normal ranges are difficult to isolate since the t-spine is intimately connected with cervical and lumbar spine function. Suffice to say need to be able to at least reverse the normal thoracic kyphosis to straight and be able to rotate at least 45 degrees in each direction from a tall seated position with the hips/pelvis stabilized. The T-spine is truly a huge player in full body movement capacity, breathing, and posture. Its influence on the c-spine (including the jaw/TMJ) and shoulders is often ignored in painful conditions.
Shoulder Mobility Assessment
In this video, Keats takes a look at Bret’s shoulder and scapular mobility from various directions. Normal ranges include 0-180degrees of shoulder flexion, 0-60 degrees of shoulder extension, 0-180 degrees for shoulder abduction, 0-90 degrees of external rotation, and 0-70 degrees of shoulder internal rotation. Also included are basic length tests for pectorilas major, pectoralis minor, latissimus dorsi and teres major which to a large part, determine the mobility in this region.
Hip, Ankle, and Big Toe Mobility Assessment
In this video, Keats takes a look at my hip mobility, ankle mobility, and big toe mobility from various directions. Normal ranges include 0-120 degrees of hip flexion (with bent knee), 0-90 with straight/extended knee, 0-30 degrees of hip extension (from prone position (knee extended), 0-45 degrees of hip abduction, 0-30 degrees of hip adduction, 0-45 degrees of hip external rotation, 0-40 degrees of hip internal rotation, 0-20 degrees of ankle dorsiflexion, 0-50 degrees of plantar flexion, 0-35 degrees of inversion, 0-15 degrees of eversion, and 0-65 degrees of big toe extension (although only 45 degrees are needed for gait). Also included is the thomas test for hip-flexor length. Not shown but extremely important is the “obers test” for hip-abduction contracture/tightness.
What do I do if Clients Don’t Possess Normal Ranges of Motion in Various Joints?
There are three basic scenarios that can occur with your assessments:
1) the individual will possess adequate ROM that doesn’t require any remedial stretching or mobilizations. For these people, a quality training/conditionig program will serve to maintain the range they already have. Semi-frequent re-testing is needed to make sure this range of motion isn’t lost however.
2) the individual has excessive ROM which may or may not be a problem depending the strength and motor control capacities of the person. Too much ROM (hypermobility) can be as bad in some situations as too little ROM! For specifically assessing if someone has too much ligamentous laxity/hypermobility all over there body, the Beighton Score is an easy testing protocol to administer.
3) the individual will possess decreased ROM/hypomobility in a given joint motion which could signify that either a musculo-tendinous/fascial or “extra-articular” (outside the joint) problem exists. Or, there could be a problem within the joint (intra-articular) that would required more attention to the joint capsule and other structures that would be best performed by a licensed professional trained to administer joint mobilitzation (Osteopath, physical/physio-therapist, chiropractor). This is a good reason for personal trainers and bodyworkersto have a good network of other professionals who can perform any specific joint work that might be needed. The basic goal with these people is to improve the range of motion of the truly short, or stiff tissues. Utilizing the corrective strategies concept as promoted by the FMS, once lost ROM is regained, it must be backed up with some stability training (static, then dynamic stability) in order for it to stick. Stretching in and of itself is often not enought to change movement in any meaningful way!
A Hypothetical Scenario – Tight Hamstrings
Corrective exercise for a mobility restriction or stability problem is an art unto itself and would require an entire book (just read Gray Cook’s new book which should be available soon) to list all the various protocols. To give one example of a corrective sequence, let’s say that an individual has poor hamstring flexibility. Perhaps they are overworked from synergistic dominance due to weak glutes and tight hip-flexors on the other side. You would want to incorporate self-myofascial release for the hip flexors and activation work for the glutes in order to “release the brakes” on the hamstrings and decrease hypertonicity.
You would also want to incorporate various types of stretches and mobility drills for the hamstrings. Finally, you may want to start the client off with rack pulls and work on gradually increasing the range of motion until a full range deadlift can be perform while maintaining a neutral spine. Knowing various drills and progressions is critical in improving motor patterns and eliminating dysfunction. Assessments & Screens provide you with great information but you also need to know what to do with that information in terms of exercise selection and program design.
At any rate, we hope you enjoyed the videos. Over time, we will try to post more blogs that provide more information on screening and corrective exercise. Thanks for reading and watching!
Have you ever stubbed one of your toes really hard? Hurts a lot doesn’t it? In fact, more four letter words have probably been uttered in the agonizing seconds immediately following the dreaded event than almost any other accidental (yet non-serious) injury. Fortunately, unless you break the darn thing, the stubbed toe probably stays sore for a couple of days and then fades away with no recurring or lingering pain or alterations in function.
Such is not always the case with athletic injuries to the toes and specifically the big toe. One of the most common injuries to this toe (also called the “hallux),” is the ubiquitous “turf toe” injury, which is essentially a hyper-extension injury (or more accurately a hyper-dorsiflexion injury).
The Dreaded Turf Toe Injury!
This is a common injury among speed and power athletes and is commonly seen with too much play on artificial turf and hard surfaces like basketball courts. While seemingly trivial, this initial insult to the big toe often sets the stage for future degenerative changes that over time, can severely limit range of motion and cause other dysfunctions up the kinetic chain which will be discussed below.
This injury is no stranger to the author as I suffered the injury during high school playing field hockey (field hockey…yeah yeah, I know what you’re thinking..and no, I did not wear a skirt!).
Me playing Field Hockey in High School; gotta love the short shorts!
Thus, the remainder of this article will dive into the many body-wide ramifications that can occur when adequate range of motion (primarily in 1stMPJ dorsiflexion) does not exist. Finally, I will also give some practical treatment advice in the form of some videos I filmed with my twin brother Franz Snideman and my friend and colleague Patrick Ward. Hopefully, by the end of this article, you will never look at the big toe the same again!
With a Stiff Big Toe, it’s Hard to Go!
The primary dysfunction we’re going to discuss here is called Hallux Limutus/Rigidus, which is a combination of degenerative changes and restricted range of motion in dorsiflexion of the 1st MPJ. There is another condition called functionalhallux limitus (FHL)that is similar to hallux rigidus except that degenerative changes are not seen on an x-ray. The main finding with FHL is that normal ROM is found during non-weight bearing of this joint which subsequently is significantly reduced during weight bearing gait (walking and running). The usual sequence of events that occur in response to an injury like turf toe is to first develop FHL, followed by hallux limitus, and then finally as the arthritic changes worsen, hallux rigidus sets in. Hallux Rigidus Sucks!
Before we continue, here is a video doing some basic anatomy of the bony structures of the foot:
Here is a video off Youtube that explains more about Hallux Limitus and Rigidus:
Before we go any further it might be helpful to go over the expected normal ROM for this joint. Typically, the theoretical model that has been taught in schools of Podiatric and Orthopedic Medicine respectively has been to look for 65-75 degrees of dorsiflexion. There is some confusion however with these numbers since not every clinician or researcher was being clear as to how the measurement was being taken, weight-bearing or non-weight bearing? The real key is what happens in this joint during walking and running (i.e. weight bearing), the more practical/functional way we use the 1st MPJ. And until recently, there has been very little data and no definitive accurate methodology to measure the ROM during gait.
Like Former President Bush, the Research Can Be Confusing!
In 1999 however, a study was published by Nawoczenski, et al, which looked at the motion of the 1stMPJ in 10 healthy people during gait. To measure the motion of the hallux relative to the first metatarsal bone, they used an electromagnetic tracking device. What they found was that the average dorsiflexion ROM during gait was around 42 degrees. The average ROM tested during non-weight bearing of this same group was 57 degrees. Therefore, there are some researchers who now recommend that the gold standard “normal” ROM for this joint during weight-bearing should be 45 degrees. But this was during walking, what about running?
There is no published data that I could find on this but in an article in Podiatry Today (How to Treat Halux Rigidus in Runners, by Doug Richie Jr., DPM, April 2009), unpublished research by Mari Adad, DPM, showed that the average ROM of dorsiflexion during running was found to be only 26 degrees! This is considerably lower than the 42 degrees found in the research by Nawoczenski as mentioned above. This may account why several runners with hallux rigidus/limitus may feel worse when walking as compared to running. I could not find any data on the ROM during sprinting, which is my recreational sport so if anyone knows of any, please send it my way! (ksnideman@gmail.com)
There’s a Lack of Scientific Data on Sprinting and the Big Toe!
Regardless of what the research says about the exact requirements of dorsiflexion at the hallux, a lack of ROM can cause the following disruptions/compensations up the kinetic chain (Chaitow & DeLany 2002):
Closer to the foot, the lack of 1stMPJ dorsiflexion will cause limited plantar flexion at the ankle joint (talo-crural joint) which will strain the Achilles/gastroc-soleus musculo-tendinous complex. This can lead to pain and subsequent tendonosis of the Achilles region and plantar fascia problems. Excessive pronation of the foot will often be seen as well even though the weight will often be shifted to the outside of the foot to avoid stressing the big toe.
The lack of plantar flexion leads to early knee flexion which disrupts the entire gait cycle and limits normal hip-extension.
With limited hip-extension, trunk flexion will often occur to compensate which over time, can be stressful to the intervertebral discs.
Because of limited hip-extension, the hip-flexors are not lengthened properly (lack of pre-stretch) which makes them have to work that much harder to advance the leg on the “swing’ cycle of gait. This can lead to chronic shortening and trigger point activity in the ilopsaos, rectus femoris, TFL, Sartorius, and possibly even the short adductor muscles. I know this chronic hip-flexor pattern all too well since I’ve had it as long as I can remember since high school.
There will also be a contralateral side-bend away from the restricted side that will be coupled with a rotational force which is challenging to the facet joints and lumbar discs. Chronic quadratus lumborum (QL) and even abdominal oblique tightness and trigger point activity will usually result. The opposite S-I joint can be overly stressed as well leading to chronic shortening of the piriformis muscle in efforts to stabilize the joint.
Chronic Trigger Points in Quadratus Lumborum (QL)
If you follow the compensations up higher, there will even be changes to the thoracic spine (increased flexion often) with subsequent righting mechanisms of connections are mostly mechanical however which in turn lead to changes in the myo-fascial tissues, joint/connective tissues, and to nervous and vascular systems. It’s hard to effect one system without affecting them all!
Abnormal Biomechanics Due to Hypomobile Big Toe!
So here’s what the gait patterns look like between a normal 1stMPJ dorsiflexion range and a limited one:
Normal ROM
Limited ROM!
And here is a potential gaiting pattern dysfunction of the entire body when viewed from the side:
NOT GOOD…This could be me and my twin brother in 30-40 years!!
Treatment Options
There are many treatment options available for those suffering from Hallux Limitus/Rigidus/FHL including conservative therapies/care like orthotics, pain killers and anti-inflammatroy drugs, and finally surgery. My focus in on the conservative options, assuming that someone is not so far degenerated in the 1stMPJ that they can’t regain any lost ROM. There is a point of no return unfortunately in any joint where conservative treatment options will not be of any real value. For such individuals, this is a time for considering surgical options and very specific orthotic devices. Surgery is obviously not my area of expertise so I won’t be discussing those options and consultation with an appropriate podiatrist or orthopedic surgical specialist would be warranted.
One thing medically I did pick up in my research for this article is that neither anti-inflammatory drugs nor cortisone injections seem to be that effective for long-term improvements. This makes sense since masking the pain and putting out fires (inflammation) temporarily does very little to alter the behavior or mechanical faults that lead to the condition in the first place!
Anti-Inflammatory Drugs
Cortisone Shots
The primary conservative options I’m going to discuss include soft-tissue and joint mobilization, alteration of footwear, as well as daily mobility exercises and stretches.
Footwear
There are two schools of thought when it comes to treating this condition with regards to footwear:
2) Try to get the ankle/foot complex to function well on its own (a la going “barefoot”).
Orthotics for Everyone?
In reality, there are some cases where people should be wearing orthotics due to their specific condition or dysfunction while others would be better served trying to take the minimalist shoe approach and wear shoes that permit a more natural, barefoot-like gait pattern. Which route to choose must be made after careful assessment of an individual’s unique case history?
I am personally biased towards trying to regain as much functional mobility and capacity first, before trying orthotic devices but again, this must be made on a case-by-case basis. Since not everyone gets the miracle cure from going barefoot, a shoe is often needed with some support. I recommend however that the shoe be as minimalist as possible and does not “over-support” your foot.Vibram 5-Fingers are Getting Very Popular!
The Kigo Shoe, another Barefoot Option
The Ultimate Barefoot Shoe!
Below is a video clip of my thoughts and opinions on the barefoot versus orthotic controversy:
Self-Mobility Exercises and Stretches
There are several stretches and self-mobilizations that can be performed daily or even several times per day to encourage better mobility at stiff/restricted segments of the ankle and foot. To recap all the possible options would be impossible but below are two videos of some self-mobilizations that I filmed with my twin brother Franz Snideman during a recent visit to Arizona.
Soft-tissue Mobilization
A great place to start here is with releasing the stiff and shortened tissues that are either directly or indirectly affecting the 1stRay/MPJ. We could probably start at the pelvis and lumbar spine and look at lumbar erector spinae, QL muscles, the hip-flexors (psoas, iliacus, TFL, Sartorius), quads (primarily rectus femoris) and groin; all the muscles indicated to be potentially shortened in a lower Cross Syndrome. Increased tone in these muscles can cause anterior rotation and a forward displacement of the pelvis in the saggital plane which can shit the weight of the body more anterior on to the toes and balls of the feet; the typical resting position for a power/speed athlete. Many endurance athletes may fit this criterion as well.
From here, the lower leg should be treated in its entirety which can be conveniently broken down into 3 compartments:
The Anterior Compartment: which consists of the anterior tibialis, extensor hallucis longus, extensor digitorum longus, and the peroneus tertius (if present).
The Lateral Compartment: which consists of the peroneus longus and brevis.
The Posterior Compartment: which consists of a superficial layer which houses the gastrocnemius, soleus, and plantaris mucles; and a deep layer which contains the tibialis posterior, flexor hallucis longus, and the flexor digitorum longus muscle.
Moving to the foot, the dorsal (top) and plantar (bottom) surfaces would then be examined with specific attention paid to the muscles attaching to the first ray including the two sesamoid bones that sit under the distal end of the 1st metatarsal bone.
The Sesamoid Bones are Very Important!
Here is a video of my friend and colleague Patrick Ward talking more about treatment options for big toe dysfunctions.
Joint Mobilizations
To perform specific joint mobilizations requires the proper license so many of these techniques are out of the scope of a typical personal trainer or strength and conditioning coach. With that said, it still important for the fitness or even massage professional to understand the basics of joint mobilization and realize when a referral might be needed to a competent rehabilitation professional trained and skilled in joint mobilization techniques. The techniques I will summarize come from the greats in the field of manual medicine such as Geoffery Maitland, James Cyriax, Freddie Kaltenborn, and Brian Mulligan.
There are several different types of joint mobilization techniques and the proper one to use is based on several key issues:
1) The current state of pain of the joint in question
2) The level of degenerative changes present in the joint to be mobilized.
In the case of the big toe (1st MPJ), what is often needed is not only a regaining of basic physiological motion(i.e. flexion, extension, etc..); but also to re-esatablish the proper accessory motionswhich must accompany the phsyiological ones. The accessory joint motions are classified as: compression, distraction, slide, roll, and spin. These are more specifically known as joint-play motion and they cannot be made actively or consciously; they occur (or should occur) as a result of normal joint motion. So in the case of walking for example, when toeing off the ground, the normal dosri-flexion that must occur at the 1st MPJ must be accomanied by a dorsal glide and so a combination of traction of anterior to posterior glides might be helpful to try and restore the normal joint play. Again, these mobilizations are much more complex than simple massage/soft-tissue techniques and must be performed by a licnesed health care provider trained in such techniques.
Other Problems of the First Toe/Differential Diagnosis
Many other conditions can disrupt the healthy functioning of the big toes including Hallux Valgus (often seen with bunions and often involved with Hallux limitus/FHL), Hallux Varus, hammer Toes, claw toes, gout, neuropathy, infection, cancer, tumors and many other rare, systemic conditions that are beyond scope of this article. If you have big toe pain or dysfunction (and the compensatory pain it often cause up the kinetic chain), it always best to get medically evaluated first before trying any self-treatment options so you know what you are really dealing with.
Hallux Valgus!
Bunion
Conclusion/Putting it All Together
I hope that this has been a helpful and possibly eye-opening article and that some of you reading will come away with some strategies and ideas for dealing with limitations of movement in the 1st MPJ. If you have no big toe issues yourself, you probably might know someone who does, so please pass this on to them. Also, please send comments or feedback to ksnideman@gmail.com. Thanks for reading!
Keats
Resources
1). Clinical Applications of Neuromuscular Techniques, Volume 2: The Lower Bodyby Leon Chaitow and Judith Walker Delany. 2002 Elsevier Science Limited.
2) Evaluation, Treatment and Prevention of Musculoskeletal Disorders, Volume 2: Extremities (3rd Edition) by John P. Tomberlin and H. Duane Saunders. 1994 The Saunders Group.
3) How To Treat Hallux Rigidus in Runners, by Doug Richie Jr., DPM. Podiatry Today (www.podiatrytoday.com) April 2009 (pgs. 46-56).
4) Nawocenski DA, Baumhauer JF, Umberger BR. Relationship between clinical measurements and motion of of first metatarso-phalangeal joint during Gait. J of Bone Joint Surgery, 81(3): 370-6, 1999.
5) Contributions from Franz Snideman, RKC-TL, CK-FMS and Patrick Ward, CSCS, LMT, CNMT
This is the second blogpost about a former client (Jun-Ho, a Korean college student) who I was helping prepare for eventually taking the RKC. He has since left to return to South Korea to serve a mandatory 2 years in the military. In the first blogpost I went over the process I used with him to determine a safe and effective program for improving his skill and strength in the primary kettlebell lifts and even some RKC II moves (Jerks primarily).
On his last day with me I filmed him performing a mock test as would be done during the RKC level I certification. The video of his performance of the 6 key RKC movements can be seen below:
At the end of the session I then proceeded to give him a mock 5 minute snatch test although it was with a 20 KG bell instead of the 24KG that he would need to use for the certification. This was still a PR for him and he has 2 years to prepare with the heavier bell. He is well on his way to becomming an RKC instructor. Good Luck Jun Ho!
This blog-post is about two weeks late since I’ve been dealing with some issues getting my website switched over to a new server. All is done with the transfer, so now I can begin blogging away since I have a lot of ideas to write about!
Review of the Functional Movement Screen Workshop!
Two weekends ago (May 7-8) I was fortunate enough to take the Functional Movement Screen workshop & certification put on by Perform Better with Gray Cook and Lee Burton of Functional Movement Systems.
Gray Cook Lee Burton
For those who aren’t familiar with the Functional Movement Screen (FMS for short), it a series of 7 tests/screens which evaluate and rank movement quality in fundamental movement patterns that most able-bodied humans should be able to perform. The movements are all ranked on a 3 point testing scale with a score of zero given for pain. Therefore, the maximum score anyone could achieve is a 21. Statistically, a score of 14 and below appears to be the cutoff point for increased risk of injury. Since many of the test also test the left and right side of the body independently, the screen is also looking for asymmetries since they are implicated with increased risk of injury as well. The 7 fundamental tests are as follows:
1) Deep Squat
2) Hurdle Step
3)In-line Lunge
4) Shoulder Mobility
5) Active Straight-leg Raise
6) Trunk Stability Push-up
7) Rotary Stability
In addition to these 7 patterns, are 3 clearing tests which include an impingement test for the shoulder and a flexion and extension clearing test for the lumbar spine. The shoulder and lumbar areas are amongst the most commonly injured due to the inherent lack of stability often found in these joints. Any pain on these clearing tests would make the preceding movement screen score an automatic zero with an appropriate referral to a competent medical professional if needed.
You can read more about all the tests and see photos and descriptions here.
The major goal of the screen is to identify those individual (young or old) who are at increased risk for injury (specifically non-contact type of injuries). The screen is the only kind in existence that is being used on a large scale right now with professional, collegiate, even high school athletics as a way to statistically demonstrate and correlate risk in certain individuals who fall below a minimum level of movement competency.
Wisdom and Knowledge from Gray Cook and Lee Burton
The following are some of the notes I jotted down during the seminar that struck me as revelatory or important:
About the FMS in General
*We build systems to protect us from our own subjectivity… the FMS is that system for movement evaluation. FMS is about capturing movement patterns from a behavioral standpoint to asses injury risk.
*FMS is a system, not a program.
*Systems= if this, than that..if this than that= more options!
*Programs= no matter what…do this= less options!
*FMS is a “screen,” which doesn’t tell us what is wrong..only that something is not functioning properly..to find out more you then need to assess and evaluate with different more “specific’ testing.
* FMS really tells us 2 things:
1)If there is pain or dysfunction
2) If a client/athlete can move..
*Quality movement is the is foundation of all good skill and performance so needs to come first!
*Fitness on top of good movement= insurance policy.
*Fitness on top of poor movement= increase risk for injury and jeopardized performance.
*FMS is not a sensitive enough test for people currently in pain, that’s not what its designed for. Refer out to someone who can do the SFMA (Selective Functional Movement Assessment) instead.
*FMS with kids and elderly can still be done. Don’t omit a test; if it can’t be done then just give a zero score and list why. Do as many tests as can be performed to capture movement capacity of the individual.
*Unless you can document that a movement pattern is whole, its not..its not authentic yet.
*Table tests only give you a brief “snapshot” of a great big movie. They don’t tell you how a given individual can put movement patterns together,etc..
*Strength and ROM on a table can be the same in 2 different individuals, yet functional performance is vastly different!
*Quality (i.e. “authentic”) movement is the key..if that’s out, nothing else matters! Programming is secondary to a quality a baseline of movement competency.
*Movement and Metabolics is how we get quality performance!
Central Nervous System stuff and more…
*The CNS is key! Kinesiology 101 is a map..a map of movement and a map of anatomy are NOT the same thing! In other words…the map is not the terrain!
*Muscle function is movement-pattern specific; isolation does not necessarily improve integrated movement.
*In a stressful (i.e. survival or threatened) environment/situation, the body will always sacrifice movement quality for movement quantity (i.e. run away from saber-tooth tiger in pre-historic man).
*The brain many times, will create a mobility problem, cause its the only option left.
*Developmental Kinesiology- the eyes start the process of “reflex” learning of primitive movements which eventually lead to movement patterns. You must challenge perception to increase awareness in clients..they must make mistakes to learn. This is organic and authentic learning.
*We’ve damn-near made exercise “idiot-proof” with machines and professional rep-counters in big-box gyms. You need to be mentally engaged for exercise to have a positive effect!
Core Issues, Motor Control and more..
Two different core functions:
1) Hard-core/high-threshold strategy- this would be more of the global “outer’ muscles that are more responsible for torque production/reduction (Rectus abdominus, obliques, erector spinae). The movement screen test that really tests this is the TSPU (Trunk stability push-up).
2) Soft-core/Reactive Core (RC)/low-threshold strategy- this involves the deeper “stabilizer” muscles (aka “Inner Unit) including TVA, Diaphragm, pelvic floor, multifidus. These muscles are more responsible for stability, timing, adjustment, or what Gray called “tapping the breaks.” The key is that these muscles have to contract first, before the bigger, prime-mover muscles. The movement screen that tests this specifically is the Rotary Stability test (RS).
*You can’t strengthen a “stabilizer” muscle in an isolated way and expect it to function well dynamically.
*The Reactive Core (RC) needs faster, quicker contractions; they need to be finely tuned to control proper movement path in the joints involved in a particular movement. Use of quick hands, push-ups with claps, etc.. can train this function.
*Best way to re-set core is to remove or improve biggest restriction/obstacle that is impeding healthy movement; in other words..work on the worst of the 7 scores. For many people it means improving their straight leg raise or shoulder mobility scores.
*If you want to see your abs, eat better! If you want better functioning abs…move better!
*Motor Control is key! The timing of the stabilizers with the mover muscles is the key to healthy movement quality.
On Correcting Movment Problems, Programming, etc..
*Best place to start with most people is on correcting their ASLR and SM. These are more related to “primitive patterns” and cleaning these up first will often correct more “functional” standing patterns like the DS, HS, and ILL.
*Poor SM scores are often T-spine problems. Correcting breathing patterns, massage/stick work, and improving thoracic mobility (often in extension and rotation) are keys to a healthy gleno-humeral joint.
*Don’t micro-manage specific muscles, fix the pattern!
*Pain requires immediate attention first. Asymmetries are next in importance to fix. Then address primitive patterns (i.e. rolling patterns) to re-set reflexive core activity.
*Inconsistencies in screening are often stability problems where recurring restrictions are most likely mobility issues.
*Think “get people back to the crib!” Many people need to practice basic crawling and rolling patterns to re-learn how to engage core muscles properly. See “Secrets Of Primitive Patterns” for more on this!
*After screening the key is to first restore any lost mobility that the person might need. Without adequate mobility is will be impossible to achieve true, or “authentic” stability elsewhere. Decreased mobility leads to less proprioception and awareness of any given area.
*Tightness oftnes replace authentic stability.
*You can’t fix it and if you can’t feel it!
*Exercises like the Turkish Get-Up and Indian Clubs done well, are great for improving stability and mobility problems simultaneously. Gray Cook, Brett Jones, and Dr. Mark Cheng did a great DVD on the intricacies of the Get-Up call Kalo Thenos, Kettlebells from the Ground Up. Get the DVD!
*Its important to keep client relaxed when fixing a movement patter. You don’t want to engage a high-threshold strategy. Look for loose traps and face. If face is grimacing chances are breathing has altered as well and has become upper chest than diaphragmatic. Keep shoulders down!
Conclusion
Well, that’s enough for now since the post is becoming way too long; I could keep writing since I have several more pages of notes. But this is a pretty good start!
If you are a fitness professional and have not taken the FMS workshops (either through Perform Better or Dragon Door), I would highly recommend them! If you are not a fitness professional but just an active person or someone who is considering becoming more active, I highly recommend seeking out an FMS certified individual who can take you through the screen. The FMS is a fantastic system for ranking movement and should be utilized a lot more throughout and athletic and general population. What is your FMS score?
If you live in AZ and would like to be screened please do give a ring and make an appointment to come in to my facility for a screen. Otherwise, you can look on the FMS directory page, or on Dragon Door to find someone who is trained in the very exciting CK-FMS certification which combines the best corrective strategies already inherent to the RKC system of teaching kettlebells with the strategies as taught by Gray Cook of Functional Movement Systems. Kettlebells and the FMS, a winning combination.
This past weekend (April 17, 2010), I attended the Perform Better One-Day Learn-By-Doing Seminar here in Phoenix, AZ. It was pretty neat to start with since several of my friends and colleagues from around here were there including: Patrick Ward and his wife Ivonne, Carson Bodicker(down from Flagstaff), the GluteGuy himself, Bret Contreras, and Don Miller (an incredible massage therapist colleague). The seminar was broken up into four 1-hour lectures in the morning and various hands-on practical exercise sessions in the afternoon.
The speakers and topics presented for this seminar were as follows:
Mike Boyle- owner of MBSC (Mike Boyle Strength & Conditioning) and the Strengthcoach.com website that is quickly becoming one of the best sites on the web for everything about performance enhancement and injury prevention). I’ve been a member of Strengthcoach.com for over a year now and I highly recommend any fitness professional or fitness enthusiast to check it out! At only $9.95 per month it’s a steal for the quality of information that’s available to the members in the form of articles, videos, and the lively and highly active forum discussions.
In Mike’s talk, he opened by saying that “change is good,” and that Alwyn Cosgrove says that people should never be punished for learning;great point! As many people might know, Mike Boyle is famous for his recent stance on eliminating back squats (and many bi-lateral lower body movements in general) and replacing them with mostly single-leg exercises instead. To say Mike is controversial is an understatement but when you hear him lecture. a lot of his stuff really makes sense.
The remainder of Mike’s lecture went over his approach to designing the pre-workout warm-up by utilizing the “joint-by-joint approach” to mobility and stability. This concept, which Mike says he originally learned from Gray Cook, has gained popularity over the last few years and is really starting to change the way people look at how we train for increases in tissue length and functional range of motion (ROM) about a joint. The basic jist of is that certain joints require more or less mobility or stability based on it’s architecture and that basic programming should reflect these needs from joint to joint. Of particular interest, Mike talked about the importance of ankle and hip mobility to decrease risk of injuries to the knees and lumbar spine. And as you may now guess, the knees and the lumbar spine should be trained for more stability rather than mobility. Back to Mike’s recipe for the pre-workout warm-up…
Mike’s basic “recipe” for warming up is as follows:
1) Frist, foam rolling is done to improve tissue quality by reducing what Mike calls “tissue density.” This can help reduce “knots” or trigger points and help improve subsequent stretching and mobility work.
2) This is immediately followed up by a bout of the always-controversial static stretching; that’s right….you heard me…STATIC STRETCHING! Mike is very un-apoloegtic about his inclusion of stretching prior to training and his rationale really makes sense. Although most research on stretching show immediate decreases in power, Mike’s explanation is that the research is flawed since nobody really stretches hard for several minutes and than immediately goes into sprinting, jumping, or some other explosive type of movement. Instead, if static stretching is followed by bouts of more dynamic activities, the negative effects from stretching are mostly eliminated while the benefits of having more supple connective tissues (i.e. fascia) are obtained and accumulated over time if stretching remains in the program.
3) Following the static stretching, dynamic joint mobility work takes place which helps to bridge the gap from foam rolling/stretching to more dynamic and “game-like” performance. After this, plyometrics and/or speed work could be done or a transfer to more general strength training and explosive-type of lifts.
Mike’s talk was great and we were able to experience first hand how he organized his stretching with his clients and athletes in the afternoon session, where Mike took everyone through a timed stretching and then active mobility session in real time.
Alwyn Cosgrove- is the co-owner of Results Fitness and a sought-after presenter. He is hands down, one of the funniest presenters I’ve ever seen! Alan talked about theSecrets of Successful Semi-Private Training Programsand gave a lot of the myths that keep fitness professionals from realizing their full business potential. So the talk went over both the practical, training part of training small groups of people and also the business and marketing side of things that can help make semi-private training a reality for many trainers and coaches. In a nutshell, Alan thinks that one-on-one training is mostly DEAD and that most people would actually prefer to train in groups because we are after all, social animals! I think he has a great point here for sure…
He finished with some great practical examples of how he sequences training programs from the warm-ups, corrective exercises, strength moves, and metabolic conditioning. In the afternoon he treated us all to a challenging sessions that involved both dynamic warm-up with core and activation exercises. This definitely got our bodies warmed-up and a little sweaty!
Todd Durkin- is the owner of Todd Durkin Enterprises and Fitness Quest 10,one of San Diego’s premier health and fitness facilities. To say this guys is inspirational or motivated is a vast understatement. Quite frankly, he was one of the most driven and intense speakers I’ve seen in a while and he clearly has TONS of passion for what he does! His talk was called “The 3-D Approach to Program Design for a Successful Fitness Business.”
Todd’s speech was full of energy and enthusiasm that it was possible that he had a lot of Red Bull that morning! He talked a lot about his approach to training people which is to train almost everyone as an athlete. He utilizes a lot of different tools and modalities in his training approach and really promotes a sense of pride in doing whatever you do for your training. One of his repeating mantras was “What can you do to improve yourself today? In the afternoon sessions, Todd took everyone through a sample of training elements including TRX exercises, the Battling Ropes, Agility Ladder drills, and a cameo appearance from my friend and colleague Josh Henkin, who was slaughtering us with an assault of tough sandbag exercises!
Gray Cook- need I say more…the legendary Physical Therapist and co-creator of the Functional Movement Screem (FMS) talked about Dynamic Stability Training. Here are some of my notes:
*tightness is a survival mechanism. Most people train for Synthetic Strength (appearance-based) rather than Authentic Strength (function based). What do you train for?
*Why do non-contact injuries really occur? Movement problems are really to blame, not just “tight” or inflexible muscles but faulty timing and the improper use of them. Assymetries have been shown to be a big factor in predicting injuries.
*Flexibility in and of itself has almost zero ability to predict injures..why? Because isolated flexibility tests tell nothing of how a given person integrates their body or “puts it all together” from a movement pattern perspective.
*The FMS (functional movement screen) is just a risk-assessment. Stop micro-managing muscles and look at movement “patterns.”
* The top 5 Bio markers for Injury: Previous Injury, Asymmetries, Motor Control (the real deal according to Gray), BMI (larger people can have more injuries), Stupidity (dumb-ass training).
*Motor Control and proprioception are key: if they can’t feel it…they can’t fix it!
* Don’t use tests/assessments as exercises. If you can’t do a fundamental movement pattern, then your inner core (TA) is out. Look at breathing…it is a BAROMETER of your CORE function!
* Authentic Breathing= Diaphragmatic Breathing. Best way to improve or reset the core is to not do any core exercises at all. Establish better breathing strategies and work on improving worst asymmetry or movement pattern in the FMS and then train static and eventually dynamic stability as skill improves.
Gray also presented a wonderful session in the afternoon demonstrating 1 lb. Indian Clubs and some basic movement drills you can do with them. He then demonstrated some great Reactive Neuromuscular Control exercises on myself and Patrick as well as some great ideas on how to use the bottom’s up Kettlebell exercises as a way to assess and train full body integration and core activation..cool stuff for sure.
The real pearls of knowledge came after the seminar when Carson, Patrick, Bret and myself asked him specific questions over various issues with FMS, rolling patterns, and even some great advice on how to treat my stiff big toe problem that us causing my Achilles tendon to be so irritated on my left leg. This was worth the price of admission by itself.
All in all this was an informative and entertaining seminar. Boyle and Cook were very solid with their theoretical and training recommendations and Cosgrove and Durkin gave great business advice! I would recommend these seminars to anyone who hasn’t seen these presenters before.
This blog will review the training process of a client of mine, Jun Ho, who has been working with me since late January of this year (2010). He is a young Korean student at ASU studying Exercise & Wellness but is very much interested in kettlebells and eventually becoming an RKC. He first must serve 2 years in the South Korean army before he can take the RKC but he intelligently decided he wanted to master the proper kettlbell technique and RKC principles so he can practice during his time in the Korean military. He found my name off the Dragondoor RKC directory and on Jan. 26 we begain his training process.
Evaluation/Screening
This first step I took with Jun Ho, was to take him through a Functional Movement Screen (FMS) and mobility assessment to see what movement problems/impairments he had that might interfere with his safe execution of the 6 key RKC Lifts:
1) The Swing
2) Get-Up
3) Clean
4) Press
5) Front Squat
6) Snatch
Luckily, for his sake, his movement screen was quite good (16/21) so we could start with more demanding training right away. His main issues were more stability problems as he possesed very good joint mobility, particularly in squatting. He had already been training with KB’s on his own for some time without any pain or injury so he was already moving quite well. I determined that he needed more abdominal and glute activation along with some easy hip-flexor stretching and thoracic rotational stretches. So his basic pre-training routine looks like this:
3) Activation work: Glute bridging primarily- needed more hip snap on finish of swing
4) KB Specific Warm-up- Arm bar, Get-up to over head waiters walk -1-2 reps per side, halos, around the body pass, ligth 1-arm swings and goblet squats to warm-up knees.
The Training Routines
His training routines with me (he trains 2x per week with me and the rest on his own) involve the alternation of 2 primary types of sessions: the first, is more of a “grind” or max-strength type of session that really emphasizes learning how to create appropriate levels of tension and breath control to “link’ his body together better, especially during presses. When Jun Ho first came to me he could press the 44 with some challenge and the 53 was quite tough for a rep or two. After some practice on the “skill” of strength, he recently succesfully pressed the 62 lb. KB and with consistent training will be pressing the 70 (which is half his bodyweight)! Below are some videos of his “grind” days. We include Trap Bar Dead’s and chins on those days to help increase his overall body strength and hip power since his only trainig tools at his dorm are (2) 35-lb. KB’s.
Interesting to note during his first attempt to press the 62 on his right am, his clean was poor which led him to lose “linkage” and connectedness from his torso. He basically missed the lift becasue he was “leaking” force out of his trunk that couldn’t be harnessed for the press. In the RKC sysyem there is a saying, “your press is only as good as your clean,” and that was a great visual demonstration of that. He rounded out that session with some weighted chins (35 lb. KB) and 1-legged Deadlifts (since he struggles with those). As a finisher he did some heavier swings (62 lb) supersetted with an anti-rotation press on a cable system (Pallof Press). All in all a quality day with a PR!
The second session during the week is more geared towards power (since he really wanted to practice jerks, etc..) and some general strength and power endurance, which he will need to pass the RKC Snatch Test! Below is a video of one of his training sessions.
Training Jun Ho has been a great experience for me and I wish him good luck in the future! He will make a fine RKC one day!
Have you ever wanted to learn how to do a one legged-squat, or what is called a “pistol” by some in the fitness industry and especially in the RKC Kettlebell community? Well then you’re in luck, because my twin brother Franz Snideman, of Revolution Fitness has created some great videos on how to safely and properly progress to doing a full pistol. But before the videos lets look at the requirements for a safe pistol.
The pistol is not an exercise for everyone as it requires full range of motion in the ankle, hip, and knee, which many people to not posses. It also is difficult to maitain adequate lumbar curve (i.e. lordosis) in the bottom position which may be an irritant to some people’s lower backs, especially if they have posterior disc bulges or herniations. In that case, this is definately not a suitable exercise! However, if no real orthopedic limitations or injuries exist beyond fear and air, than you might enjoy the process of learning this very challenging single leg exercise!
From the Bottom Up
In this first video, my brother demonstrates and explains some key principles about tension and proper foot/big toe position when in the bottom position.
The Importance of Tension and “Breath” in the Bottom Position
In this second video, Franz discusses the importance of breath in the creation of compression and tension in the bottom of the pistol to help you come out of the bottom position. Great info!
Pull Yourself Down into the Bottom Position
In this last video, my brother teaches how to engage the hip-flexor muscles to acitvely “pull yourself down” into the bottom of the 1-legged squat position. It is a skill that is heavily used in the RCK system of teaching squatting which instantly makes squatting (of any variety) stronger and safer. Check it out!
Conclusion
Hopefully, these videos will give you an a nice blueprint of how to safely learn this incredible and challenging exercise. As a programming note, take your time when learning a new exercise such as the pistol which takes your joints through some extreme ranges of motion. Follow the progressions and keep the reps low (1-5) and well as the sets. Better to do more sets of low reps for more of a motor-learning approach rather than a “workout.” Enjoy and thanks for reading and watching!
This blog will review the first ever Arizona Hardstyle Kettlebell Certification (HKC) that was hosted at the Reality-Based Fitness/Optimum Sports Performance facility on March 20, 2010. This new one-day certification is a precursor to the Russian Kettlebell Challenge (RKC) instructor certification course put on by Pavel Tsatsouline and DragonDoor. Actually, as far as I know, this was the first ever DragonDoor event to be held in the state of Arizona and I hope to be involved in several more in the near future as kettlebells are becoming more and more popular all the time. The problem is that many people (including personal trainers!) do not know how to use them properly and Dragon Door and their staff of incredible instructors are the best in the business.
The course was taught by Master RKC Mark Reifkind and was assisted primarily by Mark’s wife, Tracy Reifkind, RKC. I also helped out where needed. The course participant number was small,with only six participants; but it actually turned out to be a good number of people for a nice flow to the course. The course started with some mandatory strength testing in which each male particpant was required to perform 5 full range-of-motion pull-ups/chins. The females were required to hold at least 15 seconds in a bar hang with the chin above the bar. It was nice to see everyone pass as can be seen in the video I took below:
In a nutshell, the course was focused on teaching the foundational prinicples of the RKC system of human conditioning ,which is quickly becoming one the best, if not the best, human movement coaching programs available. Mark is such an excellent teacher and did a fantastic job of teaching the students the real keys to proper athletic movement, including a great explanation of what “hardstyle” kettelbell training is really all about. As many people might be unaware of, the RKC system is so much more than just learning to swing some kettlebells around. It is truly a school of strength and human movement. Many of the principles learned can be applied to other exercise tools/modalities and sporting situations. Here is just a small sample of what Mark had to say:
The course teaches these priciples by focusing on three fundamentals kettlebell lifts:
1) The Swing- refered to by Mark Reifkind as “the center of the RKC universe.” This lift is perhaps the most dynamic and simple (relatively) way to teach the trainee the proper activation of the body’s power source: the hips, pelvic gridle, and tunk (or shall we say “core”). Check out the video below for some of the adventures the participants (i.e. “victims”) had in learning the swing, inclduing some kick-butt KB swing sessions from Tracy Reifkind!
2) The Get-Up- this exercise is fast becoming popular in both rehab and performance circles. It is really a great tool for both performance and general stability and injury prevention. Here’s a short video of Mark (“Rif” for short) teaching the students:
3) The Goblet Squat- last but not least was the teaching of the goblet squat. Originally popularized by Dan John (now a Senior RKC!), this movement is one of the simplest ways to teach a victim how to squat properly without having to load the body excessively. Mark did a great job explaning it to the students:
All in all, the certification was a great success with all 6 particpants passing! If anyone is interestesd in taking the RKC certification course I HIGHLY recommend to take the HKC first, which serves as downpayment for the RKC anway so its almost like getting it for free. With so many people failing the RKC certification for various reasons (lack of fitness, poor thoracic/overhead mobility, poor coaching ability of KB lifts), the HKC makes a lot of sense to take since it will give someone a great headstart for mastering the fundamentals of proper kettlebell technique and basic coaching progressions for the lifts.
I want to thank Mark and Tracy Reifkind for putting on such a fantastic event and letting me assist where needed. This will hopefully lead to more interest of RKC/HKC kettlebell certificaiton in Arizona and I hope to be the major facility involved with this incredible “school of strength.”
In this blogpost I’d like to review the informative and entertaining book “Explain Pain,” written by David Butler and Lorimer Moseley (plus very unique artistic illustrations by an artist called Sunyata). As mentioned in the preface to the book, the authors describe the book’s four primary aims:
1) To assist health professionals who deal with patients in pain by serving as a conduit from the modern field of neuroscience.
2) To help people in pain understand more about their condition and to encourage them to be less fearful of the pain. Modern neuroscience tells us that by helping people understand their pain, it lessens the “threat value” of the pain and by reducing the threat, can help even reduce the pain and improve functional outcomes.
3) To assist those in pain (and the other people involved), to make the best decisions about the management of their condition.
4) Lastly, to provide modern models of magement to help those suffering from pain to overcome their pain and return to normal life.
So in general, the book is actually aimed towards both clinicians and patients suffering with chronic “non-specific” type of pain conditions (such as low-back pain or elbow pain) as well as anyone (such as friends and family members) who helps or is part of the support system of those in pain.
The book is broken down into 6 sections that explain the various aspects of the basic neuroscience of pain, as well as pratical management tools to encourage healthy coping strategies and improvements in function. Complicated concepts are explained in more “laymen” terms and are visually represented with unique and provocative artistic/cartoon-type of illustrations. Below is a summary of some key points that stood out for me as particulary important and interesting:
*Pain is a very normal and protective repsonse to stiimuli that your brain determines to be a threat or danger. Many people have “arthritic” or “degnerated’ joints yet have no pain whatsoever. Simply put, if you’re brain doesn’t perceive the tissue damage to be threatening, there will be no pain. Interesting!
* The amount of pain that any of us epxerience isn’t necessarily related to the actual tissue damage present. A solider in the heat of war for example, may have a life-threatening gun shot wound that he/she hardly even feels at the time of the injury. Conversely, a tiny papercut can be excruciating, yet isn’t life threatening at all!
* Pain relies heavily on the context in which it is occurring and is influenced by social and emotional factors. For example, a musician (violinist is used in the book) might experience more pain in a minor finger injury than someone who doesn’t consider their hands and fingers as valuable to their line of work. Also, emotions can directly affect things like muscle tension and breathing patterns, both of which have an immediate impact on the pain experience.
* Every body part is represented neurologically in the brain in what is called the “virtual body.” Technically called the “sensory homonculus,” the virtual body lets us know where our actual body is in space (also referred to as kinesthesia or proprioception). Sometimes, pain can remain or exist in bodyparts that have been lost or amputated, a phenomenon known as a “phantom limb pain.” So while pain is actually “in our heads (brains), it doesn’t make it any less real. However, by understanding how the brain works, pain can be better controlled and even lessened. This is a recurrent theme in this book.
* There are danger sensors located all over the human body. A minimum threshold of stimulation (known as the “all or none” point) must take place in order for a message (impulse) to be sent to the spinal cord and brain. Once arrived at the brain, an impulse from a danger sensor must be evaluated for an appropriate output to be made. Only if the body percieves sufficient danger or threat from the impulse will it result in pain.
* Damage to tissues causes inflammation which helps to activate the immune system and promote healing. Tissue healing is dependent on blood supply. When tissues are chronically deprived of adequate blood (ischemia), healing is compromised. This is why prolonged inactivity or bedrest has been shown to be counterproductive and even harmful for things like simple back aches or sprains.
* If pain persists for longer than would be normally expected, the danger alarms system become more sensitive and certain neurons can become more easily excitable and produce more sensors for excitatory chemicals and neurotransmitters. This is the genesis of chronic type of pain syndrome in many people.
* As the chronicity of pain continues, thoughts and beliefs (including emotions) become increasingly more powerful in contributing to and perperutating the problem of pain.
* The brain can then adapt and become more efficient at producing what is called the “neurotag” of pain, or the “pain tune.” However this tune would be a bad tune if actually played as music! It would be noise and static.
* Modern pain management models are less concerned with the tissue level, and more with the brain’s alarm system sensitivity as well as the fears, thoughts, beliefs, and attitude about their specific condition or situation.
* How well one undertands their problem and the basic science of pain will determine their coping strategies over time. Using pain only as their guide is a poor management tool since pain is often inaccurate as to the actual state of tissue health. Often pain can remain (in the brain) yet the injury is actually healed at the tissue level. The brain still thinks it is in harm however so the pain continues.
* The key is to learn to gradually increase the activity level of a painful area while knowing that some pain and stifness may occur. This requires patience and persistence to establish a slope of improvement over time. Some days will be better than others. The goal is a long-term reduction in pain and stifness and improvement in function.
*There are also ways to activate the “virtual body” in your brain by doing things such as:
1) Imagining Painful Movements: just by thinking of moving in a particular way, the brain activates many of the same parts of the brain as when doing the actual movement. Sometimes even imagining movements can be painful so movements can be made smaller in your image to try to lessen the pain neurotag for that movement.
2) Alter Gravitational Influences: Movements can be alterd by performing them in various lying postions or even in water to alter the mechanical stress that would normall be associated with that movement.
3) Varying the Visual Inputs: Clsoing the eyes during a movement alters the demand to virtual body as can looking at the body in the mirror. Perhaps watching a non-injured limb perform a normally painful movement for the other limb in a mirror can trick the body into lessening the pain tune by seeing the apparent reflection of the painful limb perform pain-free activity.
4) Performing Various Neurodynamic Techniques: By using various movements designed to particularly sensitize nerves in the body, nervous tissue can learn to be less threatened with movements that stretch in a bit. Under normal, healthy conditions, nerves slide within and around muscles and fascia freely without excessive tension or pressure on them. In painful or pathological states, nerves can be overly stretched or compressed leading to what is often called “adverse neural tension.” By gently performing what are called “sliders,” particular nerves can be gently mobilized within their myo-fascial housing.
Conclusion
This is a fascinating book that could and should be read my many people who suffer from pain, help treat those in pain, or are a friend or loved one of someone in chronic pain. The book can be purchased from Amazon on the internet as shown below.
While 2009 seemed to be a pretty crappy year for many people and our country in general (due to bad economy, doom & gloom media, etc….), it was actually a very productive year for me personally when I look back on it.
It all started with meeting Patrick Ward, who was a fellow contributor of articles and quality forum discussion on Michael Boyle’s StrengthCoach.com website. Once we realized we lived in the same town (Chandler, AZ), we started trading for soft-tissue work and talking shop. This was shortly followed by something I’ve been meaning to do for several years: starting up a podcast. This we named the Reality-Based Fitness Podcast.
After that, we set out to find a facility of our own since both of us were in the same boat renting at various massage and fitness facilities where we were not able to be at our full force. In July of last summer, after having searched for months for a quality space, we were not having any real luck and were both pretty dejected. But, on one very hot summer day I drove relentlessly around a particular industrial area of Tempe and found the exact location we were looking for. In just a few days we had signed a lease and were on our way to creating the Reality-Based Fitness/Optimum Sports Performance Training Center!
Later, in August, I successfully completed the Russian Kettebell Challenge in San Diego, CA, someting I had wanted to do for years. Since then, its just been great having a place to call my own again and being able to see clients when ever I want and even being able to start some small group fitness/kettlebell classes. In March of this year, I am hosting the first ever HKC certification at the RBF/OSP facility and Patrick and I are also starting to work on our own client assessment seminar for fitness professionals and massage therapists. So things are definately moving in the right direction!
As with most years, 2009 was a year when I read and studied some excellent educational material of various but related topics. Some of things I thought were noteworthy enough to write a blog about include the following:
1) I learned that Mike Boyle’s Strenthcoach.com website has a lot of quality coaches and practitioners on it! The articles and videos available are incredible and the forum discussions is quite lively and entertaining. For just $9.95/month it is money well spent in my opinion.
2) I learned about Flexible Intermittent Fasting from Brad Pilon and realized that you don’t have to eat 6-7 times per day and that small 24-hour breaks from food once or twice per week have incredible effects on fat loss and health in general. It’s simply the most no-brainer simple method for weight (fat) control. Brad Pilon was a guest on the Reality-Based Fitness Podcast and you can listen to the great interview here!
3) I also realized that I’m still OK and quite healthy by not taking a multi-vitamin/mineral supplement. I started this experiment in the Spring of 2008 when there were several studies and experts saying that a healthy under-50 adult probably didn’t really gain any health benefit by taking extra vitamins and minerals beyond what one should be able to obtain from a relatively mixed, or “omnivore” type of diet. The only supplements I use now are a protein powder occasionally for smoothies and to add to my tasty morning Oatmeal. I also alternate between using some flax-oil in my shakes (1 Tbspn/day) or a couple of teaspoons of lemon-flavored fish-oil at night. But these I don’t even use every day, just a couple of time per week. I’m not even sure I need to be taking those omega-3 supplements? I may try some creatine again this spring and maybe even some of the much touted “leucine” amino acid to see if I notice anything from it. In general though, I feel most supplements are not worth the money and most people would benefit from just trying to eat more nutritious foods (fruits, veggies, lean meats, whole grains, low-fat dairy, etc…).
4) I learned just how much fitness, health issues, weight control, neural science and adaptations to stressors in general are more easily understood through the lens of evolution. Everything just seems to make more sense through an evolutionary perspective! One of the many Evolution books I’ve read that really helped give me a better grasp on this incredible scientific fact and theory includes: Why Evolution is True, by Jerry Coyne.
5) I was humbled to say the least, after taking the RKC certification and I realized how great of a system Pavel Tsatsouline and Dragon Door have for teaching the absolute fundamentals of moving well and getting strong; the tool they use just happens to be the kettlebell. I’m very much against gimmicky type of things and some people may see kettelbells as a gimmick being that they’re now being sold at vendors such as Wal-Mart, etc… But learning the simple, yet powerful techinques that Pavel and his band of instructors have continued to refine and improve every year is one of the most valuable things a fitness or strength coach could do for themselves personally, and for their clients.
6) I learned how much I continue to enjoy science, critical thinking, and skepticism. I also came to truly realize how wonderful and scarry the internet is since any jackass can practically create a cult if he is persuasive enough! We live in a country that allows us to speak our mind, whatever non-sense might come out if it; and for that I am greatful. But I also know we need to be critical of claims that are made and not just accept what somebody says is the truth without adequate evidence. That’s what science is for…its the ultimate truth filter..hence the name of the podcast we created Reality-Based Fitness!
7) I continued to learn how powerful listening to podcasts can be while driving. Its like turning your car into a University on wheels. Some of the podcasts I routinely listen include: (just look these up on iTunes if interested)
* Brain Science Podcast
*The Skeptics Guide to the Universe
* Quackcast
* Skepticaility
*Skeptoid
*Point of Inquiry
*The Strengthcoach Podcast
*In The Trenches Fitness with Mike Robertson
* Adonis Lifestyle
There’s a lot more I listen to but those listed above are probably the ones I like the most. As you can see, there is a heavy skeptical theme to the podcasts I listen to because most stuff out there these days is so uncritically biased and we all can make major mental errors in our thinking with out second guessing ourselves for even a second. Well, its good to second guess your thought-processess and many of the podcasts mentioned above can help us to stimulate our critical thinking skills!
Most importantly, I learned how challenging and rewarding it is to be a father of two incredible boys and the huge responsibility we (as parents) have to our children to foster and encrouage them to have an insatiable appetite for learning, for caring and loving others, and for life! This year is also very special to me and my wife Tammy as we will be celebrating our 10th year Wedding Anniversary in February!
Yikes..not a Goniometer!
Most importantly, I learned how challenging and rewarding it is to be a father of two incredible boys and the huge responsibility we (as parents) have to our children to foster and encrouage them to have an insatiable appetite for learning, for caring and loving others, and for life! This year is also very special to me and my wife Tammy as we will be celebrating our 10th year Wedding Anniversary in February!
