Mobility Monday: Airplane Back Survival Guide

Whether you are sitting on a plane for hours and hours or you have a long car ride and there just isn't a good place to stop your back can take the brunt of it.  The long hours of sitting and the compression that results on your spinal column can be extremely tough and agonizing.  Simple tricks can help take off the pressure on your back and make your trip a little less sore.  Give it a try.

Things It Helps:
-Low Back Pain
-Helping with Sitting for Long Periods of Time

Mobility Monday: Death by Desk

If you're going to be anything like me this holiday season you may find yourself sitting quite a bit and enjoying the down time (and being a little lazy).  While that can be all well and good for your mental health and relaxation it can be extremely hard on your body.  Who knew that sitting in something comfortable for while could really be that hard on you body.  Dr. Starrett breaks it all down and gives you some great ideas to help combat sitting.

Things It Helps: 
-Tight hip flexors
-Low back pain
-Generalized stiff hips

Friday Food: Garlic Brown Sugar Glazed Salmon

We are huge fans of salmon and there are so many health benefits from eating it.  It is high in protein content which is always a good thing but also the health fatty acids salmon can bring with it make it a favorite.  Combine that with some garlic and its own health boosting properties and you're all set to go.  Give this one a try with the added brown sugar to give a little sweetness.

Ingredients:

• 2 pounds salmon
• 2 tbsp olive oil
• 1/4 cup brown sugar
• 1/4 cup soy sauce
• 3 garlic cloves, minced
• Juice of one lemon
• 1 tsp salt
• 1/2 tsp pepper
• Garnish with sliced lemons and chopped parsley if desired.

The Game Plan: 

1. Preheat over to 350 degrees.  Line a baking sheet with aluminum foil.  Lay the salmon on top and sprinkle with salt and pepper.  Fold up the sides of the aluminum foil around the salmon.
2. In a small bowl whisk together the olive oil, brown sugar, soy sauce, garlic, lemon juice, salt and pepper.  pour the glaze over the salmon.  Top the salmon with aluminum foil and seal.
3. Bake for 20-25 minutes or until salmon is cooked throughout.  Take the foil off of the top and baste the salmon with the sauce in the foil.  Broil for 3-5 minutes until brown and caramelized. Garnish with lemon slices and chopped parsley if desired.

Resource: The Recipe Critic

Practice Based Evidence

By: Joel Luedke

Evidence occurs along spectrum and how you utilize it should also occur along a spectrum.  Evidence based practice (EBP) has been a major push for a long time in a lot of professions.  Lately the increased focused on EBP worked its way through the field of athletic training.*

Evidence is great and the research is needed but I am going to talk about in this post is why we can't jump all in on just EBP and go on to say "there is not evidence" and let that make something we are doing not worth doing.

More Questions than Answers

I read a good amount of research and while there are connections you can make out of the studies there is almost never a study that directly applies to what population you are working with or the issue that you are dealing with.  This makes the transfer of evidence difficult.  Along with this issue there is the problem of repeatability.  Several studies may look at similar circumstances and based on a number of factors come out with extremely different results.  So which one do you use?  Do you use nothing at all?

The research problem is also difficult in that there has to be a long progression of studies building on themselves in order figure out the root of an issue or problem.  That can also be a frustration with research in that most studies leave more questions asked than questions answered.  Problems are identified but rarely are answer ever clear.  This makes implementation difficult.

Individual Response

I would argue training and treatment is just as much art as it is science.  Everyone is so individual in their response to the same stimulus that is it almost impossible to expect success with the same treatment or intervention.  I believe this is where an idea I stumbled upon of 'Practice Based Evidence' comes into play.  While it may not be double blinded or randomized controlled if something works, then it works and I think that is important in and of itself.

By looking at basic concepts that can be found in research (i.e. principles of training or soft tissue work) the partitioner can then find the right instrument for the right person that facilities the best outcomes.  At the end of the day I believe this should be the ultimate goal in getting the client/patient/athlete the best and most efficient outcomes they are searching after.

Research is vital but getting caught up in only practicing a certain way I think leads us down a path of missing things and not fully providing the best practice we are able to.  Ground what you do in research and stay on the cutting edge and most importantly have a 'why' in terms of everything you do but never forget the importance of patient outcomes.

*At no point am I saying that research and evidence shouldn't be a major part of everything we do, it just shouldn't be the only thing focus on.

Mobility Monday: Subscap Mobility

The subscapularis is the muscle of the rotator cuff group that moves your arm into internal rotation.   This muscle can also cause problems with limiting external rotation if the muscle is locked down and feeding into upper crossed syndrome.  These are a few simple mobilizations that can help loosen this area up and get you moving.

Things It Helps:
-Shoulder Pain
-Limited External Rotation
-Generalized Shoulder Tightness

Study Spotlight: Effect of cold vs. ice water immersion on recovery from intermittent running exercise

By: Joel Luedke

Cold water immersion (aka hoping in the cold tub) has been long used as a form of recovery in hopes of reducing soreness and coming back feeling more fresh for the next round of workouts.  The science behind its use waivers and you can pick and choose what ones fit your argument.  Does it really help soreness?  It is hard to say.  Can it help you body down regulate and set you up for enhanced recovery?  That is definitely a possibility.

This study seems to challenge all of these ideas in something new.  Find out more below.

What They Did:

This research project looked at how cold vs ice water immersion compared to a control group in 9 male team sport players.  Exercise was performed and then each group took part in a 12 minute immersion or just a control of doing nothing.  Maximal cycle performance and markers of recovery were measured before and in the 0-72 hours after exercise.

What They Found:

What they authors found is that peak power was impaired when in both the cold and ice water immersion when compared to the control.  After 72 hours of immersion the groups seemed to recoup peak power compared to control but it did take time.

What It All Means:

Based on this study it would show that doing cold or ice water after high intensity exercise would not be a good idea when it comes to trying to do repeated bouts of high intensity exercise within the following 3 days.  It shows that there could be potential to have a decrease in performance in terms of power output.  This could obviously be detrimental for games or important training sessions following major outputs of power and performance.  There is potential that after the three days you could still have your output at pre-exercise levels but you have to know if that is a risk you'd like to take.

Limitations:

The hard part about this study is such a small sample size.  9 isn't large (but we have to start somewhere) and that hurts how applicable you can make it across the board.  Also, as with any study, it focuses on specific tests and how people respond to certain exercises.   I think until this study is repeated and also can potentially be done on a larger scale.  Until that time, do your own trial and error and see what works best for you.

Resource: Anderson, D.  Effect of cold (14degC) vs. ice (5degC) water immersion on recovery from intermittent running exercise.  Journal of Strength and Conditioning Research. 2017.

Antifragility: Patient Care

Disclaimer: The concept of anti fragility is a new one to me and while not completely through the book (Antifragile-Nassim Taleb) the concept is one I've wanted to explore and try my hand at applying to my life and in doing so trying to explain it while applying it to different things in my life.  Here is the first attempt (most likely to be modified later).

The book explains that we have a full definition of 'fragile' but there is no word for the opposite.  The author introduces the concept of 'antifragile' which we have defined out of a couple quotes below.

"Antifragility is beyond resilience or robustness.  The resilient resists shocks and stays the same; the antifragile gets better.  The anti fragile loves randomness and uncertainty, which also means-crucially-a love of errors, a certain class of errors.  Antifragility has a singular property of allowing us to deal with the unknown, to do things without understanding them-and do them well."

How can this concept be applied to the practitioner (which is the focus of this post).  We can be resilient in our patient care by taking our hits if things don't go completely how we planned and we  continue on with our process and even potentially refer out.  We absorb the shock and we stay the same.  We approach every injury that seems to be the same with the same tools that we always use.  See the nail, use a hammer.  See the screw, give the hammer a try.  Obviously this ins't good for the care of the patient in the fact that every patient's issues and pain are unique to them.

This is where I think being 'antifragile' in your patient care is not only a win for the patient but a win for you, the practitioner.  If we look at the definition above we want the randomness and the uncertainty and the errors that come along wit that.  This is where we can excel and absorb the shocks that we could just past by, we use them to get better.  If there is an 'error' in diagnosis or care we learn from it immediately or it forces us to adapt in real time.  We get stronger and both entities benefit.

By maintaining an open mind you can become antifragile and accept mistakes, adapt to them and get stronger both for you and your patient.  Don't put yourself in a corner and allow that to affect you and/or your patients.

Mobility Monday: Bias, Bias, Hip Flexion and External Rotation

A lot of little changes can bring about big results when it comes to health and performance.  Focusing on biasing the hip flexion and external rotation are a couple of those things.  This video breaks down why making sure you focus on these couple of hip movements is so important and that implementing simple mobility work and stretches can be extremely beneficial.

Things It Helps: 
-Improved Squat Mechanics
-Pelvic Positioning
-Low Back Pain

Friday Food: Slow Cooker Barbacoa

We've become a cooking shredded meats lately (pulled pork has gone well) so we decided we needed to find one that we could do with beef and this is what we came up with.  Simple, cooks all day and you can make so many different meals out just one recipe.  Try it out.

Ingredients:

• 4 lbs beef brisket (or beef chuck roast will also work)
• 2 tbsp avocado oil
• 3-4 chipotle chilis in adobo
• 1 1/4 cups beef broth
• 4 tsp minced garlic
• 1 1/2 tbsp ground cumin
• 1 tbsp dried oregano
• 3/4 tsp salt, then more to taste
• 1/2 tsp ground black pepper
• 1/4 tsp ground cloves
• 1/4 cup fresh lime juice

The Game Plan:

1. Cut the beef into large cubes.  In a large skillet over medium high heat add the avocado oil and sear the beef on each side.  Transfer to your slow cooker.
2. In a food processor add adobo chilis, beef broth, garlic, cumin, oregano, salt, pepper, cloves, and lime juice.  Pulse until blended and pour on top of the meat.
3. Cook on low for 8-9 hours or high for 6 hours.  Shred the meat with two forks and turn on warm.

Source: The Recipe Critic

The Importance of Inter-Professional Collaboration

By: Joel Luedke

In a world where specialization is the norm and you can be bounced around from one appointment to the next and sometimes vision can get narrowed and that can be dangerous...for you.

Having a team that works together and collaborates for your health can be one of the most `powerful things in healthcare, wellness and performance.  This article's purpose is talk about how that inter professional collaboration, what you should look for, and why it'll benefit you.

I believe one of the best things about inter-professional collaboration is that it can benefit the patient the most and at the end of it all, that's what is important.  This can occur mainly because for professionals to work together and build off of each others knowledge base they have to check their ego at the door, this is paramount.  Having the practitioner be able to look outside themselves and ask for assistance and another point of view means the world to getting something figured out to help the patient.

As the patient you should look for a practitioner that works in an integrative practice as then they have those instant resources.  That isn't always possible to find so looking for someone that has gone outside what their deemed 'comfort zone'.  While we do believe that being a 'jack of all trades' can be beneficial we also think that at some point you either need to specialize to benefit the patient or be able to refer our in order to match the person with who they need to help benefit them the most.

Inter-Professional collaboration is an in-vogue term bouncing around the medical profession but at no time has it been more important.  Finding a team that can put your interest first and their ego behind them is best for you and anyone else that they come in contact with.

Practitioners, know what you know and know what you don't know.

Patients, find someone that is willing to ask the question and puts your health first.

Mobility Monday: Torque is King

THIS IS THE VIDEO!!!  If you can focus on getting significant torque through your hips and training your body to do it on a regular basis the results are well worth it.  Your hips are the transition point between lower body and upper body and the more you can control the position and torque of your hips the better the performance and body control.  Check it out to implement these simple techniques.

Things It Helps:
-Correcting anterior pelvic tilt
-Relieving low back pain
-Increasing power through your hips

Friday Food: No-Bake Chocolate Energy Bites

Anytime you can take some energy to go and not have to bake it, we think you have a winner.  We found this recipe that can give you a boost in energy and also get you a chocolate fix while you're at it.  Simple and pretty quick to make up.  Give them a try.

Ingredients:

• 1/2 cup no stir almond butter or creamy peanut butter
• 1/4 cup + 2 tbsp honey
• 1 tsp vanilla extract
• 3 tbsp unsweetened cocoa powder
• Up to 4 tsp warm water, as needed
• 1 cup old fashioned oats (raw)
• 3/4 cup toasted or raw coconut 
• 1/2 cup flaxseed meal
• 6 tbsp semi-sweet chocolate chips

Instructions:

1. In a mixing bowl, stir together almond butter, honey, vanilla and coachmen's powder.  If mixture seems to thick stir in 2 tsp warm water to thin.  Add oats, coconut, flaxseed meal and chocolate chips and stir until evenly coated.  At this post if mixture still doesn't stick well, stir up to 2 tsp water as needed.  Transfer mixture to refrigerator or freezer and chill until nearly set and easier to handle.
2. Remove from refrigerator and shape into 1-inch balls.  Store in refrigerator in an airtight container.

Source: www.cookingclass.com 

Study Spotlight: Effect of Deep and Slow Breathing on Pain Perception

The idea of the mind and the 'self' being able to control the reaction of the body has been a long held idea in many disciplines.  Recently it has become more accepted as something that needs to be integrated into general healthy living along with utilizing it for athletic performance.  The idea that the mind can control so much when it comes to the body's response to pain is key in this concept and this study takes a one way to help utilize it.

What They Did:

Subjects were placed in one of two treatment groups.  Attentive deep and slow breathing and relaxation deep and slow breathing.  These groups were trained in their breathing techniques.  For measurable outcomes skin conductance levels (indicating sympathetic tone) were measures,  thermal detection and pain threshold for cold and hot stimuli and profile of mood states were examined before and after the breathing sessions.

What They Found:

Both breathing groups appeared to have similar reductions when it came to mood states and negative feelings.  Pain thresholds increased for the relaxed ground but no significant changes were seen for the attentive group.  Mean skin conductance levels indicating sympathetic activity decreased in the relaxed group but not with the attentive deep and slow breathing group.

What It All Means:

I think there are a couple major parts to the results of this study.  The first being that we, as humans, have the capacity to control intensities in pain with our breath.  This leads to the idea that you can control so much of your body and what it's reaction is to different stimuli but utilizing your mind and controlling your nervous system.  If you haven't heard of Wim Hof I recommend finding something on him to listen to as he is one of the masters of this concept.   Just think (get it?) that you could help control your pain, potentially your healing (at least your reaction to it) and where that could take you in performance or just in daily life.

The second part of these results that I found extremely interesting was the difference being attentive vs relaxed when you are doing the deep slow breathing.  As someone who doesn't like to turn their mind off and hasn't even tried meditating this is an area I think that could be especially important with the type of fast passed world we live in.  Not only do you have to slow down and break deep you have to relax in the process in order to maximize efficiency.  

So the bottom line is: relax, take a deep and slow breath and let your body respond to that.

Source: Busch, Volker. The Effect of Deep and Slow Breathing on Pain Perception, Autonomic Activity, and Mood Processing-An Experimental Study. Psychology, Psychiatry and Brain Neuroscience Section.

Mobility Monday: Improving Shoulder Wind Up

Mobility is important when it comes to your shoulders but having the ability to create stability through your shoulders is equally important.  This video gets you deep into how to work to achieve both when it comes to your shoulder health.  Some simple things you can focus on to increase stability to help prevent injuries down the road.

Things It Helps:
-Shoulder Stability
-Increased Strength
-Improving Chronic Shoulder Pain

Friday Food: Cream of Turkey & Wild Rice Soup

How could we think about food on a day like this?  The day after and the turkey hangover is in full effect.  Along with that you always seem to have leftovers that you can't quite seem to figure out what to do with.  Here is a simple recipe to use up some of that turkey (can combine it with a roll or two) that you can have throughout the week and for a change of pace.

Ingredients:

• 1 tbsp extra-virgin olive oil
• 2 cups sliced mushrooms (about 4 oz)
• 3/4 cup chopped celery
• 3/4 cup chopped carrots
• 1/4 cup chopped shallots
• 1/4 cup all-purpose flour
• 1/4 tsp salt
• 1/4 tsp ground black pepper
• 4 cups reduced sodium chicken broth
• 1 cup quick-cooking or instant wild rice
• 3 cups shredded cooked turkey
• 1/2 cup reduced fat sour cream
• 2 tbsp chopped fresh parsley

The Game Plan: 

1. Heat oil in a large saucepan over medium heat.  Add mushrooms, celery, carrots and shallots and cook, stirring, until softened, about 5 minutes.  Add flour, salt and pepper and cook, stirring, for 2 minutes more.
2. Add broth and bring to a boil, scraping up any browned bit.  Add rice and reduce heat to a simmer.  Cover and cook until the rice is tender, 5 to 7 minutes.  Stir in turkey, sour cream and parsley and cook until heated through, about 2 minutes more.

Courtesy: www.EatingWell.com

Study Spotlight: Effect of Varying Self Myofasical Release Duration on Subsequent Athletic Performance

By: Joel Luedke

Soft myofascial release (soft tissue work/foam rolling) can be very effective for many things if it is applied properly.  It can reduce tightness/soreness, increase ROM, and potentially aid in increasing performance.  As with most things though if you do too much you could potentially get results you weren't looking for.  This Study Spotlight looks at different durations and their effects.

What They Did: 

Researching looked at ankle and knee ROM assessments using modified weight bearing and kneeling lunge.  They also tested vertical jump and pro agility performance.  All the tests were conducted before and immediately after one minute self myofascial release (SMR), five minute SMR or after a control condition.  The SMR was done on the quadriceps and triceps surae (calves) using a standardized protocol and foam roller. 

What They Found:

Overall what the researchers found was that ROM increased in the SMR either in the one minute or 5 minute group compared to control.  The also found that pro agility time improved slightly following SMR but decreased following the control or SMR of 5 minutes.  There was also a decrease in vertical jump after 5 minutes of SMR and changed little after SMR of 1 minute or the control.

What It All Means:

Foam rolling can be effective for many things but the dosing of use is very important.  Most things that can be good for you can turn very bad for you if you do too much of it.  Self myofascial release is no different.

Depending on your goals you need to roll appropriately.  If you are looking for increases in ROM that is great, go a little longer (2-5 minutes) but we would recommend not doing so before you are trying to participate or train for an important athletic event.  As the results show if you do too much work too long it can have detrimental effects on your body's ability to perform explosive tasks (vertical jump and pro agility in this case.  

That doesn't mean you can't work on a tight spot before you want to do something athletic you just need to be sure that when you do it it is short duration, less than a minute, and you then you shouldn't have to worry about decreases in performance.  Use the foam roller or other tool as you need too but be cognizant of how much, how often, based on your goals.

Source: Phillips, J.  The Effect of Varying Self-myofascial release duration on Subsequent Athletic Performance.  Board #116

Does the IT Band Really Stretch?

By: Joel Luedke

Nope, not really....Post Done.

The IT band and IT band friction syndrome is a source of a lot of frustration for both patients and clinicians alike.  Grounded in the chronic injury world is the idea that your IT band gets tight.  The syndrome that comes out of this is IT band friction syndrome.  The symptoms of this problem generally involves pain at the lateral side of the knee especially with landing during running and especially with going down hill. The patient may have pain along the lateral upper leg which is where people believe the 'tightness' comes from.

First things first, the anatomy.  The IT band is a very long, very thick, very strong tendon.  It is

NOT a muscle, therefore most traditional soft tissue work doesn't have the same effect on it as it would in a muscle belly.  The IT band originates from the tensor fascia latae (TFL), the iliac crest and the glute max.  These muscle are important to keep in mind when we talk about the soft tissue work you will want to focus on.

When we talk about how strong the IT band is, we mean really strong.  It is strong to the point that with maximum force put on it (before failure) the IT band can stretch about 0.2%.  For an example you can hang the weight of a Volkswagen from the IT band before it'll snap.  That is strong. That leads us to think that going at the IT band with different tools and stretching probably isn't going to result in promising or lasting results.

What is could really be going on with you pain?  I personally think most of the problems with your IT band are underlying.  If we were to put your leg in a relaxed position and did some digging around we would find a lot of latent (and you might already know of some active) trigger points in your lateral quad, up into your TFL and your glute max.  When we look at pain referral patterns of trigger points pioneered by Travell and Simmons the common trigger point areas of the lateral leg can settle their referred pain to the lateral knee.  The common location of pain when it comes to the IT band.

There can be pain as a result of mechanical issues at the lateral knee with a bowing in and out of the tendon as it comes across the knee.  Tightness and adhesions along the later quad can be a contributing factor but we also need to look at your running mechanics.  If you are looking at the stability in your hips when you run and notice that the knee dives in and your arch potentially flattens as your running we are setting up for this 'bowing' at your IT band to be exaggerated and cause more pain,

What to Do About It:

Targeted and effective soft tissue work for the lateral quad, TFL and glute max.  Focusing on these areas can help reduce pain and tightness along the lateral side of your upper leg.  This can help reduce the 'tightness' and pain you feel at the lateral portion of your know.

Strengthening the lateral hip musculature for general stability is also extremely important to help stabilize your hips and put your knee and foot in the best position to connect efficiently with the ground.  Running is something we learn to do innately as we grow up but we tend to change a lot unintentionally and then never return to it.  Treat your running form as a skill much like you would shooting a basketball or swinging a golf club and you'll reduce your risk of injury period.

LINK: Lateral Quad/"IT Band" Soft Tissue Work-VIDEO

LINK: Running Exercises-VIDEO

LINK: Treating Running Like a Skill-Article

LINK: Lower Extremity Mobility Guide (.pdf)

Mobility Monday: Thoracic Wall Walk

Thoracic mobility can lead to a lot of beneficial things for your shoulders, upper body tightness and pain and eventually increase performance.  It is an area of your body that if you can have the available mobility it can unlock so many things for you when it comes to health and performance.  This is an often overlooked place when it comes to shoulder mobility and performance.  Check this out and give it a try.

Things It Helps
>Thoracic Spine Mobility
>Shoulder Mobility
>Improved Upper Extremity Mechanics

Friday Food: Sweet N' Spicy PeppTater Boat

This recipe looks fantastic and we are glad we found it through a colleague of ours at FitRiss Studios.   the combination of peppers, potatoes and onions sounds really good and especially because you can take your time in getting this one put together and eat when you are ready.  Check it out.

Source: FitRiss Studios FitRecipes

Ingredients:

• 1 red, grey, or yellow bell pepper, halved and unseeded.
• 1 whole sweet potato
• 1 white onion, sliced
• 2 tbsp olive oil
• Dah of Garlic Salt, Pepper and Cayenne Pepper

The Game Plan

1. Add an inch of water and 1 tbsp of olive oil to the bottom of the crock pot
2. After washing sweet potato and piercing it several times with a sharp knife, placed it in the crock pot.  Leave on medium heat for 6-7 hours, or high heat for 4-5 hours.
3. After placing sweet potato in crock pot, line backing sheet with tin foil.
4. Grab each half of the bell pepper and drizzle each with olive oil.  Add spices and refrigerate on a baking sheet lined with tin foil.
5. Head out for the day and let it cook.
6. Upon arrival home, preheat oven to 400 degF and place bell pepper halves into oven.  Bake for 25-30 minutes (or until you see some wrinkles start to form in the pepper).
7. Cut open and scope out the sweet potato into a serving dish. Mash up.
8. Scoop half the mashed sweet potato out of the bowl and add it to each bell pepper boat.
9. The onion should still be in the crock pot at this time, half the onion batch with a spatula and add to the top of the mashed potatoes.
10. Enjoy.

Study Spotlight: Cryotherapy on 3D Ankle Kinematics During Cutting

By: Joel Luedke

We have thoroughly challenged the idea of icing all your aches, pains and injuries and have really asked if it is truly the best way to treat those conditions (see links below).  That being said we never want to stop looking into ways to prove ourselves wrong and then we stumbled upon this article.  It's 14 years old but anytime we can find something that make us challenge what we are doing we think it is worth checking out.  See how icing can affect the ankles motion in a cutting movement.

What They Did: 

Researchers took 21 healthy subjects and had them perform a 45deg sidestep cut prior to and after

limb cooling for 10 minutes.  They used biomechanics analysis to look at the kinematics of the ankle joint and if the displacements and velocities would be affected at all by the cooling.

What They Found:

Results showed that there was no statistical difference between the PRE and POST icing conditions when it came to the displacements and velocities of the ankle joint during a 45deg sidestep cut.

What It All Means:

The researchers used a 10 minute cooling period to mimic what could potentially happen in sport if someone were to suffer an ankle injury and want to ice it at half time.  Based on the outcomes of this study it would show that there would be in theory no changes to how the ankle moved coming back after that cooling period and returning to the game if you were able to with the injury.  This does give some evidence to that being a good case scenario if you choose to use ice as your treatment modality.

They did not look at the effects of cooling for longer periods of time and if that would cause any different effects when it came to movement nor did they look at any of the movements of the rest of the leg during the cut (while not directly affecting the hip due to icing the ankle the general movement potentially could play a role).

This lends back to what I have said for quite sometime with the athletes I work with.  If you believe that ice helps and can get you back to where you want to be, by all means put a bag of ice on it.  If you are unsure if it helps or just do it out of routine, is there a 'better' way we could approach the injury and what we could do during that halftime period to help maximize your results.  I generally choose to go to the later and encourage as much pain free movement as possible in order to keep blood flow high through the ankle and limit the amount of potentially 'damage' that could occur by potential swelling.

In the end, know what works for you and have you purpose when it comes to the treatment and recovery modalities that you choose, it'll serve you better in the long run.

Limitations:

The greatest limitations the researchers noted was not doing biomechanics analysis of the whole leg during the cutting movement and not standardizing shoes (expenses) and having the cut performed barefoot.  By doing it barefoot that would have messed with some of the kinematics as it isn't the most natural way to do the movement when it comes to sport.

Source: Atnip, B. The Effect of Cryotherapy on Three Dimensional Ankle Kinematics during a Sidestep Cutting Maneuver.  Journal of Sports Science and Medicine (2004) 3, 83-90.

TAT Resources:
LINK: Can I get a bag of ice? Can you tell me why?
LINK: Study Spotlight: Is Ice Right?
LINK: Inflammation and Swelling, More to the Story
LINK: Gary Reinl-The Anti Ice Guy

Mobility Monday: Working Upstream and Downstream

Pain is a symptom and it doesn't always occur in the location of the problem that is it's source.  Often pain and settle in one location and while that is what you're feeling and there might be injured or damaged tissue there but when we really break down what is going on we often find that the reason that pain is occurring is from tissue or structures that are upstream or down stream from where you are feeling it.  This video gives you a great breakdown on how to identify it and work through it all.

Things It Helps:
-Looking beyond the pain
-Finding tissues that need to be addressed
-Greater pain relief

Study Spotlight: Self Myofascial Release vs. IASTM on Vertical and Horizontal Power

By: Joel Luedke

Soft tissue work can be really beneficial in both the prevention and recovery of injury.  Could it also be helpful in increasing performance in both vertical and horizontal power? This Study Spotlight takes a look a couple different versions of soft tissue work and exactly how it

corresponds to power output.

What They Did:

This study looked at whether doing pre-exercise self myofascial release (SMR) and instrument assisted soft tissue mobilization (IASTM) would improve performance on measures of vertical jump height and 40 yard sprint time in recreational.  They also took a look at perceived pain levels.  Both soft tissue work groups had work done on the quadriceps, hamstrings and gastroc-soleus complex.

What They Found:

There was no interaction between the massage intervention between the massage intervention and sex for both the vertical jump and 40 yard sprint tests. There was a significant main effect for vertical jump.

What It All Means:

This study is in interesting as it corresponds with a previous Study Spotlight on Dry Needling and vertical jump.  While the results of the study show some promise that you can increase your performance with simple techniques there are a couple things to take into account here when it comes to athletics and performance.

In the study the researchers used a 5 minute bike warm up followed directly by soft tissue work in either group and then the performance of the task of vertical jump or 40 yard dash.   In the world of  'proper' warm ups we don't believe that this would count as something that would count and by just doing a more extensive and intensive warm up on its own could yield some of the same results that this study did with simple myofascial release.

The utilization of recreational athletes is also something to take into account with this study.  You can't take the results of this study and do a blanket application to all athletes.  If it were that simple to get a performance increase I think there would be more occurring in athletics when it comes to targeted soft tissue work to increase athletic performance.  The results of this study give ideas that soft tissue work can show benefits to performance but be careful in applying it to everyone.

Limitations:

As we mentioned above, the biggest limitation in this study is to be careful to not apply this one to everyone and every situation as the way the study was run doesn't fully mimic 'proper' athletic warm up.  Further research with extended periods of warm up and different sets of athletes could provide more information as we move forward.

Resource: Stroiney, D. Examination of self-myofascial release vs instrument assisted soft tissue mobilization techniques on vertical and horizontal power in recreational athletes. Journal of Strength and Conditioning Research. 2018.

Immediate Injury Management

By: Joel Luedke

Anytime you are engaged in an athletic activity you risk injury.  Those injuries can range from something acute and traumatic that can set you back from a long time and lead to surgery to something that builds over time and then causes chronic pain and problems.  How you manage those injuries especially early on can have a huge impact on how your recovery process plays out.

In this short article we want to take a look at how to manage an acute injury like an ankle sprain or minor knee sprain to help jump start the healing process.

Protect and Move

Seems counterproductive to try and do both but it really is a huge part of getting your body in the right spot to start healing.  We want to protect for as much of the day/night that we can and put your body in the best position to heal during those times.  In the example of an ankle sprain that means a walking boot which is not a death sentence but more a treatment during the day.  We want no pain so we can be set up to have the best treatment and rehabilitation setting that we can.

That is where the movement part comes in.  "Use your brain, no pain" is our slogan when it comes to movement early on in the process. Going along with our ankle sprain example this means ankle pumps, writing the ABCs with your big toe and getting the bodies natural swelling removal system to do its thing in helping the injury process.  As you progress through the injury you want to increase the level of movement and work your way to return to play.

Rest as Much as You Need to but No More

This can be the hard part of the rehab process.  When to start moving forward and when to hold back in the rehab process. We want to make sure that we do take some rest early on, let the healing process get started and then introduce movement as soon as we can but no sooner.  This is where the testing process comes in and makes the protection portion from above so vital.  You can get the rest in between rehab sessions along with returning to activity.  Don't wait too long but make sure you listen to your body as you go.

Is Ice Right

Without getting too far into the argument (please see the links below) ice is really your decision.  Do we think it adds to the rehab process?  Not so much and in fact can actually slow things down during the process.  There is little to no solid evidence showing how it enhances the function of trying to get swelling to evacuate and get more into the rehab process.  If it makes you feel that much better, by all means, but don't just throw a bag on for the sake of doing it.

LINK: Is Ice Right?
LINK: "Can I have a Bag of Ice?"

Mobility Monday: TMJ Work

You don't realize how important the tempero-mandibular joint is until it flares up and lets you know how important it is.  The pain and dysfunction can be excruciating but the good news is you can do a lot of work on your own to make sure that it doesn't become an issue.  Check it out below.

Things It Helps: 
-TMJ Pain and Soreness
-Tension Headaches
-Associated Neck Pain

Study Spotlight: Dry Needling vs. Sham on Performance of Vertical Jump

Dry needling is a very powerful soft tissue technique that goes directly to the spot of a myofascial trigger point.  While that can be helpful in a treatment and rehabilitation sense could it also be beneficial for performance?  We take a look at that question in this weeks Study Spotlight.

What They Did:

Researchers looked 35 healthy students (19m, 16f) who were divided into two groups, dry needling and sham.  The dry needling group received needling at four sites on bilateral gastroc muscles, two in the medial and lateral head.  The sham group had four areas pressed with the tube housing the needed but the need was never inserted into the skin. 

Two legged vertical testing was done by reaching up with a chalk mark at standing and then doing a countermovement jump and remarking with chalk on the jump and measuring the distance in between.  One jumped was performed prior to treatment and another after.

What They Found:

After analysis of the data it was found that the dry needling group significantly increased vertical jump height of 1.2 inches over the sham group.

What It All Means:

This study can give us ideas of how beneficial soft tissue work can be for your performance.  It doesn't always have to be something like dry needling in order to get the results of soft tissue work that could be beneficial to performance.  Give foam rolling and self myofascial release a try to help not only feel better but also get increased performance benefits.

Limitations:

Dry needling can be a hard treatment to recreate as a sham treatment due to the fact that no needle is inserted with the sham and therefore nothing remains in or on the skin like it would during an actual treatment.  There is also nothing to remove either in a sham treatment like there is with an actual treatment.

Testing vertical jump height can be tough and it can be hard to find the best testing set up to get maximum results.  There could be different results in the vertical jump test if the subject is given a goal in order to reach and this can result in increased performance.

Source: Brandy, W. Comparison of dry needling vs. sham on the performance of vertical jump. The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017

Mobility Monday: Recovery Workout

This isn't exactly mobility, it is recovery but the two go hand in hand.  In order to increase your mobility and allow your body to do the things you want it to you have to recover.  This is becoming more of an awareness across the world of elite sports and we hope that it trickles down to the other levels in order to help younger athletes get more out of their career.

Check out this recovery work out by Ryan Flaherty and how he utilizes it with the athletes he works with.

Things It Helps:
-Increased Mobility
-Enhanced Recovery
-Overall Better Performance

Getting Things Done...One Step at a Time

By: Joel Luedke

"Most people OVERestimate what they can get done in a week but UNDERestimate what they can get done in a year." -Tony Robbins

I've found myself quoting this line more and more lately as well as constantly reminding myself of the same words.  In this post we will talk about a couple different applications of this idea and why it's important to not just focus on the short term but also to look at the long game when it comes to things in your life.

Accomplishing Fitness & Nutrition Goals

If you try and change everything in your life in an attempt to eat better or get in shape you're almost doomed to fail.  It is almost impossible to maintain.  Find things you can change in your day that you can do one at a time.  (See more ideas from this CP Short, featuring Own the Day: Own Your Life by Aubrey Marcus). 

Instead of changing your entire diet and then missing certain things, find one main thing, adjust it, attack it, own it and then find the next one and repeat.  This is a much more sustainable way to progress and allows you to not have a guilt if you do slip up to an old favorite.

The same applies to fitness, you can't make up for weeks and weeks of bad diet and inactivity with one workout or week of workouts.  No amount of sweat or soreness is going to make up for that period of inactivity.  It is the accumulation of all those activities and workouts that will add up to the success that you are looking for.

Accomplishing Coaching & Career Goals

Ambitious people in the health, fitness and medical space want to know everything they can as soon as they can and it is almost impossible to accomplish.  When we try and consume all that information in a short period of time it is difficult to absorb it all and then apply it to your work.  This notoriously happens after a great weekend seminar but then there is not follow up on the application of the information in the following weeks.

Take a look at this way, instead of trying to cram all kinds of information in as fast as you can attack things one day at a time.  If you were to learn and own one thing every day for an entire year you are looking at picking up 365 really good bits of information that you can take and apply to your work and start making connections between all those things you learn.  This can make a huge impact when you are looking helping people because you can implement it as you go.  If you try and consume all that information one weekend...most of the time it just kind of fades away.

Don't get overly ambitious in a short amount of time, it's hard to sustain that and keep that information alive and in your mind.  Take it step by step, own what you learn and make a huge impact.

Mobility Monday: Scapular Mobility

The shoulder is a very complicated joint.  What it can do and how it can more in order to accomplish those specific tasks are quite impressive.  Often when we think of the shoulder we think the main glenohumeral joint and everything that occurs there.  Often the scapulo-thoracic movement is overlooked and this can be a huge mistake when it comes to looking to improve shoulder mobility.  Find some great ideas in this video.

Things It Helps:
-Generalized Shoulder Pain
-Upper Back Pain/Tightness
-Improved Mechanics

Mobility Monday: Chair of Death

We've long held the stand point that 'sitting is the new smoking'.  That might be a little extreme (but what isn't in health and fitness these days) but there are a lot of things that sitting for long periods of time can do to you body.  Now it is really hard to avoid sitting all day as our culture is set up around it.  You can do a lot of things though to help yourself out and make sure that it doesn't really mess with your hips and potentially lead to all kinds of problems.  Check some ideas out below.

Things It Helps:
-Problems Sitting in Chairs
-Low Back Pain
-Tight Hip Flexors

Mobility Monday: Fibular Head and Knee Pain

The knee doesn't seem like it would be that complex but there are a lot of moving pieces going on that could have an effect on why you might be having some knee pain.  One area that isn't so common (at least we haven't seen it that way) is how the fibular head plays a role in how the knee works.  This video gives you a little insight on to how that could play a factor and helps to make sure that you aren't overlooking it.

Things It Helps:
-Generalized Lateral Knee Pain
-Better Knee Mechanics

Reducing Electromagnetic Fields (EMFs) in Your Life: 3 Easy Ways

By: Joel Luedke

Electromagnetic Fields (EMFs) are around us everywhere but as with most things technology today you don't really see it or know its there, like the cloud ("no one understands the cloud").  The use of these EMFs to transmit information is nothing new but after listening to more information on the subject it can be surprisingly outdated.  The standards that were set on what levels are safe were created in the late 1990s and cell phones have changed quite a bit since then (think Zach Morris cell phone). 

While at this point we would be hard pressed to eliminate EMFs from our life we can do a lot of simple things to control them.  These ideas fall under the area of small changes in life that may not have an immediate and huge impact but in the long run could really benefit you and how your body responds to stresses. Check them out.

Headphones of Speaker Phone When you Talk

How a cell phone might effect your brain and the regulations on that information go way back, like 20 years back.  Not only that but the 'person' they used to gather this data was not a person but a mannequin that mimicked a 6'2" 250 person...not your typical average Joe.  Cell phones emit waves and wifi and bluetooth but what are you to do?.  You can purchase a case to help reduce the EMFs (see below).  Another simple idea is to hold the phone away from your head a little bit (they did in the testing) or try and get on speak or use a hard wired head set or ear buds for your conversation.

In the long run this can really add up to less direct and close access of the EMFs coming off your phone and going directly into your head.  Again, small changes that could have big benefit and we are pretty certain will not make matters worse.

LINK: SafeSleeve Phone Case

WIFI Off at Night

This is one we are definitely going to try along with getting our phone on 'airplane mode' throughout the evening.  The science is still young but there are a lot of thoughts that the WIFI signal can subtly but substantially mess with your sleep.  The easiest way to get around this is to get your WIFI router somewhere far away from your bed, ours is currently in the room underneath out bedroom (not exactly great placement).  The next best option and one that is easy is to put your router and modem on a timer.  By having it turn off right around when you go to bed and turn back on when you wake up you are able to limit your exposure during the night time and not affect your sleep.  Again, simple with the potential to have profound impacts.

LINK: Outlet Timer

Hardwired is the Way to Go

The last one is one that would seemingly set us back to the Stone Age, hardwire everything.  If you have the option at work get away from the WIFI and sitting at your computer and get it hardwired.  This can help again reduce your exposure throughout the day and how you are needing to deal with it constantly.  Another plus is you'll get dropped less and maybe even have a little extra speed.

This is also the case with cell phones and land lines.  If you are able to make sure you use something that is wired in as it again can help reduce your exposure during the day from all the signals that are running through the air.

Simple ideas that can have profound effects on the long term of your health and they don't require a lot of extra effort on your part.  Are they game changers?  It is hard to say but it won't hurt and why not hedge your bets.  We are looking forward to seeing how it helps us.

Human Optimization Hour w/ Kyle Kingsbury

Mobility Monday: Adductor Destructor

Working on your adductors is not a fun thing.  It is often an area that can get extremely tight and when you get in deep to that tissue that doesn't seem worth it until you're finally finished.  This is a good technique that you can try to start working into all of those areas and getting something accomplished making sure you get it loose to help you out.

Things It Helps:
-Adductor/Groin Tightness
-Weak aBDucdtors
-Reduction in anterior hip pain

Friday Food: Greek Tortellini Salad

Big fans of tortellini around here and anyway we can incorporate it into a meal we are happy to do so.  This recipe is a little different then your typical tortellini and sauce dinner (even though it isn't pesto).  Something that you can make up ahead of time and use the next day and still get a good set of macros in for a meal.  Give it a try.

The Ingredients:

• 10 oz refrigerated cheese tortellini (2 1/2 cups)
• 1/4 cup crumbled feta cheese
• 3 tbsp extra-virgin olive oil
• 2 tbsp red-wine vinegar
• 1 tbsp chopped fresh oregano
• 1/2 tsp ground pepper
• 1/4 sp salt
• 1 cup chopped tomatoes
• 1 cup chopped cucumber
• 1 cup sliced spinach
• 1/4 cup chopped red onion

The Game Plan: 

1. Bring a large pot of water to a boil.  Add tortellini and cook until just tender, about 4 minutes.  Drain.
2. Meanwhile, whisk feta, oil, vinegar, oregano, pepper and salt together in a large bowl.  Add tomatoes, cucumber, spinach, red onion and the cooked tortellini. Toss to coat.

Refrigerate for up to 1 day.

Source: Eating Well

Study Spotlight: Clinical Exam and Intramuscular Tendon Involvement in Hamstring Injuries

By: Joel Luedke

Hamstring injuries are the most common non-contact soft tissue injuries that are likely to be suffered by an athletic population.  They are not hard to evaluate but in order to determine the true severity of the injury and if it involves the intramuscular tendon can be tricky.  This Study Spotlight takes a look at that very process, identifying tendon involvement based on the clinical examination.  Check out what they found.

What They Did: 

Researchers in this study set out to take a look at if by using flexibility and strength testing if we are able to determine if intramuscular tendon involvement is present in a hamstring injury.  They wanted to know if we are able to gather this information could it be used in better classification of injury severity on clinical exam.  They did this by measuring flexibility, strength and comparing to diagnosis via MRI.

What They Found:

Of the 74 acute hamstring injuries they evaluated, 52 (70.3%) of the injuries affected the myotendinous junction.  These 52 injuries showed increased deficits in flexibility and decrease mean strength when tested at 15deg of knee flexion compared to the injuries without intramuscular tendon discontinuity.  They also found that flexibility and strength showed major overlap and variance among injuries with and without intramuscular tendon involvement.

What It All Means:

While it is not surprising there was differences when it comes to the flexibility and strength with these more severe hamstring injuries the results show that it is still almost impossible to differentiate the extent of severity with clinical tests alone.  This can make it hard to determine 'proper' return to play timelines due to the fact that you can't really tell intramuscular tendon involvement on clinical exam.

The frequency as which they found intramuscular involvement, 70.3% I think is extremely telling that this might be more common than I previously expected.  While there are on 74 in the study the fact that the percentage is that high will be something we keep in mind as we treat hamstring injuries and look at return to play guidelines.

Limitations

I think the researchers did a good job in listing their limitations with the major one is not being able to know where the subjects were at strength or flexibility wise prior to the injury (as they weren't intentionally injured as part of the study).  This could play a role in how the subjects responded post injury but something that isn't able to be controlled for.

Resource: Can a Clinical Examination Demonstrate Intramuscular Tendon Involvement in Acute Hamstring Injuries?