"If a practitioner cannot define what they are feeling for in any realistic, scientific manner, then what is the outcome measures guiding their treatment? By this I don’t mean the outcome measure used to define success in the eyes of patients such as pain or range of motion. I mean what is the tactile finding that, on a moment-by-moment basis, guidance the practitioners treatment? How does one know when soft tissue ‘release’ procedures are appropriate vs. passive modalities? How does one know the needed amplitude and direction of force to apply? How does one know when the treatment is over? These and many other questions require that the practitioner is able to palpably distinguish between normal and abnormal anatomic structure, and further that they have a working definition/understanding of what they are looking for."
- Andreo Spina
Interview by Patrick Ward, http://optimumsportsperformance.com
1) Thanks for taking the time out of your busy clinical and teaching schedule to do this interview, Dr. Spina. Can you please give the readers a short overview of your background??
I studied Kinesiology at McMaster University in Hamilton, Ontario, Canada. I later graduated with summa cum laude and clinic honors from the Canadian Memorial Chiropractic College as a Doctor of Chiropractic and subsequently completed the two-year post-graduate fellowship in sports sciences. During my time studying Chiropractic, I became the first pre-graduate student to tutor in the cadaver laboratory in the department of Human Anatomy, a position that continued throughout my post-graduate fellowship program.
Stemming from my passion of studying and teaching anatomy, in 2006 I created Functional Anatomic Palpation Systems (F.A.P.)™ which is a systematic approach to soft tissue assessment and palpation. Following the success of F.A.P. seminars, I later created a follow up system of soft tissue release and rehabilitation called Functional Range Release (F.R.)® technique which is now being utilized by manual practitioners around the world including the medical staffs of various professional sports organizations. I then combined the scientific knowledge gained during my studies with my 29 years of martial arts training in various disciplines to create the third installment of my curriculum, Functional Range Conditioning (FRC)™, which is a system of mobility conditioning and joint strengthening.
Aside from my work teaching seminars, I also own a sports centre in Toronto, Ontario where I practice and train clients. I am a published researcher, and I have authored chapters in various sports medicine textbooks.
2) You approach to soft tissue therapy is extremely comprehensive and, after having attending one of your courses before, it is obvious that you have spent a lot of time reading research in order to develop your thought processes and theories about what may be taking place when we apply contact to another person’s body. The fascial system is a big part of your approach and the concept of the fascial system and how the body is connected has gained a lot of popularity in recent years. Can you please explain your approach and this concept you refer to as “Bioflow Anatomy”?
To say that the Functional Range Release system has a sole focus on fascia is not entirely accurate actually, although it might have been in the not so distant past. Further examination of literature has led/forced me to be more inclusive of other tissues, which together constitute the most abundant type of tissue in the human body, namely Connective Tissue (CT). Examples of other tissues inclusive in CT other than fascia include bone, cartilage, tendons, ligaments, blood vessels, lymphatic tissues…and even 80% of nerve structure. When contemplating the effects of manual therapy ‘inputs,’ or even training inputs for that matter, we must be inclusive of all of these tissue types as each of them will equally adapt to applied inputs. To say that with a particular soft tissue technique application I am affecting one tissue vs. another is as inaccurate as claiming that any particular exercise targets a single tissue, which is in fact impossible. This line of thought stems from literature examining the effects of load inputs on cellular/subcellular processes…a topic that we dive into deeply in the FR Release curriculum.
Continue to read the rest of this article by clicking HERE
Thanks to Patrick Ward for this interview!
They say the early bird gets the worm, but at BSMPG there are no worms - just the best sports medicine and performance professionals from around the world! See speakers such as Mark Lindsay, Joel Jamieson, Charlie Weingroff, Stu McGill, Adriaan Louw and Marco Cardinale all under one roof followed by our incredible social Friday night and the best sports science, equipment and nutrition suppliers in our vendor area throughout the two days.
Don't miss out on our EARLY BIRD SPECIAL - After April 15th price of admission is $349 (pending seat availability)
When it comes to developing the highest level of athletes, few professionals understand what this actually means like Marco Cardinale.
Lucky you - now you can.
Learn from the man that led Britian's Sports Science activities for the Olympic preparation at the Beijing 2008, Vancouver 2010 and London 2012 Olympic Games at the 2013 BSMPG Summer Seminar. As if your time at our annual seminar with Dr. Cardinale and other leaders in sports medicine and performance isn't enough, you'll also be entered to win win a copy of his book,
Strength and Conditioning: Biological Principles and Practical Applications
Like you needed another reason to attend the world's top Sports Medicine and Performance Seminar.
This book provides the latest scientific and practical information in the field of strength and conditioning.
The text is presented in four sections, the first of which covers the biological aspects of the subject, laying the foundation for a better understanding of the second on the biological responses to strength and conditioning programs. Section three deals with the most effective monitoring strategies for evaluating a training program and establishing guidelines for writing a successful strength and conditioning program. The final section examines the role of strength and conditioning as a rehabilitation tool and as applied to those with disabilities.
This book is an invaluable textbook and reference both for academic programs and for the continuing education of sports professionals.
- Integrates the latest research on physiological, anatomical and biomechanical aspects of strength and conditioning
- Offers numerous practical examples of applications
- Provides guidelines for writing and monitoring effective strength training programs
Join the leaders in Sports Medicine and Performance in Boston May 17 & 18, 2013 for the BSMPG Annual Summer Seminar featuring Marco Cardinale, Stuart McGill, Fergus Connolly and Adriaan Louw as Keynote speakers.
Sign up today - discounted rates end December 31st, 2012.
Click below to see highlights from our 2012 BSMPG Summer Seminar featuring Keynote Speaker, Irving "Boo" Schexnayder.
More highlights are set to come in the next few weeks so stay tuned!
Save the date for the 2013 BSMPG Summer Seminar - May 17th & 18th in Boston MA.
Keynote Speakers include: Dr. Stuart McGill, Dr. Marco Cardinale, Fergus Connolly, Adriann Louw and Marvin Chun. Individual learning track speakers will be announced shortly.
This is sure to be the biggest Sports Medicine and Sports Performance Seminar to date!
A special thanks again to our SPONSORS!
Meet Gil Blander and learn more about Inside Tracker from Segterra at the 2012 BSMPG Summer Seminar.
InsideTracker analyzes your bloodwork and gives you recommendations and an optimal eating plan. All InsideTracker recommendations are based on scientific evidence and tailored to you. If your life changes, so does InsideTracker.
See the leaders in Sports Medicine and Performance at the 2012 BSMPG Summer Seminar!
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The Fusion Event Track at BSMPG
May 19th 2:30-3:30pm
The fusion of sports and medicine becomes a more potent mixture each day. Using tools that gauge performance with a high degree of accuracy allows us to quantify our results in almost any fashion imaginable. Tracking minute changes in the body such as heart rate, function, mobility and mechanics provides us information on our athletes that we can rely on to develop customized programs for each athlete. Real-time reporting functions provided by today’s latest technology make it simple and efficient to make evidenced based decisions in any setting.
Doctors, physicians and trainers are all working closely with one another to bring the most comprehensive care an athlete can hope for. Student athletes are among the top demographic to benefit from this union of sports and medicine where coaches and trainers regularly evaluate hundreds of students regularly. Coordinated care breeches team practices in addition to advising on lifestyle choices and curriculum.
Outside of institutions, merging is evident in private facilities where athletic development is the number one priority. Through the eyes of Dr. Thomas Lam, Director of Athletic Development at FITS Toronto, an environment focused on sports-science and coordinated care is a premier destination for training and therapy. Located in the hub of Canada, Dr. Lam’s two Toronto locations service every level of athlete, each equipped with a sports science lab. Tracking manipulations to the nervous system by evaluating the results in through changes to the biomechanical system, Evan Chait of Kinetic PT brings his discussion to OptoSource’s Fusion Track workshop.
For attendees of the Boston Sports Medicine & Performance Group, the Fusion Track will be the ideal chance to learn about incorporating data collection into sports performance planning and get a look at the best tools for managing all of the streams of information sports performance programs rely on today.
Speakers for this presentation include:
Dr. Thomas Lam of FITS Toronto on integrating objective analysis into an existing sports performance and medicine program.
Evan Chait of Kinetic PT will discuss The Chait Neuropathic Release Technique (CNRT), a multidisciplinary diagnostic and treatment process that focuses on 3 tiers of health. The 3 Tiers include the nervous system, biomechanical system, and the movement pattern system.
What to expect:
- Using the cloud to safely and efficiently manage data.
- Incorporating multiple streams of objective analysis into existing programs.
- Tracking and trending change for coordinating care.
Visit OptoSource for more information!
See this track along with 22 other lectures to choose from during our 2 day event this May 19th and 20th. A few seats remain - sign up before the last one goes!!!
Basketball is a multifactorial sport where recovery, nutrition, training, technical & tactical aspects, mental preparation and innate conditions are involved. As S&C coaches, our ultimate goal is to enhance the team performance by optimising each player´s physical condition and helping them stay away from injuries.
Profiling athletes is an important part of the training process that helps me to decide what is the most appropriate strategy for each of the players I coach.
The image below represents the average results of 3 pre-season assessments to determine the % of Type I muscle fiber (Slow Twitch). It is an example of two different football players, both of them playing for the same team but with a different muscular profile.
The player on the left seems to have lower predominance of slow twitch as every muscle group except Semitendinosus (very postural muscle) is within 30-45% of slow muscle fibres.
The player on the right seems to have higher predominance of slow twitch, especially on key muscle groups like Biceps Fem (59,8%) and Gluteus Max (62%).
Click HERE to continue reading...
See Jose and other internationally known speakers at the 2012 BSMPG Summer Seminar May 19-20th.
Hurry - Seats are limited.
Ever wonder why some Performance Coaches, Athletic Trainers, or Physical Therapists always seem to be ahead of the curve?
What do they see that you don't?
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This is part 1 of the weekly “Friday Five” series where I ask 5 tough questions to world class elite coaches.
Irving "Boo" Schexnayder is regarded internationally as one of the leading authorities in training design, especially in the Jump events. He coached triple jumper Walter Davis, long jumper John Moffitt, and 19 NCAA Champions.
Boo will be speaking at the Boston Sports Medicine and Performance Group (BSMPG) on May 19-20, 2012.
You can also see his complete jumps DVD package for the Long, Triple and High Jump (plus a weight training bonus).
Q1 – SpeedEndurance.com: A lot of confusion and mystery lies with the true volumes of jump training that is sufficient for stimulating neuromuscular adaptions and teaching. While small doses are often looked at as the goal, teaching takes repetition. Could you expand on how important the sequence of the training year and the quality of foot strike? Can you explain why it seems that some programs thrive off of higher volumes while some just lead to injury?
BOO: As far as foot strike, the ability to properly dissipate impact forces through full-footed landings is obviously a huge help to staying injury free while jump training. I think there are two other, more subtle keys to successful progression and remaining injury free in jump training. The first lies in variety, specifically advancing training cycles in a timely fashion. The other is taking a purposeful approach to the process.
Just as athletes do, we as coaches tend to settle into comfort zones. You get your athletes doing particular forms of jump training. Then, as mastery is approached, it’s time to move on to something else, but our natural tendency is to breathe easy and admire our work for a while. Periodic shifts in exercise choice, volume and intensity are critical, even though they might make life for the coach tougher. Successful higher volume programs do this and show a bit of a pioneer spirit.
Also, everything done must have a very specific purpose. That purpose might be establishing initial volumes, technical development, high end or low end elastic strength development, or whatever. It’s easy to fall into a “this is my fallback workout” philosophy if you are not targeting something specific. This is the primary rationale behind the small volume programs, and I think this is the key with high training age athletes who have already accumulated injuries and other physical issues over the course of a career.
In either case, whether it is failure to progress or mindless repetition, at this point jump training quits being a stimulus and becomes simply another piece of baggage that must be carried around that increases injury risk.
Q2 – SpeedEndurance.com: You mention that Olympic lifts are great harmonizing agents to a program. With your experience could you address what mechanisms and systems such as posture and coordination enable the lifts to transfer to sprinting and jumping?
BOO: The results I see in my program are the main reason I feel strongly about using Olympic lifts. I don’t want to give anyone the impression that I researched them first and then started to use them. My personal journey was more of a matter of seeing huge gains and then figuring out why.
I think the orders of joint firing and the mixing of absolute strength, power, and eccentric activity show huge transfer into sport specific skills. Also, the need to stabilize the core while performing something functional like an Olympic lift does more for the body’s core than all the crunches in the world. In short, they are highly functional.
I am a fan of functional training. But I have never gone completely that way, always keeping a base in more old school approaches. Maybe it’s because I started my career in football, but it’s also because I have watched too many great athletes train that way to scrap it.
I think a key variable in strength training is the amount of muscle tissue activated in the course of a repetition. That variable, more than any other, affects blood chemistry and endocrine responses. Many exercises are functional but don’t elicit enough muscle fiber activation to accomplish this. Olympics are where gross movements meet functional training and old school meets new school.
Continue reading on speedendurance.com
See Coach Schexnayder at the 2012 BSMPG Summer Seminar as he talks, "Mulitjump Exercises: Applications for Teaching, Training, and Rehab"
Coach Schexnayder joins Chris Powers, Craig Liebenson, Bill Knowles, and Alan Grodin as Keynotes speaers. See these world class speakers along with the best Sports Medicine, Hockey and Basketball therapists and performance coaches throughout the weekend - May 19-20.
Register today before seats fill up!
By Art Horne
With recent season ending ACL injuries to New York Knicks Iman Shumpert, and Chicago Bull’s point guard Derrick Rose coming on the same day, (not to mention Eric Maynor from the Thunder and Spanish Star Ricky Rubio earlier this season) discussion has arisen as to how these terrible injuries could have been avoided. Although the possible contributing factors are endless, ranging from previous injury to simply fatigue, one area worth shedding more light on, especially in the case of young Rose, is the implication of the kinetic chain as a whole.
Let’s start at the ground and work our way up.
I think we’d all agree that the big toe is a big deal. But how closely are we looking at this “pivotal” body-ground juncture?
In a study by Munuera et al, researchers found that “Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet. There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion.” (Munuera et al, 2012).
TRANSLATION: People with abnormally stiff or limited motion at the great toe had excessive motion at the joint just distal.
If you don’t have mobility where you need it, you’ll surely get it somewhere else.
Let’s move up the chain shall we?
In a study by Van Gheluwe and his group, researchers looked at how a stiff or limited great toe joint changes the way we walk. In their study, “two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics. The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head. Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads. Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur.”
TRANSLATION: if you have a limited motion in your great toe, pressure changes will occur – increase pressure changes will cause pain over time (think blister on your foot).
And pain changes the way we move – period.
Let’s take a look at the ankle.
In an article by Denegar et al, the authors outline the importance of regaining normal talocrural joint arthrokinematics following an ankle injury. The authors note,
“All of the athletes we studied had completed a rehabilitation program as directed by their physician under the supervision of a certified athletic trainer, and had returned to sports participation. Furthermore, all had performed some form of heel-cord stretching. None, however, had received joint mobilization of the talocrural complex. Despite the return to sports and evidence of restoration in dorsiflexion range of motion, there was restriction of posterior talar mobility in most of the injured ankles. Posterior talar mobilization shortens the time required to restore dorsiflexion range and a normal gait. Without proper talar mobilization, dorsiflexion range of motion may be restored through excessive stretching of the plantar flexors, excessive motion at surrounding joints, or forced to occur through an abnormal axis of rotation at the talocrural joint.” (pg. 172)
TRANSLATION: I repeat, Without proper talar mobilization, dorsiflexion range of motion may be restored through excessive stretching of the plantar flexors, excessive motion at surrounding joints, or forced to occur through an abnormal axis of rotation at the talocrural joint.” (pg. 172)
If you don’t have normal ankle motion, and specifically at the talus, your ankle motion (although appearing normal) is probably coming from other joints and/or in a combination with foot pronation.
Foot Pronation = Tibial Internal Rotation
Tibial Internal Rotation = Femoral Internal Rotation
Tibia and Femur Internal Rotation = Knee Valgus (or knee collapse)
Knee Valgus = BAD
But just because you have some extra motion doesn’t mean you’re doomed right?
But, excessive motion without the ability to control that motion certainly does. So where does knee control come from? The Hip!
But hip strength, control, and neuromuscular timing is seldom appreciated, and in the case of the basketball athlete it is certainly poorly measured, especially after ankle injury.
In a study by Bullock-Saxton, researchers investigated muscle activation during hip extension after ankle sprain and showed a changes in timing of muscle activation in the ankle sprain grouped compared to the non-injured group.
“the results highlight the importance of the clinician’s paying attention to function of muscles around the joints separated from the site of injury. Significant delay of entry of the gluteus maximus muscle into the hip extension pattern is of special concern, as it has been proposed by Janda that the early activation of this muscle provides appropriate stability to the pelvis in such functional activities as gait.” (pg. 333)
In another study examining ipsilateral hip strength/weakness after the classic ankle sprain, researchers demonstrated that subjects with unilateral chronic ankle sprains had weaker hip abduction strength and less plantar flexion range of motion on the involved sides (Friel et al., 2006)
“Our findings of weaker hip abductors in the involved limb of people with chronic ankle sprains supports this view of a potential chronic loss of stability throughout the kinetic chain or compensations by the involved limb, thus contributing to repeat injury at the ankle.” (pg. 76)
“If the firing, recruitment, and strength of the hip abductor muscles in people with ankle sprains have been altered because of the distal injury, the frontal-plane stability normally supplied by this muscle is lacking, and the risk for repeat injury increases. Weak hip abductors are unable to counteract the lateral sway, and an injury to the ankle may ensue.”
TRANSLATION: Ankle sprains cause neuromuscular changes up the chain and specifically in the hip. If this weakness is not addressed after an ankle injury,” frontal-plane stability normally supplied by this muscle is lacking.”
Lack of frontal-plane stability + Knee Valgus = Injury
Of course suggesting that the above points are exactly the reason for which Rose suffered his injury is certainly a stretch and not the intention of this post, nor is it to question the treatment that he or any other NBA player received prior to their devastating injury (for the record, the Chicago Bulls Sports Medicine and Strength Staff are regarded as one of the very best in the league). What I am suggesting however is that examining athletes and patients with the use of advanced technology to determine a state of readiness to participate, and/or examine more closely changes in gait and neuromuscular firing is certainly worth pursuing, especially in light of the ever-rising salaries within professional sports. A quick look is certainly worth the small investment.
One thing is for sure, ACL injury is not limited to teenage females or only seen on the soccer pitch.
The NBA Should Have Learned From The NFL - Injuries On The Rise
Did The NBA Lock-out Ultimately End Chauncey Billups' Career?
See lectures directly related to gait, injury prevention, and performance at the 2012 BSMPG Summer Seminar:
1. Dr. Bruce Williams: Hit the ground running: Appreciating the importance of foot strike in NBA injuries
2. Dr. Bruce Williams: Breakout Session: Restoring Gait with evidence based medicine
3. Art Horne and Dr. Pete Viteritti: Improving Health & Performance - Restoring ankle dorsiflexion utilizing a manual therapy approach
4. Dr. Tim Morgan: Biomechanics and Theories of Human Gait: Therpeutic and Training Considerations
5. Jose Fernandez: Advanced Player Monitoring for Injury Reduction
See the most advanced player monitoring equipment currently available at the 2012 BSMPG Summer Seminar:
Munuera PV, Trujillo P, Guiza L, Guiza I. Hallux Interphalangeal Joint Range of Motion in Feet with and Without Limited First Metatarsophalangeal Joint Dorsiflexion. J Am Podiatr Med Assoc. 102(1): 47-53, 2012.
Denegar, C., Hertel, J., Fonesca, J. The Effect of Lateral Ankle Sprain on Dorsiflexion Range of Motion, Posterior Talar Glide, and Joint Laxity. J Orthop Sports Phys Ther. 2002; 32(4):166-173.
Van Gheluwe B, Dananberg HJ, Hagman F, Vanstaen K. Effects of Hallux Limitus on Plantar Foot Pressure and Foot Kinematics During Walking. J Am Podiatr Med Assoc. 96(5): 428-436, 2006.
Bullock-Saxton, J. E., Janda, V., & Bullock, M. I. (1994) The Influence of Ankle Sprain Injury on Muscle
Activation during Hip Extension. Int. J. Sports Med. Vol. 15 No. 6, 330-334.
Friel, K., McLean, N., Myers, C., & Caceres, M. (2006). Ipsilateral Hip Abductor Weakness After Inversion
Ankle Sprain. Journal of Athletic Training. Vol. 41 No.1, 74-78
Smith RW, Reischl SF. Treatment of ankle sprains in young athletes. Am J Sports Med. 1986;14:465-471.