Boston Sports Medicine and Performance Group, LLC Blog

Speaker at this past summer's, "Standing On The Shoulders Of Giants" Seminar, Clare Frank continues to educate the nations top sports medicine and rehabilitation clinicians in her upcoming 2012 speaking engagements.

See Clare's 2012 Speaking dates below.

Asuza - 2012 DNS Course

Janda Approach - Arcadia 2012

by Art Horne

Over the past several years I have made the integration of Sports Medicine care and Strength Training a core principle within our department.  This is relatively a new concept as strength coaches and sports medicine professionals have often been pitted against each other by sport coaches, athletes and often themselves.  Although this new path to better health and performance is clearly thwart with challenges, there are some simple steps that both departments can make that immediately impacts BOTH the health and performance of the student-athlete and leaves both professionals looking better in the eyes of all those around them.  Below is a question from a colleague that I wanted to share publicly.  In order to answer his question, as well as many others, it is my intention over the next few months to describe and share with you the many small steps that any college or university can implement in order to provide an improved care and performance model.

Question:

I would like to start out by saying that I really enjoy watching the videos and articles that you have released in reference to the approach you use at Northeastern University to bridge the gap between strength and conditioning and sports medicine. I am a strength and conditioning coach for a small Div. I college and also have a background in athletic training. I wanted to see if you could provide more insight as to how you take the results from the screening and testing that you do and then implement them into your programming. We screen our athletes, which consist of the FMS and a couple more orthopedic screens that we feel are applicable to the particular sport (Modified Thomas Test, Bridge w/ Leg Extension, Reach/Roll/Lift, etc….). How would you then use the results in the development of your program? Do you give each athlete individual work or do you use a systematic team approach addressing common faults or dysfunctions? I am torn as to what to do because as I am sure you are familiar with, time I have to spend with athletes is limited and getting them to comply with performing certain exercises on their own time can be very difficult at times. Any advice or examples that you could provide would be very beneficial. Thanks in advance for your time.

The Language Barrier:

The first step in any “relationship” is being able to understand what the other person is saying, and there is no greater communication gap in existence than the one that currently exists between Sport Medicine and Strength Training professionals.  In order to discuss dysfunctional movement patterns, corrective exercises, rehabilitation goals or substitutions/alternatives for strength exercises both parties must share a common language and then demand continuity with these terms.

I remember many years ago speaking to one of our staff members about a particular athlete and suggesting that she speak to the strength staff about an alternative exercise for an athlete who was suffering from some low back pain.  When asked what I recommended I immediately suggested a more spine sparing approach to her current “core strengthening” exercises and that we recommend McGill’s “Birddog” exercise which has been proven to be safer on the spine than the flexion based crunches the athlete was accustomed to in the weight room.  Not knowing what a “Birddog” exercise was, I quickly demonstrated the exercise to my co-worker at which time she smiled and said that she was familiar with the exercise but learned it as a kneeling opposite arm-leg reach.   Confused, (since McGill made the exercise famous as part of his “Big Three”) I asked another staff member what the exercise was that I was performing to which he replied, “a quadruped contralateral reach.”  Now slightly irritated (but happy that the name at least described the movement), I bolted over to the strength room to inquire about their knowledge of Stuart McGill, his research and what they called this particular exercise.  To my surprise McGill’s work had never been heard of and that this particular exercise was programmed as a “Flying Superman” within the student-athletes performance training.  It became painfully clear that the first order of business was getting both staffs to speak the same language, both within each department and across them. 

Because most of the members on your staff (both Sports Medicine and Strength) have come from a variety of educational backgrounds, continuing education courses and levels of expertise, it is important to begin formulating a shared exercise and assessment language in order for civil conversations to first take place.  By investing only a small amount of time and addressing this often overlooked, yet integral first step your staff will begin to enjoy the following benefits:

1. Provide improved services to your student-athletes.  Imagine the previous example taking place and a student-athlete approaching you for help with their kneeling opposite arm-leg reaches.  Now, the name basically tells you exactly what is needed, but imagine you knowing the exercise as a different name and perhaps emphasizing a different teaching point altogether.  Would you teach the athlete how to do the exercise “your” way? Find the athletic trainer who wrote the rehabilitation program to help them out? Or tell them that you’re sorry but you don’t know what they should be doing?  In any case precious time is wasted and as a fellow athletic trainer, this is something none of us has enough of.  In addition, you can imagine the frustration of the student-athlete witnessing your staff stumble through the most basic exercise descriptions!

2. A shared language allows staff members to be interchangeable because now each staff member is calling the same exercise the same name and teaching it while emphasising the same teaching points.  This allows athletic trainers to jump in and help with all rehabilitation programs, and not just “their own teams” as well as provide continued care during an athletic trainer’s absence (sick day, vacation or travel with another team).

3. Continued care and coaching along the performance continuum.   Here’s where the magic happens: whether the athlete your provide care for is one week into their ACL rehabilitation or the starting point guard for the basketball team pushing 300 pounds in the squat rack, the exercises if named the same, taught the same and progressed the same all fall along the same care-performance continuum.    Let’s examine the above example to really understand the power of the shared language.  Imagine on the far left hand side the student-athlete one week post-op ACL reconstruction and on the far right side the starting point guard pushing serious weight and performing at the highest level.  Moving along the continuum from left to right the athlete will experience and undergo exercises such as: Quad Sets, Straight leg Raises, Clams, Glute-Bridges, Mini-Band walks, Wall Squats, Body weight squats, Lunges, Box Jumps, and the list goes on.  At some time this athlete will be in the weight room and not be able to perform the Olympic lift for example programmed for the team that day but can certainly do pull-ups, side bridges and a number of other exercises that the strength coach has put in place during any particular phase or block of training.  If a shared language exists, the athletic trainer and the strength coach can have a civil and meaningful conversation about where the athlete is and discuss and implement substitutions for exercises that are not appropriate for them all while progressing the athlete safely along this care-performance line.  Not to mention, many of the rehabilitation exercises can be implemented safely within strength training program as substitutions for advanced exercises thus minimizing the athlete’s daily rehabilitation time and allowing the athletic trainer who is providing care for this athlete more time to focus on other athletes or say for example address soft tissue restrictions with the same athlete during “rehab” time which often requires a one-on-one time period, thus making their strength training time much more effective.

Now, some people may say that a couple of exercise names or switching names from time to time is really not a big deal.  Perhaps not.  If you only care for one team, perform all the rehabilitation by yourself and no other staff member helps you, then you can certainly come up with your own language.  But imagine for a moment a car factory where all the parts are all called different names, put on in different orders and actually assembled with various degrees of precision.  Would you ever buy a car from a factory like this?  The answer is a resounding no - so how can we expect our student-athletes to buy in to what we are saying if each staff member is saying something different?  By having an Exercise Pool to draw consistent language from, the number of benefits far outweigh any possible downside while also reducing the amount of confusion among your own staff and encouraging an atmosphere of shared help and patient responsibility. 

Next week: How a shared language during initial assessment can limit overall injury rate and increase performance immediately.

We asked what the Giants in Sports Medicine & Rehabilitation, Basketball and Hockey performance training have read or are currently reading and we brought their list to you.  

Click HERE to view our recommended library with an ongoing list from these speakers who presented at the BSMPG "Standing On The Shoulders Of Giants" 2011 summer seminar.

Brijesh Patel

If you're going to work...

work hard.

That way, you'll have something to show for it.

The biggest waste is to do that thing you call work, but to interrupt it, compromise it, cheat it and still call it work.

In the same amount of time you can expend twice the effort and get far more in exchange.

From our family to yours - Happy Independence Day!

Wishing you a wonderful weekend with friends, family, fireworks and hopefully a little bit of fitness this long weekend.

Happy Canada Day to our readers north of the border!

So often individuals with knee pain miss out on the opportunity to resolve their troublesome and agonizing cases because the answer comes dressed in overalls, a hard hat and carries a lunch box.  Addressing knee pain means so much more than sitting back and relaxing in your local physical therapy or athletic training center with an ice bag and electrical stimulation on your knee.  Addressing knee pain takes hard work and requires that patients become an active participant in their care plan.

In a recent article published in Sports Health, Lake and Wofford reviewed current literature examining therapeutic modalities and their effectiveness for the treatment of patellofemoral pain syndrome (PFPS) or good old fashion knee pain.  Their findings come as no surprise to those that understand that knee pain is a real pain in the butt – meaning, quite literally it's cause is coming from your butt (or a lack thereof).  Conclusions drawn from their examination was that, “none of the therapeutic modalities reviewed has sound scientific justification for the treatment of PFPS when used alone.”

So what’s the answer?

Let’s not throw the baby out with the bath water quite yet.  A comprehensive treatment approach offering therapeutic modalities as needed with a focus on eccentric strength training along with an overall strengthening program for the hips and gluteus musculature in addition to providing mobility above and below the knee (hips and ankle) continues to be the best approach to getting athletes back to competition faster and putting smiles on knee pain sufferers  time and time again.

See additional knee pain articles below: 

Treating Anterior Knee Pain - Part I and Part II

Lake D., and Wofford N. Effect of Therapeutic Modalities on Patients With Patellofemoral Pain Syndrome: A Systematic Review. 2011. Sports Health, Vol. 3(2)p.182-189.

We fight an endless battle with gravity, the comforts of modern living and the pollutants in the air.

We are always in need of corrective exercise and performance training simply to maintain the delicate balance between suffering and just getting by for another day. 

A friend asked me why so much “Corrective” work in my programming.

“If you are always doing corrective work, then how come it never gets corrected?” He asked.  “And what’s the opposite of corrective work anyways,…. Destructive work?”

Good question.

You must admit that there are forces that you will never ever win against. You may delay them, but you will never win. Like death and taxes, aging and gravity always win.  Other “destructive” forces include poor posture, sitting and typing at the comfort of our computer terminal, poor exercise choices and poor exercise technique just to name a few.

These are all destructive in nature and if left unmanaged or not corrected, cause havic on our system.

Now, I am of the opinion that a great strength program in and of itself can be constructive and corrective  without specific “corrective exercises” but a great strength program may not always be able to address the regular “trauma” incurred while playing division one athletics or the previous wear and tear accumulated prior to beginning said strength program.  Sometimes, the cumulative destructive insult from all causative factors is even too much for a well planned strength program, and a comprehensive “performance plan” is at times necessary, which includes a corrective or rehabilitative flavor to address some of these cob webs.

Regardless of professional affiliation – PT, ATC or Strength coach, at least part of our job is to provide our patients and athletes with services that prepare them for this battle against nature.  And although you’ll never ever win this particular fight, it’s one that is surely worth fighting.

Growing old is tough. No sissies allowed.

The hard part (one of them)

A guy asked his friend, the writer David Foster Wallace,

"Say, Dave, how'd y'get t'be so dang smart?"

His answer:

"I did the reading."

No one said the preparation part was fun, but yes, it's important. I wonder why we believe we can skip it and still be so dang smart.

by Shaun Bossio

I had a colleague recently come to me out of frustration. Their position grade was below that of several other people in their department that they felt were not as valuable. In addition, they felt as though both title-wise and salary-wise they should be receiving more consideration than these folks that they felt had received some undue advancement. After about three years in their position, they felt as though they deserved more than the token merit increases that they had seen over that time.

In actuality, there are two different problems here. The first is that they felt as though they were not receiving the proper recognition. The second and most important though is that they were measuring themselves against the performance of others within their department. Therein is where the problem lies for you. Unless these staff members are reporting to you, there is not a whole heck of a lot you can do about their perceived performance vs. yours. Equating yourself to other comparable employees within your organization is a lot like playing golf. You cannot control what your opponents are shooting, so your best option is just to concentrate on shooting the best score that YOU can. Focusing on comparisons between your coworkers and yourself is a trap that many people fall into and really it is energy that could be better spent making yourself an even better employee.

Many of us at one time or another have felt as though we were not receiving the proper amount of credit (compensation, title, accolades, etc). It is important to remember that while this may be the case, it is a matter to be handled between your employer and yourself and has nothing to do with your coworkers. If you are truly underappreciated in your organization, then it is time to approach your supervisor and let them know why and remind them of the value that you provide to them. In some cases it may be as simple as making a solid case for your yourself and in others the possibility exists of setting goals that, if met, will yield increased benefits to you. Sometimes however, your opportunity lies elsewhere. In many organizations (universities in particular come to mind), unfortunately your best chance is in taking a promotion with another company. In these cases, if you revere your organization, the chances of returning at a higher salary/title have already increased.

Regardless of how you perceive your future, know that the best thing for you is to simply focus on yourself and to do the best job that you can do. If you get to a point where you feel as though you are not being properly appreciated, take some time to remind your employer what they have and why they need you around. The folks that are busy comparing themselves to each other are the ones that are only concerned with doing their job as well or slightly better than their coworkers. In the meantime, you can be the one excelling and getting people to notice.

Shaun Bossio is the Assistant Business Manager at the Boston University FitRec.