Boston Sports Medicine and Performance Group, LLC Blog

IMPROVING COLLABORATION BETWEEN SPORTS MEDICINE AND SPORTS PERFORMANCE SERVICES; A NEW MODEL FOR THE CARE OF STUDENT ATHLETES

Posted by Boston Sports Medicine and Performance Group on Thu, May 3, 2012 @ 07:05 AM

Leaders

by Art Horne

In the classic model for the care of student athletes, sports medicine and performance training services are provided under the supervision of the athletics department. This has been challenged recently with suggestions of alternate organizational schemes, including at Boston University, where oversight of athletic training services was transferred from athletics to college health, arranging athletic training services into “medically-oriented units.”

At Boston University, they noted some key advantages: delivery of superior health care services, improved on-going educational opportunities for staff and students, and enhanced working conditions for athletic trainers.

In 2011, here at Northeastern University we followed suit, placing both athletic training and performance services under the direct supervision of sports medicine personnel. The head team physician for the university provides oversight for a dual-trained athletic trainer and strength coach who directs these sports performance services. These changes were in response to difficulties we had observed, including an apparent lack of standardization of services, especially related to prevention models provided by athletic training and strength and conditioning.

Also apparent were communication breaches between and among the coaching staff, strength and conditioning personnel, sports medicine providers, and the student-athletes who were receiving care from these individuals.

So university authorities agreed to implement a new model for the care of student athletes that placed athletic training as well as strength and conditioning under the supervision of sports medicine. This allowed us to consider the potential advantages as well as challenges that will be encountered as the model is implemented.

One clear advantage is to improve collaboration during pre-participation screening for athletes. In 2007, the NCAA mandated that all student athletes receive a pre-participation examination (PPE) by medical staff prior to engaging in collegiate sports.

 

Continue to read this article by clicking HERE

 

Meet the Leaders in Sports Medicine and Performance at the 2012 BSMPG Summer Seminar, May 19-20th in Boston.

 

Click me

 

 

Topics: Art Horne, basketball resources, athletic training conference, boston hockey conference, Leaders, Leaders in Performance

Readings from last week

Posted by Boston Sports Medicine and Performance Group on Mon, Mar 26, 2012 @ 07:03 AM

Readings from last week.

Enjoy!

 

Cold-Water Immersion for Preventing and Treating Muscle Soreness After Exercise  

 

Predictive Factors for Ankle Sprain  

 

Assessing the SI Joint   

 

Don't forget to sign up for the 2012 BSMPG Summer Seminar featuring Dr. Craig Liebenson along with 14 other leaders from the worlds of sports medicine, performance and hockey/basketball specific training!

 

Click me

 

 

 

Topics: Art Horne, basketball resources, BSMPG, athletic training conference, boston hockey summit, basketball videos, hockey conference, Bruce Williams, Cal Dietz, Bill Knowles, Alan Grodin, Dan Boothby

Gifts for the Sports Medicine and Strength Professional on your List!

Posted by Boston Sports Medicine and Performance Group on Tue, Nov 22, 2011 @ 07:11 AM

BSMPG

 

It happens every year, you're stuck trying to decide on a gift for the Sports Medicine or Strength professional on your list. 

Should you give them another lousy water bottle? A new stop watch? How about one of those new fancy fanny packs?

 

fannypack

 

Of course not! Give them the gift that will keep on giving back to them.  Purchase an educational product from BSMPG for the Sports Medicine or Strength professional on your list who is looking to improve their specific skill set.  If your gift list includes an athletic trainer, physical therapist, strength coach or manual therapist, BSMPG has conference videos that will provide hours upon hours of education material that is sure to make even the toughest person on your list happy! (Even the Hulk himself would be happy)

Visit our site for videos and information from Tom Myers, Clare Frank, Charlie Weingroff, and Bill Hartman to name a few. 

Have a Hockey or Basketball fanatic on your list? We have them covered too, with videos from the best college and professional strength coaches and therapist from accross the country!

What about that zanny cousin who is always talking about going barefoot in the gym or running across town with nothing on their feet? Purchase a copy of Barefoot in Boston as a stocking stuff and keep them from getting sidelined with injury.

Need a really impactful gift? Send them to the DNS Course "A" scheduled in Boston March 30-April 1st, 2012.

 

Happy Holidays from all of us at BSMPG!

 

 

Topics: basketball resources, basketball conference, BSMPG, athletic training conference, boston hockey conference, Barefoot in Boston

Highlights from the 2011 BSMPG Intensive Track - featuring Tom Myers

Posted by Boston Sports Medicine and Performance Group on Mon, Oct 24, 2011 @ 07:10 AM

 

Missed Tom Myer's presentation during the Intenstive Study Track from our conference in June?  No problem!!

 

Watch highlights from this presentation here.  This DVD will be available shortly for purchase on BSMPG.com - your one stop for the best in continuing education!

 

 

To purchase other video's from this conference click HERE.

 

Topics: basketball resources, BSMPG, athletic training conference, boston hockey summit, Tom Myers

Essential Reading Spotlight - Greenman's Principles of Manual Medicine

Posted by Boston Sports Medicine and Performance Group on Wed, Oct 12, 2011 @ 06:10 AM

I have to admit I missed the boat on the importance of manual medicine for a long time.  After speaking to the best clinicians and therapists in the area there was one book that each and everyone of them, regardless of their current treatment approach, recommended I read - Greenman's Principles of Manual Medicine (Point (Lippincott Williams & Wilkins))   

After recently completing this book I now know why.  This book is a must for anyone treating musculoskeletal dysfunction on a daily basis.  Below is a short excerpt from this book.

 

 

The Manipulable Lesion

"The acceptable term for this entity is somatic dysfunction. It is defined as impaired or altered function or related components of the somatic (body framework) system; skeletal, arthrodial, and myofascial structures; and related vascular, lymphatic, and neutral elements. Notice that the emphasis is on altered function of the musculoskeletal system and not on a disease state or pain syndrome." pg 11


DIAGNOSTIC TRIAD FOR SOMATIC DYSFUNCTION 


"The mnemonic ART can express the diagnostic criteria for identification for somatic dysfunction.

“A” stands for asymmetry of related of the musculoskeletal system, either structural or functional.
“R” stands for range of motion of a joint, several joints, or region of the musculoskeletal system. The range of motion could be abnormal by being either increased (hypermobility) or restricted (hypomobility). The usual finding in somatic dysfunction is restricted mobility, identified by observation and palpation using both active and passive patient cooperation.
“T” stands for tissue texture abnormality of the soft tissues of the musculoskeletal system (skin, fascia, muscle, ligament, etc.). Tissue texture abnormalities are identified by observation and a number of different palpatory tests.

Some authors add one of two other letters to this mnemonic. “P” or a second “T”. “P” stands for pain associated with other findings, and “T” stands for tenderness on palpation of the area. Tenderness is particularly diagnostic if localized to a ligament. A normal ligament is not tender. A tender ligament is always abnormal. However, both pain and tenderness are subjective findings instead of the objective findings of symmetry, altered range of motion, and tissue texture abnormality. By the use of these criteria, one attempts to identify the presence of somatic dysfunctions, their location, whether they are acute or chronic, and particularly whether they are significant for the state of the patients wellness of illness at that moment in time. In addition to the diagnostic value, changes in these criteria can be of prognostic value in monitoring the response of the patient, not only to manipulative treatment directed toward the somatic dysfunction, but also to other therapeutic interventions."  Pg 11-12

 

 

Topics: Art Horne, basketball performance, basketball resources, BSMPG, athletic training conference, boston hockey summit, boston hockey conference, barefoot strength training, barefoot training

Integrated Care - Part VII: Mastering the Hip Hinge

Posted by Boston Sports Medicine and Performance Group on Mon, Oct 3, 2011 @ 07:10 AM

by Art Horne

 

Last week we discussed the importance of bringing all professionals who care for and provide performance services to your student-athletes together to develop a consistent teaching methodology and progression to mastering the squat pattern.  This week we look at the Hip Hinge.

 

hip hinge

 

Deadlift – Hip Hinge

Hip Hinge: all athletes should be able to separate their hips from a back strategy both in 2-legs and single leg stance -whether its knee, hip or other LE injury pain, we should be able to look at this movement pattern and address some overall concerns IN ADDITION to their traditional rehab program.

 
The hip hinge can be easily taught and standardized with our stick series.

Teaching Stick Series:


1. Stick maintains contact with three points (head, back and butt crack) throughout entire movement.
2. Reach butt backwards; knees should have slight bend.
3. Start with two feet on ground and progress to single leg stance.
4. This is not a squat pattern – be sure to hinge at the hips.
5. Maintain a packed neck (c-spine in-line with sternum throughout movement).


Start one foot away from wall (maybe just less) and reach back towards the wall with butt

1. Maintain three points of contact with stick on head, back and butt crack
2. This is not a squat pattern – first motion should be back towards the wall and not downwards.
3. Inch outwards from the wall with each successful repetition and repeat until you have found your end range.
4. ALTERNATIVE: face wall and touch with hands, move away from wall and repeat until you have reached max distance from wall while maintaining perfect form


Progression:


1. Two Leg Stick
2. SL Stick
3. 2-Leg – 2 hand Kettlebell Deadlift
4. SL 2-DB Deadlift
5. SL contralateral 1-DB Deadlift

 

When you finally get strength and sports medicine professionals together in the same room some amazing things begin to happen, especially when you start talking about hinging at the hips including:


1. Agreement to Pack the Neck: Packing the neck and maintaining a neutral cervical spine instead of admiring yourself in the mirror during a hip hinge stick series becomes a universal theme among both groups and taught and coached consistently – whether it’s pulling 300 pounds from the floor during a sumo squat or 4 weeks post ACL surgery during a simple stick series.  Knowing where an athlete is going and where they’ve come from is half the battle in my opinion.

2. Glute activation takes on a whole new meaning to athletic trainers when they see firsthand the work and technical coaching  that strength coaches employ with their athletes.  Sets of 3x10 for glute bridges and then discharge to full participation is no longer acceptable.

3. Bad Hip Hinge means Bad Back: In the same breath, strength coaches are able to discuss challenges with low back pain patients with sports medicine professionals and appreciate how important they are in the rehabilitation and care of those persons as well as how incredibly dangerous a poorly performed lift can be.
 

deadlift


Read article on Hip Hinge by clicking HERE.

Topics: basketball resources, basketball training programs, athletic training conference, athletic training, athletic training books, barefoot strength training, Hip Hinge, deadlift Art Horne

Standing On The Shoulders Of Giants DVD's Available

Posted by Boston Sports Medicine and Performance Group on Thu, Sep 29, 2011 @ 08:09 AM

Missed this summer's BSMPG summer seminar?

Wished you could have seen the authors of these books and video speak while they were in Boston?

 

Tom Myers  Charlie Weingroff  Clare Frank

Well now you can - We captured three groundbreaking presentations from this once in a lifetime seminar.  Catch three of these Giants in action as they presented at the 2011 "Standing On The Shoulders Of Giants" Summer Seminar.

This conference was held in Boston, MA on June 3rd and 4th, 2011

Included: 3 DVDs with over 4.5 hours of Sports Medicine and Rehabilitation Information

Presentations by: Clare Frank - Muscle Balance and Stability, Tom Myers - Anatomy Trains and Myofascial Fitness and Charlie Weingroff - Trying to Define the Core.

clare frank Tom Myers Charlie Weingroff

Click HERE for complete details.

Topics: Art Horne, basketball resources, basketball conference, BSMPG, boston hockey summit, athletic training, Charlie Weingroff, boston hockey conference, Tom Myers, athletic training books, barefoot strength training, Clare Frank

Integrated Care - Part VI: Getting Everyone To Squat

Posted by Boston Sports Medicine and Performance Group on Tue, Sep 27, 2011 @ 07:09 AM

 

by Art Horne

Since squatting and the decision to squat or not comes up more often than any other subject when it comes to sports medicine and performance professionals, we decided to tackle this subject head on in this latest post.  Everyone should be able to squat - there I said it. So whether you'll be teaching it after surgery, or training it in the weight room it's important that the beliefs and concepts that you have pertaining to the squat is the same as those that you work with in order to achieve the highest level of athlete success. 

Below is an outline which we have used in a staff journal club to finalize our teaching progressions and teaching cues for the squat pattern while also getting everyone on the same page and on board with the importance of squatting.

sports medicine

 

Squat Goal: all athletes should be constantly working towards a score of three on their OH Squat test. Whether they initially present to Sports Medicine with back, knee, hip or other LE injury or pain, all care and performance training providers should be able to look at this movement pattern and address any movement concerns IN ADDITION to their traditional rehab or performance program regardless of initial pain or injury presentation.

FMS Squat Test:  see functionalmovement.com  for complete details
(Have a staff member certified or familiar with the FMS review testing criteria, followed by staff members from both staff’s testing and evaluating each other).

 

What if the student-athlete describes PAIN during the squat test?

 

sports medicine

 

Only qualified medical professionals should deal with pain and painful movement patterns.  If a student-athlete experiences pain they should be referred to the athletic trainer coordinating their care at the college level or another health care professional if you are working in the private sector.  Although many “painful” maneuvers are often neglected and played down by the student-athlete, seldom do those with pain during a simple bodyweight squat ever go on to compete at a high level without future injury and time loss.

Since PAIN is complicated, multifactorial and often unpredictable, a painful pattern should be “broken down” to its component parts so to find the underlying pain generator or limiting factor.  The Selective Functional Movement Assessment TM offers health care providers a systematic approach and a common movement language among all staff members.

(Have a staff member certified or familiar with the SFMA squat breakout present this algorithm to the remainder of your staff and then follow up by having individuals from both groups evaluate each other while identifying the limiting factor within each individual’s squat pattern.


SFMA Squat Breakout:


1. Overhead deep squatting pattern

2. Fingers interlocked behind neck into deep squat position
a. This position lowers the difficulty by not having the shoulders flexed vertical
b. Removes the upper body components and reduces the level of dynamic stability needed to perform the squat.

3. Assisted Squat from ATC into deep squat
a. Athlete holds hands of evaluator while performing squat.
b. Looks at the true symmetrical mobility of the lower body (hips, knees, ankles) without the requirement of dynamic stability.

4. Half kneeling Dorsi-flexion (test for ankle ROM)
a. Place foot on weight bench and lean forward over the foot as far as possible without the heel coming off the bench.
b. The knee should move forward out past the toes at around 4 inches.
c. Repeat for both sides.

5. Supine Knees-to-chest – test for anatomical limitations at hip in non-weight bearing position.
a. Looks at mobility of the hips, knees and spine in a non-weight bearing position.
b. Can help differentiate a mobility vs. stability problem
c. Have the patient grab both shins and attempt to touch their thighs to their lower rib cage.
d. If they can’t get their calves to touch their thighs due to knee tightness, have them grab their thigh instead and repeat thin maneuver. (This will help differentiate between hip and knee mobility issues. If in this position they still can’t get their thighs to touch their rib cage, then there is a potential hip dysfunction).


What’s Next?

Since so many of us sit on our butts all day it’s no surprise that our butts are rarely working to the level they should be. 

(Unless of course you use your butt for a simple paper weight – then your butt works just fine).

Because the squat is the end goal for all athletes in terms of both health and performance, it’s important for athletic trainers and other health care professionals to begin grooving this pattern early on in the rehabilitation process so that there is not only a seamless transition from one Sports Medicine to Performance Training, but also a clear message when it comes to cueing and technique among all professionals on staff.  In order to have everyone speaking the same squat language, starting everyone back on the ground and building a solid and logical progression from post-surgical all the way to high performance only makes sense while the entire staff is playing nice together.

Below is a starting point with a few teaching cues to get the conversation started and a solid progression built between the two groups.   (I have purposefully not included a complete progression below so to force the issue with your own staff.  People tend to complete tasks fully if they have had an opportunity to contribute to so be sure to ask for feedback from both staffs – Sports Medicine and Strength & Conditioning).

 

Back to Basics: (Supine Table Series)


1. Teach Glute Max w/ Bridge
2. Supine Bridge w/ Thera-band
3. Supine Bridge w/ Marching
4. Single Leg Hip Bridge


Teaching Points:


a. Squeeze Glutes to hold “gold coin” between butt cheeks or pretend to “crack a walnut” while bridging
b. brace core musculature as taught by Stu McGill
c. Ensure hamstrings are not dominate during exercise by palpating medial tendons.
d. Add a theraband around knees or create an ADDuction force to the knees to facilitate additional glute max contraction


– NEVER PLACE A BALL BETWEEN THE KNEES!


Teaching Progression for the Troubled Squat

 

gobletsquat

 


1. Goblet Squat: hold Kettlebell by the horns and squat to depth (providing a weight to the anterior portion of body balances the athlete and gives an additional point of stability

2. Descend squat so that elbows touch VMO of each knee.

3. If depth is a problem “wedge” elbows inside of knees to mobilize the hips.

4. In the early stages be sure to stand behind your athlete to ensure safety – encourage thoracic extension and a flat back

5. ** use clinical judgment based on patient presentation and injury. If unsure, REGRESS activity and PERFECT – OWN THE MOVEMENT before progressing to more advanced alternatives.

 


READ:  Squatting - An Expression Of Health

 

Next week: Bringing both staffs together to learn and master the hip hinge – a must for avoiding and rehabilitating back pain and also pulling big deadlift numbers!

 

 

Topics: Basketball Related, Art Horne, basketball resources, BSMPG, athletic training conference, athletic training, FMS, Barefoot in Boston

Integrated Care - Part V: When NOT Touching Your Toes is NOT a Hamstring Problem

Posted by Boston Sports Medicine and Performance Group on Sun, Sep 18, 2011 @ 06:09 AM

by Art Horne

 


I remember being taught in school that people have low back pain because their hamstrings are tight.  Therego, stretch the hamstrings and resolve the low back pain.  It was a simple solution to a very complex and often misunderstood problem and yet as a student it was a clean and direct resolution to an often nagging dilemma.

Further testing and evaluation always “proved” the hamstrings as the culprit since so many of the low back pain patients were never able to touch their toes, and of course toe touching was a direct result of hamstring length.  Again, this bore out to make sense since after spending an exhausting amount of time stretching these patient’s hamstrings, and then retesting, some measurable change were noted (sometimes) with the patient inching closer to their toes.  The only problem in this clean and concise “hamstring-LBP” relationship was that these patients, no matter how long I stretched them or which stretching technique I employed ALWAYS ended up coming back the very next day for the same stretching routine and the same unresolved back pain.

 

BSMPG

Insanity: Doing the same thing over and over again and expecting different results.

 

Of course, many of these patients really never had “tight” hamstrings after all, but instead had hamstrings that were preventing them from a place they no had no business being in the first place. 

What do I mean?

Well, many of these patients, or at least the majority of them,  were flexion intolerant which means both flexing their spine and/or moving into flexion caused a reflexive “tightening” of the hamstrings to essentially keep them from FLEXING FORWARD and moving into a region which would exacerbate their current condition, or “a place they have no business being.”  In addition, many of these “tight hamstring” patients were never ever feeling a hamstring stretch, but instead were experiencing a neural stretch, which unfortunately after stretching only continued their “tight-stretch-pain-tight” cycle. 

Soo… Should I Stretch or Not?

1. First distinguish between hamstring tightness and neural tension.  Neural tension is always described differently than muscular tightness – that is if you’re listening.  I had a professor who told me that your patient will always tell exactly what is wrong with them if you listen long enough.  And if you listen just a little bit longer, they’ll also tell you exactly how to make them better.  This case is no different – of course, if you’re too busy catering water you’ll never have enough time to listen long enough.

2. Neural tension is often described as “pinching” or with other words that clearly denote nerve origin such as “zapping” or “burning.”  Muscle tension doesn’t zap or burn.

3. Confirm neural involvement with a slump test – then STOP stretching and begin a nerve flossing regiment if indicated.

4. Does the patient need more mobility (hamstring stretching) or do they simply lack the appropriate stability (or neuromuscular control) which ultimately is limiting them from moving into a place where they simply didn’t have the requisite control? I’m willing to bet that more often than not that stability/neuromuscular control is the limiting factor and not hamstring length – especially in low back pain patients.

So what does this have to do with integrated care?

1. On evaluation during pre-participation screenings a simply toe touch as a gross indicator of both ability and willingness to forward flex will “catch” those athletes who either have had previous back pain, current back pain or a complete lack of understanding relating to lumbar spine/pelvis position and an ability to disassociate them during normal daily living.

2. Those with pain or previous pain should be referred to sports medicine for further evaluation – yes, even those that don’t currently have pain.

3. Those that have trouble separating hip and lumbar motion should be placed into a “teaching” group while in the weight room until they can successfully “stiffen” their spine while gaining mobility and motion throughout the hips; both which are essential if any type of squat or deadlift pattern are prescribed in their program.  But really more importantly, these two patterns occur each and every day of their lives and must be grooved before major lumbar spine pathology presents itself.

Click HERE for a quick note on establishing a hip hinge.


Next week: A quick in-service to get both Sports Medicine and Strength Training hinging at the hips and teaching all athletes a great squat pattern. 

Topics: Art Horne, basketball performance, basketball resources, basketball conference, basketball training programs, athletic training conference, barefoot strength training, Barefoot in Boston, barefoot training

BSMPG Summer Seminar DVD's Now Available!

Posted by Boston Sports Medicine and Performance Group on Thu, Sep 15, 2011 @ 07:09 AM

Missed this summer's BSMPG summer seminar?

No Problem - We captured three groundbreaking presentations from this once in a lifetime seminar.  Catch three of these Giants in action as they presented at the 2011 "Standing On The Shoulders Of Giants" Summer Seminar.

This conference was held in Boston, MA on June 3rd and 4th, 2011

Included: 3 DVDs with over 4.5 hours of Sports Medicine and Rehabilitation Information

Presentations by: Clare Frank - Muscle Balance and Stability, Tom Myers - Anatomy Trains and Myofascial Fitness and Charlie Weingroff - Trying to Define the Core.

clare frank Tom Myers Charlie Weingroff

Click HERE for complete details.

Topics: basketball resources, athletic training conference, boston hockey summit, athletic training, Charlie Weingroff, boston hockey conference, Tom Myers, athletic training books, Clare Frank