Boston Sports Medicine and Performance Group, LLC Blog

By Art Horne

In a follow up from a previous post (Up The Chain It Goes), additional evidence supporting the relationship within the kinetic chain has emerged from south of the equator.  In a study out of South Africa examining the link between available dorsiflexion and mechanical low back pain researchers found a statistically significant decrease in ankle dorsiflexion ROM and associated reporting of low back pain (Brantingham, 2006).   With the vast majority of adults suffering from low back pain at some time in their life, (some reports are up to 85%) and 80% of people reporting foot problems during their lifespan, it’s not a surprise to see that these two conditions may very well be related.

Let’s take a closer look:

Methods: “ The study was a blinded, 2-arm, non-randomized clinical study involving 100 subjects with chronic or recurrent mechanical low back pain (intervention group) and 104 subjects without chronic mechanical low back pain (control group) between the ages of 18 and 45.  A blind assessor performed weight-bearing goniometry of the ankle and big toe and the navicular drop test on all subjects in both groups.”

Results: “An independent t-test (inter-group) revealed a statistically significant decrease in ankle dorsiflexion range of motion in individuals with chronic mechanical low back pain.”

Conclusions: “This study’s data found that a statistically significant decrease in ankle dorsiflexion ROM, but not flatter feet, was associated with subject report of chronic mechanical low back pain disorders.”

Discussion: “The findings of this blinded study support previous reports suggesting that decreased ankle dorsiflexion may be a factor in chronic mechanical low-back pain.  There was no clear association found between decreased hallux ROM and mechanical low back pain in this study.  If these findings are confirmed through additional studies, exercise and manipulation therapy to increase ankle range of motion could become an important consideration in the treatment of some patients with mechanical low back pain disorders.”

Hmmm, if only we had some additional studies….

Perhaps this will help.

During a routine exit physical, 60 division one athletes were assessed for available weight bearing dorsiflexion bilaterally as described by Bennell et al in 1998 (inclinometer was replace by Clinometer app for ITouch) to examine limitations in this movement.   Ten athletes with limited weight bearing dorsiflexion (less than 4 inches from knee to wall) volunteered for follow up evaluation and manual treatment. Out of the initial 120 measured ankles, 47 ankles (21 right, 26 left) demonstrated limited weight bearing dorsiflexion range of motion.

Athletes were then asked to walk normally in their athletic shoes while wearing an in-shoe pressure sensor (Tekscan) and through an optical measurement system (Optojump).  Each athlete then underwent a general manual therapy intervention aimed to improve ankle dorsiflexion, followed again by the same gait analysis and pressure mapping data capture.

Gait Cliff Notes: optimal gait should have two mountains with a trough between them. The first mountain represents heel strike to midstance, the trough representing the mid-stance phase, and the second mountain being propulsion from full foot contact to toe-off.

Easy right? Good. 

Note: The second mountain should almost always be higher than the first.

Case Study 1:

Pre-treatment (RED):

Notice how the first mountain is slightly higher than the second – this is BAD!

Remember from our cliff notes: the second mountain should be higher.

Post-treatment (GREEN):

Notice change in toe off from pre- to post-treatment which specifically targeted patient's limited dorsiflexion?  The second mountain is now higher than the first. That’s a GOOD thing!

Awesome right?

Better yet – athlete was measured 3 days post treatment and improvement in Dorsiflexion range of motion stuck!  Try doing that with a slant board stretch.

See Art Horne and Dr. Pete Viteritti discuss these and other changes at the foot and ankle, and how to assess and address soft tissue and bony restrictions in their presentation at the 2012 BSMPG Summer Seminar May 19-20^th in Boston.

References

Bennell KL, Talbot RC, Wajswelner H, Techovanich W, Kelly DH and Hall AJ. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Australian Journal of Physiotherapy. 44;175-180.

Brantingham JW, Gilbert JL, Shaik J, Globe G. Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain. J of Chiropractic Medicine. 2006; 4(5); 123-127.

A: Bill Knowles

There is a reason why top athletes and clubs from around the world seek out Bill Knowles after surgery.  He is simply one of the best in the world at returning athletes to pre-surgery performance levels. 

Meet Bill Knowles at the 2012 BSMPG Summer Seminar, May 19-20th as he lectures about Reconditioning and Return to Competition Strategies for the Joint Compromised Athlete.

Athletic Development Coach and Sports Rehabilitation Specialist
Certified Athletic Trainer, Certified Strength and Conditioning Specialist

Experience:
• 21 years professional experience working with World-class, Olympic, Professional, Elite, & Nationally ranked athletes from around the world.
• Professional and World-Class sports include: Soccer (football), Rugby Union, Ice Hockey, Basketball, Football, Aussie Rules Football, Golf, Alpine and Freestyle Mogul Skiing, Snowboarding and Swimming
•Former Head Athletic Trainer and Director of Strength and Conditioning at Burke Mountain Academy (Vermont, USA) for 12 years. BMA is recognized historically as the best youth sports academy in the world for alpine ski racing. 
The list of Olympic, World Cup, and World Junior success is unparallel in the Unites States and worldwide.
• Author of numerous articles on injury prevention and performance training in ski publications, strength and conditioning magazines and health journals.
• Featured speaker dozens of times around the United States, Canada, England and Scotland on topics related to injury reduction programs, rehabilitation/reconditioning, and performance training for all types of athletes.

For the past 21 years Bill Knowles has been working with elite level athletes from around the world. As a sports rehabilitation specialist, Bill has helped Professional and Olympic level athletes recover from season ending and career threatening injuries. His energy and enthusiasm keeps every training session educational and fresh, while his unique experiences allows a creative approach to address any injury situation. Bill’s rehab philosophy allows each athlete the opportunity to express their inherent athletic ability quickly following injury or surgery. This mean the “down time” is minimal and the athlete stays very active and motivated.

After receiving his education at Cortland State College in New York, Bill began his career at the world renowned sports academy for Alpine and Nordic ski racing; Burke Mountain Academy. As the Head Athletic Trainer and Performance Director Bill took care of countless knee injuries and developed his skills that began to attract world-class ski racers from Europe and North America. Since then athletes from England, Scotland, Ireland, and Australia have visited Bill in Killington, Vermont. Bill has also traveled extensively working with and visiting many of the top sports clubs in the world.

This success has evolved to designing and implementing rehab and performance programs that have placed athletes back into the English Premiership and Championship Football Leagues, The Rugby World Cup and Premiership Squads, Baseball World Series, Winter Olympic podiums and X-Game podiums.

As a former collegiate soccer player, ski racer, and coach, Bill delivers his training programs they way an athlete understands and respects.

Register for the 2012 BSMPG Summer Seminar Today!

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?

No.

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.

Previous Posts:

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:

References:

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.

by Carl Valle

I decided to interview Rob Shugg from Kinetic Performance after hearing a few new definitions of what power is, and felt that we needed more sport science tools to help the performance community understand how to develop power in team sports. Track and field is very objective, but the methodologies tend to be cloudy. I wanted to get Rob's opinion on the matters of true development and monitoring of elite sport as he has many years with the Australian Institute of Sport and in the private sector with technology and performance. The BSMPG is the first conference in the US to promote Gymaware and Kinetic Performance as technology and data is becoming more and more important to help teams find the winning edge. 

Most of the US professional and college teams are familiar with linear transducers for measuring power, could you expand on the differences between Gymaware and the Tendo system, specifically with the advanced analytics and cloud benefits. 

First I’d like to give your readers a quick outline of the GymAware components:GymAware Power Tool - A linear transducer that connects via bluetooth to an iPad, iPod Touch or iPhone. 

iOS apps: 

GymAware Lite App - a stand-alone weightlifting analyzer app withextensive training, feedback and plotting functions. 

GymAware App - a cloud-connected weightlifting analyzer app offering online data and athlete management. 

GymAware/Kinetic-Athlete cloud analysis server - a web based account for managing and analysing Power Tool and other athlete performance data.So as you can see, while the Power Tool and the Tendo weightlifting analyser are both linear transducers, only GymAware offers a complete athlete performance stack, from data collection to athlete performance management. You canstill use the Power Tool like you use the Tendo unit to motivate and train athletes, but in addition you can start to look at[other variables] like dip and lift profile to improve technique. 

The GymAware Power Tool has evolved through 5 different models over the last 10 years with each new release improving accuracy and usability. There is a good comparison [here] between the latest Power Tool and the Tendo Power and Speed Analyzer. To talk about the benefits of the cloud server and advanced analytics, you first need to look at system accuracy as this is fundamental to the success of the advanced features.The high accuracy of the Power Tool opens up new opportunities in preparing athletes for competition. With high accuracy you can look for more subtle changes over time that give you real insight into the state of the athlete. 

Power is often pursued by teams, could you look at how power can act as a marker of both performance and fatigue with team sports? Currently Benchmarks and profiling seem to be important for individualization. 

There’s no doubt that power is a key factor in producing game winning performances, and power profiling to optimize power training plays a vital role in any professional team. But recently in Australia, regular (3 to 5 times per week) power and/or velocity monitoring has proved to be a very reliable way of monitoring for fatigue. At last year’s ASCA conference Dr Kristie Taylor suggested that we should 

Other performance managers have reported to us that the Power Tool measurements are so sensitive that they can see slower power recovery after games played at a particular stadium known to have a hard playing surface. Regular monitoring with GymAware adds a completely new dimension to the knowledge available to the sports performance professional. 

Kinetic Athlete is not new to player monitoring, why does Kinetic Performance's experience make you a leader in player management? I think to answer this you need to look at environment that lead to the development ofGymAware. 
 

Click HERE to continue reading...

Learn more about this new technology along with the most advanced health and performance monitoring tools currently available at the 2012 BSMPG Summer Seminar - May 19/20th.

article by Jose Fernandez

After reading last week´s posts from Coach Boyle and Carl Valle I decided to do a little research on Self Myofascial Release and foam rolling. What motivated me is that there is not a clear protocol stablished regarding when, how and for how long athletes should use foam rollers. Some coaches recommend to roll before working out and others after, some coaches prefer to just continuously roll over the muscle surface and others recommend to hold on the trigger point for a few seconds.

What is foam rolling? (by wikipedia):

“Foam rolling is a self-myofascial release (SMR) technique that is used by athletes and physical therapists to inhibit overactive muscles. This form of stretching utilizes the concept of autogenic inhibition to improve soft tissue extensibility, thus relaxing the muscle and allowing the activation of the antagonist muscle.

It is accomplished by rolling the foam roller under each muscle group until a tender area is found, and maintaining pressure on the tender area for 30–60 seconds.”

Looking at the scientific evidence, I could not find a lot of published material either. See below some of papers I found:

A comparison of the pressure exerted on soft tissue by 2 myofascial rollers

Foam Rollers Show No Increase in the Flexibility of the Hamstring Muscle Group

The Acute Effect Of Self-Myofascial Release On Lower Extremity Plyometric Performance

In this case study we used Tensiomyography (TMG) to assess the change in contractile muscle properties (contraction time and muscle tone) after applying 2 different protocols with foam rollers. Click here to see one of my previous post with a detailed explanation about TMG and the information that it provides.

Foam Rolling & TMG Case Study:

The purpose of this case study was to analyse the change in contractile muscle properties assessed with TMG before and after applying two different SMR protocols using a foam roller. Characteristics of the roller that we used can be found here.

A professional basketball player (Age:22, H: 6.2ft, W: 198.4lbs, no injuries) with more than 6 months experience using foam rollers volunteered for the test, which was performed after a day off and consisted of assessing the Left Vastus Lateralis (dominant leg) with TMG before and after applying two different rolling interventions.

Protocol 1: Holding on the trigger point

- TMG Initial assessment on resting conditions

- Roll until the area of maximum pain is found. Hold the roll on that point for 30 seconds. Immediately after the 30 seconds continue rolling 5-6 times over the whole muscle surface

- TMG Post treatment Assessment 

Protocol 2: Cotinuous Rolling

- TMG Initial assessment

- Continuously roll over the whole muscle surface for 60 seconds

- TMG Post treatment Assessment

Restults:

Protocol 1:

Click HERE to continue reading this article...

BSMPG has begun plans to host DNS Course "B" in Boston in the spring of 2013.  Due to the overwhelming response of our Course "A" offering, we have begun plans to host course "B" next spring.

Stay tuned to bsmpg.com for complete details.

Click video below to watch interview with Boston Course "A" instructor, Clare Frank who would also be teaching Course "B" upcoming.

Click below to watch an interview with Craig Liebenson as he talks about the DNS approach.

See Craig Liebenson at the 2012 BSMPG Summer Seminar - May 19th and 20th in Boston MA.

Hurry - this program has a limited number of seats!

by Craig Liebenson 

Mid-Thoracic Dysfunction: A Key Perpetuating Factor of Pain in the Locomotor System 

Dysfunction involving excessive T4-T8 kyphosis is common. Symptoms arising from regions at a distance to the mid-thoracic area are often secondary to T4-T8 dysfunction. This article will discuss why (rationale), when (indications), what (skills), and how (practical integration) T4-8 dysfunction is addressed.

Why

Mid-thoracic dysfunction involves increased kyphosis of the thoracic spine from T4-T8, usually the result of prolonged sitting in a constrained posture. Thoracic, lumbopelvic and cervicocranial posture are interrelated as links in a chain (see Figure 1). When excessive slumping becomes habitual, according to Brügger, it is called the sternosymphyseal syndrome (Lewit 1996, 1999, Liebenson et al., 1998, Liebenson 1999).

Mid-thoracic dysfunction affects the whole body's center of alignment and posture. Head and shoulder forward posture causes orofacial, neck and shoulder disorders; slumping affects breathing by leading to inhibition of the diaphragm and overactivation of the scalenes; and lumbar disc syndromes and nerve impingement have been shown to result from repetitive end-range flexion overload (Callaghan, McGill 2001).

When

Indications for treating the mid-thoracic region arise from postural analysis, passive joint mobility testing, and active joint mobility testing. The postural sign of increased thoracolumbar hypertonus is a classic sign of overactivity of the superficial "global" muscles and indicates poor "deep" muscle function (Janda 1996, Richardson 1999, Jull 2000, Hodges 2002).

Palpation of passive joint mobility and quality of end-feel is best performed in the seated position, as shown by Brügger (Brügger 2000).

The dynamic mobility screen of choice is the standing arm elevation test (Liebenson 2001).

What

Managing T4-8 dysfunction requires a broad skill set incorporating postural advice, manual manipulation, and therapeutic exercise.

Sample Exercises for Improving T4-8 Extension Mobility

• Brügger relief position - beginner

   

  

   

• Back stretch on the ball - intermediate

   

  
• Kolár's wall slide with arm elevation - advanced

   

  

  How

  Knowing why mid-thoracic dysfunction is clinically important, when it should be addressed, and what techniques are therapeutic is only the beginning point for successful management of the patient with a problem in this area. Satisfactory results will result from learning how to incorporate this knowledge and skill into patient care efficiently. A moment or two per session spent explaining the relationship between function and pain is one such step. Each exercise requires a unique "report of findings" to motivate the patient to incorporate it into his or her daily routine.

  The Brügger relief position is an ideal workplace "micro-break." It activates an entire chain of muscles linked to the upright posture. To prevent the tendency to hyperextend the lumbar spine with this exercise, it should be performed with active exhalation.

  The back stretch on the ball is comfortable and relaxing. It promotes improved respiration. It can cause dizziness at first, so the patient should be guided slowly onto it until he or she has learned how to balance on the ball.

  Kolár's wall slide with arm elevation is a functional exercise, since it combines arm elevation, squatting and breathing. Patients typically feel a nice stretch in the lattismus dorsi with this exercise.

  Summary

  T4-8 dysfunction is a common source of muscle imbalance, trigger points, joint dysfunction, and faulty movement patterns. While often asymptomatic, it is nonetheless a key source of biomechanical overload involving the neck, TMJ, shoulder, arm, and even low back regions. Treatments which aim only at the site of symptoms are bound to fail if function is disturbed due to excessive kyphosis in the mid-back.

  Rehabilitation of the upright posture is fundamental to optimization of function in the locomotor system. Neurological programs for maintenance of the upright posture are "hard-wired" into the central nervous system, making rehabilitation of the mid-thoracic area of central importance, both biomechanically and neurophysiologically. The mid-thoracic region is "linked" to a multitude of common musculoskeletal pain syndromes, and the simple assessment and treatments shown here are an excellent complement to chiropractic practice.

  References

   

• Brügger A. Lehrbuch der Funktionellen Storungen des Bewegungssystems. Brugger-Verlag GmbH, Zollikon, Benglen, 2000.
• Callaghan JP, McGill SM. Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clinical Biomechanics 2001;16:28-37.
• Hodges PW, Jull GA. Motor relearning strategies for the rehabilitation of invertebral control of the spine. In Liebenson CS. Rehabilitaiton of the Spine: A Practitioner's Manual (2nd ed). Lippincott/Williams & Wilkins, Baltimore, sched pub 2002.
• Janda V 1996. The evaluation of muscle imbalance in Liebenson CS (ed) Rehabilitation of the Spine: A Practitioner's Manual, Lippincott/Williams and Wilkins, Baltimore, 1996.
• Jull GA. Deep cervical flexor muscle dysfunction in whiplash. Journal of Musculoskeletal Pain 2000. 8:143-154,
• Lewit K 1996. The role of manipulation in spinal rehabilitation in Liebenson CS (ed) Rehabilitation of the Spine: A Practitioner's Manual, Lippincott/Williams and Wilkins, Baltimore.
• Lewit K 1999. Manipulative Therapy in Rehabilitation of the Motor System. 3rd edition. London: Butterworths.
• Liebenson CS, DeFranca C, Lefebvre R 1998. Rehabilitation of the Spine: Functional Evaluation of the Cervical Spine, Williams & Wilkins, Baltimore.
• Liebenson CS, Advice for the clinician and patient: The Brugger relief position. Journal of Bodywork and Movement Therapies 1999. 3:147-149.
• Liebenson CS, Advice for the clinician and patient: Self-treatment of mid-thoracic dysfunction: a key link in the body axis. Journal of Bodywork and Movement Therapies 2001. 5:90-100.
• Richardson C, Jull G, Hides J, Hodges P 1999. Therapeutic Exercise for Spinal Stabilization in Lower Back Pain, Churchill Livingstone. 

See Craig Liebenson speak at the 2012 BSMPG Summer Seminar this May 19-20 in Boston MA.

Co-Presenters at the 2011 BSMPG Summer Seminar, Dr. John DiMuro and Mark Toomey return to Boston in May for the 2012 BSMPG Summer Seminar for a series of lectures that are sure to provide attendees with a number of monumental "ah-ha" moments as they show with fluoroscopy EXACTLY what is happening during exercises in both your rehabilitation and performance training programs.  

The difference between what you thought was happening during simple exercises and what is actually occuring at each joint will have you thinking twice before you prescribe your next exercise program or therapeutic intervention.

Click HERE to listen to a recent interview with Dr. DiMuro and Mark Toomey on SportsRehabExpert.com

Dr John DiMuro DO, MBA

Dr. DiMuro is a Board Certified Anesthesiologist and Pain Medicine expert who specializes in advanced interventional pain treatments for all types of pain conditions. He grew up in central New Jersey prior to attending medical and business school in Philadelphia . He has an M.B.A. in health care management from St. Joseph 's University and completed his internship at the Tampa Bay Heart Institute. He was chief resident during his Anesthesiology residency at Georgetown University in Washington , D.C. prior to completing a pain medicine fellowship at the world-renowned Memorial Sloan-Kettering Cancer Center in New York City . He currently serves on the Carson Tahoe Hospital Cancer Committee. He continues to work in private practice and lectures nationally for the Kimberly Clark Company and Boston Scientific.

Mark Toomey, Sr RKC, CSCS

Mark Toomey is a fitness instructor from Reno , Nevada . He serves as a Subject Matter Expert (SME) in fitness and conditioning for the United States Navy and the United States Marine Corps. He is the Director of Operations for Dragon Door Publications, a producer of cutting edge material on strength and conditioning and acts as a Senior Instructor for the RKC, the first and largest entity specializing in kettlebell and body weight exercise instruction. Mark is an NSCA Certified Strength and Conditioning Specialist and a certified CK-FMS practitioner.

Be sure to register for the 2012 BSMPG Summer Seminar today before they sell out!

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!

Join Jose Fernandez and other top Sports Medicine and Sports Performance professionals from across the world as they desend on Boston this May 19th-20th for the 2012 BSMPG Summer Seminar.  Choose from a number of specific learning tracks or mix and match to suit your learning needs.  Keynote speakers throughout the weekend include Dr. Craig Liebenson, Chris Powers, Alan Grodin, Irving Schexnayder, and Bill Knowles. 

Register today for this once in a lifetime event! Seats are limited!

Boston Sport Medicine and Performance Conference

Advanced Athlete Monitoring for Injury Reduction

Jose Fernandez

Abstract:

Professional athletes are experts at what they do, regardless how many S&C sessions they perform a week, they either have the quality to average 20 points per night or they don´t. From a physical perspective, coaches need to make sure their athletes are healthy and available to play every night. A healthy professional athlete should be capable to display a good performance just by being healthy. Everything else that can be achieved with training is a plus.

In a league where teams have to play 3-4 games a week and take more than 90 flights per season, time is limited for coaches to carry out physical training sessions with their players. A training program must be precise, specific and adjusted to the individual needs of each athlete. Coaches should focus on maintaining and reducing the loss of training adaptations throughout the season while enhancing the recovery and regeneration strategies.

At this year´s BSMPG Conference, I will be presenting ideas on how to objectively profile athletes attending to their neuromuscular characteristics and type of muscle fiber predominance. Continuing with this neuromuscular approach to athlete monitoring, innovative ways to quantify effects and duration of the training and treatments will be discussed. Being able to control the rate at which each muscle gains and looses activation after a training session or how exactly certain therapy treatment affects the functionality of any muscle group is crucial if we want to schedule training actions at the right moment, with the aim to maximize the physical performance and minimize risk of injury during the competition.

From an injury prevention perspective, new concepts to evaluate athlete´s readiness to train and assessment of change in muscle response induced by training will also be suggested, with a clear focus on practicality and applicability.

Aiming for maximal performance is a complex task. The purpose of my presentation is to offer some insight into the analysis of an athlete´s neuromuscular condition and how this can help coaches optimize training in an objective, reliable and time saving manner.

I look forward to seeing you at the BSMPG Conference in May!