Boston Sports Medicine and Performance Group, LLC Blog

Up the Chain it Goes...

Posted by Boston Sports Medicine and Performance Group on Sun, Apr 29, 2012 @ 15:04 PM

By Art Horne



derrick rose torn acl



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.


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:


 zeo affectiva  ithlete

BioSensics  Zflo insideTracker


Dartfish  freelap timing   Tekscanoptosource

Click me




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.

Topics: Art Horne, basketball performance, basketball training programs, BSMPG, athletic training conference, Charlie Weingroff, boston hockey conference, barefoot strength training, Andrea Hudy, Bruce Williams, Cal Dietz, Alan Grodin, Barefoot in Boston, Dr. DiMuro, Dan Boothby, Chris Powers, achilles pain, Dorsiflexion, ankle problems

Jeff Cubos Talks Dynamic Neuromuscular Stabilization : Filling the Gaps

Posted by Boston Sports Medicine and Performance Group on Mon, Apr 9, 2012 @ 07:04 AM

by Jeff Cubos


It’s been over a year since I first began the Dynamic Neuromuscular Stabilization program. Since that initial “A” course, my clinical thought process has expanded exponentially through following up with the “B” and “C” courses, my privileged opportunity to visit Motol in Prague, and the day to day reflections of my current practice.

Well recently, I had the privilege of taking part in another DNS A course that was put forth by Michael Maxwell of Somatic Senses and taught by Alena Kobesova and Brett Winchester. This particular experience was quite special for me because not only was it local (hence no flight costs), but it provided me with the opportunity to share my experiences to date with many of my friends and colleagues who attended the course…including my wife.

I would say however, that the most beneficial aspect of being present was that it afforded me the opportunity to “fill in the gaps”.



Continue to read this article by Jeff Cubos by clicking HERE

Meet Jeff Cubos and other top therapists and strength coaches as attendees at the 2012 BSMPG Summer Seminar.

Register today before seats are filled!!


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Topics: BSMPG, athletic training conference, Craig Liebenson, Charlie Weingroff, boston hockey conference, Cal Dietz, Jeff Cubos, Barefoot in Boston, Dan Boothby, Clare Frank, DNS course, barefoot training

Interview with Mark Toomey and Dr. John DiMuro - 2012 BSMPG Summer Seminar Presenters

Posted by Boston Sports Medicine and Performance Group on Wed, Mar 28, 2012 @ 07:03 AM

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



Mark Toomey


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!

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Topics: basketball conference, athletic training conference, boston hockey summit, Craig Liebenson, boston hockey conference, Bruce Williams, Cal Dietz, Bill Knowles, Dan Boothby, barefoot running

Readings from last week

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

Readings from last week.



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

Advanced Athlete Monitoring For Injury Reduction at the 2012 BSMPG Summer Seminar

Posted by Boston Sports Medicine and Performance Group on Wed, Mar 7, 2012 @ 07:03 AM

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!


BSMPG Summer Seminar


        BSMPG Summer Seminar


Boston Sport Medicine and Performance Conference

Advanced Athlete Monitoring for Injury Reduction

Jose Fernandez



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!



Topics: Art Horne, basketball performance, BSMPG, athletic training conference, boston hockey conference, Logan Schwartz, Andrea Hudy, Bruce Williams, Mark Toomey, Cal Dietz, Alan Grodin, Joel Jamieson, Dan Boothby, Jose Fernandez

Register for the 2012 BSMPG Summer Seminar and Win Prizes!

Posted by Boston Sports Medicine and Performance Group on Mon, Feb 6, 2012 @ 19:02 PM

Who Doesn't Love Free Prizes?

Complete details are now available for the 2012 BSMPG Summer Seminar and this year looks better than ever!  In addition to another world-class speaker list, BSMPG and our sponsors are offering a ridiculous number of prizes.

Prizes: Attendees are automatically registered to win prizes from a number of our sponsors including: Freelap Timing Systems, Zeo Sleep Manager and Perform Better.

Other Raffle Prizes include: Barefoot in Boston by Art Horne and Human Locomotion by Thomas Michaud


Human LocomotionBarefoot in Boston 

 freelap timing system zeo


Attendees who register before April 15th will be placed in a raffle to win a Free Registration pass to the  2013 BSMPG Summer Seminar!


Click HERE for registration and complete details.



Topics: Art Horne, basketball conference, BSMPG, athletic training conference, Craig Liebenson, boston hockey conference, Andrea Hudy, Bruce Williams, Cal Dietz, Bill Knowles, Alan Grodin, Barefoot in Boston, Dr. DiMuro, Dan Boothby

BSMPG Announces Dan Boothby as Speaker at 2012 BSMPG Summer Seminar

Posted by Boston Sports Medicine and Performance Group on Fri, Jan 20, 2012 @ 07:01 AM

BSMPG is proud to announce Dan Boothby as a speaker within the Hockey Specific Training Track for the 2012 BSMPG Summer Seminar, May 19-20, 2012 in Boston MA.


dan boothby


Northeastern University

Dan Boothby begins his sixth full season as strength & conditioning coach for the Northeastern University hockey team. Boothby oversees all strength, conditioning and nutrition for the team, and aides in team building and organization.

Boothby was promoted to Director of Strength & Conditioning at Northeastern in 2010.

Boothby has spent the last five years working with Northeastern athletes, having joined the staff as an Assistant Strength & Conditioning Coach in Nov. 2005. He has served as the Director of Player Development for the Northeastern men’s and women’s hockey teams since July 2006. In his first role, Boothby had the opportunity to design and implement strength and conditioning programs for various Husky athletic teams, including year-round nutrition, weight and injury-prevention programs. Working with the hockey teams, Boothby expanded his role to include budget management and biomechanical evaluations.

Boothby, a National Strength and Conditioning Association Certified Strength and Conditioning Specialist, also holds Dan Boothby Performance Training camps, which are tailored for sport-specific strength and conditioning for all levels, including high school, college, professional and Olympic-caliber athletes. Over the past year, he has been advising Northeastern alumna Zara Northover, who competed in the shot put at the Olympics in Beijing.

Before coming to Northeastern, Boothby served under the Head Strength & Conditioning coach at Central Connecticut State University as an undergraduate intern while playing on the offensive line of CCSU’s football team for four seasons.

The Kennebunk, Maine, native graduated from Central Connecticut State in 2005 with a bachelor’s degree in Exercise Science and now resides in Allston, Mass.



Famously uttered by Sir Isaac Newton,

“If I can see further than anyone else, it is only because I am standing on the shoulders of giants.”

In 2011 BSMPG invited the titans of Sports Medicine and Performance to Boston for the largest conference of its kind, and many attendees left asking the question, "how could you ever top that speaker line-up?" Well, we did. BSMPG is proud to announce May 19-20, 2012 as the selected date for Sports Medicine and Strength professionals to desend upon Boston MA for another monster conference!

So how could we ever top last year's speaker set?

Let's just say that we asked last year's speakers who they wanted to hear and we got em!

Stay tuned over the next few weeks as we reveal our entire 2012 speaker set. As we did last year, this seminar will be divided into three distinct educational tracks including a Hockey focus, a Basketball Focus and a clear Sports Medicine/Rehabilitation Track with Keynote Speakers throughout the weekend bringing each track together for common lectures. Attendees may choose to stay within one track throughout the entire weekend or mix and match to meet their educational needs. Remember to save the date now - you won't want to miss another great summer seminar presented by BSMPG.

May 19-20, 2012 - Boston MA. Complete details coming soon!


Remember to Save the Date for the BSMPG 2012 Summer Seminar - May 19-20th in Boston MA.


A limited number of seats still remain for our DNS "A" course. Sign up now before the last seat is gone!

Topics: basketball conference, basketball training programs, BSMPG, athletic training conference, boston hockey conference, Dan Boothby