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!

In Gray Cook's most recent podcast, he discusses the importance of going without shoes and the benefits that come along with going with less on your feet.

Click HERE to listen to Gray Cook.

For more information on going barefoot and how to implement a barefoot program safely click HERE to visit our web page dedicated to going with less on your feet or purchase BAREFOOT IN BOSTON today - your feet will thank you!

Barefoot expert and Harvard Professor Daniel Lieberman talks about the obesity problem in America.  This 13 minute presentation examines our evolutionary path to obesity and concludes with a radical idea to fight this growing problem.

Enjoy!

by Scot Spak

Athletic Trainer, Massachusetts Institute of Technology

In the past four years, home values have fallen as fast and as hard as Tiger Woods.  Government officials are spending too much money (or is it too little?), and yet our economy hasn’t budged.  Jobs seem as scarce as an L.A. Clipper’s post-season visit (Thank You Chris Paul).  All of this should sound familiar, and if it does, should we as Sports Medicine professionals be concerned?

In a world where everyone is looking at increasing revenue or decreasing expenses, where do athletic trainers fit?  In the traditional Sports Medicine setting, can we accomplish either without creating too much strain on an already overtaxed resource?

Can Sports Medicine Departments sustain the current economic environment without adapting or proving their worth, an environment where the all mighty dollar speaks very loudly?  Athletic trainers traditionally bring in NO money for its employer, while draining their bottom line.  It’s time to re-evaluate that model: demonstrate your value!

Investigate implementing a Medical Model of health care at your setting.  Bring in the college’s student-health center or your University’s hospital and place the athletic trainer in a clinical health care structure versus an athletic structure.  The potential benefits include:

• enhance your professional development as you interact and operate with other health care professionals.  
• report to and get feedback from another health care professional instead of an athletic director
• enhance your work-life balance by demonstrating, documenting, and presenting your overall volume and load to individuals who understand what it takes to provide adequate health care
• increase your salary to more accurately reflect a health care providers income

Collect Injury Data anyway you can:

• producing reports with actual values will help you better demonstrate what you do on a daily basis, but objective data is more tangible and easier to understand than subjective statements
• we employ a swipe system where each patient swipes there ID for certain items they need: Injury Evaluation, Wound Care, Rehab, etc. 

Let me tell you how powerful those numbers look when you present the data set to the administration, coaches, and health center.  These figures allow you to more adequately defend your time. For example, you are given a new project to conduct, without new allocation of funding or human resources to support it.  Explain to administration based off of your current volume (objective data) what you can’t get to because of the new request.  Explain to a coach that “Sarah” will need to complete her rehab off-campus at a PT facility do to your new project. Could you get release time to finish the project?  Could you get Per Diem money allocated to your department to complete this task?  You won’t know unless you can support your rationale and then ask.

Find ways to bring money into your institution:

Focus on looking at alumni outreach/support for fundraising. College and University revenue is hugely impacted by alumni gifts.  This form of generating money is so large for these entities that they employ substantial departments to bring in alumni donations.  Tap former patients to contribute to the Athletic Department, Health Center, or the Sports Medicine Department. Generate a targeted outreach letter to past patients.  Your predecessor could have positively influenced the life of a patient who turned out to be the CEO of a financial institution.  Considering giving back already for several reasons the CEO needed a push from the alumni office, gets a targeted letter from you, and before you know it you receive $250,000 to create a new athletic training room named after your predecessor.  Now that’s creating worth. 

You could start as simple as creating a Sports Medicine Fund.  Every former student-athlete would receive a letter from athletics asking for a contribution and your unit will be represented on the form.  Image starting to receive annual contributions and building relationships with donors; your perception around the institution would positively change.  You would be seen as more instrumental within your department and provide more power when needing or asking for things (think staff and money).     

These are just a few options to explore.  Justifying your position and making it a sustainable resource provides job security.  Providing objective data to highlight underserved areas or increasing your institution’s revenue make you a valuable resource.  Reporting to individuals who understand healthcare can produce increase job satisfaction and support for additional resources.

Consider these items and think outside of the box to create a better working environment for yourself and enhancing opportunities for the profession.  Promote your value and worth as a professional.

Retention of Movement Pattern Changes After a Lower Extremity Injury Prevention Program Is Affected by Program Duration

Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage.

Breathing and Low Back Pain: Is there a correlation?

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

The Path to Excellence was a study undertaken by the United States Olympic Committee (USOC) in an attempt to describe and understand the factors that contributed to the development of U.S. Olympians (1). This study presents a number of practical findings relevant to athlete development and talent identification that are along similar lines to those being investigated in the Pathways to the Podium Research Project.

816 male and female Olympians were recruited to participate in this study; all of whom competed in either the Summer or Winter Olympic Games between the years 1984 to 1998. All athletes completed a detailed questionnaire regarding the history of their involvement in sport, and their experiences throughout their journey to the Olympics. Some of the main findings that I found particularly interesting and applicable to coaching and athlete development are outlined below.

The Important Qualities of a Coach

What do athletes look for in a coach? The Olympians were asked to identify and rank the characteristics they value most in a coach. Here are the results:

CLICK HERE TO CONTINUE READING...

The wait is finally over - Triphasic Training by Cal Dietz and Ben Peterson is finally here. 

Click HERE to order Cal's Book.

Read a portion of Cal's Book by viewing a previous post HERE.

Table of Contents

See Alan Grodin at the 2012 BSMPG Summer Seminar as he discusses the importance of matching the appropriate intervention strategy to your patient's underlying pathology.  Learn why exercise and strengthening is not always the answer for a muscle testing weak, along with the appropriate interventions for the most common musculoskeletal pathologies.

ALAN GRODIN

Topic: The Importance of Seeing the Big Picture: Choosing the Appropriate Intervention Strategy 

Alan Grodin is Senior Vice President of Sovereign Rehabilitation (SR).  A nationally renowned, master clinician, Alan is recognized as one of Atlanta’s leading physical therapists.  Especially respected for his expertise in spine-related physical therapy, Alan commonly treats Atlanta Hawks players.

As a licensed physical therapist, Alan’s career spans more than three decades. After spending his early years in a hospital setting and several years in mentorship under the industry’s pioneers, Alan formed the first Sovereign Rehabilitation's (SR) in 1982. After 12 years of significant growth, SR merged with a national rehabilitation company. Alan subsequently led that company’s most successful region . 

After 13 years in the corporate rehabilitation environment, Alan decided to return to the ideals and operational environment afforded by private practice. Thus, SR was re-launched in 2007.

A member of the American Physical Therapy Association, Alan is extensively published, including a third-edition textbook. He is a sought after instructor and lecturer, who has taught courses throughout the United States as well as in Chile, Japan, and Iceland. Alan is also a longtime faculty member of University of St. Augustine, a premier physical and occupational therapy college.

Alan earned his bachelor’s degree in biology and anthropology from the State University of New York (SUNY) - Binghamton and his physical therapy degree from SUNY Downstate Medical Center. He has also completed kinesiology master’s work at New York University.  

Excerpt from Alan's book, MYOFASCIAL MANIPULATION: Theory and Clinical Application (first edition)

"One of the classic works on muscle response to immobilization was performed by Tabery et al. In this study, cat soleus muscles were immobilized at various lengths of time. The animals were immobilized by plaster cast. Some of the animals were killed and the muscles were biochemically and histologically analyzed. Biochemically, the passive length-tension was increased in the muscles immobilized in the shortened position, probably because of the connective tissue changes within and surrounding the muscle. Muscles immobilized in the lengthened position had no significant changes in passive length-tension characteristics. From a histological standpoint, the muscles immobilized in the shortened position had a 40% loss of sarcomeres, with an overall decreased in fiber length. The muscles immobilized in the lengthened position exhibited a 19% increase in sarcomeres and an overall increase in fiber length. After 4 weeks of remobilization, the number of sarcomeres in the muscles returned to normal. This study illustrates the principle that muscle tissue will adapt to change in length by increasing or decreasing sarcomeres in order to keep sarcomeres at optimal lengths.

In a follow- up study performed by Tabery and Tardieu, muscle changes caused by prolonged active shortening were studied. Sciatic nerves of guinea pigs were stimulated for 12 hours in either the shortened or lengthened position. The muscles stimulated in the shortened range had a loss of 25% sarcomeres after only 12 hours of contraction. Sarcomeres were completely recovered in the muscles between 48 and 72 hours. The implication of these studies is that muscles passively shortened lose sarcomeres at a much slower pace than muscles actively shortened.

The clinical implication of these findings relates to the types of immbolization that occur in the practice setting. Immobilization may occur artificially (external or internal fixation), or as a physiological mechanism. In the clinical setting, immobility may be due to trauma, past or present. A good example is the whiplash injury, in which immobilization is caused intrinsically by the cervical and upper thoracic paravertebral muscles, the scapulothoracic muscles, and the shoulder girdle muscles. In many cases, the surrounding musculature remains tonically active long after the facet or ligamentous sprain-strain has healed. The body learns a new recruitment pattern for surrounding muscles, and this hypertonic pattern remains long after healing. The muscles are then actively “immobilized,” causing some of the histological changes mentioned above. Often, the most difficult part of the therapeutic process is dealing with this hypertonicity, which is secondary to the original injury." (page 52)

THIS COURSE IS SOLD OUT!

The DNS Course "A" orginially offered March 30-April 1st in Boston, MA is sold out!  We are currently working on offering another Course "A" seminar in the near future and a Course "B" in 2013.  If you are interested in attending a Course "A" in the future, or would like to be placed on our cancellation list for the above event please contact course organizers at bostonsmpg@gmail.com.

Dynamic Neuromuscular Stabilization Course "A"

The “Prague School of Rehabilitation and Manual Medicine” was established by key neurologists/physiatrists, all of whom were giants in the 20th century rehabilitation era i.e. Karel Lewit and the late Professors Vaclav Vojta, Vladimir Janda & Frantisek Vele.  Based on groundbreaking neurodevelopmental and rehabilitation principles by these men, Professor Pavel Kolar has successfully integrated the work of his predecessors in proposing the underlying neurodevelopmental mechanism for how the movement system develops hand-in-hand with CNS maturation.  This complex approach is “cutting-edge” in that it provides a window into provides a window into the complexity and plasticity of the CNS and its effect on the movement system.  The DNS approach can be used in the rehabilitation of a myriad of neurologic, musculoskeletal pain syndromes as well as performance athletic training.

For more information on this approach please check out www.rehabps.com

Since the inception of BSMPG we have featured a number of books, resources, and professionals that we believe are changing the way we practice sports medicine and performance training right before our eyes.  One such professional is Cal Dietz from the University of Minnesota.

Personally, there are only a few strength coaches that I follow closely and that have influenced my development in both sports medicine and sports performance; and then there is Cal Dietz.

See a portion from Cal's new book below which will be released later this week - a must have for all those that take performance training seriously!

See Cal speak at the BSMPG summer seminar May 19-20th in Boston MA.

Transferring Force and Improving Performance Through the Foot and Ankle Complex

By: Cal Dietz & Ben Peterson
Edited By: Daniel Raimondi

Over many years of coaching I have witnessed athletes who have made tremendous gains in knee and hip flexion and explosiveness in their training, yet this training time and advancement never seem to transfer into training results for testing. Then one day about 8 years ago I was able to spot the main reason why all this newly developed athletic potential and speed did not transfer over into testing. The question arose with several athletes I made much stronger in the knee and hip joint, along with explosion from those various joints. However, in testing the athletes’ 10 and 20-yard dash we didn’t see the results that we anticipated based on their gains everywhere else in the weight room and/or vertical jump. When we tested one particular athlete we saw no advancements in the 10 and 20 yd dash, which was a huge concern and misunderstanding on my part. I realized at this point that I must dig into this to its fullest extent.

As I reviewed the tape of the athlete running the starts in the 10 and 20 I was able to spot something that was of key importance. The original reason I was video tapping was to rectify some technical flaws that could improve the 10 and 20 times, but since this athletes was a hockey player, just by practicing the skill he got much better. Anyone that has ever trained a hockey athlete for running realizes how poor the technique often is when they start coming right out of the season. What I saw on this day was that as the athlete's foot struck the ground on the second step I saw that the heel lost 2-3 inches from the point when the toes hit the ground. When I say “lost” I mean there was a reversal of direction of the center of mass in the body and the heel thus, became closer to the ground. This indicated a loss of power being, incapable of helping the athlete run faster.

I then reversed the tape and looked at the first step and the same thing was happening with the athletes out of the initial start. I realized what had taken place: I made the hip and knee joint much more powerful and stronger, but the ankle joint (being a hockey player) couldn’t absorb the force from the knee and hip. It was as if all the athletes had been running their times on sand. Since I made the hip and knee stronger the ankle, the weak link in the chain, was unable to absorb the force that dampened the stiffness qualities and those particular testing results By addressing the ankle complex weaknesses that existed to absorb the force and power we were able to within one week make the ankle complex strong enough to withstand the foot striking the ground.

This can often be seen in a number of populations. The aforementioned example of hockey players is obvious because they spend most of the season in the boot. Basketball players are often suspect because their ankles become weakened in the season due to the excessive taping and braces that they wear. I‘ve seen throwers(shotput and/or discus) have this coming across the ring as they change directions. This technique flaw often happens when they start to spin and transfer across the rear of the ring to the front of the ring. You will see their ankle give and at that point many gains can be made in speed and quickness in the ankle and foot.

One must have a full understanding of the foot/ankle complex and its functions many athletes demonstrate dysfunctional patterns in the said area. Hopefully you have a good medical staff that can manipulate the foot (Or are willing to learn if they can’t) to better transfer this force into the ground such that performance improves. Fortunately, I have been able to learn a number of techniques to help manipulate the foot so that it functions better. Without functioning correctly you will never get the entire benefits of the training program.

Let’s first look at the basic functions of the ankle foot as it’s used in sport. As the foot strikes the ground, whether during acceleration or at top speed, near the small toes as it tries to find the ground. What then occurs is a transfer of forces from the small toes over to the big toe at push off. The transference is utilizing the size and strength of the big toe in running; this action must be used in all movements in training. So keep in mind that in every possible  action you must use a few key coaching points/actions with your athletes:

1.  Focus on pushing through the big toe
You will see a huge improvement in their  jumping ability if you add this one component to your jumping/plyometric programs. Also, in any weight lifting movement that applies extension of all three joints (at a slow or high speed) this also must be implemented to transfer weight room performance to the field. So, in your cleans, cue the athletes to push through the big toe at the top of the pull. This is not recommended for Olympic weight lifters; however, for sports performance it would be highly recommended. The walking lunge is another example of how this should be implemented. As an athlete would push and finish off the movement at the top, all the forces must be transferred off the foot to the big toe to strengthen it and emphasize its mobility and strength at the range of motion.

2. Calf raises for sport training should be done explosively with a knee bend.
That knee bend must be timed with the extension of the foot at the top when completing the exercise. The feet sometimes misfire on the timing at the beginning of sporting movements, but remember it is an absolute necessity to transfer all the actions on the joint to the sporting field. Bodybuilders would not want to implement this. Athletes should execute this exercise at the end of the a training cycle in the last 4-6 weeks. Just completing heavy loads without the knee bend would be fine, but keep in mind you must always finish with the explosive knee bend calf raises, being sure to push through the big toe at the top.

No matter what sport you play, if it involves movement with the legs, you must constantly coach the athletes up on these finer points of foot function. Essentially, what happens is they’re losing all the potential power from the main two joints of explosion and not transferring it onto the speed on the field. I’ve seen too many athletes underutilize their potential and have a simple biomechanical problem that can’t be transferred over because of one joint in the kinetic chain in applying power and force to the ground. You lose so much potential. 

Having your squatting potential transfer to the sporting field to optimize results:
Many athletes and/or coaches use an Olympic or powerlifting style squat when they are performing front and back squats when training for sport. Let’s keep in mind that these are all excellent exercises in gaining strength for athletes to become faster and more explosive. Please keep in mind that I use these various techniques throughout the year, but you can’t get the greatest sport results by not changing up these methods once your athletes have become strong enough. When making this statement one must realize that you can’t keep squatting heavier and heavier and have performance keep improving. This has never been the case with any athlete that I’ve seen. You must have a level of strength that is high enough to perform the task at hand. Once the strength has been developed one must use more sports specific methods to transfer the gains made from the Olympic and power-lifting squat over to the field.

This is where the “sport back squat” comes into play. The sport back squat essentially is taking your wider stance squat and moving the feet of the athlete to a very narrow position (shoulder width or slightly within/outside based on size). The reason for this is that during the majority of performances the athlete completes the feet will be in this position. To facilitate the transfer and strength gains from the Olympic and power lifting style back squat, the last 4 to 6 weeks of training (potentially longer during the in season) would use the sport back squat to get the most specific position of your feet when squatting.  Some things change in this particular style of squat, especially with athletes that have a long thigh bone; they will not be able to go as deep as before as in the Olympic or power lifting style back squat. Keep in mind when you switch from the Olympic or power lifting style back squat to the sport back squat that you most likely wont have your athletes go as deep for biomechanical reasons. So realizing that your athletes wont go as deep you must increase the glute and hamstring work in your programming because you will not be utilizing the hamstring and glutes as much as you would in the deeper Olympic and power squats.

Many people often ask, “Well is not squatting deep the ideal thing for my athletes?” I would say unless they are going into some type of squatting competition not to worry about it because in sport they rarely ever get into that deep of a position; also, they will not lose much strength in regard to squatting during the transition time utilizing the sport back squat, which again should be the last 4 to 6 weeks of your training cycles to get optimal transfer of sports performance. Dr. Bondarchuck rarely ever squatted his athletes that deep because they never went into those deep positions in their throwing movements. He felt that squatting at the angles that they would compete at was optimal and got the best results. His results speak for themselves, being arguably the greatest coach in the history of the summer games. Just remember when utilizing the sport back squat one can also come up with some very specific glute and hamstring exercises to help your athletes transfer into their sporting event.