Boston Sports Medicine and Performance Group, LLC Blog

What do omelets have to do with rehab?

Everything.

Every omelets is made with eggs.

You can add your own mushrooms, peppers and even some cheese on top - but it all starts with the eggs. 

Yes, even all white omelets are made with eggs.

When approaching rehab protocols, say for example, treating an athlete with knee pain, every protocol should include hip strengthening exercises. Yes, every single one.  Hip/Glute med strengthening is an egg in your knee pain omelet.  You may choose to add massage or even Russian e-stim to strengthen the vmo if you’d like, but without exercises that target the hips you simply don’t have an omelet.

I’m still amazed at the number of Sports Medicine departments that have staff members that approach common injuries differently.

“That’s just the way I do it” each one will respond, or “there’s more than one way to skin a cat you know.”

True, there is more than one way to skin a cat, but we’re making omelets.

Rehab eggs don’t have individual preferences or bias. Save that for the type of cheese you want. Eggs are evidence based. Eggs are a must in every omelet – and without them you simply have a pan full of veggies and cheese – and well, that’s stir fry – and nobody wants to eat stir fry for breakfast.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

BSMPG would like to thank all those professionals that follow our blog and attend our continuing education events.

Enjoy the holidays.

 - the BSMPG family

They don't teach you how to solve interesting problems in school.

Memorize the information and take the test.

Repeat with new information.

Receive diploma - congrats - you are very good at memorizing information.

Is it any wonder so many young professionals lack the skills or courage to make decisions or champion a project that will change how you do business for the better?

Next time you have an opening on your staff hire an architect, or at least someone excited to solve interesting problems.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

Hire an architect by Seth Godin

Architects don't manufacture nails, assemble windows or chop down trees. Instead, they take existing components and assemble them in interesting and important ways.

It used to be that if you wanted to build an organization, you had to be prepared to do a lot of manufacturing and assembly--of something. My first internet company had 60 or 70 people at its peak... and today, you could run the same organization with six people. The rest? They were busy building an infrastructure that now exists. Restaurants used to be built by chefs. Now, more than ever, they're built by impresarios who know how to tie together real estate, promotion, service and chefs into a package that consumers want to buy. The difficult part isn't installing the stove, the difficult (and scarce) part is telling a story.

I'm talking about intentionally building a structure and a strategy and a position, not focusing your energy on the mechanics, because mechanics alone are insufficient. Just as you can't build a class A office building with nothing but a skilled carpenter, you can't build a business for the ages that merely puts widgets into boxes.

My friend Jerry calls these people corporate chiropractors. They don't do surgery, they realign and recognize what's out of place.
Organizational architects know how to find suppliers, use the cloud (of people, of data, of resources), identify freelancers, tie together disparate resources and weave them into a business that scales. You either need to become one or hire one.
The organizations that matter are busy being run by people who figure out what to do next.

My dad used to say this all the time and is probably the one to blame for why I’m so crazy about the things we can do better.

When it comes to Sports Medicine however, this concept of prevention seems to be somewhat fuzzy.

Most athletic trainers do an unbelievable job at promoting the prevention of dehydration, cramping, heat exhaustion and ultimately death during the hot fall pre-season, yet when it comes to prevention in the winter or spring seasons the concept is almost completely forgotten about.  Sure we continue to do a great job at preventing the spread of skin infections, the flu and blood borne pathogens, but how many hours of your day are spent addressing these concerns after they’ve happened?

How come we are never as passionate about preventing ACL tears, ankle sprains, low back pain or stress fractures as we are dehydration?  Isn’t the majority of our day spent dealing with these musculoskeletal injuries?

Even the BOC website places PREVENTION as the first of the five practice domains of Athletic Training and describes Athletic Training as encompassing the PREVENTION, diagnosis and intervention of emergency, acute and chronic medical conditions involving impairment, functional limitations and disabilities.
Yet how many Sports Medicine programs actually have a system in place to evaluate and address for these injuries and illnesses that take up so much of our time? How many programs place athletes with a previous injury on a “pre-hab” program to address this concern? Doesn’t pain alter mechanics?

Isn’t time that Sports Medicine embrace prevention and intervention of musculoskeletal injuries with the same zealous of other prevention strategies?

My dad also used to tell me to measure twice and cut once.

Sorry dad, but in the case of sports medicine and prevention, I’d rather measure three, four or five times if it means our athletes never have to get cut once.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

Congrats to the University of Pittsburgh and Strength and Conditioning Coach Tim Beltz for winning the 2010 2K Sports Classic this past weekend at Madison Square Garden over the University of Texas 68-66.

Watch Tim discuss how he assesses and prepares his basketball team each year for the rigors of Big East play and how his strength programming has this team in the national spot light again.

Watch Tim's full presentation along with presentations from basketball's best strength coaches including Keith D'Amelio from the University of Stanford, Mike Curtis from the University of Virginia, Amanda Kimball from the University of Connecticut and many more by purchasing the 2010 BSMPG Basketball Conference Video.

BSMPG is proud to announce that Dr. Clare Frank will join Dr. Shirley Sahrmann and Tom Myers as featured speakers in Boston June 3rd and 4th, 2011.

Dr Frank was born and raised in Malaysia where she found her passion in sports. She started competing at the age of 10 and went on to win several state and national competitions in badminton.  Shortly after representing Malaysia in the International Women’s Uber Cup Championships, she left for the United States to pursue her education as a physiotherapist. While at Northern Illinois University, she earned All American honors and the distinguished Broderick Award in Badminton.  Her experience in competitive, elite sports and training has set the backdrop for her keen interest in the neuromuscular system and its relationship with musculoskeletal pain syndromes and dysfunction.

Dr. Frank received her physical therapy degree from Northern Illinois University. She completed the Kaiser Permanente Orthopedic Residency program in 1993 while working on her Master of Science degree in Physical Therapy  & Biokinesiology at University of Southern California. She then went on to receive her post-professional doctorate degree from Western University of Health Sciences, Pomona, California in 2003.  She is a board certified specialist in Orthopedic Physical Therapy (OCS) and a fellow in the American Academy of Orthopedic Manual Physical Therapy (FAAOMPT).
 
Her clinical career has been greatly influenced by Shirley Sahrmann PT, PhD, and the Prague School of Manual Medicine faculty, namely, the late Vladimir Janda MD, Karel Lewit MD, and Pavel Kolar PT, PhD. Dr. Frank practices at a private clinic in Los Angeles, California. She has been instrumental in setting up the Movement Science Fellowship at Kaiser Permanente, Los Angeles and is one of the primary clinical instructors for the program. She is also a certified instructor for Bands, Balls & Balance, Janda's Approach to Musculoskeletal Pain Syndromes and Kolar's Approach to Dynamic Neuromuscular Stabilization.  Dr Frank also serves as an adjunct lecturer at Western University of Health Sciences and Azusa Pacific University. She has presented at both state and national conferences and has recently published a book on "Assessment and Treatment of Muscle Imbalancels:  The Janda Approach" .  She currently teaches in the U.S. and internationally.

Laziness has changed.

It used to be about avoiding physical labor. The lazy person could nap or have a cup of tea while others got hot and sweaty and exhausted. Part of the reason society frowns on the lazy is that this behavior means more work for the rest of us.

When it came time to carry the canoe over the portage, I was always hard to find. The effort and the pain gave me two good reasons to be lazy.

But the new laziness has nothing to do with physical labor and everything to do with fear. If you're not going to make those sales calls or invent that innovation or push that insight, you're not avoiding it because you need physical rest. You're hiding out because you're afraid of expending emotional labor.

This is great news, because it's much easier to become brave about extending yourself than it is to become strong enough to haul an eighty pound canoe.

Kate Moss made this saying famous and unfortunately many of our student-athletes have taken this saying quite literally.  If you are struggling with a student-athlete who continues to obsess about the way they look pass on this link from Dove, it might just give them the nudge they need and provides a nice “ah-ha” moment.

For more information on eating disorders, visit the National Eating Disorders Association.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

Competitive rowing is generally regarded as an endurance sport where the crew with the highest VO2 will win. It is my belief, strength has a larger part to the success of an oarsman but this is a controversial topic, which I look to prove at a later time. What happens in a competitive situation where every boat has comparable athletes from every aspect: height, weight, aerobic capacity, and strength? The boat with the most efficient crew with the longest stroke will almost certainly will be faster.

Watching the 2010 Head of the Charles Regatta last week, I was amazed how many crews do not reach full compression at the catch. There are a few possibilities for cause of this: the coxswain may have been calling for too high of a stroke rate and the crew was compensating by shortening their recovery; or maybe they are not flexible enough to compress their body at the catch. Being a strength coach for rowers, my first priority is to work on mobility, so the oarsman can comfortably reach full compression in the catch and be able to sink the blade in the water.

It is all a simple math equation. If we can increase the length of the stroke for an oarsman on the boat by one inch, the result in the water is approximately three inches due to the ratio of the inboard and outboard portions of the oar. In a typical 2,000 meter race each crew will take anywhere between 200-250 strokes. [3 inches x 200 strokes = 600 inches / 12 inches per foot = 50 feet] This equation demonstrates that two boats evenly matched up in every aspect except boat ‘A’ crew is able to extend the stroke by one inch, will beat boat ‘B’ by 50 feet, who cannot extend their stroke.

The first muscle I am going to look at is the latissimus dorsi (lats). The lats are broad, flat, triangular shaped muscles that originate at the lumbodorsal fascia into the spines of the lower six thoracic vertebrae, lumbar vertebrae, lower 3 to 4 ribs and iliac crest. The lat then spirals around the Teres major to insert in the floor of the intertubercular groove of the humerus. It is regarded as the prime mover of arm extension. During the stroke the lats are primarily responsible for pulling the handle to your body during the final phase of the stroke. They also play a large role at the catch, this time not in strength but in mobility. At the catch the oarsman needs to be able to sink the blade into the water. This sounds simple, but at full compression the oarsman is typically reaching as far forward as he can already putting the lat into a stretch. Then to sink the blade he raises his arms, stretching the lat further, this might become difficult for a tight oarsman.

We have two main exercises that we use to promote flexibility and range of motion in the lats: the Kneeling Lat Stretch is a static hold, and Floor Angels focus on dynamic mobility.

Kneeling Lat Stretch: Start in a prone position with hands knees and toes on the ground. Use your fingers to walk your right arm out at a 45 degree angle in front of your left hand. Once you have gone as far as you can, flip your right hand over so your palm is facing up. From here grab your right lat with your left hand and try to sink your right armpit to the ground. Hold this position for 10-30 seconds and repeat with your left arm.

Floor Angels: Lying supine on the ground place your arms on the ground as if you were to perform a shoulder press horizontally. Raise your knees to place your feet flat on the ground then flatten your lower back to the floor, maintain this position with your trunk the whole time. Now, press your hands horizontally above your head keeping your hands and as much of your arms on the ground as possible. once you reach maximal extension, hold for three seconds then bring your arms back down. This motion should be repeated multiple times.

Testing the Mobility of the Lat

To test the mobility of the lats in our rowers we have devised a Lat Flexibility Test. This test has a similar starting position as the floor angel: supine, knees bent and lower back flat against the ground. The oarsman will start with their right arm vertically straight up with their wrist flexed toward their feet. Then they will lower their arm overhead in the sagittal plane until they cannot maintain their lower back flat on the ground. We then measure the distance of the wrist from the ground. This process is then repeated for the left arm. These scores are unique to each oarsman because of arm length but this allows us to track changes over time. The goal we have implemented for every oarsman is to touch the ground with their wrist.

To assess the athletes we have developed a staircase measuring device. Each riser on the stairs is 1 inch and on the tread we have the height labeled. To measure the oarsman we simply slide the stairs under the wrist till we hit a riser. If the oarsman’s wrist touches the riser above the step labeled 5 we know the athlete is at least 5 inches off the ground but not more than 6 inches. The stairs allow us to measure large groups efficiently.

Please check back for Part 2, where I will continue to break down the catch position and provide you with more mobility exercise to include in every rower’s warm up.

Mike Zawilinski CSCS, NSCA-CPT, is a Strength & Conditioning Coach at Northeastern University, Boston MA, where he is also currently working to complete a Masters’ in Sports Nutrition. Mike is the coordinator of care for Men’s and Women’s Rowing teams, Women’s Basketball and Women’s Volleyball. He also volunteers as the Coach of the Northeastern Powerlifting Team and he is a competitive powerlifter as well, holding the Massachusetts state Bench Press Record.  He can be reached at m.zawilinski@neu.edu.

Jim Collins, author of Good to Great, describes the Hedgehog concept as “an operating model that reflects understanding of three intersecting circles: what you can be the best in the world at, what you are deeply passionate about, and what best drives your economic or resource engine.”

“But Art, Jim Collin’s research and the businesses described in Good to Great include the likes of Wells Fargo and Walgreens, his theory and concepts have nothing to do with patient care or performance training.”

I’ve heard this more than once and each time I attempt to get a friend to read this book it’s usually handed back either partially read or not read at all.   At first look, to compare these operating systems to Sports Medicine or Sports Performance may be a stretch, but the three questions that Collins’ research asks can certainly be asked when examining your own operating system and how you handle your business each day.

What can you be the best in the world at?

- Is it patient education, practicing and applying evidence based medicine or simply a seamless referral system for student-athlete mental health issues?
- By asking and challenging your staff what you can be the best in the world at automatically sets the bar much higher than before and thus only those actions in line with this new standard should be accepted and rewarded.

What are you deeply passionate about?

- I found this to be the easiest question to ask and answer. Each one of your staff members is particularly interested and passionate about a segment of your operating system. Once you have identified which one, allow them to develop this area to its fullest.
- If your strength staff is deeply passionate about squatting and teaching the squat (I image they are or they wouldn’t be in the field) allow them to create an in-service and teach the sports medicine staff the finer points of the squat. Your athletes will thank you for the consistency of teaching cues and progression from rehab to high end performance.

What best drives your economic or resource engine?

- If you’re at most schools, athletic departments are actually a huge drain on the finances of the university.  Does your department spend frivolously on specialty items that have little impact on your athletes or only impacts a small sector of your athlete population?
- In the Sports Performance area, what exercises produce the greatest impact on your athlete’s performance profile (VJ, sprint times, etc)? Should you spend your valuable time perfecting and encouraging the squat or are you spending time having your athletes lay on their back performing hollowing exercises to train the TA?

The challenge now is to examine your operating system with honest eyes. This is often the most difficult part of the process since most believe they are already doing their very best – if resistance is met, ask dumb questions or invite an alien to your next staff meeting, that usually does the trick.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.