Boston Sports Medicine and Performance Group, LLC Blog

If you want to be the Best, then join the Best

Posted by Boston Sports Medicine and Performance Group on Mon, Oct 1, 2012 @ 07:10 AM


If you want to be the Best, then you need to join the Best sports medicine and performance professionals from around the world at the 2013 BSMPG Summer Seminar - May 17th and 18th in Boston MA!

Registration for this event is now open!

Visit our website for complete conference details including our keynote and individual track speakers.


Keynote Speakers include: Stu McGill, Adriaan Louw, Fergus Connolly, Marco Cardinale, and Marvin Chun.


Stuart McGill  Adriaan Louw  Fergus Connolly  Marco Cardinale  Marvin Chun  Robert Butler  Randall Huntington


More speakers are being being announced weekly!

Stay tuned to for seminar updates and announcements.

Register Today - This seminar will sell out!


Register for the 2013 BSMPG  Summer Seminar Today



Topics: Art Horne, Stu McGill, Ben Prentiss, Bill Knowles, Marco Cardinale, Marvin Chun, Fergus Connolly

Your Anatomy Teacher was WRONG!

Posted by Boston Sports Medicine and Performance Group on Wed, Sep 26, 2012 @ 07:09 AM


By Art Horne



Knee Version



Your college anatomy teacher will have you believe that the knee is a simple hinge joint that’s only action is flexion and extension.   Of course they probably mentioned the “screw home” mechanism and its related rotational component at some point, but this motion was most likely reviewed only as a side note to the main lecture with no further mention. 

Unfortunately, this critical motion is often forgotten about during both the evaluation and rehabilitation of knee pain and for those with limited rotation in either direction, or an inappropriate axes of rotation, traditional knee pain management strategies aimed at limitations in flexion and extension will only lead to frustration.

Why care about tibio-femoral rotation?


Ignoring knee rotation and only examining the flexion-extension component is akin to checking the wheels on a train and then ignoring the tracks beneath them.  Both are required if you’re hoping to efficiently move from A to B.   So what happens when this critical motion is off?  Inappropriate arthrokinematic motion will cause excessive motion or friction on adjacent structures – think train grinding around a corner and the screeching of wheels on the tracks.

“Fixed rotation of either the femur or tibia has a significant influence on the patellofemoral joint contact areas and pressures.  This is due to the anatomic asymmetry in the knee with respect to all planes, as well as the laterally directed force vector that naturally exists in bipedal lower-limb biomechanics.  Specifically, femoral rotation results in an increase in patellofemoral contact pressures on the contralateral facets of the patella, and tibial rotation results in an increase in patellofemoral contact pressures on the ipsilateral facets of the patella.  This difference can be elucidated when one considers that rotation of the femur is biomechanically different than rotation of the tibia.  For both tibial and femoral rotations, the patella’s distal attachment to the tibial tubercle influence the direction of patellar movement.” (Lee et al, 2003 p.686)

This influence on the patella by the relative motion between the tibia and femur is echoed by Kapandji,

“During movements of axial rotation the patella displacements relative to the tibia occur in a coronal plane.  In the neutral position of rotation the patellar ligament runs a slightly oblique course inferiorly and laterally.  During medial rotation the femur is laterally rotated with respect to the tibia, dragging the patella laterally, and the patellar ligament now runs obliquely inferiorly and medially.  During lateral rotation, the opposite movements take place: the femur drags the patella medially and the patellar ligament now runs inferiorly and laterally with a greater obliquity than in the neutral position.”(Kapandji, pg.106)

“Patella displacements relative to the tibia are therefore indispensable for movement of both flexion-extension and axial rotation.”(Kapandji, pg. 106)


What exactly is happening?

“During lateral rotation of the tibia on the femur the lateral condyle moves forward on the lateral tibial surface, while the medial condyle moves backwards on the medial tibial surface.  During medial rotation of the tibia on the femur the converse is true:  the lateral condyle moves backwards and the medial condyle forwards on their corresponding tibial surfaces.  In reality, the anteroposterior movements of the condyles on their corresponding tibial surfaces are not identical.” (Kapandji, pg. 90)

Because of this unequal movement, the axis of rotation is NOT between the two intercondylar tubercles as many people would think, or what your college professor lead you to believe, but actually through the articular surface of the medial tubercle which serves as the central pivot point of the knee joint.


So now you’ve identified a limitation, how would you treat it?

Treatment Example:  Below is an example taken from Greenman (Greenman’s Principles of Manual Medicine, Fourth Edition. Page 453), in an effort to restore normal tibia internal rotation

Position: Tibia Externally rotated

Motion Restriction: Internal rotation of tibia

  1. Patient is prone on the table with the operator standing at the side of the dysfunctional extremity
  2. Operator flexes the knee to 90 degrees and grasps the heel and the forefoot of patient.
  3. Operator dorsiflexes the ankle and internally rotates the tibia to the barrier.
  4. Patient externally rotates the forefoot against operator resistance for 3-5 seconds and three to five repeitions.
  5. Following each patient effort, the operator internally rotates the foot to the new barrier.
  6. Retest.


Are you treating Tibial rotation limitations in multiple stages of flexion?

Considering the obvious fact that the knee experiences a large excursion in flexion angles during sporting activity and also that patella contact pressures change as a result of knee flexion angle, (“Earlier in vitro studies have demonstrated that, in weight bearing, contact pressures within the patellofemoral joint increase as the knee flexes from 0 to 90 and decrease as the knee extends.” Lee, 2003), it is clearly warranted to treat limitations in both normal tibio-femoral along with patella and patellar tendon mobility in these various degrees of motion, and not simply in the traditional supine, table supported manner.

Closing Thoughts:   Evaluating knee rotation is a critical part of any comprehensive knee pain evaluation, especially for those evaluations involving pain and swelling of a “non-specific” origin (aka: patellofemoral pain syndrome).  For those that are familiar with the SFMA, limitations in multi-segmental rotation can be evaluated in a minimal amount of time and will lead you directly to this rotational component should a limitation exist.  Treating this limitation should reflect the knee angle in which the restriction actually corresponds to.


Learn more advanced evaluation and rehabilitation techniques from the leaders in sports medicine and performance at the 2013 BSMPG Summer Seminar.

Register today before this event sells out!

Register for the 2013 BSMPG  Summer Seminar Today




  1. Greenman’s Principles of Manual Medicine, Fourth Edition.
  2. Kapandji, AI. The Physiology of the Joints. Volume Two. The Lower Limb. Churchill Livingstone Elsevier. 2006.
  3. Lee TQ, Morriss G, Cstinalan R.  The Influence of Tibial and Femoral Rotation on Patellofemoral Contact Area and Pressure.  J Orthop Sports Phys Ther.  2003;33(11):686-693.
  4. Lee TQ, Yang BY, Sandusky MD, McMahon PJ. The effects of tibial rotation on the patellofemoral joint: assessment of the changes in in situstrain in the peripatellar retinaculum and the patellofemoral contact pressures and areas. J Rehabil Res Dev. 2001;38:463-469.
  5. Li G, DeFrate LE, Zayontz S, Park SE, Gill TJ. The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads. J Orthop Res. 2004;22:801-806.



Topics: Art Horne, knee pain, BSMPG Summer Seminar

Predicting Performance and Injury Resilience in Collegiate Basketball Athletes : Part II

Posted by Boston Sports Medicine and Performance Group on Thu, Aug 30, 2012 @ 07:08 AM


by Art Horne


BSMPG Basketball Seminar


Just recently Dr. Stuart McGill, Jordan Andersen, and I published an article in the Journal of Strength and Conditioning Research examining the link between traditional pre-season strength, fitness, and sports medicine testing to overall on-court basketball performance and injury resilience throughout the course of two collegiate basketball seasons.  Although I would be the first to admit that there are some clear limitations to this study (number of participants for example), key performance predictors (points scored, ability to rebound, block shots, etc) were NOT associated with traditional strength or performance measures so often pursued in collegiate basketball strength programs.

Below is a summary of our most interesting findings followed by my thoughts and experiences from the last decade of both training and caring for the collegiate basketball athlete.  The two should not be confused as one and the same, although many of the findings in this study only strengthen my position when it comes to training and caring for the basketball athlete.  Findings are in bold, with narrative following in normal text.


1. A “stiffer” torso leads to better performance

This goes without saying. 

This is most evident when watching elite vs. novice athletes performing lateral shuffling followed by a change of direction.  In general, elite athletes will be able to “stiffen” their core/spine quickly providing a stable base from which their limbs may generate force against in preparation for the sudden stop and change in direction.  Novice athletes tend to take much more time to slow down and reverse directions.  This is a major contributor to the decreased lane agility times seen in elite athletes (see #4 below).  The ability to stiffen quickly however is not solely responsible for improved change of direction time and increased performance.  The ability to “relax” this same musculature is much more important – yet rarely trained in modern performance programs.   

This phenomenon has been studied at length by Leo Matveyev, one of the leading Russian sports scientist where he found an underlying theme among the top level of sports mastery in the Russian system of classification – those that achieved the highest level also had the highest speed of muscle relaxation.  The speed of relaxation following muscular contraction was nearly 200 percent faster than lower level athletes, and those that were classified just below “master of sport” demonstrated relaxation times of about 50% slower! (Dietz, 2012)

These findings mirror McGill’s work where he examined elite MMA fighters as they struck a punching bag and discovered a “double-peak” in muscle activity where initial muscle contraction was quickly followed by relaxation as the striking limb traveled through the air, followed again but a rapid increase in muscular tension as the limb contacted the bag.

“Muscle activation using electromyography and 3-dimensional spine motion was measured. A variety of strikes were performed. Many of the strikes intend to create fast motion and finish with a very large striking force, demonstrating a "double peak" of muscle activity. An initial peak was timed with the initiation of motion presumably to enhance stiffness and stability through the body before motion. This appeared to create an inertial mass in the large "core" for limb muscles to "pry" against to initiate limb motion. Then, some muscles underwent a relaxation phase as speed of limb motion increased. A second peak was observed upon contact with the opponent (heavy bag). It was postulated that this would increase stiffness through the body linkage, resulting in a higher effective mass behind the strike and likely a higher strike force. Observation of the contract-relax-contract pulsing cycle during forceful and quick strikes suggests that it may be fruitful to consider pulse training that involves not only the rate of muscle contraction but also the rate of muscle relaxation.” (McGill, 2010)

In personal conversations with McGill we both agree that this “double-peak” phenomenon, although not yet measured in basketball athletes, also occurs in elite level point guards during a cross-over maneuver as they blow by the opposition on the way to the basket and is a must at the highest level of basketball competition – think Derrick Rose, Chris Paul and JJB.  I first witnessed this contract-relax-contract mastery at Northeastern University while working with a young kid from Puerto Rico named Jose Juan Barea as he sliced up defender after defender on his way to becoming an NBA champion with the Dallas Mavericks most recently in 2011. 


basketball seminarbasketball conference

The LA Lakers and Miami Heat found out firsthand just how important spine stiffness and relaxation is during the 2011 NBA Playoffs - courtesy of one JJB.


Torso stiffness is paramount in the game of basketball and a must for those looking to change direction quickly on their way to the basket but also for those absorbing repeated bouts of body blows down on the blocks.


2. More hip range of motion was linked to better  performance

Appropriate hip range of motion is another no-brainer.  Its impact on low back and anterior knee pain are well documented in the literature from an injury perspective and should be evaluated both on initial contact with your athletes but also periodically throughout the competitive season as a simple check to ensure healthy tissue qualities and cooperation from joints above and below (tibio-femoral rotation along with SI position).


3. Bench Press correlated with blocks per game (r=.0.59)

We’ve all beaten the Kevin Durant bench press story to death and know that his inability to push 185 pounds off his chest during the NBA combine hasn’t impacted his ability to perform on the court. Now, I’m not ready to suggest that basketball athletes need to bench press, but if you’ve ever played basketball or at least watched a game, you know that the contribution from the upper body is immense when it comes to establishing position on the blocks and fighting through screens.  Although the actual “block” needs minimal upper body strength, the ability to position yourself for said block usually takes some pushing and shoving – both of which are aided by some impressive upper body strength.


4. Long Jump distance and Lane Agility Test were the most closely linked performance tests to actual performance

  1. Long Jump scores correlated with: minutes, rebounds, and blocks per game
  2. Lane Agility time correlated negatively with minutes played, points, assists and steals per game (meaning that a faster time was linked to more performance)
  3. Vertical Jump did not correlate with any variable below


  • Long jump is related to one’s ability to produce force into the ground and forward acceleration (Holm, 2008)
  • Vertical jump conversely is related to top end speed (and of course those highlight dunks on ESPN Sports Center)
  • Basketball courts measure 94 feet long from end to end.  Plays that result in scoring or prevent scoring almost always take place within the half court, with the majority of those occurring within the 3-point arc.  Therefore, if you were to choose between an athlete with incredible top end speed or incredible acceleration abilities, knowing that the majority of his productive (scoring or preventing scoring) minutes will take place within the 3-point arc, which would you choose?  My money is with the acceleration guy!  Although highflying dunks are popular in warm-up and during your morning Sports Center show, the rate at which this quality is utilized during an actual game is far less than qualities associated with acceleration, and as such, traditional strength training programming must reflect this end. 
  • If you have to choose, pick the guy with a huge horizontal jump – he’ll be able to cover more space more quickly over short distances and will be more valuable within the context of the game overall.


5. Back injured group had, on average played more games and more minutes per game and had a greater number of rebounds and steals per game but NOT more assists or points scored.

Only 5 injures were observed – those getting injured however played many more minutes per game, had double the rebounds and fivefold more blocks.


BSMPG Summer Seminar

Oakafur was a beast in college, but battling bodies like Big Baby Davis' will take a toll on even the healthiest of backs.

Athletes that play more minutes simply have a greater chance of getting injured due to the higher exposure rate – plain and simple.  What’s interesting however is the number of rebounds and blocks tallied by those suffering more injuries, suggesting a willingness to get physically involved in the trenches and the not-so-glamorous side of the game.  These athletes in my opinion also have a much higher general risk behavior and are more often willing to take a charge or dive after a loose ball.  These are the guys that coaches and teammates love for their hustle play but usually end up injured more often.  Because of their increased opportunity for injury, these athletes should be evaluated more often throughout the season through physical examination, subjective questionnaires or other means such as HRV with appropriate recovery and treatment methods applied in an effort to keep nagging pains from becoming a missed games due to injury.


The next article will focus on how we can interpret these very preliminary results and address deficiencies in your athletes this fall prior to the start of the season in both the weight room and sports medicine clinic.


See the leaders in Sports Medicine and Performance at the BSMPG 2013 Summer Seminar including Stuart McGill, Marco Cardinale, Fergus Connolly and Adriaan Louw.

Register for the 2013 BSMPG  Summer Seminar Today



Dietz C, Peterson B. Triphasic Training: A systematic approach to elite speed and explosive strength performance. 2012.

Holm DJ, Stalbom M, Keogh JWL, Cronin J. Relationship between the kinetics and kinematics of a unilateral horizontal drop jump to sprint performance. J Strength Cond Res. 2008 Sept:22(5):1589-1596.

McGill SM, Chaimber JD, Frost DM, Fenwick CM. Evidence of double peak in muscle activation to enhance strick speed and force: an example with elite mixed martial arts fighters. J Strength Cond Res. 2010 Feb:24(2):348-57.

Topics: Basketball Related, Art Horne

BSMPG 2012 Summer Seminar Highlights - Irving "Boo" Schexnayder

Posted by Boston Sports Medicine and Performance Group on Wed, Aug 15, 2012 @ 07:08 AM


Click below to see highlights from our 2012 BSMPG Summer Seminar featuring Keynote Speaker, Irving "Boo" Schexnayder.

More highlights are set to come in the next few weeks so stay tuned!





Save the date for the 2013 BSMPG Summer Seminar - May 17th & 18th in Boston MA.


Keynote Speakers include: Dr. Stuart McGill, Dr. Marco Cardinale, Fergus Connolly, Adriann Louw and Marvin Chun.  Individual learning track speakers will be announced shortly. 


This is sure to be the biggest Sports Medicine and Sports Performance Seminar to date!

A special thanks again to our SPONSORS!

Topics: Art Horne, BSMPG, athletic training conference, boston hockey conference, Bill Knowles, Marco Cardinale, Marvin Chun, Stuart McGill

World Pain Expert, Adriaan Louw Joins BSMPG 2013 Summer Seminar Keynote Speaker Set

Posted by Boston Sports Medicine and Performance Group on Mon, Aug 13, 2012 @ 06:08 AM

BSMPG is proud to announce Ariaan Louw as a keynote speaker at the 2013 BSMPG Summer Seminar - May 17th and 18th, 2013!  Adriaan joins keynote speakers, Dr. Stuart McGill, Marco Cardinale, Fergus Connolly and Marvin Chun for this weekend event.  With the most thorough and integrated speaker line-up ever assembled, the 2013 BSMPG Summer Seminar will be the WORLD'S most sought after Sports Medicine & Performance Seminar to date!!

We are expecting the largest crowd in the history of BSMPG events with speakers and attendees traveling the globe to be in Boston in May of 2013, and thus have already made plans to move our main lecture hall to a newly renovated multi-tier auditorium.

Be sure to save the date now - hotels will fill fast with this event along with normal Boston traffic so start making plans now!

See you in Boston next May!!!


Adriaan Louw


BSMPG Summer Seminar


ADRIAAN LOUW, PT, PhD (c), M.App.Sc (physio), GCRM, CSMT

International Spine and Pain Institute

Adriaan Louw attended the University of Stellenbosch in Cape Town, South Africa, where he graduated in 1992 from an extensive physiotherapy program, including a very stringent manual therapy based training. Adriaan is an adjunct faculty member at Rockhurst University in Kansas City, where he teaches spinal manipulative therapy. Adriaan maintains clinical practice and is a co-owner, part-time clinician and spine specialist at The Ortho Spine and Pain Clinic in Story City, Iowa. Adriaan has been teaching postgraduate spinal manual therapy and pain science classes throughout the US and internationally since 1996. Adriaan completed his Graduate Certificate in Research Methodology from the University of South Australia, followed by his Masters degree in research into spinal surgery rehabilitation at his alma mater, Stellenbosch University. Adriaan is a Certified Spinal Manual Therapist through International Spine and Pain Institute. Adriaan is in the final stages of his PhD, focusing on therapeutic neuroscience education and spinal disorders. Adriaan has presented at numerous national and international manual therapy, pain science and medical conferences and has authored and co-authored numerous articles and book chapters related to spinal disorders and pain science.


Save the Date: May 17 & 18th, 2013 - Boston MA.  This will be one conference that you will not want to miss!!

Topics: Art Horne, Brian McCormick, basketball conference, Craig Liebenson, Chronic Pain, Adriaan Louw, BSMPG Summer Seminar, Cal Dietz, Marco Cardinale, Stuart McGill

Fergus Connolly joins Dr. Stuart McGill and Marco Cardinale as Keynote Speakers at 2013 BSMPG Summer Seminar

Posted by Boston Sports Medicine and Performance Group on Mon, Aug 6, 2012 @ 06:08 AM


BSMPG is proud to announce Fergus Connolly as a keynote speakers at the 2013 BSMPG Summer Seminar - May 17th and 18th, 2013!  Fergus joins keynote speakers, Dr. Stuart McGill and Marco Cardinale and Marvin Chun for this weekend event.  With the most thorough and integrated speaker line-up assembled, the 2013 BSMPG Summer Seminar will be the WORLD'S most sought after Sports Medicine & Performance Seminar to date!!

We are expecting the largest crowd in the history of BSMPG events with speakers and attendees traveling the globe to be in Boston in May of 2013, and thus have already made plans to move our main lecture hall to a newly renovated multi-tier auditorium.

Be sure to save the date now - hotels will fill fast with this event along with normal Boston traffic so start making plans now!

See you in Boston next May!!!


Fergus Connolly


BSMPG Summer Seminar



Performance Consultant: Liverpool FC and others

Fergus Connolly is regarded as one of the leading performance experts in elite team sport. His experience spans some of the most successful teams in NFL, NBA, Premiership Football, International Rugby, Professional Boxing and Special Operations. These experiences have refined pioneering protocols for the integrated optimisation (IO) of performance in Team Sport and Elite Athletes. Specialised knowledge working with some of the most successful coaches, academics and practitioners and research in computer optimisation and management, he is an original researcher in the development and application of unique effective monitoring, coaching, training recovery and regeneration approaches to winning in team sport.

Save the Date: May 17 & 18th, 2013 - Boston MA.  This will be one conference that you will not want to miss!!

Topics: Art Horne, Charlie Weingroff, Stu McGill, Bill Knowles, Marco Cardinale, Fergus Connolly, Rob Butler

Predicting Performance and Injury Resilience in Collegiate Basketball Athletes

Posted by Boston Sports Medicine and Performance Group on Wed, Aug 1, 2012 @ 06:08 AM


by Art Horne



basketball performance resized 600


Just recently Dr. Stuart McGill, Jordan Andersen and myself published an article in the Journal of Strength and Conditioning Research examining the link between traditional pre-season strength, fitness, and sports medicine testing to overall on-court basketball performance and injury resilience throughout the course of two collegiate basketball seasons.  Although I would be the first to admit that there are some clear limitations to this study (number of participants for example), key performance predictors (points scored, ability to rebound, block shots, etc) were NOT associated with traditional strength or performance measures so often pursued in collegiate basketball strength programs.

Over the course of the next few weeks I will review this article in detail and provide insight into how actual on-court basketball performance may be improved upon beyond simply finding better parents or recruiting.  


Predicting Performance and Injury Resilience From Movement Quality and Fitness Scores in a Basketball Team Over 2 Years

McGill, Stuart M.1; Andersen, Jordan T.1; Horne, Arthur D.2

Journal of Strength and Conditioning Research

July 2012



The ability to successfully predict injury resilience and competition performance from preseason testing is a very wishful goal; however, questions remain regarding this objective: Do tests of fitness have a predictive ability for injury and are there other factors that can be assessed that may predict injury? Are there specific indicators that predict performance? This study was motivated by these questions.

Attempts to understand injury mechanisms and performance sometimes consider links to fitness. Traditionally, fitness testing, at least in occupational settings, has included the assessment of strength (13), joint range of motion (ROM) (23), and physiological variables such as heart rate, blood pressure, and oxygen uptake (2), but the performance scores in the occupational context are difficult to quantify. In contrast, there have been some studies relating fitness to sporting performance that are more tangible. In studies of ice hockey players (6,24), success could be more tangibly quantified from on-ice measures such as total minutes played and scoring chances. Green at al. stated that “goals scored” was not the best measure of hockey skill. Studies of football players suggest that those who score higher on movement quality tests have few injuries (11,12); however, preseason football combine testing is dominated by tests of strength and running speed. Recognizing that movement asymmetry and compromises to neuromuscular control have been linked to both future injury (11,12) and with having a history of back injury (17), movement assessments have been developed (3,4) and have been suggested to predict injury rates. Further, several fitness and movement tests have been implicitly assumed to predict “playing” performance by their inclusion into standard preseason tests. These include tests of endurance, strength, joint ROM, agility, and speed. The question remains as to the validity of these factors when attempting to predict injury resilience and performance.

Although links between moving well and injury resilience and performance seem intuitive, this notion remains controversial. Interestingly, some evidence suggests that fitness training alone may not ensure peak performance or injury resilience (8,20). In addition, movement quality has been suggested to predict future injury (12). A possible mechanism may be that injury changes the way a person moves as an accommodation to pain (consider, e.g., the changes in mechanics throughout the anatomical linkage when limping from foot pain). Having a history of injury, in particular back injury, appears to change movement patterns (17). Movement patterns determine important injury criteria, such as joint and tissue load, together with influencing the length of time and repetitions an individual is able to perform a task with uncompromised form. Compromised form exposes the tissues to inordinate load elevating the risk of injury. Several examples of this link are available, for example, not maintaining a neutral curve in the lumbar spine while bending and lifting decreases the tolerable load at injury (in this case tissue failure [18]); having restricted hip motion is linked to having more spine motion when bending (17). Movement competency has also been linked with anterior cruciate ligament (ACL) injury rates, for example, having larger knee abduction moments and angles when landing from a jump predicted higher ACL injury rates (9). Given the variety of considerations for interpreting the links between movement, fitness, performance, and potential injury, the goal of this study was to first evaluate some traditional fitness test scores in a controlled athletic group that has a variety of challenging movement demands and also perform an assessment of the quality of movement. It was hoped that following a test group for a period of time would reveal links between specific fitness scores and movement quality with variables to predict injury resilience and performance. If such links exist, they could form a rationale for specific tests to be included in preseason testing.

The purpose of this study was to see if specific tests of fitness, and movement quality, could predict injury resilience and performance in a team of basketball players over 2 years (playing seasons).

It was hypothesized that in a university basketball population, (a) Preseason movement quality and fitness scores would predict in-season performance scores. (b). Preseason movement quality and fitness scores would predict in-season injury resilience.



See Dr. Stuart McGill and other world authority in Sports Medicine, Science and Performance at the 2013 BSMPG Summer Seminar - May 17 & 18 in Boston MA

Topics: Art Horne, Brian McCormick, basketball performance, basketball conference, basketball training programs, athletic training conference, Craig Liebenson, Shawn Windle, Basketball Training, Stuart McGill, Keith D'Amelio

Five Hidden Signs of Instability by Perry Nickelston, DC, SFMA

Posted by Boston Sports Medicine and Performance Group on Wed, Jun 6, 2012 @ 07:06 AM

by Perry Nickeston, DC 


If you work with athletes long enough you come to realize a few in-the-trenches facts.


  1. Athletes are master compensators. They can ‘cheat’ and power through movement patterns pulling from all the wrong places. Movements appear easy and effortless in spite of underlying dysfunctional patterns.
  2. Just because an athlete looks good on the outside does not mean they function efficiently on the inside. Sort of like a Ferrari car with nothing underneath the hood.
  3. They can only rely in talent for so long before the movement engine breaks down and the durability factor takes a nose dive potentially ending a career.
  4. The body craves stability (motor control) and will find it anyway possible, whether it’s functional or dysfunctional. It’s usually dysfunctional!
  5. Athletes don’t like to slow down. They play hard and train hard. Their mind is bigger than their body’s ability to keep up. Go hard or go home is the paradigm. That paradigm is a breeding ground for dysfunction.


Athletes are covert at hiding dysfunction. Count on it! There are many assessments and evaluation procedures specifically designed to spot dysfunctional patterns and compensations. However, subtle signs of compensation chaos may be overlooked by an untrained eye because the athlete is so good at ‘cheating’ movement. So what can you do to look for the hidden signs of dysfunction that athletes are so great at covering up? How can you find the kink in the armor? Search for neurological signs of compensation the body uses as a fall back mechanism for stability. The best part is an athlete has no idea they are doing these compensations, so it’s a ‘tell’ of instability (poor motor control). These five signs are extremely valuable for divulging central core dysfunction. An athlete must have central (proximal) stability to achieve optimal distal mobility. If this relationship is altered, they will ‘bleed’ energy and move inefficiently with loss of power, speed, endurance, and performance. That’s bad.


These signs are ‘Red Flags’ of dysfunction. So what are they?

1.       Foot Stability

Assess your athlete in a single leg stance position with bare feet. The foot should appear stable. Signs of stability dysfunction include: The tendency of the foot to excessively pronate or supinate. Toes grip (claw) the ground for dear life. Extensor tendons on the dorsum of the foot are popping out like mad.


2.       Breathing Patterns

Labored breathing is a surefire sign of dysfunction. Monitoring how an athlete breathes during non stressful movements and during high intensity training divulges valuable information about their core. Optimal breathing patterns are achieved via the diaphragm. The diaphragm is one of four primary components to the inner core (diaphragm, pelvic floor, transverses abdominis, and multifidi). If the diaphragm is not functioning at optimum and is facilitated you can have inhibition of the pelvic floor and transverse abdominis leading to faulty recruitment of the core.

  • Look for the following dysfunctional patterns:
  • Athletes breathe in deeply and the chest/shoulders move up and abdominal wall hollows, as opposed to diaphragm pushing out.
  • Athletes hold breath when moving through simple patterns.
  • Asymmetrical labored breathing. Have athlete rotate to the left in a seated position with arms crossed and inhale deeply. Repeat on the other side. Ask if they feel more difficulty on one side compared to another. This may also indicate dysfunctional thoracic rotation.
  • Establish an isometric position of a standing straight arm pushdown using a resistance band and ask athlete to breathe. Can they breathe through the diaphragm while maintain the position

3.       Jaw Clenching

The jaw muscles are a default mechanism for overcompensation. In other words, the jaw muscles can become facilitated for other inhibited muscles throughout the body. Clenching up the jaw during minimal challenges to the core is a sure sign of instability. The pterygoids often inhibit the scalenes, the latissimus dorsi, the obliques, the quadratus lumborum, and the hip abductors. If these relationships are left unattended the tension in the jaw muscles increases tremendously resulting in the aforementioned symptoms. The jaw muscles must be considered in global relationships with the rest of the movement chains.

Observe for jaw holding or clenching when athletes are challenging the core in positions such as planks, side planks, chops/lifts, and isometric work. If you see the jaw clenched, have them open and relax the jaw and notice the increase in difficulty performing the movement. Ask them if they feel a difference. The answer will be yes….less stable!

4. Grip (Clenching fist)

Finger flexors tend to be facilitated in relationship to finger extensors and synergistic muscles of the anterior chain. Often you may see an over compensation ‘death grip’ on power movements when there is inhibition in the psoas. Your brain can’t get the stability from the psoas structure so it fires on grip muscles to pull more with the upper torso as opposed to the core. Watch for athletes complaining of increased cases of elbow tendonitis or shoulder injuries. This indicates altered patterns in grip to upper extremity muscle sequencing. Watch for athlete making fists when performing isometric movements.


5.       Rolling Patterns (Ground movements)

The ground is the great equalizer for the core. It does not care how big and strong you are because it eliminates most of your global power movers relying on core stability sequencing for movement. There is no cheating on the floor! Rolling patterns championed by Gray Cook, PT are a fantastic initial screening process. Have athlete lie supine on floor with arms and legs extended and roll over to prone position using only one side of the upper body. The movement should be easy and seamless. No sticking or altered patterns from the lower extremity. The underlying weakness or core instability of sequencing will be noticed easily. Athletes will feel the difference. If an athlete cannot accomplish a simple rolling task on the ground where gravity is minimal challenge on the core for stability, you can be sure there is no way they will be stable and functional in a standing position. OWN THE FLOOR!

Click here to see a video of me demonstrating a proper roll with Chris Flo from Flo Fitness.

Be observant and diligent in your assessments. Always be assessing. As Yogi Berra said, ‘You can learn a lot just by watching.’ When it comes to optimal core function regress to progress and own precision of movements. Attention to detail will bring your athlete one step closer to becoming a champion. It’s the details and commitment to excellence that make a champion. They deserve it. So become obsessive compulsive in your foundational program of inner and outer core assessments. Motor control is the shock and awe secret of power and durability.

Perry Nickelston, DC, SFMA


  1. Cook, Gray. Movement: Functional Movement Systems : Screening, Assessment, and Corrective Strategies. Aptos, CA: On Target Publications, 2010. Print.
  2. Liebenson, Craig. Rehabilitation of the Spine: A Practitioner's Manual. Philadelphia: Lippincott Williams & Wilkins, 2007. Print.
  3. Sahrmann, Shirley. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, 2002. Print.
  4. Weinstock, David. NeuroKinetic Therapy: An Innovative Approach to Manual Muscle Testing. Berkeley, CA: North Atlantic, 2010. Print.




Topics: Art Horne, athletic training conference, Perry Nickelston, Barefoot in Boston

Review of BSMPG 2012 Summer Seminar by Jason Lightfoot

Posted by Boston Sports Medicine and Performance Group on Mon, Jun 4, 2012 @ 07:06 AM


I recently attended the BSMPG Summer 2012 conference, and over the course of two days I realised how little I know. I got the opportunity to hear a number of really smart people speak (including Bill Knowles, Craig Liebenson, Dr John DiMuro, Mark Toomey, Art Horne, Dr Pete Viteritti, Keith D’Amelio, Chris Powers, Irving Schrexnayder and Alan Grodin).

It was awesome.

Firstly, a huge thanks to Art Horne and the rest of the people who made the conference possible. Fingers crossed I’ll be able to make the trip across the pond for it next year.

Here’s a snapshot of my notes which I scribbled down throughout the conference.


“Injury is an opportunity to become a better athlete”.

We shouldn’t be talking about return to play, we should be talking about a return to competition.

Are any of your athletes load compromised, or joint compromised?

The return to competitive strategy should be months or years long, not weeks.

“It’s easy to get an athlete back to sport, it’s hard to keep them back”


Continue to read this review by clicking HERE.

Topics: Art Horne, Craig Liebenson, Charlie Weingroff, Andrea Hudy, Cal Dietz, Bill Knowles, Alan Grodin, Dan Boothby, Chris Powers

BSMPG Summer Seminar Photo Gallary - 2012

Posted by Boston Sports Medicine and Performance Group on Fri, Jun 1, 2012 @ 07:06 AM

Another year, another success. 

View pictures from the 2012 BSMPG Summer Seminar below.  For the complete photo gallary click HERE.

SAVE THE DATE: BSMPG has announced May 17-18, 2013 as the date for our next summer seminar.  Speakers will be announced soon!

Thank you again to all our attendees, speakers, sponsors, and organizers!


Chris Powers




Lunch Time!



To view the complete picture set from the 2012 BSMPG Summer Seminar click HERE.



Topics: Art Horne, Craig Liebenson, Brijesh Patel, Charlie Weingroff, Cal Dietz, Dr. DiMuro, Dan Boothby, Chris Powers