Boston Sports Medicine and Performance Group, LLC Blog

by Art Horne

Over the past several years I have made the integration of Sports Medicine care and Strength Training a core principle within our department.  This is relatively a new concept as strength coaches and sports medicine professionals have often been pitted against each other by sport coaches, athletes and often themselves.  Although this new path to better health and performance is clearly thwart with challenges, there are some simple steps that both departments can make that immediately impacts BOTH the health and performance of the student-athlete and leaves both professionals looking better in the eyes of all those around them.  Below is a question from a colleague that I wanted to share publicly.  In order to answer his question, as well as many others, it is my intention over the next few months to describe and share with you the many small steps that any college or university can implement in order to provide an improved care and performance model.

Question:

I would like to start out by saying that I really enjoy watching the videos and articles that you have released in reference to the approach you use at Northeastern University to bridge the gap between strength and conditioning and sports medicine. I am a strength and conditioning coach for a small Div. I college and also have a background in athletic training. I wanted to see if you could provide more insight as to how you take the results from the screening and testing that you do and then implement them into your programming. We screen our athletes, which consist of the FMS and a couple more orthopedic screens that we feel are applicable to the particular sport (Modified Thomas Test, Bridge w/ Leg Extension, Reach/Roll/Lift, etc….). How would you then use the results in the development of your program? Do you give each athlete individual work or do you use a systematic team approach addressing common faults or dysfunctions? I am torn as to what to do because as I am sure you are familiar with, time I have to spend with athletes is limited and getting them to comply with performing certain exercises on their own time can be very difficult at times. Any advice or examples that you could provide would be very beneficial. Thanks in advance for your time.

The Language Barrier:

The first step in any “relationship” is being able to understand what the other person is saying, and there is no greater communication gap in existence than the one that currently exists between Sport Medicine and Strength Training professionals.  In order to discuss dysfunctional movement patterns, corrective exercises, rehabilitation goals or substitutions/alternatives for strength exercises both parties must share a common language and then demand continuity with these terms.

I remember many years ago speaking to one of our staff members about a particular athlete and suggesting that she speak to the strength staff about an alternative exercise for an athlete who was suffering from some low back pain.  When asked what I recommended I immediately suggested a more spine sparing approach to her current “core strengthening” exercises and that we recommend McGill’s “Birddog” exercise which has been proven to be safer on the spine than the flexion based crunches the athlete was accustomed to in the weight room.  Not knowing what a “Birddog” exercise was, I quickly demonstrated the exercise to my co-worker at which time she smiled and said that she was familiar with the exercise but learned it as a kneeling opposite arm-leg reach.   Confused, (since McGill made the exercise famous as part of his “Big Three”) I asked another staff member what the exercise was that I was performing to which he replied, “a quadruped contralateral reach.”  Now slightly irritated (but happy that the name at least described the movement), I bolted over to the strength room to inquire about their knowledge of Stuart McGill, his research and what they called this particular exercise.  To my surprise McGill’s work had never been heard of and that this particular exercise was programmed as a “Flying Superman” within the student-athletes performance training.  It became painfully clear that the first order of business was getting both staffs to speak the same language, both within each department and across them. 

Because most of the members on your staff (both Sports Medicine and Strength) have come from a variety of educational backgrounds, continuing education courses and levels of expertise, it is important to begin formulating a shared exercise and assessment language in order for civil conversations to first take place.  By investing only a small amount of time and addressing this often overlooked, yet integral first step your staff will begin to enjoy the following benefits:

1. Provide improved services to your student-athletes.  Imagine the previous example taking place and a student-athlete approaching you for help with their kneeling opposite arm-leg reaches.  Now, the name basically tells you exactly what is needed, but imagine you knowing the exercise as a different name and perhaps emphasizing a different teaching point altogether.  Would you teach the athlete how to do the exercise “your” way? Find the athletic trainer who wrote the rehabilitation program to help them out? Or tell them that you’re sorry but you don’t know what they should be doing?  In any case precious time is wasted and as a fellow athletic trainer, this is something none of us has enough of.  In addition, you can imagine the frustration of the student-athlete witnessing your staff stumble through the most basic exercise descriptions!

2. A shared language allows staff members to be interchangeable because now each staff member is calling the same exercise the same name and teaching it while emphasising the same teaching points.  This allows athletic trainers to jump in and help with all rehabilitation programs, and not just “their own teams” as well as provide continued care during an athletic trainer’s absence (sick day, vacation or travel with another team).

3. Continued care and coaching along the performance continuum.   Here’s where the magic happens: whether the athlete your provide care for is one week into their ACL rehabilitation or the starting point guard for the basketball team pushing 300 pounds in the squat rack, the exercises if named the same, taught the same and progressed the same all fall along the same care-performance continuum.    Let’s examine the above example to really understand the power of the shared language.  Imagine on the far left hand side the student-athlete one week post-op ACL reconstruction and on the far right side the starting point guard pushing serious weight and performing at the highest level.  Moving along the continuum from left to right the athlete will experience and undergo exercises such as: Quad Sets, Straight leg Raises, Clams, Glute-Bridges, Mini-Band walks, Wall Squats, Body weight squats, Lunges, Box Jumps, and the list goes on.  At some time this athlete will be in the weight room and not be able to perform the Olympic lift for example programmed for the team that day but can certainly do pull-ups, side bridges and a number of other exercises that the strength coach has put in place during any particular phase or block of training.  If a shared language exists, the athletic trainer and the strength coach can have a civil and meaningful conversation about where the athlete is and discuss and implement substitutions for exercises that are not appropriate for them all while progressing the athlete safely along this care-performance line.  Not to mention, many of the rehabilitation exercises can be implemented safely within strength training program as substitutions for advanced exercises thus minimizing the athlete’s daily rehabilitation time and allowing the athletic trainer who is providing care for this athlete more time to focus on other athletes or say for example address soft tissue restrictions with the same athlete during “rehab” time which often requires a one-on-one time period, thus making their strength training time much more effective.

Now, some people may say that a couple of exercise names or switching names from time to time is really not a big deal.  Perhaps not.  If you only care for one team, perform all the rehabilitation by yourself and no other staff member helps you, then you can certainly come up with your own language.  But imagine for a moment a car factory where all the parts are all called different names, put on in different orders and actually assembled with various degrees of precision.  Would you ever buy a car from a factory like this?  The answer is a resounding no - so how can we expect our student-athletes to buy in to what we are saying if each staff member is saying something different?  By having an Exercise Pool to draw consistent language from, the number of benefits far outweigh any possible downside while also reducing the amount of confusion among your own staff and encouraging an atmosphere of shared help and patient responsibility. 

Next week: How a shared language during initial assessment can limit overall injury rate and increase performance immediately.

We asked what the Giants in Sports Medicine & Rehabilitation, Basketball and Hockey performance training have read or are currently reading and we brought their list to you.  

Click HERE to view our recommended library with an ongoing list from these speakers who presented at the BSMPG "Standing On The Shoulders Of Giants" 2011 summer seminar.

by: Keke Lyles, DPT, CSCS

Okay, so I can understand as a strength coach not learning about Biorheology, but getting my doctorate in physical therapy, I would have thought for sure this would have been learned somewhere along the way. So what is it? Biorheology is the study of the flow and deformation of biological materials.  As most athletic trainers or physical therapy students we had to take some form of physics. We all learned about Newton’s and Hooke’s laws and hopefully something about how air and water play a role within those laws. And more importantly we hopefully learned how it is connected to the human body. The human body is an engineering masterpiece, so of course we can learn a lot from physics and apply it to our assessments and daily treatments. But we can’t learn everything from Newton and Hooke.

The body is not merely air and water. It is made up of blood, plasma, interstitial fluid, synovial fluids, skin, tendons, muscles, vessels and etc. And these bodily materials do not behave the same as typical materials. So in order to become engineers of the body we need to read and learn more about Biorheology, so as care providers we can actually understand the demands placed on the tissues that we are working on, and how exactly they handle the stresses placed upon them. Start with reading the Journal of Biorheology. Consider understanding physiological processes at a molecular level when treating your next patient.

As your student-athletes return this fall I think it’s worth considering a concept that was introduced to me by my mother when I was a young boy.

When caring for plants or vegetables in your garden there is inherently an ongoing process from the time you plant the seed until the time of harvest.

Many outside people will only ever see the final fruits of your labor and not the countless man hours put forth prior to that final stage.  With any successful harvest, much effort has to be placed on the frontend including watering and fertilizing the plants, providing the plant with proper sunlight, protecting it from that first frost and other harsh weather and maybe most important - picking the weeds from around its base and providing it the opportunity to grow and develop.

In a similar scenario, in order to achieve elite athletic success, countless man hours must be put forth prior to actual competition to ensure that your athletes are able to grow and express their athletic ability when the lights come on. 

This of course means weeding the garden on a daily basis.

Many professionals who provide sports medicine care and strength training to collegiate athletes understand that water and fertilizer are of course necessary, but tending to the weeds is so often neglected, at least until it’s too late. 

When your athletes arrive this fall will you look at how they move – squat, toe touch, backwards bend – or will you wait until they have pain or injury to address their ankle dorsi-flexion, lumbar stability and psoas length and quality?

The challenge then is to find the time to take a look at your garden on a daily basis and provide the care and services that it so very much deserves.  In this case, and in the case of your garden at home, it is clear that you will only reap what you sew - and take care of.

Art Horne is the Director of Sports Performance at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

by Keke Lyles, DPT, CSCS

I had a conversation with someone the other day who was telling me about how he has started to train with a guy who is currently in school with aspirations to become a strength coach. He was telling me about all the different books, websites, and articles that his guy has been reading. It is always refreshing to hear about any professional who is trying to do all they can to better themselves. He continued on to tell me how his guy started to use Graston tools on him to help with his soft tissue issues, and then shared with  me how he got all “jacked up” from the Graston. He had to seek medical help to deal with the consequences.

My question to all professionals is at what point is it okay to read about different techniques or skills and then decide you are capable of performing such skill? I don’t want to sound like a bitter physical therapist who doesn’t like the idea of strength coaches trying to expand their knowledge, but as a strength coach myself, we MUST operate within our scope of practice. Even as a physical therapist, I would not recommend anyone just picking up Graston tools or any other such tool without proper training and education beforehand. Yes, it is true that given impairments would greatly benefit from such techniques, but our job as strength coaches, physical therapist, or athletic trainers is sometimes to swallow our pride and refer our clients/athletes to the people who are experts and trained properly to use specialized techniques.

Many techniques are certainly beneficial but at the same time can be very destructive to the tissues that we think we are correcting. As a result, serious consequences may arise from practitioners who are trying to do the right thing, but without the proper skill set. I urge us all to continue to read and learn about the advancements we are making both in the strength world as well as in the rehab world. However, just because I read about how great some patients responded to PRP injection in their patella tendon, doesn’t mean I am going to try to perform injections myself to everyone that comes to me complaining of patella tendon pain.  That is not my decision to make and certainly not the person to perform it.

Be responsible with your actions and continue to read to learn about the current evidence-based practices so that when you come across someone who may benefit from such technique, you can do you part of informing them of the options and then refer them to the right person who is suitable to perform such technique.

While taking a walk on vacation last summer with my fiancée, we stopped outside of a boutique when a dress caught her attention.  In town for a wedding the very next day along with a brisk change in weather, she decided that the dress in the window would work perfectly for the occasion.

Upon entering the store at 10:50 am we were quickly met by a sales person who promptly told us that they didn’t open until 11:00 am and that we’d have to wait outside until that time.

“But I’m going to buy that dress in the window – I just love it.  Can I just look?” She said.

“Sorry, You will have to wait outside - Store policy.”

And with those words the store door closed behind us while the three customer services reps inside read the paper, drank their espressos and chatted.  With the bitter taste of the rep’s reception fresh in my mouth we walked next door and dropped $200 on a similar dress.

What store policy doesn’t allow a customer to look at a product that they are obviously willing to purchase?

Would that policy have existed if the store owner was standing nearby?

It’s not that this store had a “policy” that didn’t allow customers inside until they were open that caused my blood pressure to rise, it was the fact that the customer service representative didn’t represent me, the customer.

So maybe you can’t open the cash register until 11, and maybe you really can’t allow anyone inside – but if you’re looking to make me a customer in the long run, you better at least sell me on the short term.

The challenge for many health care providers is that we too have policies that must be followed.  And maybe you aren’t able to care for the kid that walks in for treatment 10 minutes before you close, but knowing that there is a huge difference between telling them “sorry come back tomorrow” and “let me schedule you a time tomorrow where I can dedicate the time you deserve,” means the difference between that customer returning a day later and that same customer seeking services elsewhere.

Do your actions steps match your goals?

Lots of people talk the talk, but few walk the walk.

If you want to achieve your goals you’re going to have to understand that there is no escalator or elevator taking you to where you want to go.

Goals require walking the walk, plenty of hard work, and sweat.

Now get out there and take that first step.

Art Horne is the Director of Sports Performance at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

I was recently working with a patient who had injured her hamstring previously and was preparing for her upcoming sport season but just couldn’t seem to get over the hump in terms of running without pain.  I asked to see her squat, (which raised her eyebrows – because what does squatting have to do with running right?) but she appeased my wishes anyways only to fall backwards on her initial try, and then grab a table on her second attempt in order to gain some stability.

“How do you go to the bathroom?” I asked her jokingly to ease her embarrassment.

“I just kinda fall back on to it like everyone else does.”

Needless to say our evaluation really started then (as did a long conversation about sitting, squatting and getting her butt in gear).

As health care professionals we have to stop thinking about squatting as a strength coach’s responsibility, a weight room exercise, or something that causes tall guys knee pain and therefore shouldn’t be done.

Squatting is a movement that we all need for everyday activity and one of the purist expressions of health.  If your patients can’t squat or can’t squat without pain then this MUST be addressed, and addressed just as closely as the primary reason they first presented to you.  To no one’s surprise this particular athlete had difficulty recruiting her glutes and therefore was utilizing her poor hamstrings as the primary mover instead – a recipe for hamstring strains and continued pain.

A closer look into how your patients move might just reveal that their troubling squat pattern is the underlying cause to the problem that brought them in to see you in the first place. 

Art Horne is the Director of Sports Performance at Northeastern University, Boston MA.  He can be reached at a.horne@neu.edu.

We asked what the Giants in Sports Medicine & Rehabilitation, Basketball and Hockey performance training have read or are currently reading and we brought their list to you.  

Click HERE to view our recommended library with an ongoing list from these speakers who presented at the BSMPG "Standing On The Shoulders Of Giants" 2011 summer seminar.

Norman Murphy

by Shaun Bossio 

A while back, I went out to lunch with an old friend that was in town and was introduced to his father-in-law. We started talking about social media and its prominence (necessity really) in today’s business environment. The father-in-law was a little nervous about getting involved in social media as he was not as tech savvy as most, so we did our best to explain the ins and outs and the benefits that he could expect vs. the precautions he had to make sure he took. His biggest apprehension though was that anybody could post negative remarks on his Facebook page for the world to see. He was concerned that unhappy clients would take it upon themselves to write up negative reviews and drive business down. I explained to him that they could of course control what was posted on his page, but also that negative comments can be seen on virtually any company’s website. If the volume of negative comments outweighs the positive ones then the real issue at hand is not their use of social media, but how they are perceived by their consumers.

Let’s just put it on the table; how your customer-base views your business is reality. No matter how great things may seem from the view of yourself or management, the customers are the ones that drive your business perception. In that manner of speaking, even negative feedback is good feedback in that it helps to alert you to issues that may have arisen within your organization. If a customer perceives an aspect of your business as not fully meeting their needs, then it only makes sense to examine that portion to see if things can be improved. Sure, in some instances it might be a case of a particularly picky client and they might only be a single voice among the crowd, but more often than not, feedback comes from a constructive place and helps you identify areas for improvement. The problem rests in seeing feedback, both positive and negative, as an excellent way to keep you customers in touch with your business. Not only does it help you pinpoint the weak points in your organization, but it also lets your clients know that you are genuinely interested in the job you are doing. Regular interaction and personal responses to customer concerns shows them that you are willing to go the extra mile to keep their business.

So first off, do not be afraid of social media. It is your friend and there to help you grow your business. Like any business tool though, you have to know how it works and be careful while you are using it. That being said, it can be a great help in soliciting feedback from your clients and also in attracting new ones. Sure, you may get some negative feedback, but it is a great opportunity to respond to those folks to let them know how their issues are being addressed. What better way is there to show current/future customers that you value their business? Despite what you may think, their perception is your reality. After all, your business may be the best in your field, but if your customers do not see it that way then you will not be the best for long.

Shaun Bossio is the Assistant Business Manager at the Boston University FitRec.