Boston Sports Medicine and Performance Group, LLC Blog

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

www.Stopchasingpain.com

www.Painlasercenter.com

References:

  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

BSMPG 2012 Summer Seminar Review by Bangen Athletic Development

Posted by Boston Sports Medicine and Performance Group on Fri, May 25, 2012 @ 06:05 AM

 

by Bangen Athletic Development

 

BSMPG

 

This past weekend I had the pleasure of heading to Boston for my third Boston Sports Medicine and Performance Group (BSMPG) Summer Seminar. I wasn’t sure how it was going to top last year’s line-up and I can’t say for sure that it did, but it was at least on par. I was able to hear some very informative presentations from Bill Knowles, Craig Liebenson, Sean Skahan, Dan Boothby, Pete Friesen, Boo Schexnayder, Joel Jamieson, Cal Dietz, Chris Powers and Alan Grodin. The following are the three things that I am going to implement into my program at Michigan Tech as soon as I get back to Houghton tomorrow (I am writing this on the plane trip home).

1. Subjective Athlete Monitoring

Joel Jamieson spoke about allostasis and the training process. According to Joel, Allostasis is “the varying integrated adaptive responses taken by the body in order to maintain homeostasis at all times and in all circumstances as necessary to keep the body alive.” We only have a certain amount of energy (called the allostatic reserve) to accomplish these adaptations. Training is obviously one of the stressors that can disrupt homeostasis, causing allostasis to occur. However, if the training is too much in terms of volume, intensity, or both, then that allostatic reserve can be drained and we won’t get the training adaptations that we are looking for.

Therefore, it is essential to monitor the recovery levels of our athletes and quantify their training load to maintain that allostatic reserve and ensure readiness for training. Unfortunately, at Michigan Tech we don’t have the resources for an Omega Wave or even other heart rate variability technology. I also don’t have the time to measure everyone’s vertical jump or grip strength on a regular basis. However we can use subjective measures to tell how an athlete is feeling and how they perceive their training. We will now have the athletes rate on a scale of one to ten on how ready they feel to train that day after the warm-up (it’s best to do it after the warm-up because athletes rarely feel ready before, sometimes I don’t feel fully ready until after the warm-up) and they will rate their perceived difficulty and intensity after the training session. This will allow me to quantify how they are responding to training and make adjustments as needed.

2. Lowering Hurdle Height for Plyometrics

In our second, third and fourth phases of plyometric training we use hurdles to jump over and in the past we have allowed our athletes to bring their knees up, sometimes all the way to their chest in order to clear the hurdle. During Boo Schexnayder’s presentation, he repeatedly discussed the importance of posture while jumping and that the set should be stopped if posture is lost at any point.

Continue to read by clicking HERE.

 

 

Topics: Art Horne, Brijesh Patel, Charlie Weingroff, Andrea Hudy, Bruce Williams, Cal Dietz, Bill Knowles, Barefoot in Boston, Clare Frank, Chris Powers

Review of 2012 BSMPG Summer Seminar by Jeff Cubos

Posted by Boston Sports Medicine and Performance Group on Wed, May 23, 2012 @ 06:05 AM

BSMPG Summer Seminar

 

Year after year, Art Horne and the gang at the Boston Sports Medicine and Performance Group host their anual Summer Seminar. Having heard nothing but positive feedback from colleagues who have attended in the past, I decided that this would be the year to finally attend. Living in Western Canada, it certainly isn’t easy to travel across the continent both from a time and financial perspective, but I felt that in order to continually better myself as a professional, attendance was a must. Like many of my previous educational endeavors, it was important for me to be 100% confident that this event was grounded in “educational conducivity” and not just a place where many of my friends were going to be. However, upon looking at the speaker lineup, it was more difficult to convince myself not to attend.

Perhaps the most challenging task however, was deciding which sessions to attend. So aside from the keynote lectures where all delegates were present, I found myself attending lectures from the following: Sean Skahan, Dr. John DiMuro & Mark Toomey, Art Horne & Dr. Pete Viteritti, Joel Jamieson, and Keith D’Amelio. So…

Continue to read this review by Jeff Cubos by clicking HERE

 

 

Topics: Craig Liebenson, Charlie Weingroff, Andrea Hudy, Bruce Williams, Cal Dietz, Bill Knowles, Alan Grodin, Barefoot in Boston, Dr. DiMuro, Dan Boothby

BSMPG 2012 Summer Seminar a HUGE SUCCESS

Posted by Boston Sports Medicine and Performance Group on Mon, May 21, 2012 @ 07:05 AM

Another year.... Another HUGE success!!

BSMPG would like to thank all the attendees who attended the 2012 BSMPG Summer Seminar.  We wouldn't be able to run the leading Sports Medicine & Performance Seminar in the world without the leading Sports Medicine & Performance Professionals attending each and every year.  And of course a huge thank you and shout out to all of our sponsors and speakers! 

Thank you!

Additional photos and details coming soon. We've already started planning for next year so stay tuned for details coming soon!

 

Here is a little sneak peak from the Photo Gallery that will be up shortly:

GREAT SPEAKERS

Joel Jamieson

 

AMAZING CONTENT

Craig Liebenson

 

INDUSTRY LEADERS ATTENDING

NBA coaches

 

AWESOME NETWORKING & SOCIALS

BSMPG Social

 

PACKED HOUSE

IMG 2385 resized 600 

 Thanks again and it was so great to see everyone!

-BSMPG

 

Topics: Art Horne, Jay DeMayo, athletic training conference, athletic training, Craig Liebenson, Brijesh Patel, Charlie Weingroff, Logan Schwartz, Andrea Hudy, Cal Dietz, Bill Knowles, Alan Grodin, Jeff Cubos, Barefoot in Boston, Dr. DiMuro

Interview with Victor Bergonzoli, CEO of Dartfish

Posted by Boston Sports Medicine and Performance Group on Wed, May 16, 2012 @ 07:05 AM

 

Dartfish

 

Victor, the mobile market is a very disruptive movement to many software companies. How has Dartfish continued to succeed with more and more competition?

 

Actually it helps the overall picture because many coaches had not realized before how important video was. An app is only once piece of a total solution and if you do not answer all the needs (or most of the needs) of an organization, you will not be successful. Dartfish has been serving this community for more than 10 years and we have listened to our client’s needs. This why we continue to be the driver in this market. We have developed apps as well and will continue with new ones to come, but always in a fully integrated and complementary approach (cloud, software and mobile).

 

Dartfish.tv allows users to monetize their skill sets with revenue streams similar to the iTunes store. How do you see coaches take advantage of this in the world of sports performance? Many private facilities are looking for both a competitive edge and a way to keep profits from dissolving to their competition. How does this help coaches on salary such as college and professional ranks as well?

 

There are many ways where coaches can create additional revenue or at least show a very professional image with great technologies. Coaches can sell video clips online (clips, drills, etc.,), they can start remote coaching services, they can post videos of camps and clinics, they can ask parents to subscribe to competitive events. We have clients with thousands of videos on their dartfish.tv platform today.

 

Many coaches want instant feedback or analysis live during training sessions. Most experienced coaches feel just the opposite that athletes should be viewing outside the field, court, pool, or track. Shouldn't analysis be more in the office and not in the field? What problems have you heard regarding this practice?

 

Actually there is a fine line between doing too much on the field and not doing enough with video. A quick visual feedback on the field is very beneficial to the muscle memory learning experience (seeing is believing). However, doing too much can be disruptive and you will lose the impact according to our best users. Deeper analysis should be done after the training session to find out additional facts and reinforce what was communicated on the field.

 

Fusion of data sets such as EMG and Force plates can be done with your system; can you share why this is going be a major and more common practice in the future?

 

What is essential here is to be able to have the full picture. Too many times, athletes and coaches are presented with data and it is very complex to really understand what is going on just by looking at the numbers. We say that your data needs video! As more and more data systems are available to larger audiences, the fusion with video will help the understanding and communication process. It is an additive process. A picture or video may worth a thousand words, and the data/words are worth a lot, but the combination is worth a million words.

 

Speaking of the future, without giving away too much can you identify the problems coaches and therapists have with video analysis with a busy team or clinical setting that will be alleviated with the innovations you are working on currently?

 

 

We are working on offering a product for every step of the process. 3 Key elements are important for therapists and coaches: Communicate, analyze, and then share. The key is to have the solutions that are fully integrated within their processes. It is always difficult to first embrace something new (people hate changes) but as soon as you have your workflow well established and you see that you can reap the benefits (patients doing better, medals won, increased revenue) there is no more doubt. When the first vehicles were introduced, many moving companies resisted and kept their horses and carts….we don’t see them on the roads anymore.

 

Interview courtesy of Carl Valle

 

A few seats still remain for the 2012 BSMPG Summer Seminar - sign up today to avoid disappointment this Sat!

 

Click me

 

 

 

Topics: Art Horne, Craig Liebenson, Brijesh Patel, Charlie Weingroff, Dartfish, Andrea Hudy, Bruce Williams, Cal Dietz, Alan Grodin, Barefoot in Boston

Leopards or Turtles? by Jose Fernandez

Posted by Boston Sports Medicine and Performance Group on Fri, May 11, 2012 @ 07:05 AM

BSMPG

 

 

Basketball is a multifactorial sport where recovery, nutrition, training, technical & tactical aspects, mental preparation and innate conditions are involved. As S&C coaches, our ultimate goal is to enhance the team performance by optimising each player´s physical condition and helping them stay away from injuries.

Profiling athletes is an important part of the training process that helps me to decide what is the most appropriate strategy for each of the players I coach.

The image below represents the average results of 3 pre-season assessments to determine the % of Type I muscle fiber (Slow Twitch). It is an example of two different football players, both of them playing for the same team but with a different muscular profile.

The player on the left seems to have lower predominance of slow twitch as every muscle group except Semitendinosus (very postural muscle) is within 30-45% of slow muscle fibres.

The player on the right seems to have higher predominance of slow twitch, especially on key muscle groups like Biceps Fem (59,8%) and Gluteus Max (62%).

Click HERE to continue reading...

See Jose and other internationally known speakers at the 2012 BSMPG Summer Seminar May 19-20th.

Hurry - Seats are limited.

 

Click me

 

 

 

Topics: Art Horne, basketball performance, BSMPG, Craig Liebenson, boston hockey conference, Cal Dietz, Bill Knowles, Alan Grodin, Barefoot in Boston, Dan Boothby

BSMPG & Bruce Williams : Hit The Ground Running - Video and Interview

Posted by Boston Sports Medicine and Performance Group on Thu, May 10, 2012 @ 07:05 AM

Take a sneak peek into Bruce Williams' presentation, New Concepts in Foot Function & Gait Analysis Assessments & Treatments, at the 2012 BSMPG Summer Seminar.

Space is still available - Register today before the last seats are gone!

 

Click me

 

 

 

Most athletes and coaches think podiatrist means someone who makes orthotics, could you dispel that myth and talk about the holistic approach with foot care and how you even work with injuries in the low back? Many don't understand your profession deals with biomechanics, surgery, and even manual therapy.

Podiatry is a very interesting profession.  Surgery is really the highlight of what Podiatrists do and are trained to do at the present time.  All Podiatrists receive about a year of biomechanics while in school.  They are all trained to cast for orthotics and write prescriptions as well.  Some podiatrists utilize manual therapy in their practice, but probably less than 5%. 

In my practice I figured out very quickly my orthotic outcomes were not what I wanted them to be.  I set out to understand how I could do a better job for my patients and that lead me down a very interesting path of self- education.  I found a mentor to assist me in the use of in-shoe pressure and video capture technology.  He also happened to expose me to the use of manual therapy in the foot and ankle.  The use of the technology and the therapy really opened my eyes to what I was missing in practice.  The use of the quantitative data from the in-shoe pressure really exposed me to the way the foot will function and react to a shoe and to an OTC or custom foot orthosis.  This has helped me to realize my limitations in practice while also allowing me to move past most of my peers in the understanding of the foot’s importance in walking, and athletic gait. 

Most of my sports medicine podiatry peers are great collaborators with physical therapists, strength and conditioning coaches, athletic trainers and massage therapists.  We all realize that we are just a piece of the puzzle in the process of enabling our athletes to compete at their highest levels.

 

Barefoot training and minimalist shoes seem all the rage right now, can you share some objective pros and cons to what athletes may benefit and risk wise when diving into this territory?

Barefoot is the thing right now, just as toning / rocker bottom shoes were a few years back.  In moderation and in certain specific situations I see benefit for patients and athletes from both types of shoes.  The biggest problem I have with the minimalist / barefoot shoe debate is that there is very little proof that doing workouts barefoot will have the amazing results that so many people say they have had. 

I use a lot of technology to quantitate my outcomes, good or bad.  I would appreciate it if others would utilize similar technology to do the same.  Enthusiasm is wonderful, but there is a need to realize when something is not working the way we hoped it would and realize a different take is needed to get a successful outcome.  I have seen a lot of people chasing rainbows the last few years and it confuses me.  I appreciate the capacity of strength and conditioning to improve outcomes for athletes, but, there are limitations to what can be achieved and maintained.  I see the limitations daily with what I do and I try to refer to P.T. and strength coaches to assist my patients and athletes to achieve an overall better outcome.

I am regularly amazed that so many in the sports industry seem very anti-foot. I’m not really sure why this is, but my suspicion is that every podiatrist and many P.T.’s will put patients and athletes in an orthotic and often they do not work.  Podiatrists are very bad about this and often don’t have a specific reasoning or a plan for why they chose to use their devices.  I have a very specific reasoning pattern and evaluation process for doing what I do for my patients.  I really try to have a method to my madness.  I have a very good success rate, but not perfect by any means.  I am always looking for a new way to improve my outcomes whether it is through a new modification to a device, a new mobilization technique or through partnering with a better team of sports minded individuals so that we can all work together to benefit our athletes.

 

When the foot hits the ground a complex reaction of joints, muscles, and neurological responses happen. Could you share your approach with both technology and experience when working with athletes?

I use F-Scan in-shoe pressure and Dartfish as well as another older video capture technology.  I am starting to experiment with wireless emg and a nodular motion capture technology.  In-shoe pressure can give you a tremendous amount of insight into how an athlete’s foot and lower extremity functions.  There are however limitations to what the data can indicate.  This is why I use video capture and why I’m experimenting with the nodular motion capture.  It is important to know what the position of the hips, knees and lower extremity in general are doing for each step.  Relating this to the trunk position can give you insight as well. Once you have enough gait data from the trunk on down, then you can really start to incorporate a plan for the athlete from the ground up.  As you track going forward you should see what is working and what is not.

Wearable technology is being used now and will be utilized even more in the near future.  It is important to start to work with this technology or to partner with those who do use it regularly.  There are great benefits to quantifying evaluations and using wearable tech to validate plans of interventions is going to become the gold standard as we move forward.

 

You are familiar with different screens such as the FMS and traditional orthopedic assessments. Could you share your perspective on how some additional information from your methodology can help athletes reduce injuries?

FMS is a great screening tool and can give you quite a bit of information to help practitioners to formulate a plan for an athlete’s rehab or for their regular conditioning.

I have a basic screening tool that can assist or expand on the FMS as far as for evaluating the foot, ankle and lower extremity.  If you can gain a better understanding of how the foot is structured and functions then you can start to get a much better understanding of how your interventional plans will work and whether you can expect realistic improvement.

I like to use a basic scale to discern the structure and stiffness of the foot along the medial and lateral columns.  It is good to know the standing heel position of the foot, if there is any limb length difference left to right, and also the available range of motion of the big toe joints and the ankle joint.  Just having these few basic points of information can start to give insight to why an athlete may be prone to stress fractures of the metatarsals, chronic ankle sprains, and even if they may be prone to knee injuries.   Adding ranges of motion of the hips, and knees in static and walking gait can multiply your available knowledge base even more.

There are reasons and patterns for why some athletes get injured and why some do not.  Quantifying as much of the structural components of the foot and lower extremity function is the best way to start to identify those patterns.

** interview courtesy of Carl Valle

 

 

Topics: Craig Liebenson, Charlie Weingroff, Bruce Williams, Cal Dietz, Bill Knowles, Barefoot in Boston, Dan Boothby, Chris Powers

BSMPG wants to invite YOU!!

Posted by Boston Sports Medicine and Performance Group on Tue, May 8, 2012 @ 07:05 AM

BSMPG Summer Seminar

 

Happy Tuesday!

There are only two weeks remaining before our 2012 BSMPG Summer Seminar, May 19th and 20th!!! We are almost at capacity, so register today before the last remaining seats are scooped up!

DO YOU WANT TO BE A LUCKY WINNER??

BSMPG will be hosting a VIP gathering Friday, May 18th during the afternoon and early evening featuring:

Seminar speakers, performance coaches from the NBA & NHL, college strength coaches from the top programs across the country, select area athletic trainers, and physical therapists as well as representatives from the top sport science companies... and hopefully YOU!!!

This is a closed event but BSMPG is opening its doors to 8 lucky registrants. Register prior to Friday, May 11th at Midnight and be eligible for additional lectures and breakout sessions Friday afternoon. In addition, winners will be invited to our pre-seminar speaker social Friday night!

What happens if I don’t get my name picked?

Don’t worry – with BSMPG everyone is a winner! Join seminar speakers and attendees for a post-seminar social Saturday night at Symphony 8 Bar and Restaurant immediately following the last lecture of the day. Hey... learning is hard work and you deserve some food and drink provided by OPTOSource.

Attendees will also be placed in a drawing for a chance to win sponsor prizes! Where else can you get free gear and free food?

Check out http://www.bsmpg.com/2012-summer-seminar/ for complete details!

See you there!!!

 

Friday VIP Workshop 

 

Pre-Season Screening for Sport May 18th 4:00 - 5:15 pm
 
During the afternoon Jose Fernandez and Dr. Bruce Williams will do a live assessment of an athlete, followed by group discussion on best practices with screening. A focus on gait and lower body mechanics is the highlight, supported by both biochemical and biomechanics monitoring. Evidence based medicine and the latest advancements of technology, therapy, and sports performance methods will be covered. With the advent of Moneyball, Jose and Bruce will show how they look at risk analysis with athletes in team sports from both a time management perspective and decision making process. 
 
Speaker Social to follow.
 
Winners will be informed of locations and additional details after drawing.

 

 

Friday Social Sponsored by:

 

TopCoder

TopCoder is the world’s largest competitive Open Innovation Community of digital creators with over 400,000 members representing algorithmists, software developers and creative artists from over 200 countries. The TopCoder Community creates digital assets including analytics, software and creative designs and solutions for a wide-ranging client base through a competitive, rigorous, standards based methodology. Combined with our extremely talented Community this groundbreaking methodology results in superior outcomes for our clients. For more information about sponsoring TopCoder events and utilizing TopCoder’s software services and platforms, visit www.topcoder.com.

 

 

Topics: Art Horne, Alan Stein, Charlie Weingroff, Andrea Hudy, Bruce Williams, Cal Dietz, Alan Grodin, Joel Jamieson, Jeff Cubos, Barefoot in Boston, Jose Fernandez

See Tomorrow's Training Technology Today

Posted by Boston Sports Medicine and Performance Group on Sat, May 5, 2012 @ 07:05 AM

Ever wonder why some Performance Coaches, Athletic Trainers, or Physical Therapists always seem to be ahead of the curve?

What do they see that you don't?

Sometimes having a little help from the sports science world and measuring progress can go a long way....

Be the first to see tomorrow's technology today at the 2012 BSMPG Summer Seminar - May 19th and 20th in Boston MA.

Click on each logo to learn more about each company and how they are changing the way we track and progress our athletes and patients.  

Stop chasing the pack, and start moving towards the front with the help from the leaders in advanced training technology from around the world!

 

TMG     visiblegains

 

ithlete          Polar

 

 

MyotestPRO          kinetic

Affectiva          BioSensics

Dartfish         zflo

 

Zeo            Free Lap

 


 

Tekscan      Optosource

 

 

 

Inside Tracker

 

 

Register for this event and for opportunities to win prizes from these sponsors today.

 

Seats are limited!

 

Click me

 

Topics: BSMPG, athletic training conference, boston hockey summit, Craig Liebenson, Charlie Weingroff, barefoot strength training, Andrea Hudy, Cal Dietz, Bill Knowles, Alan Grodin, Barefoot in Boston, Dan Boothby, Clare Frank

Up the Chain It Goes... (Part II)

Posted by Boston Sports Medicine and Performance Group on Fri, May 4, 2012 @ 07:05 AM

By Art Horne

 

turf toe derrick rose toe injury

 

 

In a follow up from a previous post (Up The Chain It Goes), additional evidence supporting the relationship within the kinetic chain has emerged from south of the equator.  In a study out of South Africa examining the link between available dorsiflexion and mechanical low back pain researchers found a statistically significant decrease in ankle dorsiflexion ROM and associated reporting of low back pain (Brantingham, 2006).   With the vast majority of adults suffering from low back pain at some time in their life, (some reports are up to 85%) and 80% of people reporting foot problems during their lifespan, it’s not a surprise to see that these two conditions may very well be related.

Let’s take a closer look:

Methods: “ The study was a blinded, 2-arm, non-randomized clinical study involving 100 subjects with chronic or recurrent mechanical low back pain (intervention group) and 104 subjects without chronic mechanical low back pain (control group) between the ages of 18 and 45.  A blind assessor performed weight-bearing goniometry of the ankle and big toe and the navicular drop test on all subjects in both groups.”

Results: “An independent t-test (inter-group) revealed a statistically significant decrease in ankle dorsiflexion range of motion in individuals with chronic mechanical low back pain.”

Conclusions: “This study’s data found that a statistically significant decrease in ankle dorsiflexion ROM, but not flatter feet, was associated with subject report of chronic mechanical low back pain disorders.”

Discussion: “The findings of this blinded study support previous reports suggesting that decreased ankle dorsiflexion may be a factor in chronic mechanical low-back pain.  There was no clear association found between decreased hallux ROM and mechanical low back pain in this study.  If these findings are confirmed through additional studies, exercise and manipulation therapy to increase ankle range of motion could become an important consideration in the treatment of some patients with mechanical low back pain disorders.”

Hmmm, if only we had some additional studies….

Perhaps this will help.

During a routine exit physical, 60 division one athletes were assessed for available weight bearing dorsiflexion bilaterally as described by Bennell et al in 1998 (inclinometer was replace by Clinometer app for ITouch) to examine limitations in this movement.   Ten athletes with limited weight bearing dorsiflexion (less than 4 inches from knee to wall) volunteered for follow up evaluation and manual treatment. Out of the initial 120 measured ankles, 47 ankles (21 right, 26 left) demonstrated limited weight bearing dorsiflexion range of motion.

Athletes were then asked to walk normally in their athletic shoes while wearing an in-shoe pressure sensor (Tekscan) and through an optical measurement system (Optojump).  Each athlete then underwent a general manual therapy intervention aimed to improve ankle dorsiflexion, followed again by the same gait analysis and pressure mapping data capture.

 

Gait Evaluation

 

 

Gait Cliff Notes: optimal gait should have two mountains with a trough between them. The first mountain represents heel strike to midstance, the trough representing the mid-stance phase, and the second mountain being propulsion from full foot contact to toe-off.

Easy right? Good. 

Note: The second mountain should almost always be higher than the first.

 

Case Study 1:

Tekscan report

 

Pre-treatment (RED):

Notice how the first mountain is slightly higher than the second – this is BAD!

Remember from our cliff notes: the second mountain should be higher.

Post-treatment (GREEN):

Notice change in toe off from pre- to post-treatment which specifically targeted patient's limited dorsiflexion?  The second mountain is now higher than the first. That’s a GOOD thing!

Awesome right?

Better yet – athlete was measured 3 days post treatment and improvement in Dorsiflexion range of motion stuck!  Try doing that with a slant board stretch.

 

See Art Horne and Dr. Pete Viteritti discuss these and other changes at the foot and ankle, and how to assess and address soft tissue and bony restrictions in their presentation at the 2012 BSMPG Summer Seminar May 19-20th in Boston.

 

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References

Bennell KL, Talbot RC, Wajswelner H, Techovanich W, Kelly DH and Hall AJ. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Australian Journal of Physiotherapy. 44;175-180.

Brantingham JW, Gilbert JL, Shaik J, Globe G. Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain. J of Chiropractic Medicine. 2006; 4(5); 123-127.

 

 

 

Topics: Art Horne, basketball performance, basketball training programs, boston hockey conference, barefoot strength training, Bruce Williams, Cal Dietz, Bill Knowles, Barefoot in Boston, Chris Powers, Dorsiflexion