Boston Sports Medicine and Performance Group, LLC Blog

Integrated Care - Part IV : Addressing & Correcting Hip Extension Problems

Posted by Boston Sports Medicine and Performance Group on Mon, Sep 12, 2011 @ 07:09 AM

by Art Horne

 

As we mentioned last week, our society has clearly become hip flexion dominant. 

This is really no surprised as Janda identified this “epidemic” long ago and termed it, the Lower Crossed Syndrome.  Clearly ahead of his time, and well before Blackberrys and IPhones caused us to hunch over and run into people on the sidewalk, Janda also described and discussed the upper crossed syndrome which is more prevalent today than ever as well.  With that said, so many of the young “healthy” athletes that sign up to play collegiate level athletics no longer are able to express the fundamental movement patterns that we so often take for granted.  This of course is not always a mobility problem, as many athletes are not able to reach end range of these patterns simply out of a reflexive protective mechanism.

 

sports medicine resources

 

Your body will simply not allow you to go where you have no business going.  (Ever wonder why LBP patients can’t touch their toes? Hint: it has nothing to do with hamstring length and everything with your brain not letting you get to end range flexion, you know, the place you have no business going)
In other cases, mobility is the main culprit and can usually be addressed with a simple movement exam along with some corrective therapy and exercises. 


Let’s take a look at an example to see what I mean.

Case Presentation:

This athlete presented to me many years ago, and unfortunately the overall theme continues year after year despite our best efforts to educate our athletes and their high school and youth coaches.

Here’s the story:

On evaluation athlete complains of having a persistent anterior hip pain from day one of pre-season practice.  She states that she had a “significant” hip injury at age 13 which lasted about one year and limited her from all sporting activities including gymnastics where she originally hurt herself during a coach “assisted” stretch.  At the time of the stretch, the athlete’s injured leg was down and extended behind her pelvis, with knee at 90 degrees and the opposite limb forced into extreme flexion.  At that time she felt intense pain and was not able to return to any physical activities for about one year. 

She went on to a successful high school career and eventually earned a college scholarship for her efforts.

 

sports medicine

(not the same stretch - but close. OUCH!) 

 

movement screen

 


On movement evaluation utilizing the SFMA, cervical and shoulder motions were FN (functional and non-painful), multi-segmental flexion FN, multi-segmental extension FP (functional but painful), multi-segmental rotation DN (dysfunction and non-painful) away from the injured side, single leg stance was DP on injured side, FN on uninjured side (NOTE: during this test athlete complained of pain with standing hip flexion.  She was however able to get her knee/femur past 90 degrees of hip flexion but had to first abduct her leg then lift it in front – so to basically avoid iliacus involvement and use only psoas with some help from TFL and Sartorius). Lastly,  deep squat was DN. 


(Now, according to the SFMA I should have “broke out” her multi-segmental rotation pattern and addressed her subsequent restriction but given her prior history and description of pain I decided to go directly to the prone hip extension test to confirm my suspicion that she had originally injured her iliacus some 5 years ago.)

On prone hip extension, athlete was unable to extend her injured leg to a minimum of 10 degrees.

Treatment Plan: evaluate and address tissue density changes and restrictions within the hip flexion musculature including both psoas and iliacus specifically.


If you aren’t familiar with manual therapy techniques to address soft tissue restriction within the iliacus consult a co-worker or expert in your area for help or training (If you’re in the Boston area one of the most talent manual therapist I’ve ever had the pleasure working with is Dr. Pete Viteritti.


Below are a few key technical points regarding treatment of the Iliacus utilizing a manual therapy release technique.  Remember: the iliacus is to hip dysfunction as the psoas is to lumbar dysfunction.

sports medicine

 

1. Begin with the patient lying on their side, hip and knee flexed and relaxed.

2. With the contact fingers extended, work the soft contact from the anterior superior iliac spine (above the inguinal ligament) medically onto the iliacus treating from proximal all the way distal to the lesser trochanter.  The adhesion can be anywhere in the muscle.  Also, be sure to move your hand contact treating medially until you bump into the psoas.  The junction of the iliacus and psoas is very important, be sure they are not adhering to one another. (adhesion's between muscles which cause them to adhere to one another is much more of a problem than an adhesion in a muscle itself).

3.The inguinal ligament should also be checked to be sure you can bow it both distal and proximal, as it can adhere to the iliacus underneath it.  Find the inguinal ligament at the ASIS and trace it as it moves medially and deep.  It is only the lateral aspect of it that comes in contact with the iliacus and can become entrapped.

4. As you begin, be sure to move the mesentary medially and not treat through it.  Use care to avoid putting tension on the mesentary as this will not only cause discomfort to the patient, but will significantly limit treatment effectiveness.

5. Once on the tissue, begin to put tension on the tissue superiorly with your inferior hand while the superior hand backs it up.

6. Have the patient extend the hip and knee straight and then extend the hip as far as possible.

Post treatment: Athlete was able to regain full prone hip extension, pain resolved with both single leg stance (athlete was able to lift knee/leg straight up in sagittal plane) and multi-segmental extension pattern.  Deep squat pattern improved significantly but was not yet perfect.  And most impressive post treatment was the look of shock and excitement on her face.

Whether you’re dealing with a shortened iliacus, a tight psoas major or a restricted rectus femoris (or perhaps even a shortened rectus abdominis thanks to the 2 million crunches you’d done), identifying the global limitation first (an extension pattern in this case), and then referring to an expert or addressing the underlying tissue restricting this pattern yourself before high levels of organized activity begins can mean the difference between weeks of treatment post injury or a few moments of your time prior, during your screening process.  Of course identifying the exact limiting factor/tissue/pain generator is the ultimate factor when it comes to whether your treatment will be a success or not.

“So what does this have to do with integrated care?  This sounds like a pure sports medicine problem and treatment approach to me.”

Perhaps – but all strength coaches can look at global movement patterns including extension and make the appropriate referrals.  Whether it’s during your pre-participation examination or during a simple recheck in the weight room – having all coaches, athletic trainers and therapists understanding the normal parameters of human movement and speaking the same language eliminates the language barrier and allows all parties involved in the care and performance of the student-athlete to be provide a unified care approach to the identified problem.  Although many strength coaches won’t be able to apply a manual therapy technique for this identified problem, appropriate strategies within the weight room can certainly maintain this new tissue quality and “cement” this new found range of motion with strength exercises appropriate for the athlete and previous injury.

Although the skill set or specific treatment modality between the two professional groups my vary slightly, the underlying philosophy should not and in this case addressing this extension limitation with whatever tools you are allowed to use will certainly pay dividends at the end of the day.

 

 

Next Week: When Not Being Able To Touch Your Toes Is Not A Hamstring Issue

 

 

 

 

Topics: Art Horne, basketball training programs, athletic training conference, basketball videos, Pete Viteritti, athletic training books, barefoot strength training, barefoot running

Integrated Care - Part III: Breaking Down Extension Based Problems

Posted by Boston Sports Medicine and Performance Group on Mon, Sep 5, 2011 @ 07:09 AM

by Art Horne

 

Although identifying a poorly executed squat is easy for many sports medicine and strength professionals (especially given the “rules” and guidelines set forth by the FMS standards), identifying the actual underlying problem or major contributor to a deficit squat is never as easy.  However, with a systems based approach during your annual pre-participation screenings your team of health care and performance professionals can tease out these often overlooked deficiencies as part of your movement screen from the very beginning instead of reacting after future injury or poor performance.

As I mentioned in a prior post the ability to express a proper squat pattern is fundamental to human movement.  Included in this category of fundamental “expressions” is the overhead reach, or what is commonly known through the Selective Functional Movement Screen TM (SFMA) as the Multi-segmental Extension Pattern (MSE) pictured below (figure1).  This easy test that takes literally 10 seconds can produce some startling results when athletes and those observing them, witness an otherwise “healthy”  and  highly skilled athlete in the prime of their life unable to reach behind them while shifting their weight and hips forward. 

 

 

functional movement screen

figure 1.

 

Let’s break it down.


According to the SFMATM rules, or simple human movement fundamentals, normal range of motion during this test includes:

1. With heels together (this is important and often overlooked as it provides a test-retest standardization) an athlete or patient should be able to have their ASIS pass over their great toes while;

2. Reaching overhead with hands in line with their shoulders and have the spine of their scapula clear or pass behind the heels of their feet and;

3. Their hands clear or pass behind the spine of the scapula (Figure 2).

 

 

functional movement

figure 2.


These movement minimums allow clinicians and performance coaches a starting point to begin observing their athletes for general restrictions within this pattern.  If an athlete is unable to complete this movement (failure to pass the ASIS over the great toe) then the athlete is asked to cross their arms over their chest and repeat the movement.  If the athlete is unable to still exhibit this fundamental expression of extension then the athlete in my opinion should be referred to a staff athletic trainer for further evaluation with the underlying problem is identified and addressed.  Many times the athlete will not understand why they are being referred since they have never had a “problem” before, but after a quick evaluation and treatment you’ll often find their eyes beam wide open with the additional range and freedom of motion that you’ve given back to them.

To confirm your findings on the examination table (although authentic human movement rarely ever happens on an exam table. Side note: How come you can measure with a goniometer an athlete’s ankle, knee and hip range of motion on an examination table and determine that they have the requisite mobility to perform a normal and unrestricted squat pattern but when you stand them up, the pattern looks like a train wreck? Movement means so much more than just your standard orthopedic examinations), have the athlete lay prone and ask them to tighten up one butt check and extend their leg off the table.  Repeat with the opposite leg and compare.  Rarely will an athlete be able to exhibit the appropriate amount of hip extension during this prone table test and not be able to pass their ASIS over their toes during the standing evaluation with arms crossed over head.

So what’s next? How do I fix it?

Not so fast.  I think it’s worth mentioning here a few items that support adding this simple test into both your yearly screenings along with your general orthopedic examination (regardless of injury presentation).  First off, I have been utilizing the FMSTM screen for a very long time as a strength coach, and over the last year have been utilizing the SFMATM methodology during injury presentation in the clinic and the overwhelming end result to many movement dysfunction and injury/pain cases have always boiled down to two movement impairments – Shoulder Mobility (Which in the end really is T-Spine Mobility) and Hip Extension.  The FMSTM  includes a test called the Active Straight Leg Raise, and this test unfortunately has been deemed a “hamstring” flexibility test or a hip flexion test by most casual observers but this couldn’t be further from the truth or the original intent of the test (future post coming: Are your hamstrings tight or are they just not letting you go somewhere you have no business being?).

For those that are not familiar with the test, an athlete lays on their back with a 2x6 board under their knees and while keeping the bottom leg in contact with the board slowly raises an extended leg upwards exhibiting the DIFFERENCE and available motion between the two legs and NOT the amount of hamstring or hip flexion range that you have.  It is this DIFFERENCE that should be noted, which ultimately leads to an examination and treatment focus of the down-leg in most instances as I mentioned earlier as the limiting factor (hip extension).

This should really come as no surprise since we have clearly become a hip flexion dominant society (sitting at computers, video games, etc not to mention our affinity for sitting on bikes at the commercial gym and watching the TV screen instead of sprinting on an incline treadmill which of course requires a bit of hard work and the aforementioned hip extension) and have basically lost the ability to “express” hip extension.  Although strength coaches and sports medicine professionals alike advocate “stretching” this problematic area after injury I think it’s worth teasing out your future patients sooner than later with a simple test while they are healthy athletes and avoid their inevitable future visit to your sports medicine clinic as patients.

 

Next week: Addressing and Correcting this Hip Extension Problem from both sides of the wall.

 

 

Topics: basketball performance, basketball training programs, BSMPG, FMS, SFMA, functional movement screen, Barefoot in Boston

Clare Frank Announces Educational Programs For 2012

Posted by Boston Sports Medicine and Performance Group on Fri, Aug 26, 2011 @ 08:08 AM

Speaker at this past summer's, "Standing On The Shoulders Of Giants" Seminar, Clare Frank continues to educate the nations top sports medicine and rehabilitation clinicians in her upcoming 2012 speaking engagements.

See Clare's 2012 Speaking dates below.

Asuza - 2012 DNS Course

Janda Approach - Arcadia 2012

 

clare frank

Topics: basketball performance, basketball resources, basketball training programs, BSMPG, athletic training conference, Clare Frank

Integrated Care - Part I: The Language Barrier

Posted by Boston Sports Medicine and Performance Group on Mon, Aug 22, 2011 @ 07:08 AM

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:

birddog

 

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.

Topics: Art Horne, basketball performance, basketball training programs, BSMPG, athletic training conference, Barefoot in Boston, barefoot running, barefoot training

Biorheology : A Missing Link

Posted by Boston Sports Medicine and Performance Group on Thu, Aug 11, 2011 @ 07:08 AM

by: Keke Lyles, DPT, CSCS

 

athletic training

 

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.

Topics: basketball conference, basketball training programs, BSMPG, athletic training conference, conference video

Weeding The Garden

Posted by Boston Sports Medicine and Performance Group on Mon, Aug 8, 2011 @ 07:08 AM

athletic training

 

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.

Topics: Art Horne, basketball resources, basketball training programs, BSMPG, athletic training conference

When Reading Is NOT Good

Posted by Boston Sports Medicine and Performance Group on Fri, Aug 5, 2011 @ 07:08 AM


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.

 

Topics: basketball training programs, athletic training conference, boston hockey summit, boston hockey conference, athletic training books, everything basketball

Sorry, Store Policy

Posted by Boston Sports Medicine and Performance Group on Thu, Jul 28, 2011 @ 07:07 AM

athletic training

 

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.

Topics: Art Horne, basketball training programs, athletic training conference, barefoot running

What the Giants are Reading - Norman Murphy

Posted by Boston Sports Medicine and Performance Group on Fri, Jul 15, 2011 @ 06:07 AM

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

Norman Murphy

 

Topics: basketball conference, basketball training programs, athletic training conference, boston hockey summit

What the GIANTS are Reading - Shirley Sahrmann

Posted by Boston Sports Medicine and Performance Group on Fri, Jul 8, 2011 @ 07:07 AM

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.

 

Shirley Sahrmann

Keynote Speakers Pete Viteritti and Shirley Sahrmann

 

Topics: Basketball Related, basketball conference, basketball training programs, athletic training conference, boston hockey conference, Shirley Sahrmann, Pete Viteritti, athletic training books