Boston Sports Medicine and Performance Group, LLC Blog

Over the next month we will be previewing the 2013 BSMPG Summer Seminar speakers, their thoughts on the current state of Sports Medicine & Performance Training, how technology is influencing our profession (for better or worse) and preview their lectures.

Enjoy.

1. How has the field of sports medicine/performance changed in the last five years? Where do you see the field headed in the next five years

We have now more tools to measure and understand what constitutes performance and how athletes are progressing so training and nutritional prescriptions are becoming more accurate and many activities can be tailored to individual athletes to maximise their development and increase the chances of performing well. The field is moving quickly and with miniaturisation of technology it will be possible to know more about athletic performance and have better evidence to apply interventions. However training equipment does not seem to be evolving at a faster rate for various reasons. Food technology is also quickly accelerating so soon it will be possible to access functional foods tailored to individuals. More needs to be done to accelerate recovery from injury so I can see new compounds capable of accelerating muscle and tendon repair.

2. Athlete monitoring and sports analytics has emerged as leading topics within Sports Medicine and Performance Training, how has this field influenced your practice?

I think there has been a good evolution, still too many people collect too many data which do not affect performance. However data are good to provide an evidence-based approach to sports science and medicine and improve coaching decisions.

Has the field in your opinion gone too far with some professionals becoming slaves to data sets instead of providing solid clinical practice and coaching? Is there room for more monitoring? What "data sets" are you seeing as most impactful when is comes to providing athlete care and training?

Well, many people talk about data, few understand what makes good data. Clinical practice and coaching requires experience driven by knowledge and the real impact happens when knowledge combined with clinical practice make a (measurable) difference. So in some cases there has been an improvement, however in many cases people want/try to collect complex datasets but forget the collect simple ones so it is impossible to make informed decisions despite the fact that some “sexy”data sets are collected. For example, some people want to measure or measure salivary hormones but then do not have good training diaries (prescribed vs. executed) so they cannot manipulate training even if the hormone data seem to show some aspects of change.

3. What can attendees expect to hear from you at the 2013 BSMPG Summer Seminar? How may your lecture impact their practice on Monday morning?

I will address the issues presented before showing some examples of case studies as well as discussing current activities and highlighting some points being missed. I will also talk about practicality of interventions and will discuss the following concepts/approaches:

Signal-Noise

Dose-Response

Cost-Effectiveness

I am looking forward to attend the conference to share my experiences and view but most of all to meet colleagues and understand more about the state of US sport.

“…my training and experience as a teacher has been invaluable in dealing with players one-on-one, because understanding learning styles and teaching methods is fundamental to developing trust and educating players. After all, it doesn’t matter what I know, what I’ve done or what I can do – what really matters is what my clients, teams or players understand, absorb or learn and then execute. What I can translate to them is central.” 

- Fergus Connolly, 2013 BSMPG Summer Seminar Keynote Speaker

Dr Fergus Connolly has extensive experience as a Performance Consultant to Coaches, Performance Directors and Sports Scientists in elite team sports from Premiership football and International Rugby, to NFL and NBA, and from Professional Boxing to even Special Forces worldwide. A PhD in Computer Optimisation, combined with specialised knowledge acquired from apprenticeships working with some of the most successful coaches, academics and practitioners, he is an original thinker in the development of unique effective monitoring, training and regeneration approaches to improving results in team sport.

Fergus opens up the discussion by clarifying that his role is a Performance Scientist. He suggests that he does things ‘differently’ and that might be one of the reasons why some people view him and his work as effective. Fergus tells me how he has travelled the globe on a personal and professional development quest, visiting numerous targeted professional sports clubs, teams, coaches and practitioners to better understand different approaches to providing support to elite level athletes. In the years that have passed, Fergus has integrated these eclectic experiences into his own brand of supporting the athletes, coaches and teams that he works with.

Fergus goes on to describe sport as his passion and that he is constantly motivated within his role to ‘help’ the people that he comes into contact with. This notion of help shouldn’t be mistaken for a personal caring approach. Whilst this is indeed a central tenet to how he operates as a practitioner, one of the fundamental features of his work is to enhance performance. Winning is at the core of his business and he emphasises that firmly within our conversation.

Continue to read this article by clicking HERE.  

Learn how Fergus mixes just the right amount of both strength training and sports therapy together when working with clients from around the world and why the top sport franchises rely on Fergus to provide them with the winning edge at the 2013 BSMPG Summer Seminar.

BSMPG is proud to announce the addition of Kevin Neeld as a speaker within the Sports Fusion Track at the 2013 BSMPG Summer Seminar - May 17th and 18th, 2013!  Kevin joins legendary track coach Randall Huntingon and Ben Prentiss along with keynote speakers, Dr. Stuart McGill, Marco Cardinale, Fergus Connolly, Adriaan Louw and Marvin Chun for this weekend event.  With the most thorough and integrated speaker line-up ever assembled, the 2013 BSMPG Summer Seminar will be the WORLD'S most sought after Sports Medicine & Performance Seminar to date!!

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

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

See you in Boston next May!!!

KEVIN NEELD

Sponsored by:

Director of Athletic Development & Athletic Development Coach

Kevin Neeld is the President, COO, and Director of Athletic Development at Endeavor. Since joining the team in 2007 as Endeavor’s Director of Athletic Development, Kevin has rapidly established himself as an international authority on athletic development, with a reputation for creatively applying an extensive knowledge in functional anatomy, biomechanics, neural control, and injury prevention to produce superior results for his athletes.

Kevin is sought after for his expertise in both performance enhancement and injury resistance. He has helped athletes surpass previous performance bests following a multitude of common athletic injuries, including ankle sprains, knee ligament tears, hip labral tears, chronic groin and hip flexor strains, sports hernias, low back pain, shoulder dislocations/separations, and shoulder labral tears.

After completing a successful college hockey career at the University of Delaware ('05-'06: MVP; '06-'07: Team Captain, Lifetime Achievement Award, 2nd Team All-American), Kevin served as the Assistant Coach of the University of Massachusetts Amherst Women's Ice Hockey Team and assisted with the implementation of the strength and conditioning program for the UMass Amherst Men's Ice Hockey Team. Recently, Kevin has joined the US Women's National Hockey Team as a Strength and Conditioning Coach, and has been an invited guest to NHL training camps to assist in the testing and training of the players. Kevin continues his work in ice hockey serving as a coach, educator, and program consultant in the sport.

An accomplished author, Kevin has had articles published in Men’s Fitness and many of the top fitness and performance sites, including AskMen.com, StrengthCoach.com, T-Nation.com, EliteFTS.com, and SportsRehabExpert.com. Kevin is the author of Ultimate Hockey Training, a comprehensive resource on long-term player development and year-round off-ice training methods.

Kevin received his Master’s degree in Kinesiology with a concentration in Exercise Neuroscience from the University of Massachusetts Amherst, and his Bachelor’s degree from the University of Delaware with a major in Fitness Management and a minor in Strength and Conditioning.

BSMPG is proud to announce the addition of Ben Peterson as a speaker within the Sports Fusion Track at the 2013 BSMPG Summer Seminar - May 17th and 18th, 2013!  Ben joins legendary track coach Randall Huntingon and Ben Prentiss along with keynote speakers, Dr. Stuart McGill, Marco Cardinale, Fergus Connolly, Adriaan Louw and Marvin Chun for this weekend event.  With the most thorough and integrated speaker line-up ever assembled, the 2013 BSMPG Summer Seminar will be the WORLD'S most sought after Sports Medicine & Performance Seminar to date!!

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

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

See you in Boston next May!!!

BEN PETERSON, M.Ed., CSCS

Ph.D. Graduate Assistant, University of Minnesota

Topic: Repeated Sprint Ability: The metabolic and physiologic response to repeated sprint work and their implications for fatigue.

Ben is currently pursuing his Doctorate in Kinesiology and Exercise Physiology at the University of Minnesota. At the university he helps run the Sport Performance Lab, testing hundreds of athletes annually in sports ranging from cross-country skiing to football. In addition to his time in the lab, Ben helps teach two courses within the kinesiology department; Strength/Power Development and Health and Wellness. His research looks at repeated sprint ability in anaerobic athletes, specifically as it pertains to energy system efficiency and fatigue; looking at central and peripheral causes of decreased force production. His research also looks heavily at power and rate of force development in athletes and its dynamic correspondence and transferability to sport.

Ben is a graduate of Northwestern University where he played football for the Wildcats. He started his career as a performance coach working for the Minnesota Twins in 2008. Over the past five years, Ben’s passion and creativity have allowed him to work with over 100 professional athletes in the NHL, NFL, and MLB; helping them maximize the limits of their athletic potential. More recently, Ben co-Authored the book, Triphasic Training: A systematic approach to elite speed and explosive strength performance that explain the advanced training methods he uses to maximize force development and the scientific principles behind their implementation. When not teaching class or testing in the lab, Ben works as a consultant for Octagon Hockey, spending the NHL off-season working with their athletes in the Minneapolis area.

5 Steps to ensure your 2013 BSMPG Seminar is a Success 

1. Remain Calm: Yes, it's true that we have the biggest names in Sports Medicine and Performance here in Boston for the 2013 Seminar and it's also true you might never be exposed to so much brain power under one roof ever again.  But this is no reason to start dancing around your apartment like a teenage school girl who just met Justin Bieber!  Ok, maybe it is.

2. Rest Up: we certainly know how to put on the best seminar in the industry - that's understood. If you've attended an event in the past you know we also know how to put on the best socials in the industry as well.  Bring Ibuprofen and a water bottle! 

Our motto: learn hard - play hard! 

3. Bring Business Cards: We know that you come for the best speakers in the world, but we've also been known to connect sports medicine and performance professionals with the best technology support companies, nutrition experts, and a number of other industry leaders from around the world with one another.  We don't want to brag - but we're also responsible for a number of interviews and jobs over the last few years.

4. Take Notes: Not during lectures silly! That's what the powerpoint and outlines we provide you are for. Some of the most powerful conversations take place during our scheduled breaktimes, lunch hours and social events.  With the leaders in sports medicine and performance from around the globe present as attendees, some of the biggest Ah-ha moments happen outside the lecture halls. Be ready with pen and paper in hand - you might not get another chance to talk to so many NHL and NBA coaches and therapists as you do at BSMPG!

5. Secure Lodging: During this week many Boston and area colleges and universities host graduations and because of this, area hotels book up fast.  We encourage those even thinking about attending to reserve hotel rooms now! You can always cancel the week leading up to the event, but if you wait until the week prior to book, you'll certainly be out of luck. Reserve your room now. See link below.

Click HERE for a complete list of our Hotel Partners.    

Recap: Get excited because we are planning the largest BSMPG Seminar to Date - book your travel, get a babysitter, reserve a hotel room, and bring your brain and party pants to Boston! 

Let's get it on BSMPG-ers! (yes, that's a Marvin Gaye reference)

See you soon!

Register today for the world's largest Sports Medicine and Performance Seminar - May 17 & 18, 2013. Boston MA 

By Art Horne

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

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

Why care about tibio-femoral rotation?

Seriously?

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

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

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

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

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

What exactly is happening?

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

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

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

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

Position: Tibia Externally rotated

Motion Restriction: Internal rotation of tibia

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

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

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

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

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

Register today before this event sells out!

References:

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

by Keke Lyles

I know for certain that ever since I began playing sports as a young adolescent, I wanted those six-pack abs. If you look through muscle magazines from thirty years ago up until the present, this is arguably the most popular topic covered. Ninety nine percent of everyone who goes to commercial gyms dreams of that beautiful six pack. Turn on the television and during almost every commercial break you will see an advertisement on the newest gimmick, diet, trend, or flat out lie on how to achieve that goal. I guess I can’t blame anyone for buying into this “core culture” because in our great Western society we place such an emphasis on the way we look. Although that doesn’t explain why we are still one of the most obese countries in the world. Or, perhaps it does explain it. We have a misconstrued view of reality when it comes to our health. We want quick fixes (5 min abs), we want to eat whatever we want (diet fads), and at the end of the day the only results that REALLY matter to us is what we see in front of the mirror.

But don’t let me single out the everyday common folk. I have athletes all the time question my core training with them.  One afternoon I walked into my weight room after I thought everyone was gone, I found one of my guys doing sit- ups. When his eyes made contact with mine, without me saying a word, he shouted, “Well you never let me do them when I work with you!” My response was simple, “They pay me to keep you healthy and to aid in your development, and what you are doing is the opposite of that.” So why is that everyone has such a wrong view on this, or am I the one who has it all wrong?

Let us explore the “core” muscles. For the sake of keeping this simple, we are just going to focus on the RECTUS, TRANSVERSE ABDOMINIS and INTERNAL, EXTERNAL OBLIQUES. I would argue that the core is much more complex than just those four muscles, but again let’s try to keep it simple. Basic kinesiology teaches us the origin and insertion of muscles and from that, we thought we figured out what that muscle does. Because everyone reads the internet and think this makes them an expert, let’s see what Wikipedia tells us about what these muscles do. Rectus: “Flexion of the lumbar spine.”  Transverse: “Compresses abdominal contents.” Obliques: “Compresses abdomen; unilateral contraction rotates vertebral column to same side.” So simple, right? WRONG!!! But this simple way of looking at the abdominal muscles has led everyone to believe that training your abs is about getting a six pack, which means you flex your lumbar spine over and over. Perhaps that is why one of my coaches has herniated discs in his back. Thanks to Stuart McGill, we know that our spine has a flexion/extension tolerance, meaning you can only bend it so many times before it breaks.  Does P90X give you a refund after you blow out your back from the Ab Ripper? Of course not.

Now before I just rip on all the products out there, let me explain my stance. The abdominal muscles are not intended to work that way. It appears that they do, but research has revealed otherwise. Their PRIMARY function is to STABILIZE. Their other job is to transfer energy and to resist movement. Crazy, I know. Considering our spine has only so many bends in it before it breaks, we better have something that prevents all those bends. This is what the core does. If you are about to hyperextend, your core will fire to prevent spinal injury. If a football player gets hit awkwardly with his arm outreached, it is his core that will protect him. If a basketball player is jumping up to rebound and has to reach back, it is his core that allows him to stay in control to gain possession. You don’t see guys purposely doing lumbar flexion in competition, just like you don’t do it in everyday life. So why train that way?

And what is stabilization all about? Doing concentric and eccentric exercise will make a muscle bigger and stronger, but stabilization is about timing and coordination. Think of a robot-like machine that automatically swings a baseball bat as a pitch is thrown towards it. Now if you make it swing faster (stronger), what will happen? It will be a swinging strike since the bat will be in front of the ball. You must calculate the timing so it will hit the ball further. Timing and coordination are not about strength and size. Similarly when it comes to our core, it is not about strength and size. It is about our central nervous system controlling the timing and coordination of the muscle contraction to prevent an injury or transfer force. I would make the argument that training to make your core bigger and stronger to get a desired look will only interfere with its real purpose.

Additionally, a six-pack is seen because a person is lean. This comes from a combination of exercise and mostly diet. So drop the fads, leave Wikipedia alone, and challenge yourself to really understand the purpose of your muscles. Resist the temptation to measure success by the mirror. I measure it by injury reduction. Find an objective way for you to measure it.

Leave the Ab Ripper session behind and learn the real way to train your core. How can you train to stabilize? Then stabilize while adding movement to a limb, just like in sport and in life. Planks, side planks, etc. are a good start. Add farmer walks, or waiter carries, perhaps variations of bird dogs. Try prone, supine, half-kneeling, kneeling, and standing progressions. There is plenty of great material out there on how to properly train your core. The promise I will make to you is that training your core this way, along with the proper additional exercises and a solid diet, you will get that much desired six-pack, but more importantly, stay healthy.

Maybe I am crazy and sure I may be wrong about many things, but this is not one of them. My goal is for our culture to change regarding its view of the core. I want to see this shift not only for my players, but for everyone. Sit-ups should be a thing of the past, but yet we struggle to let them go. Train hard, but train smart.

-Keke Lyles

Strength and Conditioning Coach Minnesota Timberwolves

Click below to see highlights from our 2012 BSMPG Summer Seminar featuring Keynote Speaker, Craig Liebenson during his workshop session.

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

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

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

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

A special thanks again to our SPONSORS!

by Chris Joyce, DPT

Pain. A word that ignites a cascade of thoughts and emotions in a person, often formulating as questions that are specific and situational to the individual. For example:

Clinician: Joint or muscle? Disc or neural tension? Movement patterns or structural lesion?

Athlete: Season ending? Same thing as teammate’s/professional athlete’s? Scholarship jeopardized?

Patient: Copay cost and insurance coverage? Time off from work? Old age?

The answers to these questions undoubtedly play a role in the success or failure of an individual’s rehabilitation, and as such it becomes paramount that the clinician considers any and all physical or mental restrictions. With the growing accessibility of diagnostic tests, diagnostic websites, and diagnostic friends/family, the practitioner faces the challenge of not only delivering successful interventions, but also guiding the patient’s cognitive state as they become overwhelmed with input. Fortunately, in the last 20-30 years we have seen an increased availability of information that can facilitate this type of high quality comprehensive patient care that encompasses both physical and psychological medicine.  It is my personal belief that education in academia, in conjunction with numerous resources for continued knowledge, equips the AT/PT/Chiro/etc, with almost all the necessary physical skills to treat someone in pain.  However in regards to formal education, the same thing cannot be said about the required understanding of the neurophysiology of pain, including it’s psychosocial contributions. Now, it is WAY outside my scope to attempt to educate my colleagues in the complexities of neuroscience and pain modulation. Rather, my goal is to highlight the importance of pain education within our professional development, and within our everyday patient interactions.

Surely we have all heard of the phenomenon “phantom pain,” where a person with a recent (or chronic) limb amputation continues to experience pain in the absence of his extremity. And surely we have heard of the opposite phenomenon, where a person takes significant physical damage to their body yet reports no symptoms at the time of insult.  From these two examples, we can convincingly agree that pain is not simply an input from peripheral structures, but rather an output of a central processor (Melzack 2001).  Scientific evidence that dispels structural pathologies as definitive pain sources is a study done in 2007, when images were taken of tennis players who have disc herniations, spondylolisthesis and stress reactions, yet were asymptomatic (Alyas 2007).   Looking conversely, I’m sure we could all provide cases where patients complained of significant pain, were sent out for imagining and returned with normal findings. This does not mean the person is not experiencing pain, but rather that it is unlikely the source of the pain is an anatomical or even biomechanical dysfunction.   

With this established, we know we have to consider the other factors that may affect the brain’s processing of pain, such as thoughts, beliefs and emotions.   As illustrated in the introduction, these may differ greatly in an athlete or a patient, so they must be identified and addressed specific to each individual. One way proven to effectively mitigate pain and its associated impact is simply by providing education as an intervention.  In various studies, neuroscience education has had immediate effect in pain thresholds during physical tasks (Mosely 2004), improved outcomes of therapeutic exercise (Mosely 2002), and decreased fear in a patient’s perception of his pain. The methods used for transferring this information can vary greatly, but the underlying concept is fundamental: people who understand why they may feel pain can manage their pain more effectively. Therefore, the patient/athlete education we provide is a critical component in rehabilitation.  The clinician must become versed in the complex process of pain neurophysiology to be able to succinctly articulate the phenomenon.

We’re in the midst of an exciting shift in our orthopedic assessments to show greater respect to the neuromuscular system.  Failing to incorporate current concepts of pain physiology would be detrimental to our vision of global movement and function.  An excellent place to start is by reading the book Explain Pain, downloading the recently published article A neuroscience approach to managing athletes with low back pain, or attending the BSMPG course in May that will feature renown expert, Adriaan Louw.

Chris Joyce is a physical therapist at a sports orthopedic clinic in Boston. He’s currently completing a Sports Residency at Northeastern University, and can be reached at cjoyce@sportsandpt.com.

Alyas, F. Turner, M. Connell, D. (2007). MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players. British Journal of Sports Medicine 41(11), 836-841.

Melzack, R. (2001) Pain and the neuromatrix of the brain. Journal of Dental Education, 65(12), 1378-1382.

Mosely, G.L., Nicholas, M.K., Hodges, P.W. (2004). A randomized controlled trail of intenseive neurophysiology education in chronic low back pain. Clinical Journal of Pain, 20(5), 324-330.

Mosely, G.L. (2002). Combined physical therapy and education if efficacious for chronic low back pain. Australian Journal of Phyisiotherapy, 45(4) 297-302.

Mosely (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130-14.