Boston Sports Medicine and Performance Group, LLC Blog

Are you doing what you think you are doing?

Posted by Boston Sports Medicine and Performance Group on Tue, Jun 11, 2013 @ 07:06 AM

As the world of physical medicine continues to forge ahead with evidence breakthroughs and paradigm shifts there appears to emerge 3 distinct bodies of clinicians/researchers whom all make very compelling cases why their methodologies are superior for treating patients in pain. Appropriately, a cornerstone of each model is exercise, or better yet, movement.  The three ideas:

 

Biomechanical Model: There is a correct, and incorrect way to move based off of ideal joint alignment and muscle synergies, and once deviations occur improper stresses are placed on nerves, muscles, ligaments and joints, which then cause pain.  For the most part, pain is fixed by improving a person’s strength and/or mobility and taking pressure off of said structures.  Treatment is guided by evidence using mostly biomechanical assessments and EMG studies to target specific muscles.

 


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Neuromuscular Model: There is a correct and incorrect way to move governed by the central nervous system. Motor patterns developed during childhood represent movement in it’s most natural state and thus are our entryway into restoring proper function of our neuromuscular system. Emphasis is placed upon motor control, proper muscle timing and activation or deactivation of certain muscles.  Believes that pain is caused by improper stresses on joints, muscles, nerves and ligaments, but also recognizes the connection between movement and pain in the brain, and changing a person’s movement will change their pain. Treatment utilizes different techniques aimed at restoring proper motor function, with principles grounded in evidence.

                        

 

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Pain Model: There is no perfect way of movement, but rather all movement is good in variability and moderation, and lack of movement is bad. Movement mechanics are largely a construct of westernized medicine and have little relevance to actual pain past the initial insult.  Recognizes that improper stresses on joints, muscles, nerves and ligaments cause acute pain, but that pain is always an output from the brain and thus all treatment must be focused on the neuroplasticity of the brain.  Changing the brain’s perception of movement will change their pain, and changing a patient’s perception of pain, will change their brain.  Treatment is focused on patient education, patient ownership, and the neural tissues of the body.

 

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Why Rehab Works:

 

My goal is not to push people to subscribe one school of thought since it is likely that they all have their place, but rather to introduce the idea that perhaps when you’re prescribing exercise, it may be working for other reasons than you believe. For example:

 

Breathing

I won’t get into the importance about assessing your patient’s respiratory pattern-there’s an overflow of information coming out on this. But here is why breathing works in all three models:

 

Biomechanical: When properly done full exhalation engages the obliques and pulls the ribcage down into the transverse plane, optimizing its position for respiration and stabilization. According to McGill peak stabilization of the abdominal cavity occurs not at full inhalation, but in the first part of exhalation, or during the weird grunting noise you hear people make as they flirt between squeezing out that last rep or having an aneurysm. It is here that muscles responsible for stabilization of the lower back are working synergistically to prevent shear forces on discs and spinal nerves. 

 

 

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Neuromuscular: One of baby’s first skeletal muscles to ever contract post-partum is the diaphragm. Restoring proper breathing is the very first step in reprogramming motor patterns.  Piggybacking the biomechanical model, it is imperative in stabilizing the spine, which becomes the building block for the neurodevelopment of the child. As the child moves through positions in supine, then rolling, then prone etc…the spine stabilizes first in each position before coordinated extremity movements occur. Thus by placing patients into developmental positions and cuing breathing and stabilization, we are bringing motor control back to its most primitive patterns and improving neuromuscular control

 

Pain: Push play on any meditation series and the very first thing the calm soothing voice whispers to you is to draw attention to your breath. 1) it takes your mind off of anything else you may be thinking of (pain!) and 2) slow deep breaths shift your nervous system from sympathetic to parasympathetic, and we all need some of that.  There is a strong positive correlation between anxiety, stress and pain.  If we can decrease a patient’s stress, we can decrease their pain. One of the primary methods used with patients in chronic pain is meditation, and the breath is once again the foundation.    

 

Hip Hinges

 

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Biomechanical Model: Improving hip mobility will decrease lumbar mobility, and thus improve lumbar stability. If we move more with our hips, we move less with our back and avoid unnecessary forces on discs, nerves, muscles and tissues. Hip hinging drives glute activation, decreases lumbar flexion, and improve hip flexion. The joint by joint approach suggests a mobile hip and a stabile lumbar spine is the anatomical function of the lumbopelvic complex.

 

Neuromuscular Model: Have you ever looked at someone’s back and seen two guy-wires running down the sides of their spine, as if they were about to deadlift a car. Only problem is they are just standing.  

 

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(Tone much?)

 

This display of hypertonicity is an indication that there is insufficient activation of the deep stabilizers, and over activation of the global muscles. Likely caused by repetition of movements without proper stabilization, the key to restoring appropriate muscle synergy is to look into motor patterns that are incorrectly recruiting the erectors instead of deep spinal stabilizers. Instructing the patient how to move with their hips as opposed to the lower back avoids perpetuating this faulty motor control, and thus decreases erector activation.

 

Pain Model: Remember this guy?

 

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Well it appears that he plays a major role in pain patterns, especially in those with chronic pain. Living in the sensory and motor cortices the homunculus is a representation of human body in the brain. Areas of the body with greater fine movement and sensation have larger real estate in the brain, such as the thumb and the mouth. In the presence of back pain, the back’s representation can grow and which causes unassociated movements to become lumped in with back pain. Movement therapy focused on painless specific movements will better define the cortical borders of one body part from another, and may help dissociate hip movement from back movement and therefore back pain.

 

There are plenty more examples that would elucidate the concept that exercise/movement “works” on various levels.

 

Bird Dogs:

Biomechanical: Core stabilization training

Neuromuscular: Crawling pattern for baby

Pain: Movement variability is key to changing pain neurotags, and how often during the day do you get down on your hands and knees and crawl like a baby??

 

Squats:

Biomechanical: Bigtime strength and mobility exercise

Neuromuscular: A major neurodevelopmental milestone

Pain: Lots of LE movement mapping

 

So next time you prescribe an exercise think to yourself: Am I doing what I think I’m doing?

 

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.

 

 

Register for  Charlie Weingroff Seminar Oct 25-27, 2013

Topics: Charlie Weingroff, Chris Joyce, BSMPG Summer Seminar

Training = Rehab, Rehab = Training comes to Boston

Posted by Boston Sports Medicine and Performance Group on Mon, Jun 3, 2013 @ 07:06 AM

BSMPG is proud to announce the return of Charlie Weingroff to Boston this October 26-27th for: 

TRAINING = REHAB, REHAB = TRAINING Seminar

 

This seminar is based off Charlie's highly acclaimed DVD that combines the roles of the health care provider and personal trainer/strength & conditioning coach into a brilliant level of management leaving the best interests of the patient or client.  Charlie will deliver a combination of neuromuscular and sensorimotor training, bridging into lifting very heavy things.

  • Evaluating Movement, Perparation, the Sensory System
  • Understanding the Role, Programming, and Execution of Currective Exercise
  • Introduction to Principles of Joint Centration and Developmental Kinesiology
  • Linking Neuromuscular Resets to Speed and Strength Training
  • Manual Therapy Options for Licensed Health Care Professionals

Date: October 26-27th, 2013

For a complete list of course details click HERE

 

Register for  Charlie Weingroff Seminar Oct 25-27, 2013

 

Charlie Weingroff 

 

Charlie is a Doctor of Physical Therapy, a Certified Athletic Trainer, and a Certified Strength and Conditioning Specialist.  He was most recently the Director of Physical Performance and Resiliency and Lead Physical Therapist for the United States Marines Corps Special Operations Command in Camp Lejeune, NC.  He is also Director of Clinical Education for the Vibraflex Whole-Body Vibration and Andante Medical, the makers of the SmartStep, mobile force plate.  He graduated from Ursinus College with a degree in Exercise and Sports Science in 1996, and went on to earn an MSPT in 1999 and DPT in 2010 from the University of Medicine and Dentistry of New Jersey.

Prior to returning to his home state of New Jersey in the Fall of 2006 after 12 seasons of professional basketball, he was the Head Strength & Conditioning Coach and Assistant Athletic Trainer for the Philadelphia 76ers in the NBA.   Among the highlights of his tenure in Philadelphia was being part of the medical staff that ranked 1st in the NBA in Player Missed Games in the 2005-06 season.

Through rehabbing patients, he subscribes to a movement-based approach popularized by the works of Dr. Vladimir Janda, Dr. Shirley Sahrmann, Dr. Stuart McGill, and Gray Cook.  In training athletes and clients, he champions the principles of the Functional Movement Screen and sound, evidence-based training principles.  Some of the methodologies Charlie is formally trained in include DNS, ART, Dry Needling, Graston, FMS/SFMA, and the RKC.

Aside from working with patients, athletes and clients, he is also under the bar himself.  In 2007, he achieved AAPF Elite status in the 220 weight class with a total of 1915 pounds. His best powerlifting competition total is 800 squat, 510 bench press and 605 deadlift.

Currently Charlie is training and rehabbing clients of all types at Drive495 in Manhattan, NYC and Fit For Life in Marlboro, NJ.  Charlie often teaches and speaks internationally and consults regularly with Nike, the Roddick-Lavalle Tennis Academy, Perform Better, and Equinox Fitness Clubs.

Charlie lives with his wife, Kristen, and dog, Rumble, in NJ.  

 SAVE THE DATE : OCTOBER 26TH AND 27TH 2013

Topics: Charlie Weingroff

Innovators Welcome

Posted by Boston Sports Medicine and Performance Group on Mon, Apr 8, 2013 @ 07:04 AM

 

A quick video to remind us why we all put so much blood and sweat into our work - see you at BSMPG, where innovators meet.

 

 

Join the INNOVATORS in Sports Medicine and Performance Training at the 2013 BSMPG Summer Seminar - May 17 &18 in Boston MA.

 

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Topics: Charlie Weingroff, BSMPG Summer Seminar, Marco Cardinale, Fergus Connolly, Stuart McGill, Rob Butler, Bobby Alejo, Mark Lindsay

Two More Weeks for Early Bird Pricing - 2013 BSMPG Summer Seminar

Posted by Boston Sports Medicine and Performance Group on Mon, Apr 1, 2013 @ 07:04 AM

 

They say the early bird gets the worm, but at BSMPG there are no worms - just the best sports medicine and performance professionals from around the world! See speakers such as Mark Lindsay, Joel Jamieson, Charlie Weingroff, Stu McGill, Adriaan Louw and Marco Cardinale all under one roof followed by our incredible social Friday night and the best sports science, equipment and nutrition suppliers in our vendor area throughout the two days.

Don't miss out on our EARLY BIRD SPECIAL - After April 15th price of admission is $349 (pending seat availability)

 

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Topics: BSMPG, Charlie Weingroff, Adriaan Louw, BSMPG Summer Seminar, Bill Knowles, Joel Jamieson, Stuart McGill, Bobby Alejo

The World Leader in Athlete Monitoring is HERE!

Posted by Boston Sports Medicine and Performance Group on Mon, Jan 28, 2013 @ 07:01 AM

 

BSMPG is proud to announce the addition of Val Nasedkin as a speaker within the popular Sports Fusion (formally Hockey & Basketball Specific Training) Track at the 2013 BSMPG Summer Seminar - May 17th and 18th, 2013!  Val joins Dr. Stuart McGill and Marco Cardinale for this weekend event along with the leaders in Performance Training and Sports Medicine professionals from around the world!  With the greatest speaker line-up assembled to date, the 2013 BSMPG Summer Seminar will be the WORLD'S most sought after Sports Medicine & Performance Seminar to date!!

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 this May!!!

 

Omegawave

 

VAL NASEDKIN

SPONSORED BY:

 

OMEGAWAVE

TOPIC: Sport Specific Endurance Development in Explosive and Power Sports

 

Val Nasedkin, a former decathlete at the national level for the former Soviet Union, is the co-founder and technical director of Omegawave, a pioneering company in the field of functional preparedness and readiness in athletes. He has been a guest lecturer on the principles of training at numerous sport science and physical education universities around the world, and frequently acts as a consultant to Olympic committees, sports federations and national and professional teams for various sports including Dutch Olympic Committee, United States Track and Field Olympic Committee, EPL, Serie A and La Liga teams (Medical Staff), Autonoma University (Barcelona, Spain), Duke University (North Carolina, USA) and University of Calgary (Canadian National Sports Center).

 

BSMPG 2013 Summer Seminar - There is NO other Sports Medicine and Performance Training Seminar in the world - PERIOD.

Register Today before seats fill up.

Remember to book your Hotel room before area college graduations take over.

 

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Topics: Charlie Weingroff, Adriaan Louw, Val Nasedkin, Joel Jamieson, Marco Cardinale, Stuart McGill

Readings for 2013 - Evan Osar

Posted by Boston Sports Medicine and Performance Group on Wed, Jan 23, 2013 @ 07:01 AM

 

BSMPG Summer Seminar   BSMPG summer seminar

 

The Overactive Posterior Hip Complex

"Overactivation of the deep hip rotators, otherwise referred to as ‘butt gripping’ by Diane Lee and Linda-Joy Lee, is a common cause of hip dysfunction. As the name suggests, this pattern is caused by a contraction of the deep hip rotators and superficial gluteus maximus and looks as if the individual is standing or walking in a perpetual contraction. In actuality, they are. This stabilization pattern is a result of several causes, including trying to make the rear end look smaller (generally females are guilty of this); weakness in the pelvic floor, causing reflexive overactivation of the deep hip rotators and adductors; instability anywhere in the lower extremity, causing overactivation of the posterior hip musculature; and learned cuing techniques from trainers and therapists who stress to ‘squeeze the glutes as hard as possible.’

Palpation over the lateral hip region just behind the greater trochanter will reveal an indentation or hollowing, created by overactivation of the deep external rotators of the hip. In supine position, the head of the femur can be palpated by placing the hands just medial to the anterior superior iliac spine (ASIS) and pushing lightly posteriorly. It is common to palpate increased tone or ‘fullness’ in the tensor fasciae latae (just lateral to the ASIS). With this ‘gripping’ pattern, the head of the femur will generally be pushed forward and superior in the acetabulum. Not so ironically, the superoanterior aspect of the femoral head is the most common region of cartilaginous degenerative changes of the hip.

By cuing the individual to relax the hips and spread the sit bones, there is a change in the tone in the posterior hip region. Palpation over the anterior hip region will reveal the head of the femur has been centered in the socket secondary to the relaxation of the posterior hip muscles.

While the previous technique is extremely effective for releasing butt-gripping patterns, some individuals require more specific techniques for decreasing activation of the deep hip rotators and/or the posterior hip capsule. The next section demonstrates a release technique effective for releasing the posterior hip capsule as well as reducing myofascial restrictions." (p.111) 

 

Corrective Exercise Solutions to common Hip and Shoulder Dysfunction 

by Evan Osar

 

Learn from thought leaders like Osar at the 2013 BSMPG Summer Seminar May 17 & 18, 2013 in Boston MA.  

Register today before seats fill up.

 

 

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A special thanks to our top sponsors:

 

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Topics: Charlie Weingroff, BSMPG Summer Seminar, Bill Knowles

Standing Room Only - Joel Jamieson Returns for 2013 BSMPG Seminar

Posted by Boston Sports Medicine and Performance Group on Mon, Jan 21, 2013 @ 07:01 AM

 

 

BSMPG is proud to announce the return of Joel Jamieson as a speaker within the popular Sports Fusion (formally Hockey & Basketball Specific Training) Track at the 2013 BSMPG Summer Seminar - May 17th and 18th, 2013!  Joel joins Dr. Stuart McGill and Marco Cardinale for this weekend event along with the leaders in Performance Training and Sports Medicine professionals from aournd the world!  With the greatest speaker line-up assembled to date, the 2013 BSMPG Summer Seminar will be the WORLD'S most sought after Sports Medicine & Performance Seminar to date!!

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 this May!!!

 

Joel Jamieson

 

JOEL JAMIESON

SPONSORED BY:

 

NORMATEC


8Weeksout.com

Topic: Advanced Recovery Strategies to Maximize Performance

Joel Jamieson is widely regarded as one of the world’s foremost authorities on strength and conditioning for combat sports. He has more than 7 years experience working with many of the top athletes in the sport and has trained over 30 of the biggest names in MMA, including 7 world champions.

He formerly served as the Director of Strength & Conditioning for Pride FC and currently works in a similar capacity for Dream. Prior to his work in MMA and combat sports, he spent time training D-1 football players and worked in the NFL with the Seattle Seahawks. He has trained countless teams and athletes from the NFL, MLS, NHL and NBA and Olympic competitors from 5 different sports.

Joel is also the founder of www.8weeksout.com and author of the highly acclaimed book, “Ultimate MMA Conditioning.” Since its release in 2009, it has been sold in more than 103 countries and widely regarded as the definitive book on the subject. He is a regular featured contributor to Fight! Magazine, Fighting Fit (UK) Sherdog.com, Men’s Health, Muscle & Fitness and his training programs and articles have been featured in a variety of online and print media throughout the globe.

 

 

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Joel Jamieson at the 2012 BSMPG Summer Seminar - EVERY SEAT FILLED!

 

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Topics: Charlie Weingroff, BSMPG Summer Seminar, Bill Knowles, Joel Jamieson, Bobby Alejo

Jumping High: External Focus More Important than Strength?

Posted by Boston Sports Medicine and Performance Group on Wed, Jan 16, 2013 @ 07:01 AM

 

Vertec

 

from Attention and Motor Skill Learning – Gabriele Wulf

“Zachry had participants perform a jump-and-reach task using a Vertec measurement device (see photo).  Participants were instructed to jump straight up and touch the highest rung on the Vertec they could reach with the tips of their fingers.  Each participant performed five trials under one of three conditions: control, internal focus, and external focus.  For the control condition, no additional focus instruments were given.  Under the internal focus condition, participants were instructed to concentrate on the tips of their fingers.  Under the external focus condition they were instructed to concentrate on the object to be touched, that is, the rungs of the Vertec.

Participants indeed reached higher rungs when they adopted the external focus (on average 4.79 rungs) compared to the internal focus (4.12 rungs) or when they received no attentional focus instructions (4.10 rungs).  Also the time they spent in the air was longer under the external (0.491 s) than under the internal focus (0.477 s) or the control condition (0.478 s)  Thus a change in the focus of attention significantly affected reach height: Focusing on the object to be touched resulted in more effective performance than did focusing on the finger with which the object was to be touched.  Perhaps most interestingly, instructing the participants to adopt an external focus increased jump height above and beyond what participants achieved under “normal” conditions (i.e., control conditions without instructions).  These results were recently replicated by Carolina Granados in my lab (Wulf, Zachry, Granados, & Dufek, 2006, Experiment 2).  In addition to looking at reach height, Granados calculated the displacement of participants’ center of mass during the jumps.  Interestingly, she found not only the greatest reach heights under the external focus condition, but also greater vertical displacements of the center of mass (0.51 cm) compared to those in the internal focus (0.47 cm) and control conditions (0.47 cm).

These findings might seem surprising given that one might expect the jump height to be determined mainly (although not exclusively) by the participant’s strength.  Yet we also know, for example, that the coordination between and within muscles influences maximum force production as well (Hollmann & Hettinger, 2000).  It is possible tha an external focus optimizes those coordination patterns.  While we have to await further research to find out how exactly the attentional focus instructions affected jump height, the findings of this study could have implications for sports in which maximum forces must be generated in a short periods of time (e.g., high jump, long jump, pole vault, basketball layup).  In those cases, focusing on the target (e.g., the bar in the high jump) might also result in more effective performance than focusing on movement coordination or not focusing on anything in particular.” Pg 58-59

 

“The studies we have reviewed in this chapter confirm the anecdotal observation (in windsurfing) that the performance of motor skills seems to be more effective if one focuses on the effects one’s movements have on the environment rather than on the movements themselves.  The results from studies using various laboratory tasks as well as sport skills provide converging evidence for the advantage of instructions that induce an external relative to an internal focus.  The benefits of an external focus appear to be even more pronounced if the movement effect occurs at a distance from the body, thus making it more easily distinguishable from the body movements that produced it.  Furthermore, this effect seems to be rather general and not dependent on individual preferences.  In fact, performers often notice immediate changes in their performance as a function of their focus of attention.  Importantly, the effects of adopting an external focus when practicing a skill is not just temporary, that is, present only when the individual adopts that focus; rather, these benefits are seen in the retention of the skill and in transfer to novel variations of the skill.” Pg 77

 

Focus your attention to the 2013 BSMPG Summer Seminar - Where the top Sports Medicine and Performance Professionals meet every year!

 

Sign Up before April 15, 2013 and enjoy our Early Bird Pricing!

 

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Topics: Charlie Weingroff, Motor Control, BSMPG Summer Seminar, Ben Prentiss, Marco Cardinale, Marvin Chun, Fergus Connolly, Stuart McGill

Level Change: The Secret to a Long Life and Athletic Success

Posted by Boston Sports Medicine and Performance Group on Mon, Jan 7, 2013 @ 07:01 AM

 

 

 

BSMPG Summer Seminar

 

sportrehabexpert

Audio Interview with Charlie Weingroff - The Deep Overhead Squat   

 

BSMPG Summer Seminar

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Q: How does one live to 100, be a monster on the playing field while reducing the likelihood of injury?

A: Change levels often!

How: Squat, Lunge, Crawl, roll then stand up, then get back down and roll some more, climb steps, stairs and other objects, hang from tree limbs, perform pull ups, play, climb a mountain, run Harvard stadium, bend down and pick things up, pick heavy things up, put them down, then pick them up again, do some push-ups, then squat some more

 

Normally 1 + 1 equals 2, but after watching Dan Buettner's TED presentation and listening to Charlie's audio interview on SportsRehabExpert.com 1 +1 suddenly equals so much more.

 

See Charlie at the 2013 BSMPG Summer Seminar - May 17 & 18 in Boston

 

Register for the 2013 BSMPG  Summer Seminar Today

 

 

 

 

 

 

Topics: Charlie Weingroff, BSMPG Summer Seminar

Happy New Year from the BSMPG Family

Posted by Boston Sports Medicine and Performance Group on Mon, Dec 31, 2012 @ 07:12 AM

Wishing you and your family all the best this coming year.

 

BSMPG Summer Seminar

Make 2013 the year you take another step forward in your journey to becoming a leader in Sports Medicine and Performance Training by attending the 2013 BSMPG Summer Seminar - May 17 & 18th in Boston MA.

Sign up before the end of the day today and enjoy our 2012 seminar price!

 

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Topics: Charlie Weingroff, Stu McGill, Kevin Neeld, Adriaan Louw, BSMPG Summer Seminar, Ben Prentiss, Bill Knowles, Marco Cardinale, Rob Butler, Bobby Alejo