Tuesday, April 23, 2013

Charlie Weingroff Notes from Southwest Michigan Strength Clinic

A Systemic Approach to Athletic Evaluation
"The Greatest Improvements is made by the man who works most intelligently."  Bill Bowerman.

As therapist/coaches, we have to do stuff.  Compete at something, want to get better at something.  Don't forget what it's like to want to improve and excel.  

General physical prep is where most of our efforts will be.  As human we have minimum level competencies.  Athletes have Wide level.  Have a way to measure.  Baseline can be some thing like FMS but must be bodyweight, minimally cued and modifiable.  

Evaluation principles.  1. Movement  2. Preparation  3.Sensory Systems.

Locomotion testing.  Crawl-roll-step-lunge-walk-shuffle-skip-run.  
look at simple to complex, slow to fast, closed loop to open loop.  Can measure it by time or quality of movement.  

Power is single expression.  Capacity is multiple expression.  Various jump tests can give us indicators for both power and capacity.  Energy systems (all three are doing work).  

Capacity is important as clinicians.  If you're out of shape that can contribute to fibrous tissue.  Don't have the ability to use oxygen as all.  Aerobic fitness can normalize the nervous system.  Things don't hurt as much when you have good aerobic fitness.  (this doesn't mean you have to run)  

Measure what we can measure.  Get some biomarkers.  (objectively measured as an indicator of normal biological processes)  
Examples are omega wave, heart rate in the AM, grip strength tools like hand dynometer or bottoms up kettle bell press, vertical jump.

Are you ready to train or do you need to do some low CNS activity.  Don't dump on your patient/athlete more if their already down.  

5 senses (sight, touch, taste, hear, smell)  All are CNS driven and all cause a reaction. 
Vision is underrated.  20/20 vision is no longer the best.  Elite guys are showing up as 20/10 and 20/8.  Have your athletes tested.  

2nd Talk

Understanding Joint Centration (applying DNS to rehab and training)

Control in the presence of change is stability.  Motor control and timing of tonic and phasic muscles.

Joint centration allows maximum amount of load bearing.  Balance of mobilizers and stabilizers working on a joint.  Balance of agonist/antagoinst. 

Babies and the strongest,fastest people in the world do it the same.  Joint positions.  No one teaches babies.  That is why DNS (Dynamic Neuromuscular Stabilization) is powerful stuff. 

4x4 Matrix is 4 postures and 4 variances with them.
Postures are 1.unloaded (prone, supine, on side) 2. quadruped 3. Kneeling  4. Vertical.  What can change is the following.  
1.  position 2. static vs dynamic 3. load vs no load  4.  assistance vs no assistance.

Examples.  May have poor hip centration in vertical squat, but be good in quadruped.  May give assistance to the vertical squat with a band around the knees and restore hip centration this way.

Getting the diaphragm working is a major goal.  Any of the 4x4 matrix can be used.  Powerful stuff.  Diaphragm when fully engaged will get the pelvic floor engaging as well.  Breath over the brace while lifting as McGill would say.

There is a time for bracing and a time for not.  Air squat should not have the same effort as an all out barbell squat.  Biomechanicly exactly the same, but nervous system should not be.  That's why biomechanics don't always give you all the truth.

Exercises that require all out bracing like hard style kettlebells, but perhaps should follow that up with something like Indian clubs where there is flow and big movement.  

If you train tonic muscles to be phasic muscle you are lost (I've been guilty of this)  Example Glute med is a tonic muscle, yet most exercises to challenge them are making them into phasic muscles. Clam shells/band walks.

Loss of centration when phasic muscles are forced to stabilize.  

Some interesting points that didn't really fit into the flow of my recap but I found interesting.

  Biceps can be used as a thoracic extensor with crawling.  
Taylor sits with young girls may be one of the reasons girls are predisposed to ACL injuries. (note to self, don't let my daughter sit this way)
Babies from 3-14 months development go through all phases of the Turkish Get Up.   
Deep toe flexors get active, has a very negative effect on the entire body.  Try yoga toes to walk around in.
T4-8 is an important area for mobility as it is highly proprioceptive.  
Never seen serratus anterior winging without pain resolve with push ups plus.  Put a heavy bell in their hand overhead.  Watch the winging scapula disappear.  
Brain loves extremities crossing midline, it's like candy, and their is more to PNF then just contract relax.  
Skipping in multiple planes of motion barefoot is a great for the nervous system.  Foot is loaded in multiple planes, lots of mechanoreceptors active, crossing the body is involved with things like skipping carioca.  I used to always think skipping with arm movements was a waste of time in my warm ups in college.  Now I can see the merit.  
Exercises that are crawling based don't need as much time to recover from.  Think pulling heavy ass weight as you crawl.
Everything is brain driven.  

These were most of the notes I was able to jot down.  The room we were in lost lights during the presentation so I was writing in the dark.  If you see my hand writing you would think I have an upper motor lesion, now compound that with scribbling in the dark.  Charlie is one smart dude, if you get a chance to hear him speak, definitely jump at it.  

Wednesday, April 17, 2013

Could You Eat It?

The first things people do as they try to get healthy or ensure health is to look at food.  What are you eating?   Whole foods, no chemicals, no preservatives, get rid of crummy oils, no sugar, most everyone will agree on that.

 I'm as guilty as anyone when it comes to the next part, absorption.  Your skin is the largest organ in the body.  What you put on it can matter.   In fact,  because it doesn't go through the digestion process, the body doesn't break it down.  It enters pretty much unchanged.  What you put on it can be good or bad.  

Don't think it can have that big of impact?  Men with low testosterone are often given a cream to rub on them to boost this hormone.  Think of all the baseball players busted in the past decade, most of these performance enhancement drugs were lotion or cream based.  

Enter a chemical called Parabens.  In lotion the ingredient will be "-paraben."  Used as a preservative, for the most part it doesn't even need to be there.  It has been shown to be a xenoestrogen, chemicals that can mimic some estrogenic properties.  They have shown that you can have paraben build up in the bodies tissue.  No one is saying that it increases cancer risk outright, but the question becomes why risk it.  

Most people use lotion at least once a day.  Over 5-10 years, that's a lot of chemicals that your bodies tissue is absorbing and holding on to.  There are lots of options out there now that are paraben free, in fact, many are able to be ingested if for some reason you had to.  (Not saying do this)  but there should be that level of safety when it comes to the thought process.  Could I Eat This?

We care about what we eat, lets care about what we absorb on our skin routinely.  

Wednesday, April 10, 2013

Piriformis Pain in Runners

Piriformis syndrome is a pretty common dysfunction pattern that usually presents more in women then in men.  Described literally as a pain in the butt.  It can present not only with local pain, but also a sciatic type pain as the sciatic nerve can become compressed over time when the Piriformis is tight.

Soft tissue methods directly on the Piriformis can lead to short term improvement.  The question becomes why is the Piriformis irritated or feels the need to tighten.  This is how long term improvement is achieved.

One possible answer lies in the surrounding anatomy.  Looking at where the piriformis has attachments, the lateral portion of the sacrotuberous ligament has fibrous reinforcement from it.  The sacrotuberous ligament is made up of three separate bands, medial, superior and lateral.

The sacrotuberous ligaments role is to limit nutation of the sacrum.  Further down the line, the biceps femoris muscle (lateral hamstring) has direct attachments to the sacrotuberous ligament.  The biceps femoris now is understood to contract before heel strike.  Without a strong biceps femoris, gait mechanics will be changed and Sacrum/Iliac (SI) joint dysfunction can occur.  This may lead the piriformis to tighten up to try to help stabilize the SI joint.

While one can never achieve great results with just following a cookie cutter recipe in manual therapy, recognizing patterns is always helpful.  Test for weakness in the biceps femoris next time piriformis pain presents in your patient/athlete.  For the athlete dealing with this roll out the hip rotator complex and perform some hip/hamstring Swiss ball leg curls with the feet slightly turned in to try to target the biceps a little more.  Try this everyday for two weeks and see if the pain in the butt leaves.

Tuesday, April 2, 2013

Creating Hypertrophy in Lumbar Multifidi

Eight out of ten of us will have back pain in our lives.  Chances of having low back pain are significantly higher if you have had low back pain before.  Take away, it comes around again if you don't do anything about it.

One of the main reasons in the research and therapy world is that after the first bout of acute low back pain (LBP) the lumbar multifidi start to atrophy.  Not only atrophy,  but they start to get fatty infiltration.  It can be one sided atrophy on the side of the pain as well.  So not only will we have asymmetrical function from the back, but asymmetrical form as well.

The role of the multifidi was long thought to be that of a rotator/extensor.  It is probably too short to be much of a power producer but it has a high amount of muscle spindles.  This means it sends a lot of information to the brain about position and movement.  So with atrophy we get loss of form and function and lack communication with our most important organ, the brain.  It most likely alters its relationship with another important communication system as well, connective tissue.  There has been some understanding that the multifidi also play a roll in maintaining a proper lordosis or curve to the back.

The big question then is after back pain, how do we restore hypertrophy to the multifidi?  It's been shown through EMG that although lumbar extension and things like bird dog exercises make the multifidi active, they did not produce any changes in cross sectional area.  

Finally, a study showed that holding a contraction, an isometric hold of 5 seconds, was successful in increasing cross sectional area.  In between the concentric and eccentric phase of a movement, hold the contracted position for 5 seconds.  Do not go to failure.  Also, having an upper body extremity do an isometric hold increased activity of the lumbar multifidi up to 51%.  This may be a great starting point for someone coming off acute LBP or back pain surgery.

Adjustments of the area have shown to increase the lumbar multifidi to contract and activate better.  Not only post adjustment, but one week later as well.  Before an exercise program is begun, creating better mechanics through HVLA adjustment may be the kickstart the body needs.