Archives for September 2012

Random thoughts… and neck pain

4 random thoughts from a rainy day in upstate NY.

 

1. Can False Information Regarding Pain Actually Cause Pain?
The power of suggestion is real.  Compliments of Dr. Jeff Cubos.


2. Can too many tests, give us too much information, and yield poor decisions.   Studies on decision making have shown this over and over.  More information does not yield a better decision.  In fact, it often reduces accuracy.  Having the right information is helpful, having too much information is disastrous.  The combination of a lack of knowledge creating over reliance on diagnostic technology and the litigious society of order tests to cover ones’ backside does have serious (& costly) effects.  Overtreatment Is Taking a Harmful Toll


3. New Neck Pain and Chiropractic Video compliments of the West Hartford Group.


4. Well worth a listen. Really enjoyed this one!  Liebenson & Cook talking shop.   

McGill

I had the pleasure of spending a weekend in Saco, ME listening to Stuart McGill.  As you may know, Dr. McGill is a wealth of knowledge, info, research, and clinical insights.  So I don’t become one more in the long line of people to misquote Stu on the web, I’ll let his work speak for itself, you can read his books, review his research, or watch his DVDs to get his opinions and I’ll simply offer a few things I took away from this weekend.  Here’s a few reminders, tips, tricks, concepts, or soundbites I took away from the seminar. 

  • Always look at both sides of an issue.  Make an argument for it and against it.  Almost all tools/methods/systems have strengths and weaknesses.  You need to know this!  I was surprised to see how many exercises, methods, experts Dr. McGill began with I love (Insert method/technique here) it’s great at (insert desirable outcome here), but we’ve also shown that (insert negative impact or side effect).  My translation:  Use all of these great tools, just understand when to use them and when to apply other strategies.
  • Smiling is wonderful, but you can’t lift hard, train hard, or be powerful while you do it.   Concentrate and maintain complete focus until you’ve nailed some quality reps.  Smile after you reach your goal.  
  • Train the nervous system.  The evidence is overwhelming, this is what makes the best athletes.
  • Know the physical demands of the person you’re working with.  Assess their current capacities and then design a program to fill this gap.  For athletes review tape of their competition and break down the movements.  From a fundamental standpoint, what movements are you seeing?  How often? How many times? What duration?  In what combinations?  Write it down and be specific.  Train these fundamental movements.
  • Dissociate.  Proximal stability gives distal mobility and power.  If you can’t separate ball and socket movement from spine movement, stop, peel back and try again.  This is an essential skill.  (Side note great, descriptions in Osar’s book. Osar’s Movement lecture here.)
  • While movement quality  is essential, the fact that speed and load change these unpredictably cannot be ignored.  McGill’s research demonstrated that individual’s patterns changed, in both directions (from ideal to compensated and from compensated to ideal), under load.  Make sure your assessment includes something that matches your patient/athlete’s demands.  Also realize that even though someone passes an initial screen this does not mean the get the ‘green light’ to do anything.  They may have a green light to train, but you need to constantly monitor and assess for quality movement.  Patterns change with speed and load.  (This leads us into the next point.)
  • Assess, assess, assess. Constant assessment and reassessment is performed to titrate the exercise to work at the edge of the patient’s abilities.  It is also necessary to evaluate progress or impact of the intervention.  Assess, reassess, repeat if desired.  (Feel like I’ve seen this pattern somewhere before.)
  • Small things make a huge difference.  As with so many things the difference of good and great, or great and world class are little things.  Don’t overlook the little things that can take your patient to the next level.
  • You need to respect someone’s congenital limitations.  Hip shape is not uniform.  Squat depth and peak abilities will be affected.  Also simple exercise like tolerance for the elliptical trainer, can be dependent on having enough hip motion to spare the spine.  Assess the movement of the ball and sockets. Scour (perhaps daily according to Dr. Cubos).
  • Exercise selection is a risk vs. reward decision.  Stated this way I doubt many will disagree, but when presented more scientifically such as EMG activation vs. joint load, my guess is many will choose to remain in their comfort zone and stick with the exercises ‘that have worked before’.  While EMG studies have their limitations, remember risk vs. reward and that any training capacity you can spare, can be used later.  In those who are injured or at risk, choose exercises judiciously.

Other McGill resources:
Cubos notes from similar course. 

McGill resources from Liebenson

Backfitpro resources

McGill Movement Lecture

Prior post with links to McGill NY times video and article.  Hate sit ups?