Nothing new in terms of speech or movies. But this was very well done.
Monday, May 20, 2013
Tuesday, May 14, 2013
Notes on Anterior Core Training
I recently watched Eric Cressey's presentation on the Anterior Core. I found it very good. One of those, wow, Internet is amazing kind of moments. Fork over 15 bucks and get to sit and learn for 45 min from a respected leader in the field.
He opens with one comment I've come to truly appreciate. If I can learn one thing to take back to my clinic for my patients and athletes and start implementing, it was worth it. Give me one thing to take away that can have real value in my world. Not conceptual. Applicable. I learned a few.
First, I found a nice tie in with the Postural Restoration information I had went through a few weeks ago. Eric is very familiar with it, having taken their seminars and was actually one of the ways I first heard about PRI. So I found a lot of practical information on how to implement the PRI principles much easier.
Get good proximally before distally. If the core/spine aren't right, the extremities won't be either. Get to neutral and stay neutral. Use warm ups to work on getting flexed people into extension and those locked into extension into flexion, thus getting both to neutral. The workout then becomes what cements the neutral spine.
Many of the modern injuries we see can all be related back to the anterior core. Sports hernias, femoral impingement and hip labral tears can all be related back to having anterior rotated pelvis. Excessive tension through muscles like adductor longus and rectus abdominis. Thoracic outlet can also have roots from a dysfunctional anterior core.
A great test is have the patient supine. Flex the hip and internally rotate the hip. This may cause a pinching pain in many people. Now, have them brace the abs and slightly posterior tilt the pelvis. Retest flexion and internal rotation. Often the pain will be gone. It's not a hip problem, it's an anterior core problem.
He talks about another simple test to decide if your patient/athlete should even be doing overhead work. Can you raise your arms overhead without letting the ribcage tip up in the front? Important for all the Crossfit athletes that live overhead.
Everyone is unique. There are many great exercises, but you may have to coach and cue one person much different then another. Again, one may be locked in flexion, one may be locked in extension. Don't coach the exercise the same.
Anytime you lift something overhead, you are working the anterior core. Gain length in the Lats and strength in the obliques and rectus abdominis and you will gain a much more functional anterior core.
Eric goes on to discuss exercise progressions for many different lifts and exercises. These progressions, how to implement them and why you would, make up the heart of the presentation. I would highly encourage anyone that works with athletes to give it a watch. I'm sure you will walk away with one applicable nugget of information you can start to use right away.
He opens with one comment I've come to truly appreciate. If I can learn one thing to take back to my clinic for my patients and athletes and start implementing, it was worth it. Give me one thing to take away that can have real value in my world. Not conceptual. Applicable. I learned a few.
First, I found a nice tie in with the Postural Restoration information I had went through a few weeks ago. Eric is very familiar with it, having taken their seminars and was actually one of the ways I first heard about PRI. So I found a lot of practical information on how to implement the PRI principles much easier.
Get good proximally before distally. If the core/spine aren't right, the extremities won't be either. Get to neutral and stay neutral. Use warm ups to work on getting flexed people into extension and those locked into extension into flexion, thus getting both to neutral. The workout then becomes what cements the neutral spine.
Many of the modern injuries we see can all be related back to the anterior core. Sports hernias, femoral impingement and hip labral tears can all be related back to having anterior rotated pelvis. Excessive tension through muscles like adductor longus and rectus abdominis. Thoracic outlet can also have roots from a dysfunctional anterior core.
A great test is have the patient supine. Flex the hip and internally rotate the hip. This may cause a pinching pain in many people. Now, have them brace the abs and slightly posterior tilt the pelvis. Retest flexion and internal rotation. Often the pain will be gone. It's not a hip problem, it's an anterior core problem.
He talks about another simple test to decide if your patient/athlete should even be doing overhead work. Can you raise your arms overhead without letting the ribcage tip up in the front? Important for all the Crossfit athletes that live overhead.
Everyone is unique. There are many great exercises, but you may have to coach and cue one person much different then another. Again, one may be locked in flexion, one may be locked in extension. Don't coach the exercise the same.
Anytime you lift something overhead, you are working the anterior core. Gain length in the Lats and strength in the obliques and rectus abdominis and you will gain a much more functional anterior core.
Eric goes on to discuss exercise progressions for many different lifts and exercises. These progressions, how to implement them and why you would, make up the heart of the presentation. I would highly encourage anyone that works with athletes to give it a watch. I'm sure you will walk away with one applicable nugget of information you can start to use right away.
Thursday, May 9, 2013
Review of Postural Restoration Institute Respiration Course
A few weekends ago I had the opportunity to take a Postural Restoration Institute (PRI) respiration course. It was myself and about 7 physical therapists at the University of Michigan Pain clinic. James Anderson was the PRI teacher. He knew his stuff inside and out and was a great teacher, engaging and open to questions. I had several, more on that later.
First, if your thinking on taking one, I would highly recommend it. I study anatomy a lot and found myself learning and thinking about concepts in a new way. As this was a respiration course the primary focus was on the diaphragm, rib mechanics and how they influence the rest of the body. I feel I gained great insight and better understanding to both of these anatomical concepts. Surprisingly, none of the information about rib biomechanics are taught very well in chiropractic school.
PRI is built with the premise that the body is actually asymmetrical and that it's the sum of these asymmetrical parts working together in harmony that make us move and function well. It's because of some of these asymmetries that we create known dysfunctional patterns that are labeled and treated in PRI. I'm not going to get into their patterns and treatment methods, as that would take quite a lot of time, but basically the left front leg gets tight and is called an Anterior Interior Chain (AIC) which includes the diaphragm, psoas, rec femoris, TFL, vastus lateralis and biceps femoris. Also, the right upper arm gets tight, labeled Brachial Chain (BC) including the intercostals, deltoid, pec, Sibsons fascia, SCM, scalene and diaphragm. Right rib hump on the back and left rib flare on the front is generally seen (also 90% of scoliosis has this pattern)
The respiratory system is not symmetrical. Right diaphragm is larger, thicker, has a larger central tendon, has thicker crural attachments to the lumbar spine and because of this creates a right rotated lumbar spine. It's 1 to 1.5 vertebral levels deeper on the right and has a more dome shape on the right because it drapes over the liver. Because of this it has better abdominal integration for opposition. It can push better against the abs essentially.
The unique anatomy allows us to breath easier on the left and harder on the right. So the right ribs become more locked down and the left ribs become blown out on the front. We are a culture that is carrying dead air, we don't fully exhale. All of this leads to dysfunctional patterns.
Some interesting anatomy. Subclavius is the only scapular retractor on the front of the body. When it gets tight, it can inhibit the lower trap and serratus anterior, two muscles that get inhibited a lot. Thus, subclavius is an important muscle for respiration and shoulder function.
The diaphragm when dysfunctional actually becomes a paraspinal extensor. If you don't use it and breath well, you will have a tight back. Because of the described anatomy the right ribs become rotated under the scapulae. This makes the scapula dysfunctional and will create shoulder impingement at times on the right shoulder.
One of the concepts that I have an issue with that was touched on in the seminar was the use of flexed positions in the lumbar spine to create a neutral spine. They believe most people are locked in extension and to actually create a neutral spine, squats ect, must be done flexed. Please reread that. This concept attacks my paradigm. I can understand the concept that we are both after a neutral spine. Obviously no one is saying squat with hyper lordosis but to go the opposite and squat with a flexed spine to get to neutral, I'm not buying it yet. I brought up McGills research and didn't really get much of a response on that, but we agreed we are after neutral. I actually did a bunch of flexed exercises and to be honest, I had some radicular pain down my right glute and I haven't had any radicular pain in about a year and a half. N=1 was a failure for me. But, I don't believe I'm locked in extension. So flexed spine for me was a flexed spine in my opinion.
The other concept that was touched on briefly was the use of an orthotic. He pretty much came out and said if your not in a PRI orthotic all the work you are doing to solve dysfunction won't last. Really? I don't buy that one at all. I'm a big believer that feet play a major role in how we move, but not that big....for everyone. Need by need basis. He was very down on the minimalist shoe for everyone. I talked with a buddy doing PRI with himself and a few athletes and was told he has been doing great without the orthotic and is stronger then he has ever been.
Overall, I really enjoyed the PRI seminar. I truly believe I'm a better clinician having attended. I'm working with diaphragms and having success with improving shoulder mechanics via the diaphragm. They give a ton of exercises that can be used for your patients as homework. I plan on attending more of their seminars in the future, so you can say I like their stuff.
First, if your thinking on taking one, I would highly recommend it. I study anatomy a lot and found myself learning and thinking about concepts in a new way. As this was a respiration course the primary focus was on the diaphragm, rib mechanics and how they influence the rest of the body. I feel I gained great insight and better understanding to both of these anatomical concepts. Surprisingly, none of the information about rib biomechanics are taught very well in chiropractic school.
PRI is built with the premise that the body is actually asymmetrical and that it's the sum of these asymmetrical parts working together in harmony that make us move and function well. It's because of some of these asymmetries that we create known dysfunctional patterns that are labeled and treated in PRI. I'm not going to get into their patterns and treatment methods, as that would take quite a lot of time, but basically the left front leg gets tight and is called an Anterior Interior Chain (AIC) which includes the diaphragm, psoas, rec femoris, TFL, vastus lateralis and biceps femoris. Also, the right upper arm gets tight, labeled Brachial Chain (BC) including the intercostals, deltoid, pec, Sibsons fascia, SCM, scalene and diaphragm. Right rib hump on the back and left rib flare on the front is generally seen (also 90% of scoliosis has this pattern)
The respiratory system is not symmetrical. Right diaphragm is larger, thicker, has a larger central tendon, has thicker crural attachments to the lumbar spine and because of this creates a right rotated lumbar spine. It's 1 to 1.5 vertebral levels deeper on the right and has a more dome shape on the right because it drapes over the liver. Because of this it has better abdominal integration for opposition. It can push better against the abs essentially.
The unique anatomy allows us to breath easier on the left and harder on the right. So the right ribs become more locked down and the left ribs become blown out on the front. We are a culture that is carrying dead air, we don't fully exhale. All of this leads to dysfunctional patterns.
Some interesting anatomy. Subclavius is the only scapular retractor on the front of the body. When it gets tight, it can inhibit the lower trap and serratus anterior, two muscles that get inhibited a lot. Thus, subclavius is an important muscle for respiration and shoulder function.
The diaphragm when dysfunctional actually becomes a paraspinal extensor. If you don't use it and breath well, you will have a tight back. Because of the described anatomy the right ribs become rotated under the scapulae. This makes the scapula dysfunctional and will create shoulder impingement at times on the right shoulder.
One of the concepts that I have an issue with that was touched on in the seminar was the use of flexed positions in the lumbar spine to create a neutral spine. They believe most people are locked in extension and to actually create a neutral spine, squats ect, must be done flexed. Please reread that. This concept attacks my paradigm. I can understand the concept that we are both after a neutral spine. Obviously no one is saying squat with hyper lordosis but to go the opposite and squat with a flexed spine to get to neutral, I'm not buying it yet. I brought up McGills research and didn't really get much of a response on that, but we agreed we are after neutral. I actually did a bunch of flexed exercises and to be honest, I had some radicular pain down my right glute and I haven't had any radicular pain in about a year and a half. N=1 was a failure for me. But, I don't believe I'm locked in extension. So flexed spine for me was a flexed spine in my opinion.
The other concept that was touched on briefly was the use of an orthotic. He pretty much came out and said if your not in a PRI orthotic all the work you are doing to solve dysfunction won't last. Really? I don't buy that one at all. I'm a big believer that feet play a major role in how we move, but not that big....for everyone. Need by need basis. He was very down on the minimalist shoe for everyone. I talked with a buddy doing PRI with himself and a few athletes and was told he has been doing great without the orthotic and is stronger then he has ever been.
Overall, I really enjoyed the PRI seminar. I truly believe I'm a better clinician having attended. I'm working with diaphragms and having success with improving shoulder mechanics via the diaphragm. They give a ton of exercises that can be used for your patients as homework. I plan on attending more of their seminars in the future, so you can say I like their stuff.
Wednesday, May 8, 2013
Building a Circadian Rhythm Template Through Food, Light and Sleep
One of the most interesting chapters in the book "Perfect Health Diet" by Paul Jiminet was the chapter on Circadian Rhythm. Circadian Rhythm (CR) is the bodies natural tendencies and hormonal fluctuations. Every cell in your body has an internal clock. The more we learn about health and fitness the more importance the roll of maintaing a healthy CR becomes.
The body is an incredible adapter. It can adapt to anything, almost. You can get it to run faster, jump higher and lift small cars if need be. You can train it to run across deserts and climb mountains without oxygen. It can thrive (not just survive) on vary diverse diets, from Inuit protein and fat to some almost pure plant based diets. One thing we can't adapt to and probably never will, is lack of sleep and sleeping in the day time.
Sorry 3rd shifters, but that is not normal and you are messing up your CR big time. There are a lot of health risks involved with this. Maintaining a healthy sleep schedule, getting sunlight in the right time and eating at the correct period are probably the biggest steps in keeping your CR healthy.
Here are some highlights from the PHD chapter to be used as guidelines for setting up your proper Circadian Rhythm.
Get sunlight on your eyes early in the morning. Sunlight not only kick starts the CR but also we absorb Vit D more in the morning. Sunlight has tremendous amount of blue spectrum light. Great in the morning and day. (not at night) Cataracts block blue light and this is one reason elderly have messed up CR.
Avoid blue light in the evening. Just as blue light in the morning is helpful, blue light in the evening is harmful. It will block the hormone Melatonin from being produced as much. (almost 50% less) Melatonin is highly important for health. There are now filters that can be put on computer screens and ipads ect to block the blue light.
Sleep as much as you can. There are so many studies about sleep and they all say the same thing, go long enough with limited sleep and you are going to have some health issues. Some pretty serious. This is something we as humans have not been able to adapt to. Sure there are people out there that thrive on "4 hours of sleep" day in and day out, but chance are you are not them. There are amazing outliers in everything.
This brings us to food. Food can have a powerful influence on the CR. Generally speaking, eat during the daylight. Create an eight hour window to eat. Stop about 2 hours before you go to bed. Carbs have a powerful effect as they promote night rhythm and sleep. Carbs influence the hormone leptin, fat does not.
The hormone leptin follows a circadian rhythm. Low in the morning and rise as the day goes on, peaking at night. Eating carbs increases leptin levels 4-9 hours post consumption. So to time carbs influence on leptin and your natural leptin levels, most carbs should be eaten around sunset. So dinner. This goes against most of the dietary advice out there. (so it's probably right....this also has strong agreement with the Warrior Diet by Ori Hofmekler)
A few supplements that may help are Vit D in the morning, Magnesium at night and Melatonin at night. All will have strong influence on creating optimal CR. Light physical activity with your initial sun exposure in the morning can also be highly beneficial.
A healthy circadian rhythm is a template to allow you to do the things that are important to you. If you are looking for a faster 5k, lose 15 pounds of fat, total elite in powerlifting or just have the energy to enjoy your grand kids, setting your Circadian Rhythm is the foundation to the person you are building.
The body is an incredible adapter. It can adapt to anything, almost. You can get it to run faster, jump higher and lift small cars if need be. You can train it to run across deserts and climb mountains without oxygen. It can thrive (not just survive) on vary diverse diets, from Inuit protein and fat to some almost pure plant based diets. One thing we can't adapt to and probably never will, is lack of sleep and sleeping in the day time.Sorry 3rd shifters, but that is not normal and you are messing up your CR big time. There are a lot of health risks involved with this. Maintaining a healthy sleep schedule, getting sunlight in the right time and eating at the correct period are probably the biggest steps in keeping your CR healthy.
Here are some highlights from the PHD chapter to be used as guidelines for setting up your proper Circadian Rhythm.
Get sunlight on your eyes early in the morning. Sunlight not only kick starts the CR but also we absorb Vit D more in the morning. Sunlight has tremendous amount of blue spectrum light. Great in the morning and day. (not at night) Cataracts block blue light and this is one reason elderly have messed up CR.
Avoid blue light in the evening. Just as blue light in the morning is helpful, blue light in the evening is harmful. It will block the hormone Melatonin from being produced as much. (almost 50% less) Melatonin is highly important for health. There are now filters that can be put on computer screens and ipads ect to block the blue light.
Sleep as much as you can. There are so many studies about sleep and they all say the same thing, go long enough with limited sleep and you are going to have some health issues. Some pretty serious. This is something we as humans have not been able to adapt to. Sure there are people out there that thrive on "4 hours of sleep" day in and day out, but chance are you are not them. There are amazing outliers in everything.
This brings us to food. Food can have a powerful influence on the CR. Generally speaking, eat during the daylight. Create an eight hour window to eat. Stop about 2 hours before you go to bed. Carbs have a powerful effect as they promote night rhythm and sleep. Carbs influence the hormone leptin, fat does not.
The hormone leptin follows a circadian rhythm. Low in the morning and rise as the day goes on, peaking at night. Eating carbs increases leptin levels 4-9 hours post consumption. So to time carbs influence on leptin and your natural leptin levels, most carbs should be eaten around sunset. So dinner. This goes against most of the dietary advice out there. (so it's probably right....this also has strong agreement with the Warrior Diet by Ori Hofmekler)
A few supplements that may help are Vit D in the morning, Magnesium at night and Melatonin at night. All will have strong influence on creating optimal CR. Light physical activity with your initial sun exposure in the morning can also be highly beneficial.
A healthy circadian rhythm is a template to allow you to do the things that are important to you. If you are looking for a faster 5k, lose 15 pounds of fat, total elite in powerlifting or just have the energy to enjoy your grand kids, setting your Circadian Rhythm is the foundation to the person you are building.
Monday, May 6, 2013
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.
Movement.
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)
Preparation:
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.
Sensory:
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.
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.
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