How to Create a Pain Problem & Opioid Addiction

How to Create a Pain Problem & Opioid Addiction

I recently received a call from a young guy (late twenties), who was recommended by his friend to contact me as he was in need of acute post-operative rehabilitation following a recent knee menisectomy. Upon asking him, “What instructions were you given to manage your situation until your first follow-up appointment with the doc?” He responded by listing off the following recommendations given by the physician’s assistant (PA)…

  • Take pain pills as needed (prescription for 40 percocet)
  • Don’t do anything that hurts or causes pain
  • Don’t bend your knee past 90 degrees

This represents a microcosm of our current state of affairs in relation to pain management and opioid addiction. The potential societal repercussions of this situation are disconcerting. I’m hopeful we can do better!

A Guide to Treadmill Running Analysis for Clinicians & Health Professionals

A Guide to Treadmill Running Analysis for Clinicians & Health Professionals

“The S’s of Treadmill Running Analysis”

Perhaps one of the biggest mistakes I made during my early years as a physical therapist was not taking the time watch runners run. Invariably, this led to a short-sighted perspective, hasty decision making, and suboptimal outcomes for those runners seeking my care. While I was generally effective in helping runners reduce their pain and symptoms and get them back to their usual activities in the short term, they seemed to consistently experience pushback when attemtping to return to consistent training. Needless to say, I was obviously missing something, and quickly realized that my affinity to run had little to do with my ability to help runners aside from perhaps getting buy in from looking the part. Ultimately, this put me on a quest to demystify the performance demands of running so I could be in the best possible position to help runners seeking my services. After spending countless hours reading and contemplating the available literature, it became readily apparent that running is a hierarchical skill relative to most activities meaning that taking the time to watch someone run is critical before discharging them from your care. There also seems to be a set of common denominators or factors that deserve particular attention when conducting a running analysis. I like to refer to these as “The S’s of Treadmill Analysis.” 
  • Strike – footstrike
  • Sound – sound of ground contact
  • Step Rate – AKA cadence
  • Speed – running velocity
  • Shoes – impact of footwear
  • Slope – incline or decline
  • Swing – arm & leg swing
The purpose of this guide to provide clinicians and health professionals with a simple and practical framework to approach conducting a TM running analysis while learning how to interpret and apply the results in real time. By enhancing one’s understanding of running and gait retraining, loads can effectively be shifted away from sensitized or pathologic tissue while demonstrating to patients that their running related pain is malleable, and can be lessened by manipulating specific aspects of their gait. Having runners experience a rapid improvement in their symptoms through simple gait retraining has the potential to enhance a runner’s expectations and confidence with treatment, which ultimately lends to a better outcome. While one might argue that certain characteristics are missing from this list, I feel that clinicians can effectively intervene through these variables. I hope that this guide proves invaluable in helping you demystify TM running analysis and gait retraining in an effort to assist with migrating runners out of the medical system and back to STRONG, HEALTHY, and CONSISTENT running. Onward!!! To leaern more and to purchase this guide, follow this LINK. Thanks in advance for your support and hope this proves to be an invaluable resource. Happy Holidays!

http://bit.ly/2Bq4g3f

Metronome Marching & Return to Running

Metronome Marching & Return to Running

  One of the many mantras that I recite in working with runners is that “Running is about rhythm and timing.” Along these lines, If there was only one exercise that I could give to a runner following a running related injury (RRI) to safely return them to training, it would most likely be metronome marching. Having spent considerable time practicing this drill, I can say that it is arguably the ultimate form of graded exposure while taking advantage of the use of an external auditory cue (silent in the vid). The slower beat frequencies effectively serve to mitigate threat and demand the runner to load through each leg while forcing them to audit their motion. As the speed of movement increases so do the coordination requirements. Additionally, as you start to work above 100+ bpm, the runner must also naturally contact the ground with greater force. Lastly, and most importantly, every runner will hit a point at which they invariably start to adopt a float phase, which is what differentiates running from walking. So, have a practice and let me know what you think. Also, take note of the fact that when I go to contact the ground I do so with the forefoot before gently kissing the heel to the floor. This is not because I think forefoot striking is superior, but rather because it automatically reduces one’s step length, which has been shown to yield distinct benefits in addressing common RRIs. In retrospect, this drill blends pain science fundamentals, gait retraining, and cueing with the performance demands of running. If you are looking to enjoy improved outcomes in working with runners, remember that I will also be launching “The Runner’s Zone on Tues, November 15th. I am determined to make this the premier online learning platform related to running. Click HERE to reserve your spot now!

Hip Airplane + Step Up/Down

Two of my favorite drills, which I routinely incorporate into exercise programs for runners, are the hip airplane and step up. I was recently performing these exercises as part of daily training session when I suddenly thought, “Why in the hell am I not combining these two exercises?” Having come to this realization, I naturally recorded it to share it with the online community. I love drills of this nature because they are directly relevant to running while relying on minimal to no equipment yet create a unique challenge. All you need is a stair, stepper, or cinder block and you are in business. Irrespective of where you fall on the running spectrum in terms of age and ability, I’d suggest having a practice. See you on the streets and good luck to all those racing the NYC marathon this upcoming weekend.

Supine Trunk Training

I confess to having a fetish with putting my body under load in various ways while syncing it up to kinky music. Kind of weird behavior though we are all adults here ;-). This is a simple drill that I occasionally work into my routine to challenge trunk strength and control while superimposing lower extremity movements.

All you need is a flat bench and you are in business! Naturally folks, will tend to overarch their back, which is by no means the devil though something that you should aim to minimize, especially if you do not tolerate spinal extension. If this particular version of the exercise is too difficult, modify the exercise by reducing the excursion of the leg movements or slide up on the bench. As always, wishing you HAPPY, HEALTHY, & STRONG TRAINING!

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