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As an experienced athletic trainer and rehabilitation specialist I help clients who have tried everything and failed. I work with clients who seek injury prevention or rehabilitation, performance enhancement, or general fitness goals. What I do is very unique and differs from what you will find from traditional physical therapy or personal training. My programming is systematic and backed by peer-reviewed research. Please visit the ‘Train with Josh‘ page to contact me or to inquire about training services.
The grandeur of the World Cup is upon us. The world’s most popular sport has its chance to shine. As soccer gets its much deserved pedestal, summer camps fill. High school and collegiate soccer athletes become inspired. Training begins and with that begins the season of the ACL. With approximately a quarter-million ACL injuries per year, it is safe to say the injury is common in sport. Though most common in female athletes, ACL injuries happen to anyone anywhere, with soccer, basketball, and gymnastics athletes being at most risk.
While an ACL injury is traumatic in nature, the injury is rarely due to direct trauma. More than 75% of ACL injuries are non-contact in nature (1). Non-contact ACL injuries stem from a complex interaction of anatomical, hormonal and neuromuscular factors. Recent studies suggest that ACL injuries are caused by both neuromuscular fatigue and unanticipated movements commonly found in athletics, such as evasive maneuvers that involve some form of deceleration, change of direction, or landing. The coupling of these movements with modifiable risk factors (see graphic) is what leads to non-contact ACL injury. The good news is that non-contact ACL injury can be prevented by addressing these modifiable risk factors. Continue reading →
Everyone loves a nice butt. Walking down the street, at the mall, or at the bar, there is bound to be a butt that catches your eye. Like a kitten following a piece of yarn, there is the occasional butt that walks by and causes heads to turn, leaving onlookers with a severe neck strain and mouths agape. Don’t act all innocent and holier than thou, we’ve all done it! Therapists and rehabilitation specialists are no different. In fact they can spend an entire day staring at booty. However, we are not looking to see if “Baby Got Back” or how that plump bump fills a pair of Wranglers, Levis, Seven, or True Religion jeans. We have a reason to look and it is strictly professional; is the little butt working?
For several years now rehabilitation journals have published articles linking a myriad of lower extremity injuries to poor gluteal control. While the glute max – that which makes our heads turn – and the glute minimus are both important, the glute medius is the real problem. We have learned the important role the glute medius has on controlling lower extremity mechanics. Glute medius inhibition precipitates many lower extremity injuries such as ACL tears, Patellofemoral pain, Iliotibial band syndrome, Achilles tendinopathy, plantar fasciitis, MTSS (shin splints), the list goes on. Rehabilitation specialists must pay special attention in strengthening the glute med., but how? What is the best exercise?
Pop quiz: What musculoskeletal issue could result in chronic low back pain, chronic muscle strains, lower extremity tendinopathies, periscapular pain and tightness, glenohumeral and shoulder girdle pain, or tension headaches? I am sure you can think of a few possibilities, but few can result in all. Often, when a patient reports to our care with one of the aforementioned we immediately think locally. Unfortunately, the real problem could be pelvic upslip, anterior pelvic innominate, or both. Despite being oft-overlooked, these malalignments are not hard to identify if you know what to look for. Continue reading →
“Are you drinking water?” “Drink water!” “Hydrate!” “If you’re thirsty it is too late, you are already dehydrated.” This craze of hydrate, hydrate, hydrate has gone overboard and could be causing more harm than good. Who is more at risk for serious medical complications, the hyper-hydrated or dehydrated. For performance, is it best to be overly hydrated, dehydrated or euhydrated? What follows might surprise you. Continue reading →
“Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” – Gabe Mirkin, MD, March 2014
In 1978, Gabe Mirkin, MD coined the term RICE. Health care practitioners to laypersons are quick to recognize RICE as the ‘gold standard’ treatment option following injury. Followers of my blog know my stance against ice and now there is support from the physician who coined the term. Yes, the very same physician, Dr. Gabe Mirkin, who coined RICE, is now taking a step back. I reached out to Dr. Mirkin and asked for permission to share his story. As you will read below in Dr. Mirkin’s full post, the lack of evidence for cryotherapy is something we must listen to.
It’s not often I completely take a post from another, but Mr. Yusuf Boyd, of Biomechaniks in Tennessee and North Carolina wrote a post last week that was on point! While I do not agree with everything in the post, what he says has a lot of merit and is worthy of a share.
I love Athletic Training and my fellow Athletic Trainers, but honestly this is the whiniest group on the face of the planet. March is National Athletic Training month; slogans fill my twitter feed: “I love my Athletic Trainer”, “Athletic Trainers’ save lives”, “My Athletic Trainer has my back.” Great, I am glad we are a prideful bunch, but enough of this holier-than-thou attitude. All I hear is “I am a Certified Athletic Trainer! I deserve respect!” It sounds like a crying toddler who didn’t get a lollipop from the dentist.
This very profession that demands respect also has many of its constituents complaining about the BOC’s new Evidence Based Practice CEU requirements. Really, you want more respect, but will moan and complain when our certifying agency and association wants higher standards? Continue reading →
How many times have you racked your head wondering; why is this not getting better? How come they’re still in pain? How do we have all of this evidence and knowledge at our disposal, yet individuals do not respond as anticipated? The science says, for injury ‘Z’ treat with ‘X’ and rehabilitate with ‘Y’, yet when we apply those tools they don’t work? Why are they not getting better? What are you doing wrong? What are they doing wrong? Continue reading →
When we think of running injuries we immediately think lower extremity, IT Band syndrome, Patellofemoral Pain Syndrome, Achilles Tendinopathy, Medial Tibial Stress Syndrome, Plantar Fasciitis, and the like. However, one of the most common and debilitating injuries in runners is low back pain. So why are runners so at risk of developing low back pain? Most musculoskeletal injuries are multifactorial, but more often than not many chronic injuries result from underlying movement dysfunction.
Vladamir Janda (1928-2002) revolutionized human movement dysfunction and rehabilitation in 1979 when he described three compensatory movement syndromes. These syndromes were a result of pattern overload (i.e. running) and static posturing. Janda recognized that certain muscles were prone to weakness while others were overactive. He continually investigated these movement syndromes and later learned that the muscle imbalances were systematic, predictable, involved the entire body, and a common cause of injury. Continue reading →
Pain and injury to the Achilles tendon is often thought to be a result of inflammation.
The term “tendinitis” or any [insert any body part] with “itis” is tossed around as if it is the only possible cause for musculoskeletal pain. However, the “itis” is not really true. A tendon, specifically the Achilles tendon, is not really inflamed, rather it is deranged (tendiopathic / tendinopathy). In January 2013 the Annals of Human Genetics published an article that demonstrated Achilles Tendinopathy is associated with gene polymorphism (Abrahams, et al., 2013). COL51A is a gene that encodes the development and organization of Type V collagen. This collagen can be found in ligaments, tendons, and connective tissue. COL51A plays an integral role in development and maintenance of connective tissue. Abrahams, et al. (2013) demonstrated that polymorphisms occur in the COL51A gene causing altered structure of collagen resulting in tendinopathy.
The tendon may become fusiform or thickened, but it is due to cellular derangement rather than inflammation. Kannus and Jozsa in a controlled study of 891 patients with Achilles tendon rupture found that 97% of patients had degenerative changes in the ruptured tendon. The study also found that 34% of asymptomatic tendons also had degenerative changes (2) Continue reading →
Muscle is made up of two types of fibers, intrafusal and extrafusal. Extrafusal fibers are the contractile fibers and intermixed within the extrafusal fibers are intrafusal fibers. Housed within intrafusal fibers is a specific type of mechanoreceptor. Mechanoreceptors, in general, are interspersed through the entire body – hair, skin, ligaments – and are responsible for sensing tissue pressure and distortion and give our body a sense of proprioception by detecting position of our muscles, bones, and joint. There are many types of mechanoreceptors, but one specifically – the muscle spindle – lives within the intrafusal muscle fibers. The muscle spindle transmits sensory data regarding changes in muscle length, and therefore movement, to the central nervous system (CNS) via the primary afferent (sensory) neurons. The intrafusal fibers receive neural stimulation from gamma efferent (motor) neurons. Think of the gamma motor neuron as a type of sensitivity adjuster. The efferent input adjusts the length of the spindle so that it remains at an optimal length to detect changes within the muscle.
It’s a shame that a multibillion dollar industry is fueled by misleading people. The business of supplementation is championed by big businesses who utilize fear-mongering tactics to influence the public. These companies disseminate biased data and purport ridiculous claims. ‘We are a nation of rising chronic disease, take this multivitamin.’ ‘We are a nation of malnourished kids, take this multivitamin.’ ‘Autism linked to vitamin deficiency, take this multivitamin.’ ‘Agriculture has ruined our soil; it is depleted of nutrients, take this multivitamin.’ It is an infestation of pseudoscience propaganda that gets delivered daily to our email inbox and shared via social media.
Last night, I was in my normal geek mode and came across a news story on my Flipboard feed; Are multivitamins a waste of money? I was glad to see an article disputing the inaccurate claims made by the industry. The article quotes an editorial published in this week’s Annals of Internal Medicine to support the claim that using supplements and multivitamins to prevent chronic conditions is a waste of money.
In 2010, I left clinical rehabilitation and performance training. While I love my current job, I do miss the clinical aspect, which is why I seize opportunities to take on random clients with complex issues. I’ve never written about my clients, but this case is so common, yet complex, that I thought my readers might be challenged with similar clients/athletes, or might be experiencing similar issues themselves. Here is a runner’s story that went from marathon training, to painful walking and an inability to run. Her experiences with continued failed treatment and the road we have taken to get her back to training and setting personal records.Continue reading →
In July I posted a blog discussing The Overuse of Cryotherapy. The controversy surrounding the topic made it one of the most popular blogs I’ve written. What is surprising to me is that a controversy exists at all. Why, where, and when did this notion of anti-inflammation start? Ice, compression, elevation and NSAIDs are so commonplace that suggesting otherwise is laughable to most. Enter an Athletic Training Room or Physical Therapy Clinic nearly all clients are receiving some type of anti-inflammatory treatment (ice, compression, massage, NSAIDs, biophysical modalities, etc). I evaluated a client the other day and asked what are you doing currently – “Well, I am taking anti-inflammatories and icing.” Why do you want to get rid of inflammation and swelling? I ask this question for both chronic and acute injury!
Last week Twitter was abuzz due to a job posting on the NATA Career Center. Athletic Trainers on Twitter were up in arms over the posting – a full-time, temporary position with a starting salary of $8.00/hr.
Said many ATs: Somebody needs to call the Head Athletic Trainer! Why? In most cases the Head Athletic Trainer has absolutely no say regarding salary of his or her assistants. Call the school! Why? The school simply needs a body to serve as a first responder and to cover its butt in case something does go wrong. The NATA needs to ban such postings! Why? Is the NATA some totalitarian and tyrannical organization designed to hold the hand of its members and dictate what they can and cannot do? What an insult! An insult, maybe to the vast majority, but not to the several athletic trainers who do apply for the job. How could this happen? Easy, we let it happen. Continue reading →
By now, some, if not most, have read the article of the 6-year-old girl who became the youngest ever to complete a half-marathon. Not only did she become the youngest ever, she finished 5th out of 10 in a group of competitors aged 14 and under – she was the only competitor under 12 years old. Race announcer said “she seemed to be barely even breathing hard at the finish line.” So the question being asked – is this safe and appropriate? The question I ask: is this a real concern or more of an excuse? Continue reading →