Being parents who are also athletic trainers has its pros and cons. We can skip a trip to the doctor’s office for most musculoskeletal injuries. We can do our own physical therapy. We can discern whether an injury needs further evaluation or if our son just needs to rub some dirt on it. Unfortunately, it also means we understand the inherent risks of playing a particular sport. As a parent and athletic trainer, I just cannot allow my son to play tackle football. Continue reading
Clinicians are supposed to be evidence-based, but we’re not. We are sheep that follow the herd. Or, as a friend of mine from the University of Illinois often says “follow the Sacred Cows”. I am just as guilty. We go through the same mundane and antiquated treatment protocols that we always have. We don’t want to change our ways because that is what we are comfortable doing and that is what our patient expects. It takes a global paradigm shift in order for us change how we practice. Can a paradigm shift finally be underway in how we treat inflammation?
As followers, I knew our mindset toward ice and anti-inflammatory medication would only change if mainstream media started sharing the data. Now, this is just one story, but it is in the New York Times. Perhaps more articles like this will reach the public. Better yet, perhaps stories like this can appear on TV, like Dr. Oz or GMA. For now, I am just happy it’s finally being shared with the public and I look forward to more. A change will be coming folks. Below is a link to the NY Times article, with the best line saying: “There’s a reason for the inflammation” in the body after exercise, she says. “It’s part of the regenerative process and not a bad thing.”
Stone Athletic Medicine is about sharing the latest evidence in health and movement science to guide and challenge what health care providers do for their clients. This article is not about that.
Stone Athletic Medicine is also my personal place to share my thoughts on things I am very passionate about. This article is about that. I am not sure why I am putting my personal thoughts and feelings out for public display. For some reason, I am compelled to do just that. Last month, I experienced a low mental point. Some of the things I did and read (shared here) really helped me. Perhaps this article is my personal coping strategy. I am hopeful that sharing my personal experience can help someone else. Continue reading
- Poor ankle mobility, primarily dorsiflexion
- Poor hip mobility, primarily hip flexion and external rotation
- Muscle weakness/muscle imbalance of the lumbo-pelvic-hip complex
- Long femur (a high femur to torso length ratio or high femur to short tibia ratio)
- Widen the stance
- Externally rotate the legs
- Raise the heels
Should the knees migrate past the toes when performing a squat? I posted this question on social media, and the immediate response by most was “No!”. I expected this answer from most everyone, from novice to advanced lifters. To you, I happily say, you’re wrong! The debate on proper squat mechanics will never die, but I am going to steal a line from Randy B., an athletic training, and performance enhancement peer, who answered my question: “Absolutely, [the knees] should [go past the toes]. Don’t believe urban legends or follow sports med sacred cows!” I couldn’t have said this any better! Randy is spot on. This urban legend could lead to injury. The purpose of this blog is to shed some light on the debate and provide the rationale for proper squat technique.
I’ve written several articles on the use of ice on injuries, the need for inflammation, and the intricate physiological process of tissue healing. Despite the mounds of evidence that ice is not all it is cracked up to be, there still exists a dogmatic polarization that it has magical tissue-healing properties. I often get told “Prove to me that ice does not work.” No; that is not how evidence-based practice works. You need to prove that ice does work for the reasons you use it.
Read the comments I receive, and you will recognize our ice dependency. “If I don’t ice, then what do I replace it with?” That statement screams dependency. When we take away ice, we feel that a void must be filled. It doesn’t! The treatment decision is multifactorial; the injury type, severity, tissues involved, the person, etc., all play a role in how you treat that specific injury.
A 2013 position statement made by the National Athletic Trainers’ Association on the management of ankle sprains found ice therapies had a C-level of evidence 1. Meaning little or poor evidence exists. In an interview, the author of that article said: “I wish I could say that what we found is what is really being done in a clinical setting…. Maybe our European colleagues know something we don’t…there is very little icing over there.”
The blog shows how I treated an acute ankle sprain without ice by using all of the fun little tools learned through school and further honed with clinical experiences, trial, and error. I did what I thought was best. This protocol should not be used for every ankle injury. My treatment and rehabilitation plan changed daily. Everything I did was based on my ankle needs. I did NOT use any biophysical or electromagnetic modalities. Everything I did was manual. This is not to say that I would not use other modalities, I just chose not to. My only rule? No ice. Continue reading
As a father, I wanted to write this blog for the parents. It’s so hard to find time to workout in the summer. For most, fitness just takes a back seat during this time. Let’s be honest, you want to be outside. It’s the season of bar-b-que, beer, family vacations, and soaking up the sun. Your kids want and need to be outside too. For these reasons, attendance at health clubs declines significantly over the spring and summer months. So, how does one get a total body workout outside of the gym? Easy, head to the playground, jump on the swing set and try these 15 exercises.
- Pistol Squat: Stand with your feet shoulder-width apart and pointing forward. Hold arms straight out and grasp the swing for stability. Raise the right leg and lower the body while bending the left knee. Drop to a level of chair height, then return to standing. Repeat for the desired number of reps, then switch to perform on the opposite leg. Progression: Perform with the leg up on the swing’s seat.
Six months (+/- a few) is the standard time needed for an athlete to return to competition following anterior cruciate ligament (ACL) surgery. To reach this date, therapy must be thorough and exact. Range of motion, neuromuscular control, or strength deficits that go unaddressed, negatively influence return to play and can also lead to other long-term consequences.
Those who suffer from ACL injuries are at greater risk of developing knee osteoarthritis (OA). Knee OA is a condition whereby the cartilage slowly wears away. This is a painful, life-long health issue that can lead to disability. With proper rehabilitation and adequate strengthening of the quadriceps, OA can be prevented. Sounds simple, but clinicians must also deal with arthrogenic muscle inhibition (AMI).
AMI is a neuromuscular dysfunction that limits the ability to strengthen muscle and is common following ACL surgery. With AMI, neurological signals from the quadriceps muscle to the brain and spinal cord are interrupted or slowed. You can read more about Brain and CNS deficits here. So the question is, how do you combat AMI to properly strengthen the quad and subsequently prevent knee OA? The answer might be vibration training.
Vibration training employs a low-amplitude, low-frequency mechanical stimulation that exercises musculoskeletal structures. Vibration training provides strength gains without joint loading and stimulates osteoblastic and chondrocyte activity through the mechanisms of mechanobiology. Subsequently, bone and joint health are improved.
A recent article by UNC’s EXSS Impact site found that vibration training (local or whole-body) improves quadriceps function by improving central nervous system function. Following vibration training, brain activity was altered in such a way that it became easier for these subjects to activate and use their quadriceps muscles. As such, muscle vibration can be an effective method to improve quadriceps strength and reduce the risk of developing knee OA.
Below is the full article from UNC.
Why did you do this study?
Individuals with anterior cruciate ligament (ACL) injuries are at greater risk of developing osteoarthritis (OA). OA is a considerable burden on the US healthcare system and contributes to physical disability and comorbidities such as obesity and diabetes. The lifetime cost of ACL injury amounts to $7.6 billion annually for patients that undergo reconstruction, $17.7 billion for patients that undergo non-surgical rehabilitation. Quadriceps dysfunction is ubiquitous following ACL injury and reconstruction, and is a major contributor to the development of OA. The quadriceps are responsible for absorbing impact forces during everyday tasks like walking and stair climbing, and also athletic tasks like running and jumping. When the quadriceps fail to act appropriately, their ability to attenuate these forces is reduced, and cartilage within the knee joint experiences greater loading. Subtle increases in joint loading are amplified through repetitive activities like walking, and over time, greater loading contributes to a gradual breakdown of articular cartilage.
Given the implication for future OA development, the restoration of proper quadriceps function is extremely important in rehabilitation. However, quadriceps dysfunction is caused by a neuromuscular phenomenon called arthrogenic muscle inhibition (AM), which presents a substantial limitation to muscle strengthening. Essentially, sensory signals from the knee joint inform the central nervous system – the brain and spinal cord – that the ACL as been injured. In response, our central nervous system responds by inhibiting the quadriceps to prevent further damage of the injured joint. While this mechanism may protect the joint in short term, AMI persists for many years following the initial injury and is thought to contribute to excessive cartilage loading and the development of OA. Therefore, strengthening the quadriceps is important in rehabilitation, but traditional exercises do not address AMI. Novel rehabilitation modalities are needed to combat AMI prior to the implementation of strengthening exercises.
Previous work in our laboratory indicates that muscle vibration provided directly (local muscle vibration – LMV) and indirectly (whole body vibration – WBV) may improve quadriceps function. However, what remains unclear is the mechanism by which these vibratory stimuli actually work to enhance muscle function. Given that AMI involves alterations in central nervous system function, it is imperative to understand how muscle vibration influences characteristics of spinal cord and brain function. Therefore, the purpose of this study was to understand how both WBV and LMV influence characteristics of central nervous system function.
What did you do and what did you find in this study?
We recruited subjects with ACL reconstruction for this study. First, we measured various characteristics of quadriceps function (i.e. strength and activation), and also how the brain and spinal cord contribute to muscle contraction. Following baseline measurements, subjects received an intervention of WBV, LMV, or control (no vibration) treatment. We repeated the same measurements of quadriceps function and central nervous system function following the treatment.
We found that both WBV and LMV acutely improved quadriceps function (strength and activation) relative to the control treatment, and that this improvement was likely due to greater cortical neuron excitability. In other words, muscle contraction can either be voluntary (the brain tells the muscle to contract) or involuntary (spinal reflex loops). What we found was that following WBV and LMV, brain activity was altered in such a way that it became easier for these subjects to activate and use their quadriceps muscles.
How do these findings impact the public?
These findings indicate that vibratory stimuli acutely improve quadriceps function, and could be useful in addressing deficits in central nervous system function such as AMI. As such, muscle vibration could be an effective method to improve quadriceps strengthening protocols following ACL injury, and in turn reduce the risk of developing knee OA. Overall, knee OA is a major economic burden on the US healthcare system, and these findings could have important relevance for alleviating healthcare costs and physical disability.
A comprehensive rehabilitation program is vital for an athlete’s return to competitive sport. Failure to normalize range or motion, strength, and neuromuscular control can result in performance loss, reinjury, or long-term disabilities, such as knee OA. Make sure your rehabilitation program is inclusive of all components. Of course, the best cure for ACL surgery is preventing ACL tears all-together. If you want to prevent ACL injury, read about the RIDS Program designed to prevent injury.
The glutes (not counting the core) are the single most important muscle group for athletic performance and injury prevention.
I am an ass man. Not in a sexual context, but in a functional movement context. I do not care if you are fat, skinny, or look great in a pair of yoga pants. If your glutes function at an optimal level you will have better athletic performance and prevent injury. Over the years, I have worked with a variety of clients and the glutes are a focus for all of my clients. It does not matter what your current fitness level is; if you want to prevent injury, boost performance, or become more fitter, the butt is key.
Ask any client I have trained, and they will tell you that I will destroy your glutes – in a good way. Over time, I have developed some favorite booty-popping exercises. In clinical research, there isn’t any published data that truly says these exercises are best. What you have here is based on my clinical experience and what I have found to work best. These exercises are designed to give you optimal gluteal function and they might even make you look good in a pair of jeans.
“Novel treatment of muscle weakness following joint injury has sought to develop interventions that can excite the neuromuscular system and allow for more effective interactions between the nerves and muscle.”
Chad and Brent both play the same position for the same basketball team—same practice routine, same strengthening program, same injury prevention program—but Chad is suffering from left patellar tendonitis. Why is Chad injured and not Brent? We have adopted laymen medical terms such as “Runner’s Knee”, “Little Leaguer’s Elbow”, “Tennis Elbow” or “Jumper’s Knee” implying these types of injuries are caused by the activity. But are they? What if Chad’s “Jumper’s Knee” is linked to a brain or spinal cord deficit and not some musculoskeletal dysfunction?
Everything we do —touch, sense, feel, contract, move— triggers an action potential that is sensed by millions of mechanoreceptors, which follows a path to the brain.
- The action potential is picked up by peripheral nerves and carried to the dorsal root ganglion cell and travels to the spinal cord.
- The impulse goes through the dorsal column nuclei and the impulse is taken to the thalamus in the brain via the spinothalamic tract.
- In the brain, this impulse synapses with the ventroposterolateral thalamus and onto the somatosensory cortex.
- A motor response is then triggered.
This path is followed every time. Sensory or motor deficits anywhere along this path can lead to injury. Sometimes, as health care providers we get in a rut and look to treat the body part or underlying movement dysfunction. While this practice is not necessarily bad, it might not be what is needed. Correcting muscle imbalance or addressing joint dysfunction may not be the answer. Removing the athlete from activity to reduce overload may not be the answer. Our goal should aim to fix deficits along the neural path. Continue reading
Watch the video below as I take my client who is 8 months pregnant through a 30 minute total-body circuit program using only the RIP Trainer by TRX.
A little over a year ago I wrote “A Runner’s Story: From Pain to Performance” which is about a client I began working with about 2 years ago. When we met, the simple task of walking caused sharp pain in her hips and had essentially given up on her long-time passion of running.
After a few months of working together she was racing 5ks and 10ks. In one year’s time (April, 2014) she ran the Illinois half-marathon. I still train her today, but now we have a new challenge; she’s expecting a baby at the end of March. Continue reading
If you know me, you are aware of my anti-ice stance. The ice debate continues to heat up. As peer-reviewed data continues to pour in, the evidence for the use of ice to treat musculoskeletal injury still lacks. I’ve written about ice many times, but many of my anti-ice articles are science-y and focused around one topic. I wanted to do something different this time. I wanted to keep it short, sweet and comprehensive. So, I bring you 10 reasons why we shouldn’t ice injuries. Continue reading
Here’s a challenge: I bet you cannot do a forward or side plank for 1 minute straight. Many people will say that is easy. So, let me rephrase: I bet you cannot do a forward or side plank properly for 1 minute straight.
Many fitness enthusiasts choose planks to work the core, but are they really working the core? When I observe clients perform the plank exercise, 9 out of 10 fail to perform the exercise properly. Take a look at the common compensation patterns that occur during the plank exercise and then challenge yourself. Can you do the exercise for 1 minute, with perfect technique, and without compensation? Continue reading
Runners are a very particular type of athlete and will try almost anything to run longer, faster, and remain injury free. Unfortunately, there is a lot anecdotal and pseudoscience being pulled from the internet that leads runners astray. In this article I talk about the biggest myths and facts in running.
- Static stretching decreases performance.
MYTH: A study done a few years ago demonstrated static stretching reduced power output and performance. Suddenly, performance experts started saying “Static stretching is the worst thing you can do.” This is not true! These people just misinterpreted the facts. The data stated that performance decreased when the muscle was stretched for 45 seconds or longer… When a stretch was held for 30 seconds or less – as recommended – there was no performance loss. A recent study published in the Journal of Strength and Conditioning confirmed this (1). This study found that the threshold of continuous static stretching in which muscular power output decreased was 60 seconds. Static stretching for a short-duration (30 seconds) had a negligible influence on performance.
- Static stretching can increase tightness.
FACT: Muscle is made up of two types of fibers, intrafusal and extrafusal. Inside the intrafusal fibers is a receptor called the muscle spindle. It’s like a spring-loaded sensory detector. It is a protective mechanism that when over stretched sends a signal to the brain and spinal cord telling the muscle to contract and protect itself, thus making the muscle tighter. Some muscle spindles are overly active causing chronic tightness. So, when you stretch a muscle that already has over active muscle spindle, the tightness can increase. I wrote an article about this phenomena, if you want to read more about that. I understand this can be confusing, but when you read #3 you will see how all of this comes together.
- You should foam roll after running.
MYTH: Foam rolling or self myofascial release is one of the most effective tools to improve motion and prevent muscle injury. Unfortunately, many runners foam roll after a run. It is just as important, or even more important, to foam roll before a run. As I mentioned in #2, muscle spindles create tightness when stretched. Due to the repetitive nature of running, runners are very susceptible to developing hyper-active muscle spindles. Foam rolling or self myofascial release targets the muscle spindle and inhibits it (hence the term release in myofascial release). Foam rolling overloads the muscle spindle and the nervous system and gets it to relax and turn off. This allows the muscle to be stretched without the muscle spindle becoming overprotective. Every client I see is directed to foam roll first, stretch, then exercise.
- Icing or an ice bath after a run helps injury and speeds recovery
MYTH: Inflammation is REQUIRED for the body to bring supplies to worked areas, clean up any debris and help rebuild tissue. When we ice that sore knee, aching Achilles, or painful plantar fascia after a run or workout we are delaying our body’s innate ability to repair that tissue. Yes, icing is not all it is cracked up to be. Even the physician who coined the term RICE (Rest, Ice, Compression and Elevation) has said that icing is wrong. I’ve written many articles about this, but the most recent, explains why RICE is no longer accepted as the cure-all. If you want to recover, cool down with foam rolling and stretching, and have a few days of light exercise or rest.
- Drinking extra liquid will prevent heat illness.
MYTH: In general we overhydrate. Tim Noakes, MD, a long-time researcher of water balance and author of “Waterlogged: The Serious Problem of Overhydration in Endurance Sports,” says we have been misled to believe that we need to drink to stay ’ahead of thirst’. Hydration prevents dehydration, but it does NOT prevent heat illness. Dehydration and heat illness have very similar symptoms and often we use the two interchangeably, but they are not the same. If someone is suffering from heat illness, giving them water is not the answer, cooling their body temperature is. Giving excessive water to a person suffering from heat illness can cause a serious or fatal event called exercise-associated hyponatremia encephalopathy (EAHE). Marathoners and distance runners who drink at every aid station or drink excessively before a run put themselves at risk for this condition. Dr. Noakes states we should aim for ingestion rates that never exceed 27 ounces/hr (2). More about our hyper-hydration nation can be found in this article.
- Dehydration kills performance.
MYTH: It’s long been held as fact that losing more than 2 percent of bodyweight to dehydration will hurt performance. But several recent studies, as well as anecdotal evidence from the world’s top runners, suggest it’s possible to lose more than 2 percent with little to no detriment to performance. A study in the British Journal of Sports Medicine found that current hydration guidelines are erroneous and that dehydration does not impair performance (3). In this article the authors found weight loss of up to 3 percent did not slow down athletes (cyclists, in this case) or lower their power output. Finally, in 2012 a study found that Haile Gebreselassie lost a whopping 9.8 percent of his bodyweight during the 2009 Dubai Marathon—and still won, in 2:05:29 (4).
- Energy chews prevent bonk or fatigue.
FACT: But don’t be fooled: Energy chews do work to prevent fatigue during long distance running events, but so do raisins! A study published a few years ago compared raisins vs. energy gummies. There was no difference in performance between the raisin group and the gummy group. In addition, the raisin group showed a lower insulin spike when compared to the gummy group, a win for the raisin. Plus, the raisin group demonstrated higher free fatty acid content in the blood post activity, demonstrating more fat metabolism. So, for the same performance gains, you can gain additional benefits from raisins over energy gummies.
- Bananas prevent cramps
MYTH: While bananas are a great source of nutrition and do contain many electrolyte replacing nutrients, they alone do not prevent cramping. Cramping can be caused by a large number of reasons, including over hydration (see above) or poor conditioning. Tim Noakes, MD, in Lore of Running, 4th Edition, suggests muscle cramps are caused by muscle fatigue and that cramping has more to do with not training properly than nutritional or hydration deficits.
- Runners need to strength train.
FACT: Running strengthens your muscles, but it only strengthens certain muscle fibers to a certain degree. A total body strength training is imperative for running performance. Strength and stability of the core and shoulder help translate to lower body power and efficiency. If you need a kick to climb a hill faster or sprint to beat an opponent to the line, strength training is imperative. Proper strength training and targeting specific muscles will also prevent injury. John Martinez, the assistant head doctor for the Ironman World Championships says “You can run five days a week and you’ll finish a marathon, but if you want to PR or qualify for Boston you need to have some kind of strength training in there. It’s about improving our performance.” Always add a strength training component to your training program. Running alone is not enough.
- Running is the best way to lose weight.
MYTH: You’re being duped folks! Long duration cardio training does not make you lose more fat or weight. Running in the “fat burning zone” as depicted on a cardio machine does NOT burn more fat. If you want to lose weight, you need to burn calories. What burns calories? Intensity! Higher intensity requires more oxygen demand and thus a greater oxygen debt. High intensity training has a caloric after burn that lasts for 12-24 hours. Standard steady state running only has a caloric after burn of 1-4 hours. You can burn more calories in a 20 minute high intensity interval training program than you can running for 60 minutes at a steady pace. If you want to lose weight, get off the treadmill!
- Minimalist shoes improve running mechanics and prevent injury.
MYTH: Will the minimalist running trend ever end? Minimalist shoes do not prevent injury. In fact, those who jump from a normal shoe to a minimalist shoe without proper training or adaptation are at an increased risk for injury. Five separate studies presented at the annual meeting of the American College of Sports Medicine “found no significant benefits, in terms of economy, from switching to minimalist, barefoot-style footwear.” Minimalist shoes also do not magically improve your running mechanics. There are no quality studies that show running in a minimalist shoe improves mechanics. In order to improve mechanics, you need a quality strengthening and flexibility program that encourages appropriate muscles firing. If you want to go the minimalist route, walk first. Adapt to the new style and supplement with a structured training program.
- Getting a shoe that matches your arch height will prevent shin splints.
MYTH: Shin splints are not caused by a high or low arch. Many runners with a high or low arch can avoid shin splints. Similarly, runners with a “perfect” arch can develop shin splints. The cause of shin splints is multifactorial and correcting musculoskeletal dysfunction through a structured program prevents shin splints. The article Shin splints 101 demonstrates how to prevent shin splints. A systematic literature, published in the Journal of Sports Physical Therapy found that selecting running shoes based on arch height had little influence on injury risk. (5)
- A midfoot strike is best for performance.
MYTH: If you run slower than a 5-minute mile, it may be most efficient to heel strike. A study published in Medicine and Science in Sports and Exercise found that rear-foot strikers are up to 9.3 percent more economical than midfoot strikers (6). Lead author Ana Ogueta-Alday believes the reason for the improved efficiency stems from the increased ground contact time the study observed in rearfoot strikers. More contact time with the ground allows for more force to be applied, while also decreasing the metabolic cost of running. If you’re a heel striker and haven’t been chronically injured, there’s no need to change your ways.
- The more mileage you run per week the better your performance.
MYTH: If you want to improve, you need rest, recovery, and varied training. I challenge you to find an elite marathoner who trains only by running. The elite runners have rest and cross-training built into their weekly programs. See the importance of strength training in item #9 above. Two of the best known experts on running, Jack Daniels and Hal Higdon, provide run training programs. There programs stress the importance of recovery days and strength training days. In fact, Jack Daniels says that when training for long running events, train for time, not mileage. Getting 20+ miles is not the best for all runners and could cause injury.
- Preventing injury is a matter of not doing too much too fast.
FACT: There are many things that can cause injury, but one of the biggest determinants of injury is doing too much too fast. A study in the Journal of Sports Physical Therapy evaluated progression of running distance and its relation to injury. The authors found novice runners who progressed their running distance by more than 30% over a 2-week period seem to be more vulnerable to distance-related injuries than runners who increase their running distance by less than 10% (7). Owing to the exploratory nature of the present study, randomized controlled trials are needed to verify these results, and more experimental studies are needed to validate the assumptions. Still, novice runners may be well advised to progress their weekly distances by less than 30% per week over a 2-week period. So stick with the 10% rule.
If you are a runner and look to increase performance or prevent injury, please feel free to contact me for a free consultation.
- Pinto, MD, et al. Differential Effects of 30- Vs. 60-Second Static Muscle Stretching on Vertical Jump Performance. December 2014. 28:12. p 3440–3446.
- Noakes, T. Waterlogged: The Serious Problem of Overhydration in Endurance Athletes. Human Kinetics. Champaign, IL. 2012.
- Wall, BA, et. al. Current hydration guidelines are erroneous: dehydration does not impair exercise performance in the heat. Br J Sports Med. 2013 Sep 20.
- Beis, LY, et. al. Drinking behaviors of elite male runners during marathon competition. Clin J Sport Med. 2012 May;22(3):254-61
- Knapik JJ, et, al. Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations. J Orthop Sports Phys Ther. 2014 Oct;44(10):805-12.
- Ogueta-Alday, A, et. al. Rearfoot striking runners are more economical that midfoot strikers. Med Sci Sports Exerc. 2014; 46(3):580-5.
- Nielsen RØ, et. al. Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. J Orthop Sports Phys Ther.2014 Oct;44(10):739-47.
In time everything we do to treat injuries, prevent disease, or reverse disease will eventually change. Think of all the things we used to do in medicine. Cocaine was used for toothaches. In the 1600’s, “hydrotherapy” was used to would wash away insanity in mental patients. Jan Baptist van Helmont would literally drown people to death and then resuscitate, believing that water would cleanse and the near drowning would snap people back to reality. In the 1800’s ketchup was used to treat athletes foot. In rehabilitation science, we use a myriad of techniques that we think is proper today, but overtime, the way we treat will drastically change and I believe it will come sooner rather than later. Continue reading