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Reflections on the BSMPG, Part 2

Filed under: Uncategorized — Shon @ 7:04 am July 7, 2011

Again,all appologies about the delay between Part 1 and Part 2. As a relatively new blogger, I am still finding my equilibrium with regard to writing, posting and editing as well as running my clinic, treating patients and training athletes.  Plus, I can't get Wordpress to stop replacing my quotations with some odd code edit (") when I use spellcheck, delaying this even further.  Picking up where I left off:

Day 1 Recap-Great Presenters, Great Content

Again, day 1 was everything I expected in the seminar, plus more.  At this point in my career, I don't attend many multiple speaker/ multiple subject seminars, but I felt I had gained some great insight from the day 1 presenters.  The happy hour afterwards was a good time to meet some interesting attendees, say hello to a few people I had only known through e-mail, as well as plan out my day 2 strategy. 

After happy hour, I hooked up with my old college roommate Mark, who owns a successful business  near Boston.  Even though Mark has over 250 employees and 400,000 square feet of factory and warehouse space, to me he is still the guy who painted our room yellow, green and red, while hanging a Bob Marley flag on the ceiling in 1985.  Always a blast hanging out with guys like that.   I broke from my normal pseudo Paleo plan and chowed with him on French-Chinese  fare at Jae's Restaurant nearby, and finished with Belgian frites as well as a Belgian waffle with salted caramel in Faneuil Hall.  It was enough of a carb load to allow me to sleep past 3:30 AM.

Day 2

Saturday, I woke by alarm at 6:30 and headed back to the "Y', as they had a Treadwall which I wanted to try.  In the middle of the session, I got a call from Ben Bruno (yes, I had my cell phone at the gym, but for good reason-I was responsible for my wife's wake up call at 7:30 so she could get my son to flag football).  While talking to Ben, I felt extremely guilty for climbing something like the Treadwall without a 100 lb. weight vest strapped on or 75 lb. of dumbbell hanging from a belt.  Ben was at Perfrom Better with the staff from Mike Boyle's gym, and we were trying to arrange dinner later that night.

After heading back to the Northeastern campus, I got a good seat (again, in a university lecture hall, generally all seats are decent) for the first lecture of the day, outlined below:

Lecture 1-Peter Viteritti-Contemporary Concepts in Manual Medicine

The first keynote of day 2 was delivered by Dr. Viteritti, a chiropractic sports physician who practices in  a collegiate program at Northeastern, as well as with a forward thinking physical therapy group in Boston.  He explained that he works closely with physical therapists and physicians in a team approach to manual therapy and rehabilitation, and really seems to have an open mind with regard to mixed manual interventions as they relate to  traditional chiropractic skill sets.  I think we are seeing more of this professional mutual respect across the country, especially over the past 3 years.  I hope it continues, as athletes and patients benefit when turf wars are minimized and professionals work with each other's strengths vs. trying to "be all things to all people". 

Dr. Viteritti's lecture focused on comparing load (force applied to the body that has direction, magnitude and time, or stated simply: how much you ask your body to do) vs. capacity (how much can the system handle without breaking down) and respecting this relationship in the treatment of musculosketetal injury.  One  immediate takeaway as a clinician was that patients should expect 5-10% improvement per visit (which falls in line with what we see typically in our clinic), ot 10-20 visits for full resolution.  The relationship between symptoms (a sign of disease/pathology) and dysfunction ("any part of the body that is not working properly, or in some way is deficient").  Treatment would focus on increasing buffer capacity between the combination of dysfunction blocks (weakness  or adhesion for example)  and the symptom threshold.  This brought me back to my time at a seminar with Jim Porterfield and Carl DeRosa 14 years ago (in Boston,literally right up the street from Northeastern), where Jim spoke of  expecting a 2 to 5 hour window of decreased fluid /inflammation congestion and subsequent symptom control, increasing in length of time  with each sucessive treatment; "designed to enhance healing  and progress toward functional repair" (Porterfield and DeRosa, page 210; figure 6.28). 

 "Patient Centered Care" was discussed and can be best summarized  where providers (physical therapists, chiropractors, athletic trainers) who have, the most appropriate set of treatment tools to address the dysfunction at the appropriate healing timeline are utilized.  Compare this to "Clinician Centered Care", where communication is poor between providers and a redundancy of care can occur across disciplines to the ultimately hampering the recovery of the athlete/ patient.   As a physical therapist, I think Dr. Viteritti's definition of  "dysfunction" can be interchanged with "impairment" (based on the Nagi model), but that is really just semantics, as overall the presentation was excellent and informative.  A patient demonstration was performed live, which highlighted Dr. Viteritti's manual skills in neural/soft tissue mobilization on a conference attendee, rounding out the talk.  

Lecture 2-Norman Murphy-New Concepts in Foot Function and Gait Anylisys Assessments and Treatments

Dr. Murphy followed up with a technical talk on foot function analysis using pressure mapping, which is simply (and at times not so simple) measuring compression forces on the weight bearing foot as the body moves forward.  Plenty of operational definitions were reviewed with regard to biomechanical loading parameters in the foot, while guidelines for appropriate utilization and evaluation of them were discussed. Dr. Murphy's information was well organized, and technical terms were broken down enough that they were easily digested by attendees.

Overall, the presentation was more of an introduction of what pressure mapping can offer the performance and rehabilitation communities.  As concepts were introduced, some practical examples of how the data/information could be used practically.  One interesting comparison was that of the loading of a basketball player vs. a triple jumper in an actual jumping condition.  The differences were reasonably dramatic in terms of raw data (the triple jumper had more of a two phase load distribution in quite a short time vs. the basketball player); what this means in a practical arena probably has yet to be determined.  This certainly doesn't mean that the information is  not useful; it only means we now have access to a  tool (in this case, the Tekscan technology) that can help perhaps define loading parameters through the foot.  This can allow both clinicians and coaches the ability to track trends in performance throughout a training cycle, screen for loading patterns as they pertain to lower quarter injury, or determine wether footwear/ orthotic changes need to be tweaked.  

In terms of my own training, I would be curious to see my own  foot pressure map in the first 25 meters of a 100 meter race (my best part) vs. the latter 25 meters.  I would also be interested in looking at right vs. left side differences during squatting, deadlifting, as well as the quick lifts and unilateral training.  In the clinic, I think it would benefit my patients to see a pressure map of their stance phase in level surface walking as well as with stair climbing and unilateral balance activities.  Pressure mapping would be a useful tool to allow feedback and make meaningful changes in combination with other forms of therapy, and I look forward to seeing where companies like Tekscan take this down the road.

Lecture 3-Cal Dietz-Sub-Maximal High Velocity Peaking Method using Tri Phasic Undulated Periodization

Hands down, Cal's lecture was the most fun I had out of the 10 I attended.  I was initially torn between Dave Nolan's running injury lecture and this one.  However, I had seen Dave speak at the excellent "Foot Hits the Ground" biomechanical seminar in 2004, plus I was very familiar with this information as I treat a large number of running injuries in the clinic with great outcomes.  So, it was off to see Cal…

I was about 2 minutes late for the beginning of Cal's talk, and I missed his initial comments.  However, from what I could gather, he has worked with several elite track and field athletes as well as multiple Olympic and professional athletes.  Cal also has a training group of professionals that work with him in the off season, so his results pretty much speak for themselves.  The thing that I really liked about Cal was that he had a classic crazy strength coach intensity throughout the lecture.  You could tell he literally stayed awake at night thinking about and refining his concepts for his athletes.

Cal's emphasis involved utilizing an undulating block periodization model, but making the third training day the lightest day , utilizing weights generally between 55-90% 1 RM, depending on the phase of training.  Taking this a step further, he utilizes 2 week blocks emphaizing one aspect of muscle contraction in a triphasic model (concentric-isometric-eccentric).  Eccentric emphasis is the first 2 week block, followed by 2 weeks of isometric emphasis, finally finishing with 2 weeks of explosive training.  Eccentric time under tension  is generally 3-6 seconds/ repetition, while isometric holds (actually a stretched isometric/ yielding isometric) fall in in the 3 second range.  For his explosive training, sometimes a Tendo unit is utilized, with no more than 5% fall off of bar speed expected with a given exercise.  AFSM plyometrics, where antagonistic muscle relaxation is emphasized and exploited, allowing force to be expressed better in training/ competition was also covered and explained.  Timed sets, as they related to the triphasic model and utilized at Minnesota was also discussed. Video examples of training were plentiful, and Cal's XL Athlete website has hundreds of videos and articles for those interested.  

Cal explained the reason for developing this method of training was to have a more reactive athlete who could express force in season, with an implement or on the field vs. an athlete who could express strength in the weight room.  He had 3 case studies (which, of course I always am partial to) of Minnesota athletes' responses to his approach.  Some confusion arose during his talk where it seemed that he was not training maximum strength capabilities during the year.  This was not the case, especially as I clarified with him after he was done speaking.  Maximum strength is important in the Minnesota program, but as the season approaches, especially for an advanced athlete, sports specific force generation becomes the priority, not "straining strength" (as Cal put it).  He actually placed things in perspective for me in my own training, as I have been chasing both 100 meter speed and maximum strength at the same time for the past few months without great success.  As I said before, it was a lot of fun to listen to this slightly crazy and innovative coach from Minnesota.

At the risk of making this series into an R. Kelly video, I will close for now, covering Shirley Sahrmann's and Charlie Weingroff's lectues in my next installment, as well as answering a few questions from a regular reader.