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Reflections on the BSMPG 2011 Conference, Part 1

Filed under: Uncategorized — Shon @ 7:34 am June 17, 2011

Continuing education has always been an obsession since my days as a student athletic trainer at Penn State.  When you are an undergraduate, any conference, seminar, or journal article  is new information to you, and has the general effect of making you either: 

1) Feel that the person presenting, teaching or writing is the "end all-be all" content expert in the profession, giving you the clinical solution you need for a particular problem for the rest of your career.  This is the approach of many physical therapists, athletic trainers and strength coaches I have met over the past 20 years-one year of experience repeated for 20 or more years.  

2) Feel that besides the fact that you really  know nothing, you have seen the light and you now are on a quest to learn as much as you can over the lifespan of your career in the profession, be it seminars, journal reading, personal communication/ networking, and studying excellence in other professions/ industries.   This has been my personal  road map for continuing education since 1988.    

However, as I have attended more courses and spent time in clinical practice, my enthusiasm for traveling to continuing education seminars has diminished somewhat .  I have attended courses that were game changers for my practice and my patients, as well as ones that had me wondering if I was in the right profession after wasting 3 or 4 days away from home in a crappy hotel with a bad course instructor.  Also, with significant family commitments as my kids get older, being out of town over a weekend isn't as much fun as it used to be.  I still travel to 2-4 courses a year, but am a bit more select in my itinerary for now. 

  I've seen worse speakers…..

When I saw  the announcement for the Boston Sports Medicine and Performance Group (BSMPG) June Conference a few months ago, what stood out  to me was the line up of keynote speakers.  Shirley Sahrmann and  Thomas Myers were very familiar to me, as I had spent 2 days in St. Louis with Shirley and her staff, while having seen Tom at the Perform Better 3 Day Summitt last year.    I had also been a fan of  Charlie Weingroff's blog for the past year.  Although I was less familiar with Clare Frank, she was Prague School disciple, and  I had both Janda compendiums and VCR tapes for the past 5 years.  Despite unfortunately (and unintentionally) falling the same weekend as the Perform Better 3 Day Summit in Providence, I knew I had to go with BSMPG this year.


Under the Radar, but Off the Hook…..


The Trip

As I stated previously, I am less enthusiastic about traveling for continuing education now vs. 10-15 years prior.  I enjoy my time with Mary Ellen and my kids, now that Shannon is 13  and Lance 12, also given the fact I am in the clinic up to 3 nights  per week.  That said, I wanted to make the trek to Boston worthwhile, so I contaced my friend Eric Cressey and arranged to hang out at his training center for the afternoon.  The original plan was to leave my house at 7 AM and arrive in Hudson ( at the Cressey compound) by noon.  The plan was to hang out a bit and catch up, then hit a deadlift and bench max.  If you've ever seen video of Cressey Performance, or have been lucky enough to visit the place, you know that it's the environment to make that happen.

In reality, I didn't arrive in Hudson until 4PM because of a variery of factors somewhat out of my control.  I also walked into Eric's at the same time as Clare Frank and Charlie Weingroff, so it appeared training was out of the question, as "talking shop" would predominate the rest of the afternoon.  It was fun to hang out and speak casually with Charlie, who I had never met but was familiar with, as well as Clare, with whom I picked up some firs thand information on tonic/ phasic muscle activation as it related to the DNS paradigm.  It was also great to watch the workings of Cressey Performance, where the coaches intermingled with the athletes, while the athletes cranked out  intense sets of basic barbell exercises, chin/pull up/push up progressions as well as sled drags/farmer's walks with sharp technique and heavy weights. 

After 3 or so hours talking with Eric about first ray mechanics, cambered hand push ups and homemade Bodyblades, it was time to head into Boston.  My second mistake (the first was leaving so late to get into New England) was driving a 1500 series pick up truck into a major city.  I couldn't fit  my Sierra in the hotel's parking garage and had to spend the next hour finding alternative parking arrangements.  By the time I had settled in, most places to eat were closing, but I luckily found a  Shaw's supermarket, snuck in right before closing, and was able to gobble some sushi while walking back to the Midtown Hotel.

The next day (after waking up at 3:30 AM), I slipped into an old school YMCA, two blocks from the hotel.  "Y"''s can be great places to train, especially older ones.  They are like the thrift stores of training- you can be pleasantly surprised in what you find among the typical junk.  This one near Northeastern had a decent squat rack, old school York bumpers (circa pre 1980!), a set of stall bars, as well as a Versaclimber. I did not have the best session, but it was enough to counteract the 5 hours sitting in the car the day before.  It was also interesting to watch the regular members there at 6 AM train-no cutting edge stuff going on, just a hand full of people (men and women) generally age 50 or older, who have probably been at it consisently 3-4 mornings a week for years.  They appeared to know each other really well and looked to be working pretty hard on their programs, which at the end of the day is better than 95% of what goes on in the remaining "23 Hours"  or on other "Planets". 

The Seminar  

Since I didn't know my  way directly to the lecture hall, I spied people who looked like they were going to a sports medicine seminar (pretty easy-just look for Under Armor, running shoes, a sports medicine staff t-shirt/polo, someone who is fitter than average, or a combination of the aforementioned.  Vibram 5 fingers are also a dead giveaway.)  Eventually, a very nice couple with a chiropractic practice in Baltimore got me to the lecture hall. 

The best thing about seminars held at a university is the fact that lecture halls are much more amenable than hotel multipurpose rooms.  There are places for laptop power, lighting is more condusive to note taking, and seating is usually more comfortable.  At BSMPG, keynote talks were in larger lecture halls, with breakouts in smaller ones, but facilities were all wonderful.  Registration was seamless, and I was good to go.

Lecture 1-Thomas Myers-Applying the Anatomy Trains Concept to Training

Keynote speaker Thomas Myers, the  author of Anatomy Trains, was up first.  His lecture centered on first defining fascia for the audience (the entire extracellular matrix, or "anything that isn't a cell"), followed by a bit of a tangent on human sociology, anthropology and futurism/ ephemeralization prior to reconeccting  to his main points on "fascial fitness".  

Tom's main points touched on the biology and biomechanical properties of fascia ("distributes strain along the body", "is the tissue of shape"), a novel definition of fascia ("all collagenous soft tissues"), and  the fact that fascia can contract under certain conditions (which he stated he thought wasn't the case as few as five years ago).  His thoughts on improving "fascial fitness" (which he expanded on in greater detail at Perform Better Providence last June) included the use of whole body/long chain movements with dynamic pre-stretch and counter movement in multiple planes/ vectors.  He also took some time to discuss "Viking" (i.e. stiffer) fascia vs. "acrobat" (more elastic) fascia as well as the need to be patient in making long lasting fascial changes (18-24 months secondary to the long half-life of fascia, "like a Saint Bernard, slowly and loyally following" the training program).

Later that morning, Tom was seated in the lobby, where I asked him a few questions:  1) How many dissections had he done? (20-25 whole body, at a massage school in Denver, with the aid of a colleague "because I am not that good at gross dissection"), 2) Where did he get his education in histology/ cell biology? ("Thirty five years of asking questions, making mistakes, and finding out the answers").  I wanted to see how many patients/clients he saw weekly, but the array of texts and courses he had laid out on the table caught my eye and my attention.  Anatomy Trains is a fantastic text used in the right context, and I look forward to reading his additional works. 

Lecture 2- Ray Eady- Isometrics to Improve Strength and Speed Performance in Female Basketball Athletes

This presentation was a microcosm of why I loved this conference-a topic that was very specific in nature (isometric training) was being covered by a professional who works day to day with the athletes he applied these techniques to (Division 1 female basketball players).  Ray is the strength and conditioning coach for the Wisconsin Badgers women's basketball team and chose to present a topic that isn't really regarded as "sexy" in the strength and conditioning community.  As a physical therapist who utilizes yielding isometrics extensively in my practice, I wasn't going to miss this lecture.

Ray explained his rationale for isometrics in his program (meets criteria for overload, increased maximal contraction, subsequent increase in  strength gains with dynamic movements), methods of training isometrics (yielding, overcoming, reflexive and mixed), and parameters/ guidelines for each.  Triphasic muscle action, with a definitive isometric component that needs to be controlled, can be trained with a progressive, appropriate isometric component-this was the take home message for me.  There were video demonstrations which clarified each concept as well.  Overall, Ray did a great job in disseminating his information and making an impact on the audience.  

Lecture 3-Brian McCormick-Skill Development and the Strength and Conditioning Coach 

Again, a fantastic presentation given by a coach who implements the strategies he spoke about on a day to day basis.  Brian  is a PhD. candidate at the University of Utah in Psychology, is a basketball coach who has extensive knowledge in the motor learning arena;  this is what his talk focused on.  Brian spoke extensively on the task and environmental constraints in jump training as it pertains to female basketball players, and the role of bilateral jump training in a "closed loop" enviroment vs. training in a  more random unilateral fashion, which is more realistic in the context of the basketball competitive enviroment. 

Active learning was encouraged, with small breakouts among attendees.  In true motor learning/ motor control educator fashion, no definitive  cook book answers were given (which was also  the case with my stroke rehabilitation classes in PT school), but acceptance of the fact that "jump stops", jumping, landing, and varied taxonomies of task will continue to be part of basketball (the latter could be said of almost any team sport).  Strategies involvind training the brain to alter feedforward/ anticipatory responses were discussed, and we were encouraged to brainstorm drills and progressions for jump training that took into account the randomness of basketball sport performance. 

I can't tell you how much I enjoyed Brain's presentation.  Not the type of information you would typically hear at the majority of conferences, but about as sport specific as you can get.  After the lecture, Brian and I spoke occasionally over the course of the weekend, comparing notes from other presentations, as  they pertained to jump training, pressure mapping as well as the role of absolute/ relative and single leg/ bilateral lower extremity strength to jump performance.  The fact that presenters were willing to spend time with participants throughout the two days  was really refreshing, and my interaction with Brian was a prime example of that.   

Lecture 4-Paul Canavan-ACL Injuty Prevention: A New Paradigm for Effective Intervention   

Paul is a physical therapist, athletic trainer, researcher, professor and clinician-just the mix you want when looking at this topic.    Paul broke his talk down into incidence/ prevalence of ACL injury (3 of the 4 sports with the highest rates are women's sports; no surprise here), mechanism of injury,assessments/ interventions and future models of prevention .  One interesting note Paul made was shoe-surface interaction as a risk for increasing ACL injury.  I know what you are thinking-1980's turf shoe (with the silly little nubs) correlated to knee injury on  crappy Astroturf-but he actually noted increased ACL injury in a Division 1 wrestling program when new mats and new shoes were simultaneously introduced.  He also spoke of this in basketball, particularly when gym floors were re-surfaces with polyurethane.

Paul's talk made points that dovetailed with Brian's lecture-the ability to land from a jump in varied ways and in different circumstances was key, as was avoiding valgus (knocked) knees when landing from a jump, as this correlated higher to not only ACL strain, but lateral tibial/ femoral cartilage strain.  From a motor control perspective, Paul spoke of a time window of 100 milliseconds to react to a pertubation stimulus (loss of balance, unanticipated change of position, ect), but only 60-90 milliseconds for injury to occur; a 30-40% delay of our neuromuscular system's ability to stave off  serious injury.  Training for prevention should include reflexive activities to close this gap.  Paul cited Muhammad Ali's jab , which fell in that  60 millisecond window, as an example of how we do have the ability to train reflexively and close the window between these two time frames. 

I spoke with Paul afterward, briefly discussing patellofemoral issues post ACL surgery, as well as a  different return to sport paradigm I am working on based on complications I have seen over the past few years in ACL reconstructed athletes.  Paul was great- a really soft spoken "details" guy (you can't be a PhD or researcher without being a details guy), who gave me some good feedback with regard to my theories in returning to sport after ACL reconstruction.  Another worthwhile session on the first day. 

Lecture 5-Clare Frank-Muscle Balance and Dynamic Stability

The second keynote speaker, Clare Frank, a physical therapist who is on faculty with the Prague School of Manual Medicine, and the co-author of  "Assessment and Treatment of Muscle Imbalance:  The Janda Approach"  was highly anticipated by those of us who were rehabilitation specialists.  Clare's lecture was broad based, comparing and contrasting structural (generally skeletal/ ligamentous) and functional (neuromuscular/ sensoy motor) stability.  She gave an excellent overview of the Prague School/Janda approach, talking about the importance of static stabilization required for dynamic activities that starts at the subconscious level,  and the fact that we can lose these abilities as we go through life. 

Clare also touched on "muscle sling" coordination, lumbopelvic stabilization and co-activation.  She also spoke on tonic and phasic muscular control, tying this to acquired muscle imbalances and CNS adaptations.  Of course, a review of "upper crossed" and "lower crossed" syndromes, of which many participants were familliar, were covered as well.  Clare tied both of these syndromes to her DNS (Dynamic Neuromuscular Stabilzation) approach to treatment, which trains the brain to maintain central control and movement stability, prior to engaging in more dynamic movement patterns.  This was particularly applicable to my practice, as most of my patients have some level of superficial/ global muscular inhibition, which manifests into mobility/weakness (as well as pain) issues and ultimately limits their movement/ functional abilities.

The day before, I had observed Clare working with one of my employees attending the conference at Cressey Performance. She utilized manual therapy, drills to activate phasic musculature, and stretching in combination, all of which helped improve his  pain free shoulder mobility.  I spoke with her before and during the conference about private practice, continuing education, and treating international athletes. Clare  was extremely affable and willing to share information, just as were all presenters this day.  

Closing out day 1 was an informal happy hour at a local pub.  It was surreal to see Shirley Sahrmann at a bar hanging out like a college kid ( but not quite as surreal as seeing James Hetfield from Metallica  poolside at a Disney resort-another story for another day).  A great end to a really good day.

In part two, I will cover the remaining presentations- vastly different than what I saw on day one, but just as excellent.