Ten Random Thoughts - A sports medicine salad - cATalyzing Coaching & Consulting

Ten Random Thoughts: dropping sports medicine knowledge for a variety of medical and rehab professionals, as well as some general thoughts deep from the mind of a passionate certified athletic trainer and strength coach. Rather than focus on one thing, I’ll give you a little taste of a number of topics – some quick usable tips. Always able to expand on them in a later blog if requested!

I love working in a human service profession. It’s extremely rewarding seeing those I work with succeed in achieving their goals. Their successes (or learning from our failures, leading to future successes) make me want to continually get better at what I do every day.
Think “heel lift“ when dealing with calf strains, achilles problems, and knee hyperextension injuries. In the knee, the lift limits end-range knee extension during the stance phase of gait, and in the ankle the lift limits the amount of active dorsiflexion that the ankle has to go through, also during stance phase of gait. A small amount of lift can do wonders – 3/8″ to 1/2″ should do the job. Be sure to do it bilaterally as well, even if pain is only on one side, in order to keep leg length and hip position equal R and L. Once the acute inflammation phase passes, remove the lifts and continue your rehab program.
6-sided core approach: When developing a core stability program, think “6-sided” to avoid missing key components of stability (and work each component equally): Anterior (planks), Lateral right (right side plank with leg lift), Lateral left (same as previous but on the left), posterior (bridging), rotational (tubing chops), and anti-rotational (split stance anti-rotation with tubing). With all of these use slow, controlled high-rep/long duration sets (except for when working on power) with a focus on technique.
Your friendly neighborhood vasoconstrictor: Nasal spray (i.e. Afrin) is great for slowing nose bleeds (don’t spray directly into the nose – put some on the nose plug or guaze before inserting it into the nostril) or pesky bleeding cuts (saturate gauze, place over cut with moderate pressure, and use a light “massaging” motion to stimulate clotting). Additionally, “Cover-roll”/Omnifix is an excellent bandage to assist clotting, especially with cuts on the face. In addition to being hypoallergenic and elastic properties that hold the cut closed, something about the fabric matrix seems to promote faster clotting!
We Are! (Sorry lost my focus for a moment. There’s a sold-out homecoming WHITEOUT against THEM this weekend that I’m mentally preparing for)…Penn State!
Exam gloves = better grip: If you are ever in a situation when it is indicated to relocate a finger (of course, only if a fracture is not suspected, and professionally it is appropriate!), here’s a tip to help assist it back into place. Wear an exam glove (only buy non-latex JUST IN CASE you come across someone with an allergy) to improve grip, especially when their hand/fingers are sweaty.
Quick concussion evaluation tool: One quick test I perform during all of my concussion evaluations is what I call the “eye tracking series”. In this order: a) stationary head, finger pursuit all directions (L, R, Up, Down, both diags, convergence); b) stationary head saccade – eyes move back and forth quickly between two points (I hold my pointer fingers out to each side as focus points, then repeat up and down); c) stationary head fast pursuit (fast random finger movements, can both eyes keep up with the finger?); d) shaking head side to side while tracking finger; e) shaking head up and down while tracking finger; and f) side bending neck back and forth while tracking finger. I only move progress from one test to the next if the previous test was asymptomatic (no tracking problems and no increase of symptoms – headache, dizziness, nausea, “have to close eyes”). I can honestly say, since I’ve starting using this, I’ve never had someone pass that entire series acutely and still demonstrate other truly (+) signs of a concussion.
Cue externally! Tons of research is now showing the benefits of coaching/cueing your rehab patients/training clients using externally-focused cues vs. internally-focused cues. External focus (i.e. visual imagery) cueing leads to increased: retention of technique, reaction time, speed of motion, ground reaction forces, joint kinetics, and quality of skills. The physiological reasoning for this is that “internal” or self-focused cues lead to “microchoking” of the motor control processes which regulate movement. Use words that create images, cueing direction, distance, and description (action words or analogies). Your cueing should direct the person’s attention onto the movement of an object and away from the specific body movement (i.e. cue the goal). What you say may sound funny, but you’ll be creating “mental monsters”. Here’s an example: When performing a bird dog exercise, an external cue would be to imagine a cup of hot tea on your back – don’t spill it. Saw an amazing presentation this summer at the Functional Training Summit on this topic by Nick Winkelman. Thanks Nick!
External/Internal Rotation tip: Proper angle is key for rotator cuff internal rotation and external rotation exercises! Wrong pull angles = compensations/cheating/misfiring. The attachment orientation of the internally rotating subscapularis muscle and externally rotating infraspinatus and teres minor are in their ideal alignment position when the humerus is slightly abducted ~ 20-30 degrees. This is why many pros use a towel roll or noodle between the upper arm and body. But when using the roll, are you pulling at the right angle? When performing an internal rotation exercise, the line of pull should be at a downward angle (tubing/cable anchored starting at top of head height, pulling towards navel – about 20-30 deg). For external rotation, it’s the same line of pull, but moving upward and out (I anchor tubing/cable starting at knee height). With this line of pull (instead of straight horizontal as many mistakenly do), and when keeping the elbow at 90 deg flexion, it’s harder to “cheat”, especially as they are fatiguing. Watch closely – is your client truly performing glenohumeral IR/ER, or are they actually performing bicep curls/tricep extenstions or pec flys? Don’t let them get sloppy with technique! As they get better at this, remove the towel roll and see if they can still perform the exercise while maintaining the proper arm position and angle of pull.
Pumped for the Penn State Whiteout. Time to start tailgating.