By Dr. Matt Fontaine

This is the first in a series of articles that will detail a new paradigm in dealing with musculoskeletal injuries.  The first of which will deal with assessing human movement, and highlight the Functional Movement Screen™ and the Selective Functional Movement Assessment (SFMA), developed by Gray Cook and Lee Burton.  The Functional Movement Screen™ is an innovative system used to evaluate movement pattern quality for clients or athletes.

“It has also been recognized that the dysfunctions of muscles and joints are so closely related, the two should be considered a single, inseparable functional unit” Dr. Vladimir Janda

Our nervous system generates normal movement by integrating and orchestrating groups of muscles to produce fundamental movement patterns with an adequate balance of mobility and stability to meet the demands of the task at hand.

The human system will compensate normal patterns of movement in response to pain or in the presence of weakness, tightness, or structural abnormality. Over time, pain alters normal movement patterns, often causing compensation such as limping or guarding to protective injured joints or muscles.   The pain associated with movement often results in as decreased ROM, muscle length changes, and decreased strength.

Gray Cook has said that a limp is visual representation of the body giving up it’s core stability in order to prevent the loading of a painful joint.  Sometimes the body compensates in a less dramatic fashion and the altered movement patterns are more subtle.

The traditional sports medicine model is to look to the pain.  Typical RICE(rest, ice, compression, and elevation) is helpful to control inflammation.  However, using an isolated or regional approach to either evaluation or treatment will not accurately detect the issues that caused the pain, nor restore function. Gray Cook has said repeatedly that functional restoration requires a map of dysfunctional patterns and a working knowledge of functional patterns to gain clinical perspective and design an effective treatment strategy.

Pain-free functional movement for participation in occupation and lifestyle activities is desirable. In order for our body to create proper pain-free functional movements during sport or activities requires adequate posture, full unimpeded range of motion, proper muscle and fascial gliding between soft tissue structures, motor control, and balance reactions.  Impairments in  any of these areas can alter functional movement resulting in or as a consequence of pain.

Utilising the Functional Movement Screen™ and the Selective Functional Movement Assessment (SFMA) allows healthcare professionals to assess key functional movement patterns the body performs and allows the detection of faulty movement, muscle imbalances, and lack of joint mobility and stability.  This information is essential to identify dysfunctional movement. Traditional muscle length, strength, and special tests can be used to help the clinician identify the impairments, which are associated with dysfunctional movement.

By using the Selective Functional Movement Assessment (SFMA) as an approach designed to complement existing exam the practitioner can better detect faulty movement patterns and be much more specific in devising a program therapeutic exercise to help correct the problem or issues. The Functional Movement Screen™ and the Selective Functional Movement Assessment (SFMA) serve as a model to efficiently integrate the concepts of posture, muscle balance and the fundamental patterns of the movement system into musculoskeletal practice. It should also serve as a feedback system for the effectiveness of the therapeutic exercise program, which should target the dysfunctional movement pattern as well as the impairments that have been identified.

Part two will address the approach that should be utilized to properly evaluate and manage muscle and joint pain syndromes.

If your stomach isn’t as flat as you’d like it to be then you have come to the right place. Exercise alone will not get you a toned stomach – diet is a huge part of the equation. Below are 5 very easy tweaks to your eating habits that will dramatically flatten your abs.

Diet Tweak #1: Don’t eat after 6pm
This is such a simple and effective way to lose fat. Late night eating is the most damaging to your waistline, so cut it out completely.

Brush your teeth immediately following dinner. Once your teeth are brushed, you’ve put a period to the end of your consumption for the day.
Change your evening routine. If you’ve always ended your day watching your favorite shows with your hand in the snack bowl, then now is the time to change things up. Find activities that don’t revolve around food and stick with those.
Make it a habit. The first few weeks will be the hardest, but soon your new no-food-after-6pm routine will feel normal.

Diet Tweak #2: Cut back on carbs
Notice I didn’t say to cut out all carbs, but rather to cut back on carbs. These diet tweaks are meant as lifestyle changes that you stick with long term. Cutting back on carbs is a realistic and very effective way to lose weight.

Always choose whole grain bread and pasta over white. Whole grains are less likely to be stored as fat than processed grains.
Eat half of the carbs you normally do. Eat your sandwich open-faced and reduce the size of your pasta serving.
Avoid carb-filled snacks between meals. Instead of crackers or chips, have fresh fruit and veggies.

Diet Tweak #3: Eat more fiber
Most people simply do not get enough fiber in their diets. Fiber is essential when it comes to getting lean since it is low calorie while filling you up.

Instead of seeing salad just as a side item, make salads into meals. Add protein to a large pile of greens for a guiltless meal. *Try the recipe for Grilled Salmon and Peach Salad below.
Make veggies a part of every meal. The benefits of eating more vegetables are too numerous to list, just know that your body will become healthier and leaner with each fibrous bite.
Fruits are a delicious source of fiber. Incorporate fresh, seasonal fruits into your daily diet.

Diet Tweak #4: Drink tons of water
Drinking plenty of water is another extremely simple way to promote weight loss. Chronic dehydration leads to false hunger signals and unnecessary calorie consumption.

Drink a large glass of water before each meal. This will prevent overeating.
Choose water instead of sugar-filled sodas and juices. Sugar-filled drinks are a huge weight-gain trap.
Carry a water bottle with you throughout your day. Keep water in the car and at your desk for constant hydration.

Diet Tweak #5: Enjoy natural sweets
Traditional sugar-filled sweets will quickly add up around your waistline. Instead of going for sugary sweets, enjoy natural sweets.

Fruit is nature’s candy. Reach for sweet, seasonal fruit for dessert.
Avoid foods that contain white sugar or high fructose corn syrup. Consider these items ‘anti-flat-abs’.
Use wholesome sweeteners such as pure maple syrup, brown rice syrup or dates in your recipes instead of white sugar. Eliminate white sugar from your kitchen.
Eating right, coupled with challenging exercise, is the formula for a toned, lean body.

A simple trick we like to incorporate with our marathon runners in training, as well as our elite athletes, is to introduce the use of alternating ice and heat on the lower extremities following a long run, rigorous workout or even an acute soft tissue injury.  This modality  has been popular for years in treating acute injuries, in particular those of the lower extremity.  The theory behind alternating ice and heat, or contrast baths, is to create a “pumping” mechanism of opening up the vasculature (vasodilation) with heat and closing the vasculature (vasoconstriction) with the application of ice.  The protocol can be introduced by alternately submerging the extremity in hot and cold baths, or by simply applying alternating hot and cold packs.  I find both methods sufficiently effective. A standard protocol follows below ( but a modified version with fewer cycles is acceptable as long as we always start with, and end with ice):

-10 min ice followed 10 min heat

-8 min ice then 8 min heat

-6 min ice then 6 min heat

-4 min ice then 4 min heat

-2 min ice then 2 min heat

-End with 1-2 min of ice.

Although the research on this subject is limited and frankly, not very supportive of the efficacy of  alternating ice and heat, I remain a hugh fan of this approach! If heat brings healthy blood into an area, and ice helps to flush out lactic acid and other inflammatory agents, then incorporating both heat and ice will provide both therapeutic benefits.

Traditionally, this approach was thought to be most effective in the sub-acute phase of healing after the inflammation has mostly subsided, but I find the approach more beneficial than ice alone, especially in the acute or early phase of injury.  My only disclaimer is that you may experience some additional soreness initially, but the benefits will quickly follow.

If you are training for a a sport, in particular an endurance sport OR have recently suffered a soft tissue injury, try incorporating the use of alternating heat and ice to flush out lactic acid, speed up recovery and reduced post workout soreness.

I ran the Inaugural Woodrow Wilson Half Marathon this past weekend.  Having trained for a full marathon in the past, I took the challenge of 13 miles a bit lightly.  Although the race went fairly well, my various post race symptoms ranged from soreness through my lower body to an unyielding case of lightheadedness. I was reminded of the 6 Post Race Must Do’s For All Distance Runners:

1.  Re-hydrate: This is an obvious one.  What may not be as obvious is that your re-hydration must include mineral replenishment.  Most people think of Calcium and Sodium when we talk of minerals, and although these essential minerals are important, the replenishment of Potassium and Magnesium are more critical.  Look for sports drinks that list Potassium and Magnesium high on their list of replacement minerals.

2. Re-Load The Carbs: Most endurance athletes are familiar with the concept of “Carbo-Loading” prior to long distance races.  What often goes overlooked is the need to replenishing your body with carbohydrates after the race.   During exercise the body breaks down glycogen in the liver into glucose, your body then converts glucose into energy. When the liver stores of glycogen run dry, the athlete may experience the effects of “hitting the wall”. Following a race, your body continues to burn up whatever glycogen it can find.  Replenishing with carbs will replenish the glycogen stores.

3.  Ice Bath : I understand that the immediate desire following a race is to take a nice hot shower.  But remember, all of that running and wear and tear has put your body in a full- on state of inflammation.  Ice baths will help to close off the vasculature, and will help to pump the inflammation and lactic acid out of the soft tissue and into the blood stream. It’s not a whole lot of fun, but your body won’t be as sore and you will be thankful you did it.

4.  Foam Roll: Create a mechanical advantage by using a foam roller to gently roll out the knots, adhesions and scar tissue that may have formed in the hamstrings, IT band, quads and calves. Every runner I work with who owns a foam roller swears by it. You will too.

5.  Double Down on You Multivitamins: I recommend you take a another serving of your daily multivitamin and Omega 3 Fatty Acid (fish oils).  If you took them the morning of the race, take another dose, if you forgot to take them before the race, double down after the race. Your body is depleted of important vitamins, yet needs them more than ever immediately following a race or long run.

6.  Schedule your visit with your trusty Massage Therapist or Active Release Technique Specialist. Long periods of running will result in overactive muscles, and overactive muscles will result in injuries of the Joints as well as the other surrounding muscles.  Muscle work 24-48 hours Post Race is not just a special treat for a job well done, it is often the key to a speedier “Post race recovery.”

In a couple of weeks I am heading to Minneapolis to take my Spine certification in Active Release.  I am extremely excited about this particular credential because it will complete my full body training (Upper Extremity, Lower Extremity and Spine) in the Active Release Technique.

Although I have been treating soft tissue syndromes and injuries for quite some time, I continue to find that the more opportunities I have to be around talented practitioners, and practice side by side with them, the more sensitive and precise my diagnostic and treatment skills become.

Of all the populations we treat with ART, runners seem to be the group that are collectively the most sensitive to ART treatments and seem to respond the best. I recently came across a good article written in The Running Times by Tamara Rice Lave, Ph. D.  Dr. Lave represented the U.S. in the marathon at the 2003 IAAF World Track and Field Championships in Paris.

Later this year I will complete the Active Release Certification in Long Nerve Entrapments as well as a Masters Program with the founder of ART, Dr. Michael Leahy.

If you have never been suffering from chronic pain or a nagging injury, I highly recommend seeking the advice of someone certified in Active Release.

Active Release Technique: Athletic Injuries & Carpal Tunnel Syndrome

What should you do if you think you have carpal tunnel syndrome? It is recommended that you identify a provider who is trained in Active Release Technique, ideally one who incorporates a functional rehabilitation program. In order to achieve long-term results, the patient must be instructed on home care and self-care exercises that address how to strengthen weakened muscles as well as how to release the overactive muscles as well.

To read this complete article, please click here.

A young athlete never wants to hear the coach say, “sit out,” or “you’re done for today.” It’s easy for teens to think they are being punished when asked to sit out of a game because of a fall during the last play…a fall that really didn’t seem so bad. But sometimes, it is far from punishment! In fact, sitting out could save your child’s life…when you’re dealing with concussions.
A concussion is a temporary disturbance of brain function, resulting in confusion, amnesia, loss of consciousness, or loss of vision. Other symptoms include headache, dizziness, impaired orientation and difficulty concentrating.
Many coaches, parents, and young players minimize athletic brain injuries. But listen up: IT IS NOT jus t a part of the game! Young athletes should not be encouraged to “be tough” and keep pushing to remain in the game if they have experienced a potential brain trauma. You should always keep in mind that it is very easy for what appears to be a minor injury, to become a very serious injury if a player returns to the game too soon. After sustaining one brain injury, the risk for a second injury is 3 times greater, while the risk for a third injury is 8 times greater. Always, always, always, encourage young athletes to SPEAK UP! Don’t be afraid to tell a coach or another adult about an injury during play.
Keep these steps in mind about how to recognize a concussion:
1) If an athlete loses consciousness, the first step is to remove him/her from the game
2) The level of consciousness is the single most important indicator of the severity of a brain injury
a. A mild concussion may not result in any loss of consciousness
b. A moderate concussion may result in loss of consciousness that lasts 5 minutes or less
c. A severe concussion may result in loss of consciousness that lasts 5 minutes or more
3) Test the memory of the injured player. Loss of memory of events just before the injury and just after the injury is a common occurrence. A loss of memory of anything preceding the injury could be a sign of a more serious concussion.
4) Seek profession medical attention.

http://www.teengrowth.com/index.cfm?action=info_article&ID_article=1213

Let’s talk teens and sports injuries! There are two main types of sports injuries: an acute traumatic injury, and an overuse or chronic injury. An acute traumatic injury involves a trauma from a single blow to an area of the body. They can include any of the following: fractures, strains, sprains, lacerations/cuts, abrasions/scrapes, head/neck/spinal cord injuries, or bruises/contusions. Chronic injuries are the result of repetitive training or overusing an area of the body over time. These can include: stress fractures, tendonitis, growth plate overload, and repetitive motion injuries. Although acute injuries are serious, overuse injuries should not be ignored. Overtime, untreated chronic injuries are sure to get worse.
Now that we know what a sports injury is, let’s discuss prevention. Here are some tips to keep your child safe in any sports season:
1) Insist on a pre-season physical. Make sure your child is in good physical condition before playing any sport.
2) Buy appropriate equipment. Make sure any protective gear fits properly.
3) Warm up. Make sure your child has a thorough 10-15 minute warm-up before beginning any activity. Don’t forget cool down stretches at the end of any activity.
4) Drink lots of water!
5) Don’t allow sick and/or recovering children to play. Keep them at home until he/she is fully recuperated.
6) Most of all, HAVE FUN!

https://www.akronchildrens.org/cms/tips/7af13d5c04c9c9cd/index.html