MikeReinold.com - A Blog for Physical Therapy, Athletic Training, and Sports Medicine

Let’s Try That Again… You Guys Are Better Than That!

noreply@blogger.com (Mike Reinold) — Wed, 04 Nov 2009 11:00:00 +0000

Come on everyone, you guys are better than that! Let’s try this again, in the past 2 days there have been over 1000 visits to this webpage and only 30 votes! That is only 3% of you voting. Sooooo, why don't we try this again…

Every now and then I take a step back from writing articles and other bits of information for my readers to ask a favor in return. I must say it is rare but my loyal readers have always responded favorably! It has been appreciated. I once again ask for your help in exchange for all the quality material that I provide for you and all the other 2800 readers a week!

The current leader only has 119 votes, come on everyone, let’s get past that number this week!

Please click the below icon and vote for me as a top healthcare blogger at Wellsphere.com:

Thanks again,

~Mike

Vote For Me in the 2009 HealthBlogger Awards!

noreply@blogger.com (Mike Reinold) — Mon, 02 Nov 2009 10:00:00 +0000

The current leader only has 119 votes, come on everyone, let’s get past that number this week!

Please click the below icon and vote for me as a top healthcare blogger at Wellsphere.com:

Thanks again,

~Mike

The Best Exercises for the Gluteus Maximus and Gluteus Medius

noreply@blogger.com (Mike Reinold) — Mon, 26 Oct 2009 18:01:00 +0000

In a past article, I discussed assessing and treating dysfunction of the gluteus medius. I reviewed an article from the Journal of Strength and Conditioning Research and the author’s recommendations. Taking this information one step further, a recent article in JOSPT has quantified electromyographic activity of the gluteus maximus and gluteus medius during common exercises. This information is helpful when deciding which exercises to perform in your patients or clients.

Based on the results of this study, we can identify exercises that produce the highest amount of EMG activity.

Gluteus Medius

Side-lying hip abduction – 81%
Single limb squat – 64%
Lateral band walk – 61%
Single-limb deadlift – 58%

Gluteus Maximus

Single-limb squat – 59%
Single-limb deadlift – 59%
Sideways, front, and transverse lunges – 41-49%

In addition to the manuscript, there are good video demonstrations of the exercises and a PowerPoint presentation available at the JOSPT website. When I accessed this, I believe they were all available for free.

Clinical Implications

Based on the results of this article, here are a few things that came to my mind

Side-lying hip abduction should be used in all people needing glut medius strengthening. EMG activity was almost 20% higher than the next exercise.
The single limb squat and single-limb deadlift exercises activated high amounts of EMG activity for both muscles
The clam exercises produced EMG activity between 34-40% for both muscles. While this is low in comparison to other exercises, the authors did not use resistance during testing. I would still use this, especially with a resistance band around the thighs, as am early-stage or activation exercise. The authors also compared clams at 30 degrees and 60 degrees of knee flexion and showed no different in gluteus medius activity.
The lunge exercises produce a moderate amount of EMG activity and are likely good early-stage exercises to progress to prior to the single-leg squat and deadlift exercises

DiStefano, L. (2009). Gluteal Muscle Activation During Common Therapeutic Exercises Journal of Orthopaedic and Sports Physical Therapy DOI: 10.2519/jospt.2009.2796

Identifying Early Signs and Symptoms of Adhesive Capsulitis

noreply@blogger.com (Mike Reinold) — Mon, 19 Oct 2009 10:00:00 +0000

In my opinion, one of the most challenging disorders of the shoulder to properly diagnose during the early stages is adhesive capsulitis, or frozen shoulder. Let me explain that further – once a person has global tightness and loss of motion, this is a pretty easy diagnosis.

But I often wonder if some of our patients with “shoulder pain” but not loss of motion may actually have stage one irritation of the capsule that could develop into adhesive capsulitis.

If we can work with patients during this phase, maybe we can stop the process? Maybe we can prevent severe loss of motion? Unfortunately to date, there has been many anecdotal advice but no consensus on the clinical identifiers or early stage adhesive capsulitis.

A recent article in the Journal of Physical Therapy sought to develop a consensus among a group of experts regarding clinical identifiers for the first stage of adhesive capsulitis (Abstract here or if you are a subscriber of PT you can view full article here) The author’s used the Delphi technique (more information on the Delphi Technique here) to poll a group of experts within the fields of rehabilitation medicine, physical medicine, orthopedic surgery, physical therapy, chiropractic, and osteopathy.

After polling and statistical analysis, the authors report 8 factors that the group agreed upon as being strong clinical indicators of early stage adhesive capsulitis:

There is a strong component of night pain
There is a marked increase in pain with rapid or unguarded movements
It is uncomfortable to lie on the affected shoulder
The patient reports the pain is easily aggravated by movement
The onset is generally in people greater than 35 years old
On examination, there is global loss of active and passive range of motion
On examination, there is pain at the end range of motion
There is a global loss of passive glenohumeral joint movement

These factors were all selected and narrowed down from an original list of 60 items that is included in the manuscript. I thought it was interesting that many of the clinical identifiers that I use did not make the final consensus. For example, none of the below reached consensus:

The onset is generally in people less than 60 years old
The condition more commonly presents in females
There can be an association with diabetes

Perhaps these are stereotypes that I have used in my practice based on past anecdotal advice.

Clinical Implications

The results of this study in no way should be used as strict criteria in the diagnosis of adhesive capsulitis, but may provide some useful guidance during the subjective and objective portions of your exam. I would suggest integrating the above information into your examination.

I always recommend that you carefully exam someone that comes to you with “shoulder pain” to try to identify signs and symptoms of early stage adhesive capsulitis. As we all know, this pathology can have severe complications on the individual’s functional status, anything we can do to identify and prevent the progression would be extremely helpful.

Walmsley S, Rivett DA, & Osmotherly PG (2009). Adhesive capsulitis: establishing consensus on clinical identifiers for stage 1 using the DELPHI technique. Physical therapy, 89 (9), 906-17 PMID: 19589853

Reinold and Cressey Together for Limited Enrollment Seminar – Details and Registration Information Announced

noreply@blogger.com (Mike Reinold) — Mon, 12 Oct 2009 04:01:00 +0000

Eric Cressey and I will be joining forces together for a seminar in November. It will be a one-day, limited enrollment seminar on “Testing, Treating, and Training the Shoulder: From Assessment to High Performance.” The format will be 50/50 split between lecture and lab from Eric and I. This is going to be an amazing experience for all rehabilitation and fitness specialists! Full information below along with a special discount coupon code for my readers for $30 off registration

Testing, Treating, and Training the Shoulder: From Assessment to High Performance

When: Sunday November 15th, 2009. 8:30-5:00 PM. Registration begins promptly at 8:30 AM.
Where: Cressey Performance, 577 Main St., Suite 150, Hudson, MA 01749. Phone: 978-212-2688
Description: This course is designed to present the most recent and state of the art information in the assessment, evaluation, treatment and training of the shoulder. Through lecture presentations, hands-on laboratory sessions, open discussions and problem solving of patient case studies, the attendee will have an opportunity to master new and effective evaluation and treatment techniques based on current scientific evidence. The course is applicable to physical therapists, athletic trainers, strength and conditioning specialists and other rehabilitation and fitness specialists.
Faculty: Michael M. Reinold, PT, DPT, SCS, ATC, CSCS (www.mikereinold.com) and Eric Cressey, MA, CSCS (www.ericcressey.com).
Course Requirements: Lab clothing: tank top or halter-top to expose the shoulder. May bring a mat (or blanket), a pillow and a large towel for lab table.
Objectives: Upon successful completion of this seminar, the participant will learn how to: 1) Demonstrate an understanding of a proper assessment and evaluation sequence for the shoulder; 2) Perform and interpret specific clinical examination tests & maneuvers for the shoulder; 3) Design an effective and appropriate rehabilitation and fitness program based on current clinical and scientific research; 4) Analyze specific exercise techniques and evaluate the exercises’ effectiveness; and 5) Integrate the information presented and formulate a treatment plan for specific patients and clients.
CEUs: This course is eligible for 7 contact hours of continuing education. Certificates of attendance will be provided for all participants and may be used for CEU verification for specific state or organization licensure requirements. AdvancedCEU (P3259) is recognized by the NATA Board of Certification, Inc. to offer continuing education for Certified Athletic Trainers. This course has also been submitted to the NSCA.
Agenda:

8:30	Introduction & Registration
9:00	Assessment / Inefficiency vs. Pathology – The relationship between diagnostics and functional testing
10:00	Physical Examination of Specific Shoulder Pathologies
11:00	Training the Shoulder - Understanding the effect of different pathologies and how to maintain a training effect despite these injuries
12:00	The Scientific & Clinical Rationale Behind Shoulder Exercises: Principles of dynamic stabilization
1:00	Lunch – Provided
2:00	LAB – Assessing movement quality: Glenohumeral total motion, scapular function, thoracic spine mobility, interactions with core and lower extremity function
2:45	LAB – Review of Special Tests to Differentiate Specific Shoulder Pathologies
3:30	LAB – Warm-up protocols, resistance training strategies, and specific techniques
4:15	LAB – Integrating manual techniques and principles of dynamic stability
5:00	Q&A, Wrap-up, Adjourn

Special Offer For My Readers

Enrollment for this seminar is going to limited to assure that lab time is productive. Readers. Normal registration fee is $199 for the seminar but my readers can use the coupon code “Reinold” for $30 off. This coupon is valid this week only and will expire after Friday October 16th. Also,

Register Now

Be sure to register soon as spots are limited and will fill up quickly! Eric will be advertising this on his site today as well and I am sure many of his readers will be trying to obtain a seat for this seminar. Follow the link below (or click here) to register:

Info Coming Monday on My Upcoming Seminar with Eric Cressey…

noreply@blogger.com (Mike Reinold) — Fri, 09 Oct 2009 10:00:00 +0000

Just wanted to give my readers a “heads up” that Eric Cressey and I will be announcing the details for our upcoming seminar in November. We have been mentioning this for a while in our newsletters but have almost finalized planning. It will be a one-day, limited enrollment seminar on “Testing, Treating, and Training the Shoulder: From Assessment to High Performance.” The format will be 50/50 split between lecture and lab from Eric and I. This is going to be an amazing experience for all rehabilitation and fitness specialists!

As always there will be a special discount coupon code for my readers announced on Monday as well. Stay tuned, more info Monday morning on this unique opportunity!

Had to publish this video…

noreply@blogger.com (Mike Reinold) — Thu, 08 Oct 2009 10:00:00 +0000

For those that subscribe to my newsletter, I posted this video in yesterday’s email. I watched it again and again and couldn’t resist sharing this here too! Sorry, a little off topic but funny!

Are you not a subscriber to my newsletter? You are missing out! Get my free newsletter and receive my current Plays of the Week links, videos of the week like the one below, answers to reader questions, and more. Click here to read more benefits, but don’t forget that subscribers get a free copy of my Accelerated Rehabilitation Protocol Following ACL Reconstruction.

Physical Therapy in Sport

noreply@blogger.com (Mike Reinold) — Mon, 05 Oct 2009 10:00:00 +0000

I tend to read a lot of books and journals so I am always on the lookout for new sources of information. A few years ago I learned about a journal called Physical Therapy in Sport. It is published by Elsevier and is the official journal of the Association of Chartered Physiotherapists in Sports Medicine and is officially recognized by the International Federation of Sports Physiotherapy (IFSP). Here is the official description of the journal:

Physical Therapy in Sport is a peer-reviewed journal for all those professionals working in the field of sports medicine. Covering topics dealing with prevention, diagnosis and treatment of musculoskeletal injury in the physically active. Regular features of the journal include:
• Original Papers
• Review Articles
• Case Studies
• Book Reviews
• Student Submissions
• Clinical Tips

Up until recently, it was difficult to find articles from Physical Therapy in Sport unless you were looking on their website, but that has all changed now that the journal is officially indexed in MEDLINE and searchable via PubMed.

This is a big step in the life of a journal and a welcomed addition as the journal has had excellent articles. I am also proud to say that I am on the International Advisory Board for the journal so can say first hand that the review process and quality of submissions is high. I encourage you to visit their website and view some recent table of contents. As a sneak peak, here is the list of 10 most downloaded articles from the journal in 2009:

The effects of proprioceptive exercise and taping on proprioception in subjects with functional ankle instability: A review of the literature
Physical Therapy in Sport, Volume 9, Issue 3, August 2008, Pages 136-147
A systematic review of evidence for anterior cruciate ligament rehabilitation: how much and what type?
Physical Therapy in Sport, Volume 5, Issue 3, August 2004, Pages 125-145
Effects of a plyometric program on vertical landing force and jumping performance in college women
Physical Therapy in Sport, Volume 9, Issue 4, November 2008, Pages 185-192
Identifying SLAP lesions: A meta-analysis of clinical tests and exercise in clinical reasoning
Physical Therapy in Sport, Volume 9, Issue 4, November 2008, Pages 167-176
Alternating hot and cold water immersion for athlete recovery: a review
Physical Therapy in Sport, Volume 5, Issue 1, February 2004, Pages 26-32
Effect of pelvic, hip, and knee position on ankle joint range of motion
Physical Therapy in Sport, Volume 9, Issue 4, November 2008, Pages 202-208
Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis
Physical Therapy in Sport, Volume 10, Issue 1, February 2009, Pages 12-18
Strategies used by physical therapists in the U.S. for treatment and prevention of the female athlete triad
Physical Therapy in Sport, Volume 10, Issue 1, February 2009, Pages 3-11
Eccentric muscle actions: Implications for injury prevention and rehabilitation
Physical Therapy in Sport, Volume 8, Issue 2, May 2007, Pages 88-97
The effect of soft tissue release on delayed onset muscle soreness: A pilot study
Physical Therapy in Sport, Volume 10, Issue 1, February 2009, Pages 19-24

Low Back Savers From Eric Cressey

noreply@blogger.com (Mike Reinold) — Mon, 28 Sep 2009 10:00:00 +0000

As I was going through some articles that I have flagged to read or come back to down the road, I came across a series of articles called “Low Back Savers” by Eric Cressey. I enjoyed these articles and think that you would benefit from them as well. The articles are written predominantly towards the patient as the audience from the point of view of a strength and conditioning coach, but the overall message is great and pulls several theories and concepts together.

Part 1 lists Eric’s recommendations for those with low back pain. Great advice for people looking to take a little bit of the mystery out of low back pain. Lots of advice such as “Recognize that even though you may be asymptomatic, you're probably still a complete structural mess” and “Recognize that you may never get a definitive diagnosis” are recommendations that I give to my patients and athletes all the time.

Part 2 continues with some or Eric’s thoughts and recommendations for those with low back pain, with more emphasis on injuries occur and how joints such as the hip and ankle can impact low back pain.

Part 3 concludes with specific exercise recommendations and lots of video demonstrations. He breaks down some of his thoughts behind unstable surfaces and “core” programs, emphasizing the concept of neutral spine during activities.

In general, the articles are well written and referenced, which is a plus, and provide some valuable information on back pain. I like the simplified approach and always like to take a step back and think broadly about a diverse topic such as this. Although not all recommendations are appropriate for all patients, seems to be perfect for the majority of vague “low back pain” patients that we see, or at least a starting point for others.

Last Day to Register for My Online Course

noreply@blogger.com (Mike Reinold) — Thu, 24 Sep 2009 10:00:00 +0000

First off, thank you for such a great response to my first online course. If you had tried to register for my online continuing education mentorship program on the evaluation and treatment of the shoulder recently, you may have noticed that registration closed briefly as all the spots filled up. Because I received many emails about opening more spots, I am going to open up 5 more spots for today only. After today, registration will officially be closed.

UPDATE: Registration has officially closed, thanks to all those that will be joining me!

If you have registered already, thank you. Please check your email and make sure you “opt-in” to receive notification emails about the course (spam free, I promise). You will receive instructions on how to access the site next week.

How to Write a Journal Article

noreply@blogger.com (Mike Reinold) — Mon, 21 Sep 2009 10:00:00 +0000

Writing and publishing journal articles is challenging, but something that gets better with time and practice. I recently stumbled across a website from Elsevier that has a nice booklet to help get you started in the journal articles writing experience. Looks like a good place to start. Check it out >

Hints and tips on how to write for publication in academic and professional journals

I always encourage clinicians to get involve in more research. We need “clinical based research” just as much as laboratory research. Often times research done by actual clinicians have more implications for changing our clinical approach. It is not hard to get started but can be daunting at first glance.

Other resources include the Research section of the APTA and the following two books, both provide valuable information to get started:

My Online Continuing Education Mentorship Program Now Open for Registration

noreply@blogger.com (Mike Reinold) — Mon, 14 Sep 2009 10:00:00 +0000

My online continuing education mentorship program on the Recent Advances in Evidence Based Evaluation & Treatment of the Shoulder is now available for registration! It is going to be a 6-week long program beginning in early October. I’m excited to begin this program and take a leap into a new format of continuing education where I can lead you through some of my presentations and the evidence from the literature. The course will be highly interactive between myself and with all of the other participants – you can be as involved as you would like, but the more we interact the better the experience. The best part is that you can do this when ever and where ever you want, it doesn't matter what time zone or even country you are in, you participate when it is convenient to you.

Below are all the details of the program. Be sure to register soon as space is going to be very limited for this first run of the program. I want to assure that this is an intimate learning experience for us all. You can register beginning today and up until the start date of 10/5/09. At that time registration will be closed and the program will begin. But don’t delay as I am limiting enrollment. Don’t worry, I will still be posting on this website and sending out newsletters during the course of this program.

View my welcome video from the introductory week of the program for a preview of what’s to come:

Benefits of the Program

Participate and learn from the comfort of your home or office
Proceed at your own pace when convenient to you - before work, at lunch, in the evening, maybe all three! – it’s your choice.
Eliminate travel costs and don’t lose an entire weekend by attending a live seminar
Enjoy weekly online presentations and read journal articles hand selected to outline evidence based practice
Engage in group discussion with Mike and other participants to expand all of our education
Interact with Mike and other participants as much or as little as you would like, your level of participation is voluntary
The program also includes the following for FREE: Download all assigned journal articles and course materials, two of my hour long popular DVDs on examination and treatment of the shoulder with Kevin Wilk, access to my webinar on rehabilitation following rotator cuff repair

Click the button below to register now or continue reading for more information. IMPORTANT - PLEASE NOTE: When registering, the email address you provide will be used to access the program’s website and two DVDs will be mailed to the shipping address that you provide, please assure that this information is correct. Please check your email after registering for important information.

Recent Advances in Evidence Based Evaluation & Treatment of the Shoulder

Course Dates: October 5^th – November 22^nd 2009 – 6 weeks and 1 introductory week

Course Description

This course is designed to present to the clinician the most recent and state of the art information in the evaluation and treatment of selected shoulder disorders. The course was developed to provide the most pertinent information regarding the treatment of these pathologies based on current scientific evidence. The scientific and clinical rationale behind shoulder examination and treatment techniques will be discussed for rotator cuff injuries, shoulder instability, labral lesions, and the stiff shoulder using a combination of online video presentations, DVDs, journal articles, and group discussions. Participants will be able to interact through group discussion boards, periodic live interactive webinars, and email.

Course Objectives

At the successful completion of these courses the participant will be able to:

Demonstrate an understanding of the evaluation and treatment of the shoulder;
Recognize the pathomechanics of various shoulder injuries and possible tissue injury;
Interpret specific clinical examination tests & maneuvers for the shoulder;
Design an effective and appropriate rehabilitation program based on current clinical and scientific research;
Analyze specific exercise techniques and evaluate the exercises’ effectiveness;
Integrate the information presented and formulate a treatment plan for rotator cuff injuries, instability, labral lesions, and the stiff shoulder.

Requirements

This program is applicable to physical therapists, occupational therapists, assistants, athletic trainers, strength and conditioning specialists, and other orthopedic, sports medicine, rehabilitation, and fitness specialists.

There will be opportunity for live interaction through webinars, however the course work associated with the program is not live and can be done at any time. The discussion boards will take place over the course of each lesson week. Thus, there are no restrictions on what time zone or country you are in to participate.

This website and all materials are accessible by any computer connected to the internet through a variety of internet browsers. It is highly recommended that you access this course with a high-speed internet connection as the resources involved often have streaming video and large file sizes.

This website is password protected, you will need a Google account to access this site. Google accounts are free and information will be sent after you register.
Most videos will be embedded into the website for you to view with your standard web browser.
Clear instructions will be provided

Course Schedule

This course contains 6 weeks plus an introductory week. Each week, a topic will be selected for review through online videos, book, and journal article reading. A discussion of the week’s material will take place online. The schedule includes:

10/5/09 - Introduction
10/12/09 - Evaluation of the Shoulder
10/19/09 - The scientific and clinical rationale behind shoulder exercises: Principles of dynamic stability
10/26/09 - Rotator Cuff
11/2/09 - Shoulder Instability
11/9/09 - Superior Glenoid Labral (SLAP) Lesions
11/16/09 - The Stiff Shoulder

Course Assignments

Weekly assignments will proceed based off the main schedule of the program. Each week, participants will be given assignments to watch or read, including online video presentations, DVDs, and journal articles relevant to the specific week’s topic.

Group Discussion

After viewing and reading each week’s assignments. Participants will answer and discuss a select group of questions pertaining to the weekly assignments. These questions will help assist the participant to interpret the information within the assignments and apply the information to clinical practice. These discussion can take place throughout the week so it doesn’t matter where you are located and what time zone you are in!

Interactivity

Throughout the course of this program, I will be available for questions, discussions, and other interactions through group discussion boards, email, and periodic live webcasts. There will also be an open forum for participants to ask questions, discuss their own topics, and to present specific case studies.

CEU Information

This course contains 21 contact hours (3 hours per week) through the Advanced Continuing Education Institute. You will be provided a CEU certificate at the conclusion of the course which you may submit to your licensing or credentialing authority. All the necessary information will be available for you to submit the information. I am in the process of submitting this for CEU approval but can not guarantee that approval will be available for this first run of the program. Because this is a hybrid interactive/self-paced course, it is new to the CEU approval boards. I do not anticipate this to be a problem in the future but those participating this first time may or may not receive approval.

Pricing

The program is the equivalent of a 21 contact hour CEU course and will cost $350 for the 6-week program. This is a fraction of the price you would be for the length of the course, plus will include $185 worth of DVDs and webinars from AdvancedCEU.com and all the necessary journal articles. I wanted to keep the course price low, but also wanted to throw in a lot of extra goodies to enhance the experience. You will receive the following:

Full access to the website and ability to download course materials
The DVD “Clinical Examination of the Shoulder” by Kevin Wilk and Michael Reinold from AdvancedCEU.com. This is a $79.99 value.
The DVD “Treatment of the Shoulder Joint Complex: Principles of Dynamic Stabilization” by Kevin Wilk and Michael Reinold from AdvancedCEU.com. This is a $79.99 value.
These DVD’s will be mailed to you prior to the program
Access to my webinar on “Rehabilitation following Arthroscopic Rotator Cuff Repair” from AdvancedCEU.com. This is a $25 value.
All the assigned reading journal articles will be included and available for download. I am submitting for copyright permission to reprint these. There is cost and time involved in this process.

Thanks for your interest and I look forward to seeing you in the program. Click the button below to reserve your spot now! Spaces are going to be extremely limited to assure this is an intimate experience.

Celebrating 1 Year!

noreply@blogger.com (Mike Reinold) — Thu, 10 Sep 2009 10:00:00 +0000

Wow, time flies! I’m a little late with this, but realized that the one year anniversary of this site was last month - happy belated birthday! We’ve come a long way since the first article that I posted on 8/15/08.

I always like to take the time to thank my readers as this site continues to grow. When I first started this site I had no idea if anyone but myself would actually read the site, but I am glad you did. My goal always has been to provide quality information to improve how we all care for our patients, clients, and athletes. I hope you have enjoyed, I know I have. It has been a pleasure running this site and I have really enjoyed interacting with you all - the discussion have been great.

Here are some highlights of the past year:

Over 130 posts – that’s over 2 a week on average.
Almost 85,000 visitors
Over 800 subscribers and 1000 followers on Twitter.
Over 500 subscribers to my free newsletter and that is only be happening for a month. (Which reminds me, why aren’t you a subscriber yet? Fill in the box in the top right of this page to subscribe.)
Visitors from over 98 different countries. I have to admit that I had to google how many countries there were, 98 is over half! While the vast majority of visitors are from the US, Canada, UK, and Australia, thanks still goes out to that one person from Bangladesh and another from Zimbabwe! You two must be on the cutting edge as the only people that read my site in your countries!
Over the last year introduce Twitter and Facebook pages, a free newsletter, live webinars, and an online continuing education mentorship.

Speaking of the online mentorship, expect a special announcement with all the details on registering on Monday!

And what better way to celebrate a birthday than a funny birthday blooper video (my favorite is at 0:58, mute your computer or you’ll be humming that stupid Happy Birthday song to yourself all day like myself:

Thanks again, let’s have another great year,

Mike

Photo by Pink Sherbet Photography

Clinical Examination for Meniscus

noreply@blogger.com (Mike Reinold) — Mon, 07 Sep 2009 10:00:00 +0000

Today’s post is a review of a recent meta-analysis looking at the accuracy of clinical tests for meniscal lesions from our friend Dan Lorenz, MS, PT, ATC/L, CSCS.

RESEARCH UPDATE: Clinical Tests for Meniscal Lesions

Dan Lorenz, MS, PT, ATC/L, CSCS

It has been estimated that approximately 27% of all outpatient physical therapy visits are for knee pain.¹ Of the many possible lesions causing pain, one common source is from a meniscal lesion. Recently, Meserve et al2 did a meta-analysis summarizing the accuracy of clinical tests for assessing meniscal lesions of the knee. Previous researchers have performed meta-analyses on clinical tests for meniscus tear, but failed to account for the variability and in test sensitivity and specificity due to differences in methodological quality among the studies.^3-5 Because of that, diagnostic accuracy could be skewed. Clinicians should select tests with the highest sensitivity or negative likelihood ratio to rule out meniscal injury, or conversely, rule in meniscal injury with tests having high specificity or positive likelihood ratios.¹ The purpose of this update is to provide a synopsis of what was found in their review.

Eleven studies satisfied the authors criteria of sixty-four total considered for potential review. Joint line tenderness, Apley’s, and McMurray’s were reviewed based on them being the most common tests utilized. Ege’s and Thessaly tests were also evaluated, but the quality of the studies was not good based on small sample sizes. Of note, diagnostic tests findings were interpreted without considering whether the lateral or medial meniscus was torn.

The researchers ultimately found that:

Joint line tenderness was found to be the superior test in terms of sensitivity, followed by the McMurray’s and then Apley’s.
Specificity values were larger with Apley’s compared to joint line tenderness and McMurray’s.
Ege’s Test and the Thessaly Test,^6-7 tests that have either compression with weight bearing or clinician-applied axial rotation, were found to have the strongest diagnostic accuracy, but with smaller samples in the studies.

Based on this review, like any other special test used clinically, a combination of a thorough history along with a physical exam will help the clinician differentially diagnose conditions that are presented to them. As with many other tests used for other pathologies, it appears that using several tests to detect meniscal lesions is supported by the literature.

EDITOR’S NOTE: The results are interesting and clinically applicable. Anecdotally, I have always observed that joint line pain and pain with deep knee flexion, either with weightbearing or passively, where the most indicative of meniscal pathology in my hands. Conversely, passively extending the knee into hyperextension seems to be uncomfortable in patients with anterior horn tears. One test that just doesn’t seem to work well for me is the Apley’s test. Sounds like the test may still useful as the specificity is high. What has your experience been? What other tests you feel are helpful in detecting a meniscal lesion? Thanks for the review Dan.

References

Jette AM, Delitto A. Physical therapy treatment choices for musculoskeletal impairments. Phys Ther. 1997; 77: 145-54.
Meserve BB, Cleland JA, Boucher TR. A meta-analysis examining clinical test utilities for assessing meniscal injury. Clinical Rehabilitation. 2008; 22: 143-161.
Jackson JL, O’Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003; 139: 575-88.
Scholten RJ, Deville WL, Opstelten W, et al. Accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. J Fam Pract. 2001; 50: 938-44.
Solomon DH, Simel DL, Bates DW, et al. The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA. 2001; 286: 1610-20.
Akseki D, Ozcan O, Boya H, et al. A new weight bearing meniscal test and a comparison with McMurray’s test and joint line tenderness. Arthroscopy. 2004; 20: 951-58.
Karachalios T, Hantes M, Zibis AH, et al. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am. 2005; 87: 955-62.

Meserve BB, Cleland JA, & Boucher TR (2008). A meta-analysis examining clinical test utilities for assessing meniscal injury. Clinical rehabilitation, 22 (2), 143-61 PMID: 18212035

ACL Reconstruction Rehabilitation Protocol

noreply@blogger.com (Mike Reinold) — Thu, 03 Sep 2009 10:00:00 +0000

Rehabilitation following Anterior Cruciate Ligament Reconstruction (ACL) continues to be a exciting and popular topic in orthopedics and sports medicine. Just pick up any journal and you are bound to find at least one article of the ACL in each issue!

Over the past decade, Kevin Wilk, James Andrews, and I have continuously adapted and expanded our preferred treatment guidelines following ACL reconstruction. Kevin has published many classic manuscripts on the topic and we collectively have presented our treatment program several times, including the below journal articles:

Wilk KE, Reinold MM, Hooks TR. Rehabilitation following isolated and combined anterior cruciate ligament reconstruction. Orthopedic Clinics of North America; 34(1):107-138, 2003.
Reinold MM, Carter CC, Wilk KE. The evolving rehab of the ACL: Accelerating the postoperative rehabilitation program. Sports Medicine Update 15(4):24-31, 2002.
Wilk KE, Arrigo CA, Andrews JR, Clancy WG: Rehabilitation following ACL reconstruction in the female athlete. J Ath Train, 34(2):177-193, 1999
Wilk KE, Andrews JR: Current concepts in the treatment of anterior cruciate ligament disruption. J Orthop Sports Phys Ther 15(6):279-294, 1992

Since these publications, Kevin and I have continued to advance our rehabilitation protocol. I am pleased to announce that we have officially just released our latest protocol for Accelerated Rehabilitation Following ACL Reconstruction.

Get our latest version of the Accelerated Rehabilitation Following ACL Reconstruction Protocol for FREE!

Sign up for my free newsletter and you will automatically receive a free copy of this extremely popular rehabilitation protocol. In addition, you will be added to my free newsletter list and receive periodic newsletters filled with even more great content than I could possibly post on this website alone! I also tend to have exclusive special offers and announcements (like this one), available only to newsletter subscribers. I hate spam as much as you do, you’ll never receive any from me and your email will never be sold. If you are a current subscriber, have no fear, I will include info on how you too can download this protocol as well in an upcoming newsletter.

Use the form below to subscribe and you will receive an email with instructions on how to download the free rehabilitation protocols:

The protocol is among the many protocols included in our brand new 2nd Edition CDs of rehabilitation protocols available from AdvancedCEU.com. These two new CDs are the new versions of our extremely popular knee and shoulder protocol CDs.

The 2nd edition expands on the 1st edition by updating and expanding all the previous protocols PLUS expanding to include the shoulder, elbow, knee, foot, and ankle! The amount of protocols has MORE THAN DOUBLED from the 1st editions!

Visit AdvancedCEU.com for more information on the new 2nd Edition Rehabilitation Protocols and Exercise Programs for the Shoulder, Elbow, Knee, Foot, and Ankle.

Learn more about the new CDs: Rehabilitation Protocols
Click here to buy them now (don’t forget the 10% off coupon “Reinold”): Knee and Shoulder Protocol CD Combo

New Eccentric Exercise For Tennis Elbow

noreply@blogger.com (Mike Reinold) — Mon, 31 Aug 2009 10:00:00 +0000

There was a great discussion after my last post on tennis elbow straps. While the article we discussed dealt with the efficacy of straps, there was some discussion on treatment in general, including the use of eccentric exercises.

A new study presented at this year’s AOSSM meeting looked at the effect of an eccentric exercise using the Thera-Band FlexBar. 81% of patients using this eccentric exercise reported improvement in comparison to only 22% in the control group. Interesting results and worth considering in your patients as the Thera-Band FlexBar is fairly inexpensive and a good home exercise program adjunct (get them here from Amazon for under $20).

One of the researchers involved in the project, Tim Tyler, PT, ATC, has a nice interview regarding the study in this video below:

The injured wrist holds the bar in position as the healthy wrist adds a twist (still not injured wrist movement). Then, the eccentric component is the injured wrist slowly flexing to let the twisted bar release back to normal. Below is a clip of the exercise in action. In this video clip, the injured wrist is the right wrist:

See the full article > AOSSM: Tennis Elbow Eases With Eccentric-Twist-of- Wrist Exercise

Buy a Flex-Bar here and try it yourself > Thera-Band FlexBar from Amazon

Concussions in Sport Consensus

noreply@blogger.com (Mike Reinold) — Thu, 27 Aug 2009 10:00:00 +0000

There is an excellent article in the Journal of Athletic Training on concussions in sports. The article is a consensus statement from the 3rd International Conference on Concussion in Sport held in Zurich in November of 2008. The article reviews the evaluation, treatment, and return to play guidelines following a concussion in a very detailed but to the point manner.

The article also concludes with the inclusion of the SCAT2 (Sport Concussion Assessment Tool 2) that is recommended for use. The tool looks great and is something that I am going to implement in my athletes.

Best part of the Journal of Athletic Training is that the article is free to download (I have no idea how long it will be free):

Download now > Consensus Statement on Concussions in Sport

Online Continuing Education Webinars

noreply@blogger.com (Mike Reinold) — Mon, 24 Aug 2009 10:00:00 +0000

As many of you know, I have started to present more webinars over the last several months. My travel schedule currently prohibits me from speaking at as many meetings and conducting continuing education seminars as I would like. This led me to develop the webinar technology to be able to present over the internet live for anyone to view from the comfort of their computer at home or the office. I enjoy the ability to interact with people during the live Q&A sessions from a distance, I believe this is the future of continuing education for our professions.

This really has been a lot of fun and I will continue to periodically conduct a webinar. I will post an announcement of future webinars here first so please check back, next one will likely be at the end of September.

Many have joined me for my live webinars but don’t forget that the live webinars are recorded and available for download from AdvancedCEU.com if you missed them. Be sure to check them out.

Current Webinars Available:

Click here to view more info and a video demonstration of my physical therapy online education webinars.

Cheap PlyoBacks and Medicine Balls

noreply@blogger.com (Mike Reinold) — Thu, 20 Aug 2009 10:00:00 +0000

I just received an email from Exertools with many great sales offers for the month of August. I use most of these products (the 2# blue soft shell Exball is my favorite!) and these are pretty good sale prices, thought it would be worth sharing (I am not affiliated with Exertools). Not bad if your clinic is looking to upgrade it’s PlyoBack or needs some medicine balls. Looks like it is just an August sale, not sure how long these coupons will last. Check it out below >

Terms & Conditions From Exertools:

All promotions and offers are only limited to the selected items mentioned in this newsletter.
Offers may not be combined with other promotional offers or discounts. Offer not applicable to previous orders.
Price, availability and terms of offers are subject to change without notice. Taxes and shipping charges, if applicable, are not shown.
Exertools is not responsible for pricing, typographical or other errors in this newsletter.
Exertools wants to protect your security and privacy. Be assured that we will never ask for personal information in newsletter. If you receive such a request, please do not respond to that E-mail. Please see our Privacy Policy for details.

Is Throwing a Curveball Dangerous to our Youth Baseball Pitchers?

noreply@blogger.com (Mike Reinold) — Mon, 17 Aug 2009 10:00:00 +0000

Over the last few weeks, there has been some debate regarding the release of two recent studies that showed that curveballs may not be as damaging to our youth baseball pitchers as we had once thought.

I tried to let this die down a bit before discussing it, as the general press really picked up on this and started a debate with absolutely no medical background. The New York Times discussed this recently and I even saw a couple of sportscasters on ESPN discussing this on TV. A lot of people have flat out disagreed with these studies, but consider the following:

Both studies, from two different institutions here and here from AJSM in 2008 and 2009, showed that the curveball does not increase force on the throwing arm in comparison to a fastball. One of these studies was from the prestigious American Sports Medicine Institute who were the leaders in learned the majority of what we know about throwing mechanics.
Notice how they don’t say that throwing a curveball is safe or does not cause injuries.

These are simply biomechanical studies. But lets take a step back and think about this, maybe they are right. Maybe curveballs are safe? Consider the argument from the perspective of the scientist, clinician, pitching coach, and the player:

Pitching is really just a physics equation, force = mass x acceleration, right? Force = injury. So if the mass of the ball and the acceleration of the arm are similar, why would we expect force to be higher? This is purely the scientific thought process. Taking this to the next step, the angular velocity of the arm during a curveball is slower than a fastball, hence the studies that show lower force on the body.
Clinically, I would say that because the forearm position is different between the curveball and fastball, that there could be consequences. The static stabilizers (the bones, joint, and ligaments) are the same, but alter the forearm position alters the position of the forearm muscles and potentially decreases the mechanical advantage of the dynamic stabilizers (the muscles) to protect the elbow. So the curveball will have the same force, yes, but may be less able to stabilize to protect the arm. This may increase the incidence of injury.
The next thing to consider is youth mechanics. My bet would be that if we studied this, there would many youth that are not taught the correct mechanics to throw a curveball, this would certainly increase injury risk.
From the player perspective, one thing is certain: A Little League pitcher that can throw an effective curveball is going to be good, they are going to then throw a lot, and they have a high chance of being abused. It has been proven in a couple of other studies here and here that one of the highest predictors of injury in Little League pitchers is the amount of pitching that they perform, or they abuse that they endure.

I think it is definitely still a good recommendation to limit the development of a curveball in our youth baseball players, I would still say that pitchers who throw a curveball are more susceptible to injury due to the above rationale, but the curveball itself may not be as evil as once thought.

Bottom line, teach your kids how to throw an effective fastball and changeup and stick to the recommended pitch count restrictions in youth baseball. Locating strikes and changing speeds will be just as effective in Little League baseball and a changeup has actually been show to be LESS forceful on the throwing arm. As they mature, both physically and mechanically, learn to develop more advanced pitching.

Dr. Andrews summarized this best in the NY Times article:

“It may do more harm than good — quote me on that,” Andrews said during an interview in his Birmingham clinic. He fears that parents and coaches may interpret the findings improperly, as a license to teach kids to throw too many curves or begin when they are too young. “There are still some unknown questions.”

Photo by Wildernice

Dun S, Loftice J, Fleisig GS, Kingsley D, & Andrews JR (2008). A biomechanical comparison of youth baseball pitches: is the curveball potentially harmful? The American journal of sports medicine, 36 (4), 686-92 PMID: 18055920

Thanks for Your Help with the Survey

noreply@blogger.com (Mike Reinold) — Fri, 14 Aug 2009 10:00:00 +0000

Wow, thanks for the great response to the survey I posted yesterday on everyone’s interest in an online clinical education mentorship program. The response and comments were great. I read through them quickly and agree with all the comments, I should be able to accommodate everyone’s thoughts.

I’ll leave the survey open for another week so if you haven't yet, read about my upcoming online continuing education mentorship or jump straight to the 30-second survey, thanks!

Also, don't forget that the 20% deal for all products at AdvancedCEU.com expires at the end of this weekend. Read about our new 2nd edition version of our rehabilitation protocols that were just released.

Have a great weekend and thanks again,

My New Online Continuing Education Mentorship

noreply@blogger.com (Mike Reinold) — Thu, 13 Aug 2009 10:00:00 +0000

Wow, I am really excited about this and think you will be too… I am pleased to announce that I will be starting a private online continuing education mentorship program this fall. The program will be a several week course covering the Recent Advances in the Treatment of the Shoulder. If all goes well I will expand out to other courses in the future as well, but this will be a great beginning

I have a HUGE favor to ask of you at the end of this post, so please keep reading all the way to the bottom!

What is an Online Continuing Education Mentorship?

My online continuing education mentorship will be a several week long online course. If you are familiar with distance learning programs, such as those for some graduate degrees, it is very similar. Over the course of several weeks, we will cover various topics related to the treatment of the shoulder, basically everything you would get during a live course plus MORE. I will guide you through a series of my presentations and journal articles to enhance your understanding and care of the shoulder. During the program you will:

Enjoy weekly topics of information following a scheduled outline.
View a weekly video presentation (~1 hour a week). This will be a presentation that I narrate and you watch.
Read a few assigned journal articles or book chapters (~3 a week). These will be provided and be related to the topic of the week.
Answer and discuss a weekly group of questions that I pose regarding the assignments for the week. Everyone will answer a few questions that I pose to stir discussion of the topic. As each participant answers, others are encourage to respond and discuss each other’s comments.
An open Q&A forum for myself and others to answer and discuss your questions. You will have access to me via the website, email, and even live online webinar chats.
There will also be an area dedicated for you to submit a case study or discuss a difficult patient with myself and the group.

I am currently planning and submitting for CEU approval, I anticipate that you will receive CEU credit very similar to the amount you would receive if you were to take a live weekend seminar.

What are the Benefits of This Program?

I have stated this in the past but I truly believe that the future of continuing education will be web-based. There will always be live seminars as the interactivity and lab components are important, however online education will continue to grow as a source of continuing education.

Online learning at your own pace and in the comfort of your own home enhances the effectiveness and satisfaction from the course and reduces expenses associated with travel.

I anticipate that this is something that you will actually WANT to log into a couple of times a day (maybe at the beginning or work, or during lunch, or in the evening at home) to read and add to the discussion.

I know sometimes my blog can get technical, sorry I like to elaborate! This program is for anyone – PTs, OTs, assistants, ATCs, CSCSs, and any other rehabilitation, sports medicine, and fitness professional. All will enjoy.

I Have a HUGE Favor to Ask of You!

I am asking my many loyal readers to please fill out a 30-second survey regarding your interest in this program. Putting this program together is going to take considerable time and effort on my part, I want to assure that there is adequate interest before I put in all this time.

I promise it will take you 30 seconds or less. In exchange for all the information I have shared and work I have put into this website, please help me by taking this quick and painless survey:

Please click here to take my survey – It will take less than 30-seconds, I promise!

Photo by allaboutgeorge

New Rehabilitation Protocols by Wilk and Reinold

noreply@blogger.com (Mike Reinold) — Mon, 10 Aug 2009 10:00:00 +0000

About a year ago, Kevin Wilk and I decided it was time to update and enhance our rehabilitation protocols. This is a task we are actually continuously doing to some extent as we are always tweaking what we do with our patients. Over the years our rehab protocols have become fairly popular due to their level of detail, comprehensiveness, and overall quality. These are the actual protocols that we use on our own patients every day so are backed by years of experience and based on current research and evidence that we teach in our publications and seminars. You’ve probably seen and used some of them from our journal articles.

New 2nd Edition Rehabilitation Protocols Now Available!

We originally released the1st edition of our rehabilitation protocols for shoulder and knee injuries in 2004. For some reason that doesn’t seem that long ago, and if you asked me back then I would have told you that I thought that we would be taking jet packs to work in the year 2010! Almost six years have passed and we are please to announce the new 2nd edition of our CDs are now available and there are some really exciting additions to the 2nd edition!

What is so exciting about our new protocol CDs?

The number of protocols has more than doubled in the 2nd edition – 139 protocols, exercise programs, and interval sport programs in total!
The shoulder CD has been expanded to include elbow protocols
The knee CD has been expanded to include foot and ankle protocols
All of the original protocols have been updated and enhanced
There are really too many new protocols to list here, but you can see a full list of the protocols and programs available on the CDs from the rehabilitation protocol page at AdvancedCEU.com.

As always, loyal readers deserve something special, and if you have read this far down in this post, you definitely deserve something special! For one week only, from now until the end of the day on Sunday 8/16/09, AdvancedCEU.com is offering my readers 20% of all CDs and DVDs, including the new 2nd edition rehabilitation protocols. Use the coupon code “Reinold20” when checking out.

View more information here > Rehabilitation Protocols by Wilk and Reinold

or Click here to purchase now

Also, there will be an upcoming free version of our Accelerated rehabilitation following ACL reconstruction protocol exclusively to newsletter subscribers so subscribe now for free to not miss out.

Essential Reading List – The Best Physical Therapy, Athletic Training, and Strength and Conditioning Books

noreply@blogger.com (Mike Reinold) — Tue, 04 Aug 2009 13:05:00 +0000

As we have been discussing the last couple of weeks, I wanted to create a comprehensive list of recommended books, sort of a best book or an “Essential Reading List” for physical therapists, athletic trainers, strength and conditioning specialists, and really any other type of rehabilitation specialists. The goal was to include the best books that I felt were influential in my development and clinical practice. To take this one step further, I have been accumulating lists of essential readings and top book recommendations from several leaders, pioneers, and influential clinicians in our fields.

They were all asked to provide a list of recommended books that they felt impacted their career and clinical development, helping to shape their current expertise.

I published several past posts on essential reading lists from experts such as George Davies, Leon Chaitow, Sue Falsone, Eric Cressey, and Ken Crenshaw, all people that I truly admire, respect, and have certainly learned from. Notice that I tried to include people from different disciplines as I believe we can all learn from each other and grow together. If you missed any of them, be sure to view contributions to the The Essential Reading List Series by other expert clinicians:

I always like asking what other people are reading and learning, think of this as a glimpse into the bookcase of myself and other experts! Below is my summary and recommendations for books that I believe are essential reading for every physical therapist, assistant, athletic training, strength and conditioning specialist and other rehabilitation specialists. I hope that there a few new ones on the list that will broaden your perspective and clinical skills.

Best Physical Therapy Books

The following section of books provide overviews on a broad range of topics and, as you can see, build from general musculoskeletal rehab to more advanced orthopedic and sports medicine topics. These should be of interest to all, not just physical therapists, as they provide a great amount of information regarding injuries and treatment that may not otherwise be covered in athletic training or strength and conditioning books:

Pathology and Intervention in Musculoskeletal Rehabilitation – Magee, Zachazewski, Quillen. A very detailed book for such a general topic, a good place to start when learning musculoskeletal rehabilitation.
Clinical Orthopedic Rehabilitation – Brotzman and Wilk. A little more specific to orthopedics than the Magee book above, this book does well at covering a lot of topics.
Physical Rehabilitation of the Injured Athlete - Andrews, Harrelson, Wilk. Good overview book that is now getting more specific to athletes (see the progression of the book so far?).
Sports Medicine (Orthopaedic Surgery Essentials Series) – Schepsis, Busconi. A general overview of many topics related specifically to sports medicine. This series of books does a good job reviewing the broad topics from the perspective of the entire sports medicine team including physicians and rehabilitation specialists.
Therapeutic Exercise: Foundations and Techniques – Kisner & Colby. This is a classic that continues to be revised frequently. Reviews a significant amount of exercise techniques commonly used in rehabilitation. This is one of the first books often included in physical therapy curriculums so may be of benefit to those not in the PT field.

Best Rehabilitation Books – Extremities

After tackling the general rehabilitation topics, many people are then interested in specializing in specific joints. While excellent overviews, the books above are not designed to go into great detail. Consider the list below the next step in becoming more specific and advancing your knowledge with individual joints.

The Athlete's Shoulder – Wilk, Reinold, Andrews. I hate to include my own book, but this truly is the most current and comprehensive resource of the treatment of the shoulder. Covers every imaginable topic related to the shoulder with an excellent list of expert contributors. You won’t be disappointed.
Postsurgical Orthopaedic Sports Rehab Knee & Shoulder - Manske. Dedicated specifically to postoperative treatment, which is often minimized and even overlooked in some books.
Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes – Noyes. This one is about to be hot off the press and released this month. A long overdo book by one of the leading experts in the care of the Knee. This books is going to be a classic. I was fortunate to contribute a chapter and be involved.
Knee Ligament Rehabilitation – Ellenbecker. A great book but I would actually say that the title is a little misleading, I think the book applies to the knee in general as there are chapters dedicated to anatomy, biomechanics, and even patellofemoral that are not specific to “knee ligaments.”
The Athlete’s Elbow – Altchek, Andrews. Discusses the elbow in great detail, however is lacking in rehabilitation
The Elbow in Sport – Ellenbecker. Amazingly, this is one of the few elbow rehabilitation books available. Compliments The Athlete’s Elbow well.
The Elbow and It’s Disorders – Morrey. The authority on the elbow. Very detailed but very dry. Probably only for people truly wanting to specialize in the elbow. That being said, the anatomy and biomechanics chapters are outstanding.
The Shoulder – Rockwood. Similar to above, Rockwood’s classic has been recently updated and can be considered the gold standard in general shoulder books, fantastic but contains information that goes well beyond the needs of a rehabilitation specialist.

Best Rehabilitation Books – Spine

Good spine books are actually hard to come by, which makes the following books even more essential. The first group of books are general overviews, but excellent additions to your library.

Low Back Disorders: Evidence based prevention and rehab – McGill. This one was popular with the other expert’s as well. This is a must have book in the care of the spine. McGill is one of the leading experts in spine rehabilitation. His approach is simple, effective, and backed by evidence.
Ultimate Back Fitness and Performance – McGill. Eric Cressey summed this book up well - “With the prevalence of lower back problems in the general population, all of Dr. McGill’s works are must-reads. I tend to favor this one over Low Back Disorders because it’s updated more frequently (third edition, now), and places a big emphasis on prevention and not just treatment.”
Rehabilitation of the Spine: A practitioner’s Manual – Liebenson. Another popular book among the other contributors. As Leon Chaitow describes - “As a young chiropractic student, Craig Liebenson, was responsible for bringing Janda, Lewit, and others (including David Simons, Irvin Korr, and extraordinarily for me, myself) to run courses at Los Angeles College of Chiropractic in the 1980’s. He (Liebenson) is now a leader of chiropractic rehabilitation and his book Rehabilitation of the Spine incorporates much that he has synthesized from these sources.”

The next section of spine books are based on popular treatment methods, the names you have heard before like Maitland and McKenzie. I myself am not a subscriber to one specific theory so I actually own all of these books and use what I feel is the best from each. My thought is that an integrated approach is always better than sticking to just one approach, but I am sure that others would disagree.

Manual Therapy - NAGS, SNAGS and MWMS – Mulligan. The book that describes the popular Mulligan techniques. Sue Falsone explains “An easy read that is entertaining and amazingly informative all at the same time. A fantastic manual technique to have in your tool box.” A very simple book and something you can easily integrate into your clinical skill set.
Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy – McKenzie. The McKenize approach is explained in great detail in this 2-volume set. A very common method of treating that is explained well in this book.
Lumbar Spine: Mechanical Diagnosis and Therapy – McKenzie. Another 2-volume set on the McKenzie approach specifically on the lumbar spine. Together this and the previous entry make up a useful series of books on the evaluation and treatment of the spine using the McKenzie method.
Maitland’s Vertebral Manipulation – Maitland. I think this is another misleading title as this book does a great job reviewing the Maitland approach to spine evaluation and treatment. I like this book a lot, very clear and easy to follow and probably one of the better overall books on how to evaluate and treat the spine.
Manual Mobilization of the Joints: The Spine – Kaltenborn. A classic on mobilization of the spine.

Best Clinical Examination Books

Clinical examination books are important tools when attempting to diagnosis an injury. These are often times the most popular books lying around rehabilitation clinics and training rooms.

Orthopaedic Physical Assessment - Magee. George Davies summed this one up well “Still probably the most comprehensive exam book, although not all evidence-based supported.” I couldn't agree more. There is an overwhelming amount of examination techniques. Still the leader but needs to be evidence-based on the next version.
Orthopedic Physical Examination Tests: An Evidence-Based Approach – Cook. Another good examination book. Not as detailed as Magee, but this may be a good thing. Obviously the evidence-based approach is a nice touch as well.
Muscles: Testing and Function with Posture and Pain – Kendall. Eric Cressey sums this up well “This is just a true classic that everyone needs to own – whether you’re working with healthy or injured people (or both). It is one of those books that I continually refer back to when my brain gets rolling and I want to confirm or refute an idea I have.” Sue Falsone adds “A classic. Everyone should own it. Enough said.”

Best Athletic Training Books

The concepts behind the following athletic training based books are probably simplistic at best for an athletic trainer, but for physical therapists and strength and conditioning specialists, these books can come in handy when trying to understand the acute care of athletic injuries.

Principles of Athletic Training – Prentice, Arnheim. This really can be considered the study guide for the NATA board exam. It covers pretty much every aspect of athletic training, and covers it well. A great reference for physical therapists interested in sports and strength coaches and personal trainers working with athletes.
Athletic Taping and Bracing – Perrin. This book goes into more detail than Prentice on actual taping techniques. There are many taping techniques that could be used in the rehabilitation setting as well.

Best Manual Therapy Books

I couldn’t think of the perfect title for this section, so I ended up with just “Manual Therapy.” This is intended to include books that discuss manual therapy and bodywork techniques. This is an area that is not covered well in most physical therapy, athletic training, and strength and conditioning education programs, so to me this is one of the most important sections. I always admit that this was an area that I did not pay attention to early in my career and I regret this. Expand your mind and enhance your clinical skills with the following.

Anatomy Trains – Myers. This book was hand down the most popular among the expert contributors and almost unanimous. I couldn’t agree more. Eric Cressey writes “We all spent a lot of time in school learning all about muscles, tendons, bones, ligaments, and nerves, but nobody ever spent much time talking about how all these structures interact with the fascia system.” Sue Falsone writes “Takes basic anatomy and puts it together in a way that makes you appreciate the unbelievable direct anatomical connection between the foot and the head, along with everything in between.” and Leon Chaitow writes “In the early to mid-1990s I became familiar with the research suggesting a far more active role for fascia than had been previously believed. A leader in that field was Rolfer Tom Myers, who wrote several important articles on the subject for the journal I edit (Journal of Bodywork & Movement Therapies) which were subsequently expanded into his groundbreaking book Anatomy Trains.
Diagnosis and Treatment of Movement Impairment Syndromes – Sarhmann. Both Ken Crenshaw and Eric Cressey recommended this one. Cressey writes “I love Sahrmann’s work because she really makes folks think about movement inefficiencies and not just what the MRI or x-ray says. This book probably influenced my overall thought process more than any other that I’ve read, and is quite possibly the most comprehensive resource available for spotting musculoskeletal dysfunction.”
Clinical Applications of Neuromuscular Techniques: Volume 1 Upper Body – Chaitow, DeLany. I was first introduced to this work of Leon Chaitow by Ken Crenshaw. He was always talking so optimistically about the results he was getting from these techniques so i had to try them out. This is one of my “must haves.” Leon Chaitow describes how the book came about “All these influences – Goldthwait, Korr, Janda, Lewit, Simons, Myers and many others have found there way into my work and writing – with the double volume Clinical Applications of Neuromuscular Techniques : Vol.1 Upper Body and Vol.2 Lower Body, coauthored with Judith Delany; containing a practical synthesis of what I’ve learned from these giants.”
Clinical Applications of Neuromuscular Techniques: Volume 2 Lower Body – Chaitow, DeLany. Volume 2 of this set focuses on the lower body. See above.
Muscle Energy Techniques – Chaitow. One of my favorites from Chaitow. His series of books do such a good job discussing his thoughts and the science behind his techniques. Start with the 2 volume set above and then expand to this book and the next
Positional Release Techniques – Chaitow. Similar to the Muscle Energy book by Chaitow, an excellent job discussing positional release techniques in great detail.
Myofascial Pain and Dysfunction: The trigger point manual – Travell, Simmons. The definitive resource of trigger points. This is an area that we can apply immediately and see noticeable improvements with our patients and clients. Leon Chaitow writes “David Simons collaborative masterpiece with the late Janet Travell was for me, as it is for many people, a resource that continues to amaze and enlighten.
The Sensitive Nervous System – Butler. David Butler’s work in the area of the nervous system has been outstanding. This is to me one of his better books regarding the evaluation of the nervous system and his neurodynamic techniques such as nerve flossing. Leon Chaitow writes “Somewhere in the 90s I became familiar with David Butler’s important research into neural restriction (neurodynamics). His book is a masterpiece of writing about a hugely complex topic in a comprehensible way.”

Best Strength and Conditioning Books

The following books are intended mainly for the strength and conditioning specialists, but as a physical therapist and an athletic trainer, I think these books should be read by all. These are the thoughts that can take your clinical skills to the next level, especially if you want to work with athletes.

Essentials of Strength & Conditioning - NSCA. This provides many excellent concepts of the title which oftentimes physical therapists do not have a real strong back ground. This is the resource our industry uses as the study guide for its “gold standard” certification (CSCS). The book is not without it’s flaws, but is a starting point. Eric Cressey writes “I completely refute a lot of it (particularly the nutrition and periodization stuff, which are grossly outdated, conservative, and lacking in real-world efficacy), but appreciate the fact that it is the minimum someone needs to learn before they even think about train athletes.”
Functional Training for Sport – Boyle. A gem from elite strength and conditioning coach Michael Boyle. A good glimpse inside Michael’s mind when designing programs for athletes.
Core Performance - Verstegen: This books is written more for the general population, which made me hesitate to even include it, but the concepts behind the Athlete’s Performance approach led by Mark Verstegen are worth including. Sue Falsone writes “Sets the foundation for the Athletes’ Performance methodology with professional athletes and how it can be applied to everyone’s life. Focus is on Mindset, Nutrition, Movement and Recovery…a truly integrated system.”
Athletic body in balance – Cook. A popular book by Gray Cook on understanding human movement during sport and functional activities. This book describes his popular functional movement screen that can be useful in evaluating your patients, athletes, and clients. I don’t use the functional movement screen as described but do use some the concepts within. For the strength coaches, I would recommend this to develop your sense of evaluation.

Best Clinical Research Books

I believe that we should all participate in clinical research. We do not have to leave the research to the PhD’s in a lab somewhere, your patients, athletes, and clients are perfect “specimens” to study the efficacy behind many of our techniques. Getting started in research isn’t as hard as it seems, you just need a little direction. Try these books to begin.

Foundations of Clinical Research: Applications to Practice - Portney & Watkins. One of the greatest books on clinical research available. Tough read, though, very detailed but very advanced. Still, a must have for anyone interested in clinical research.
Rehabilitation Research: Principles and Applications – Domholt. Another great one, a little easier to read than Portney & Watkins if you ask me. Try this one if my description to Portney & Watkins scared you off.
SPSS for Dummies – Griffith. That’s right, I included a “dummies” book in this list! Let’s face it, using SPSS to run your stats is hard, lets “dumb” it down.
Writing a Biomedical Research Paper: A Guide to Structure and Style – Budgell. A good overview of how to write a paper, helpful for the novice. It is not that hard but does take practice. Trust me, I review a lot of manuscripts for journals, I wish more people read this book.

View contributions to the The Essential Reading List Series by other expert clinicians:

What do you think? Did I leave out one of your favorites? Reply to this post and let me know, maybe it will make the 2nd edition of this list in the future!

Photo by jamespaullong

Sue Falsone: Essential Reading List

noreply@blogger.com (Mike Reinold) — Thu, 30 Jul 2009 10:00:00 +0000

Our next contributor to the Essential Reading List is Sue Falsone, PT, MS, SCS, ATC, CSCS. Sue is the Director of Performance Physical Therapy at Athletes’ Performance in Phoenix, AZ. Sue works in a very advanced athletic environment, which demands a different thought process when rehabilitating injuries. She combines her background in physical therapy with the integration of the Athlete’s Performance philosophies, which is apparent in his essential reading list recommendations. She also has a blend of business books similar to Eric Cressey’s recommended list, showing the importance of leadership, teamwork, and personal skills in our everyday careers.

View the complete list of essential books for physical therapists, athletic trainers, and strength and conditioning specialists

Below are Sue’s recommendations with her comments, thanks Sue!

1) Core Performance by Mark Verstegen: Sets the foundation for the Athletes’ Performance methodology with professional athletes and how it can be applied to everyone’s life. Focus is on Mindset, Nutrition, Movement and Recovery…a truly integrated system.

2) Musculoskeletal Trauma- Implications for Sports Injury Management by Gary Delforge: The only physiology book that I have ever read from cover to cover. It made sense of all the concepts that seemed so difficult to understand when I was in school. Made me realize the direct connection of specific tissue physiology on the healing process, and how this has to be respected during the rehab process.

3) Anatomy Trains by Thomas Myers: Takes basic anatomy and puts it together in a way that makes you appreciate the unbelievable direct anatomical connection between the foot and the head, along with everything in between.

4) Manual Therapy “NAGS, SNAGS and MWMS” by Brian Mulligan: An easy read that is entertaining and amazingly informative all at the same time. A fantastic manual technique to have in your tool box.

5) Three Signs of a Miserable Job by Patrick Lencioni: The first management book I ever read. Very light and easy to read, yet unbelievably powerful insight as to why people will or will not perform to their individual and/ or group capability. Offers solutions that are so simple, yet so powerful

6) Five Dysfunctions of a Team by Patrick Lencioni: the second management book I ever read. Made me understand the importance and impact of true teamwork, and offered tools to create that atmosphere in any work setting.

7) The Anatomy of Breathing by Blandine Calais-Germain: Another easy read that distinguishes between the spontaneous act of oxygenation of the blood and the art of breathing for different reasons. This book answers why one would use specific breathing techniques, in order to elicit different responses in the body, as well as gives easy explanations on how to perform these exercise.

8) Neurodynamic Techniques DVD and Handbook by David Butler: Great concise handbook and DVD on peripheral nerve mobilization. Clinician technique and client self treatment techniques are demonstrated and discussed.

9) Muscles: Testing and Function with Posture and Pain by Florence Kendall: A classic. Everyone should own it. Enough said.

10) Rehabilitation of the Spine, 2^nd Ed by Craig Liebenson: Several contributors including McGill, Hodges, Kolar, Lewit and Janda. Fantastic representation of many leaders in the industry, coming together to express their views on this complicated topic.

View the complete list of essential books for physical therapists, athletic trainers, and strength and conditioning specialists

The Essential Reading List

Or view contributions to the The Essential Reading List Series by other expert clinicians:

Sign Up for Mike's FREE Newsletter!
Name
Email

Sign Up for Mike's FREE Newsletter!
Name
Email