Eric,

Thanks for the great question! For anyone that is not familiar with the term “re-set”, what Eric is referring to is the idea that when we are working with some individuals (mainly those in pain) you are trying to look for some sort of way to “re-set” their brain in order to allow them to progress forward with their rehabilitation and get back to being active and moving pain free.

Let’s start there…

When I think about a “re-set” I think about you, as the clinician or therapist, doing something to the client. This may come in the form of joint mobilizations, massage/soft tissue therapies, dry needling, etc. My friend and colleague Charlie Weingroff wrote a great blog article on manual therapy methods as a “re-set” in his blog – Putting Manual Therapy Into Perspective.

It has always been my thought processes that manual therapy (in my case soft tissue therapy mainly) opens the window. You place your hands on an individual’s skin, interact with their brain, and in some way work to change their perception about what it is they are feeling or experiencing. Basically, in my mind, you are attempting to use touch (which can be very powerful) to modulate the threat response. Once the window is open you have an opportunity to wedge a few pieces of wood under there or maybe a few books and buy yourself sometime to change their perception even more – most likely  with movement or more active therapies. If you simply open the window and then do nothing the window will just close eventually and the person will be back where they were before. This is where chiropractors who just crack their patient’s spine and then send them on their way leave a really bad taste in my mouth. The patient becomes reliant on the manipulation and has to come back frequently because they have not been taught how to build back their own confidence in their body when they window was open.

This is essentially the “re-set”. Open the window in some way, keeping in mind that not all therapies will work for all people (therapy is more “read and react” where you do something, see what the effect was, and then go from there), and then try and keep it open with some form of movement therapy to help put the patient/client in control of their own healing. This, I believe, is also where we can see some benefit from the Selective Functional Movement Assessment (SFMA) concept of first trying to work on the dysfunctional-nonpainful and/or functional-nonpainful patterns. A 2010 paper by Boudrea et al., actually discussed the concept of novel movement stimuli and its role in musculoskeletal pain disorders. One of the key points that stood out to me in the paper was that novel movement stimuli could be useful in enhancing neuroplastic changes in the brain as the patient feels that the new movement they are being taught is beneficial. In essence, the patient’s brain makes favorable changes with regard to perception of pain when movement that is new to them is emphasized. With the SFMA, when we exercises in patterns that are non-painful but dysfunctional we are basically choosing movements that don’t cause a threat response from the patient (because they aren’t movements they perceive to be painful) and because the pattern is considered to be “dysfunctional” any movement we choose in that pattern would challenge the patient as “novel stimuli”. Even with the functional-nonpainful patterns, I believe we can make large improvements in the client’s perception of pain because we can exercise in those patterns that are pain free and tell the brain “Hey, I am not that messed up! There are things I can actually do that don’t hurt!”

Just as I emphasized the power of touch above I will also emphasize that movement is just as powerful.

So, to re-cap, open the window, try and keep the window open by choosing appropriate movements, encourage the patient/client to take control of their own healing, and continually find movements that challenge the client’s brain to turn down the threat response. Those are my thoughts on the “re-set”.

How long, how much…Normal Cases?

It is hard to say anything about “normal” cases since each person is individual and each person adapts at their own rate. Additionally, this rate of adaptation is dependent on a number of variables such as their stress levels, which I wrote about in a previous blog article, and their general health. Let’s face it, people are becoming unhealthier and more unfit and not every problem that people have will be solved by some soft tissue work and exercise. People may need nutritional intervention, lifestyle intervention, better sleep, stress management, psychological intervention, etc. You can do all the great therapy you want but if the person is a walking inflammation soup on the inside it is either going to take really long to get the result you want or it is not going to happen at all. If you want really fast results you need to try and control as many variables as possible (which may not always be an option).

Being very general, I like to say that you should see some sort of result after one session and hopefully some more dramatic results after 3 sessions – people should know that you are the guy that can help them after that first session. Sometimes, depending on the individual and how proactive they are with the things I mentioned in the previous paragraph, I can make some really fast changes (like playing 3-days after having a muscle strain or making changes in a pain that someone has had for a very long time only a few sessions) but this is not always the case because people have a lot of things going on in their lives and, again, I can’t control all of those variables. My goal is always to attempt to restore the person back to normal function in the fastest time possible without compromising their health. That being said, there are three people I tend to see:

1. Those that I can help and seem to have the answers for.

2. Those that I can’t completely help but I can help manage their issue better than others might (meaning that they don’t want to take drugs or get a surgery but I can help “keep them out of the red”, so to speak).

3. Those that I can’t help because either I am not the guy for their particular problem, they have some other stuff going on that warrants medical attention, or they need to be in the care of a medical professional to help treat their problem.

So, again, being very general, if I can open the window and pick the right exercises I expect things to happen pretty quickly. I am very hard on myself in terms of how things progress with someone so if I am not seeing the changes that I want in the time that I expect to see them I am immediately thinking about what I am missing or what I need to consider further.

Hope that helps answer your questions!

Patrick
patrick@optimumsportsperformance.com

Reference

Boudreau SA, Farina D, Fall D. The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Manual Therapy 2010; 15: 410-414.

Eric Christensen, Doctor of Physical Therapy and owner of Chandler Physical Therapy, was kind enough to ask me if I would like to work out of his clinic once a week and I am excited to be there. In the 2 years I have known Eric he has become a great resource for me to bounce questions off of and talk shop with and because he is also a Selective Functional Movement Assessment (SFMA) practitioner it really helps that we speak the same language. I also appreciate that this is not a high-volume physical therapy clinic and Eric tries to stick with only two patients per hour to ensure that they get the attention they need and deserve.

For information on massage on Tuesday mornings or if you need to schedule an appointment with Eric please contact Chandler Physical Therapy.

For more information on my approach to massage therapy please check out my massage specific website, Optimum Wellness Massage.

Patrick
patrick@optimumsportsperformance.com

A few months ago I received the Dolphin Polycarbonate Tool from IAM Tools. This tool is a bit different with regard to its feel than some of the metal tools on the market. Metal tools tend to be a bit more aggressive, harder, and have a more pronounced edge to them. Not that this is a bad thing, it’s just different. Like any other tool or technique some people will respond better to one thing than another. The Dolphin Polycarbonate Tool tends to be a lot more gentle. Because the tool is not metal and because the edges are a bit softer what I have found is that there is a lot less bruising of the tissue and the feel of the tool on the skin can be rather pleasurable.

I like the polycarbonate tool for more superficial skin work, because it is less aggressive and softer, prior to attempting to access deeper layers with my hands. I tend to use some of the metal tool options when my goal is to focus on superficial treatment. I have been playing around with using the metal tools, which are a bit more abrasive and direct, to treat the skin in certain areas prior to an individual warming up for a workout and using the polycarbonate tool prior to soft tissue work (when I feel that it is necessary).

Overall I have enjoyed using the Dolphin Polycarbonate Tool and recommend it as a tool in your toolbox when looking for an option to treat the skin and superficial layers of tissue prior to addressing underlying tissue with your hands or more direct approaches.

Patrick
patrick@optimumsportsperformance.com

This is a free journal that Dr. Tourchaninov publishes himself and serves as a wonderful resource to the massage therapy community.

If you are interested in reading the case study you can do so HERE. Because the journal if focused specifically on massage therapy I did not include specific information on exercises that we used in the case study, however, you can read my assessment, thought process, and treatment approach that I used over the three consecutive days of treatment with this athlete.

Patrick
patrick@optimumsportsperformance.com

Similar to soft tissue therapy, and as I discussed a few weeks ago regarding recovery and the difference between athletes and general population clients, no two people respond the same way to the stressors you place upon them. For example, in the training environment you may have 10 athletes all training on the same program. For three of these athletes the program may be ideal for them to make progress, for another three of them it may be enough of a stimulus/stress to allow them to maintain their current level of fitness, and for the other four of them it might be too much and push them towards a state of overreaching/overtraining and breakdown.

Two studies from Beaven et al. (2008), highlighted this sort of individuality to training stresses.

Individual differences to the same training program

The first thing this group of researcher did was establish the testosterone and cortisol ratios in response to four different strength training protocols in 23 elite rugby athletes (only 15 completed all four protocols).

The four training protocols were as follows:

• 4×10 @ 70% of 1RM; RI = 2min
• 3×5 @ 85% of 1RM; RI = 3min
• 5×15 @ 55% of 1RM; RI = 1min
• 3×5 @ 40% of 1RM (performed with max speed); RI = 3min

The athletes in the program performed each one of the training protocols once during the study, in a random order, separated by at least 2-days. The same four exercises were used on all of the training days – bench, squat, leg press, and seated row.

What was interesting about the results was that when the athletes were looked at as one homogenous group testosterone did not change as a result of any of the training protocols and cortisol showed a significant decline; however, when the athletes were looked at as individuals there was an individual hormonal response to each of the training protocols. This is important information as it helps us better understand that each athlete will respond to a training program in a different fashion and what we find to be optimal for one athlete may not be great for another.

Applying specific training protocols

After this initial study the same research group, now knowing that every athlete had a different response to each training protocol, decided to take it a bit deeper and see what the result would be if the athletes were asked to perform a block of training using the protocol that provided them the greatest testosterone response versus a block of training that produced their minimum testosterone response.

This study was carried out on 16 amateur rugby players. The athletes first performed an examination phase of training where their testosterone was measured following training during each of the four protocols:

• 4×10 @ 70% of 1RM; RI = 2min
• 3×5 @ 85% of 1RM; RI = 3min
• 5×15 @ 55% of 1RM; RI = 1min
• 3×5 @ 40% of 1RM (performed with max speed); RI = 3min

The exercises used during each of the workouts were bench press, squat, leg press, and cable row. The athletes performed each of the above workout protocols twice during the examination phase, in a random order, with at least two days separating each workout.

Upon completion of the examination period the workouts, when averaged over the two repeated sessions, the protocols which produced the maximum and minimum testosterone where selected for each individual athlete.

The subjects were split into two groups. One group performed a three week block of training where they completed the protocol which elicited their maximum testosterone twice per week while the other group performed a three week block of training where they completed the protocol which elicited their minimum testosterone twice per week. After this block of training there was a five day unloading period followed by another three week block where the subjects in each group switched – those performing their maximum testosterone protocol twice per week were now asked to perform their minimum testosterone protocol twice per week and vice versa.

Following the examination period twelve of the sixteen athletes showed significant consistency in their response to the protocol which produced their maximum and minimum testosterone. The other four athletes showed inconsistent results in their stimulation of maximum and minimum testosterone during the examination period.

When performing their maximum testosterone protocols (which were different for each athlete), regardless of which group they were in and the order in which their three week blocks were set up, twelve of the sixteen athletes saw a significant increase in their strength and bodyweight. When performing their minimum testosterone protocols, again regardless of the group they were in, twelve of the sixteen subjects saw significant losses of 1RM strength and body weight.

Interestingly, the four athletes (two in each group) who did not see consistent results during the experimental training blocks (sometimes showing no change and other times showing increases in strength and bodyweight regardless of the protocol used) were also the athletes who showed inconsistent results two their maximum and minimum testosterone protocols in the experimental phase of the study.

Final thoughts

Each individual has a different response to the various treatment or training stressors we impose upon them. As a strength coach it is essential that we understand this and strive to develop training programs that are specific to the individual to produce the greatest training effect. As these studies highlight, one training protocol (with variations in training volume, intensity, and rep ranges) may be optimal for eliciting the maximum results from one athlete while the same training protocol may elicit negative results from another.

Strive for individuality as best you can. The human body is not a protocol. Training, like soft tissue therapy, is not black and white. It is not cookie cutter. Each individual presents with a different level of training, fitness, stress resistance, and recovery capabilities, thus each requires a different dose of training to see improvements.

Patrick
patrick@optimumsportsperformance.com

References

Beaven CM, et al. Salivary testosterone and cortisol responses in professional rugby players after four resistance exercise protocols. J Strength Cond Res 2008; 22(2): 427-432.

Beaven CM, et al. Significant strength gains observed in rugby players after specific resistance exercise protocols based on individual salivary testosterone responses. Journal of Strength Cond Res 2008; 22(2): 419-425.