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Eric- Great job this year. I liked the conference even more!
It was nice to meet all of the residents again.
You guys are doing awesome.I have not been doing as many running videos or mechanic breakdown so this weekend reminded me of how important this is. I do not want to be “one of those therapists who just tried to throw something else at them” Instead get to the source.
I think the key with these videos is to not split hairs, the big things will show themselves.
Does everyone use Hudle for videos?
I have not used it yet. -
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– Karim Khan is a fantastic speaker and he definitely made a hard concept to describe really simple and understandable. I will definitely be using the explanations and diagrams he used in his lecture and lab. I was glad to also hear that he referenced the isometric analgesia study and did a great description on using isometric, concentric, and eccentric exercises based on irritability of tendons.
– In the gait training lecture, Eric used the term “drills” instead of exercises. This is such a small change of wording, but I think our athletes would appreciate this subtle change in the way we describe what they will be doing in our program.
– The metronome training was really fun and personally, I felt a huge difference with the different rates and made me realize some things about my gait too. I think I failed a bit on just changing my step rate because I was also increasing speed each time as well to try to match the cadence. Was anyone else doing both? I still felt a huge change, especially from 140 to 160, but how often do you guys increase the speed on the treadmill as well?
This is so easy to replicate in the clinic, especially since we have both a speaker system (for when the clinic isn’t crowded) and iPad’s with headphones. Having some go-to songs loaded up would be great to have. Presenting some app’s that find songs with the different rates was also really helpful too and it will be a great reference for our patients for independent training.
– Has anyone used the Askling’s H test for hamstring injuries return to sport? I thought it was an interesting concept, but I’m not sure if I would tend to use this one in the clinic. What about using the Swing test that we use for functional testing? Simpler to set up, more functional, thoughts?
– Other lectures/tools I thought were especially helpful: Ready to Run training progression, the UVa Visual Gait tool taught by Jay, the multi-disciplinary approach for diagnosis and treatment of CECS
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Fully agree with Laura on Karim Khan and how he was able to simplify the subject. I’ve already used a lot of his analogies/explanations with patients and it has made a huge difference for me.
The lecture on reactive vs. degenerative tendons was great too. I had an achilles tendinopathy eval the Monday after and got to use all of it right away. Started her out with isometrics and it’s been going well so far (2 visits, so far so good).
Kyle – I’ve used dartfish (phone) and Hudl (tablet) and they’ve both worked pretty well. I’ve used it more after the VOMPTI gait/running lecture and haven’t had a chance since last weekend, but it has certainly made a difference in how I try to cue patients. The cues that have worked best for me so far are leaning forward and landing/running softly/quietly. I have not yet tried metronomes or music but will as soon as I get a chance.
Laura – I have not used that test and I’m not sure it would be something I’d go to quickly. I’ve used the swing test a lot, because – like you said – it’s more functional, shows a whole lot more and I feel like if done vigorously enough, will give you similar information about ROM and willingness to move into straight leg hip flexion.
I loved the lectures on CECS! I learned a lot there and I currently have a pt who would’ve been a perfect case for these lectures. The FAT lecture was great too, as that was something that was poorly covered in my PT program.
The article is great and I’ve definitively noticed a difference with int vs ext cues. It might be my pt load, but the most cueing I do is with low back pts and lumbopelvic motor control, especially since I’ve started with the MET exercises.
A few cues that have worked pretty well:
– supine pelvic tilts -> think of pelvis as bowl filled with water and try to spill different directions
– standing/sitting lumbar AROM EXT/SB -> reach up and over, create C shape with back; with those I use a lot of visual, tactile and verbal cueing and I’ve gotten great feedback especially with quadrant testing
– prone hip EXT or any UE/LE exercise with extension -> reach towards wall in front/back as far as you can (instead of lifting up), elongate through entire body
A lot of times these are successful, but I’ve also failed terribly with some patients using the same exact cues. I think a big part of it is just having a bunch of different ways (visual, auditory, tactile etc) to cue the same movement to different pts. Interestingly, I’ve had several pts who don’t respond to external cueing at all, but really like the internal focus type cueing. -
I have seen the H-test referenced before – have yet to use it but am currently rehabbing a patient who had a hamstring injury in the mid portion of the semimembranosus. I intend to try and use some version of the test before clearing her for full return to sport. I think you probably could modify it and make it like the swing test – essentially performing it in standing instead of supine. However, I think the key to the test is that you absolutely have to encourage the patient to go full speed – as far and as fast as possible, to get a helpful measure. Don’t think I would rely on it alone for return to sport criterion, but could definitely be included as part of a test battery.
The running lab, although at times a little comedic, was actually a point of learning for me. The first point was that I was amazed that music truly did cue you to running a different cadence. That was very fascinating and definitely pushes me to use it as a tool if increasing cadence is a goal.
The second, and more substantial piece of information I learned, is that when you change cadence you necessarily change other factors, and I question whether that is always beneficial. It was very apparent that, for me at least, when cadence was increased hip motion was incrementally decreased. This goes against the concepts of increasing hip flexion in swing as the biomechanics article Eric referenced showed reduces impact peak/loading rate. This certainly might not be true for everyone, but it was certainly the case for me. My take home – there are a number of factors that we evaluate with running mechanics, not just one; and we must be sure that when we change one factor we aren’t sacrificing another beyond that which we deem acceptable.
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For me reading the motor control article simply reinforced even stronger how I simply am almost using exclusively internally driven cues, not external. Part of the reason is that external cuing tactics and strategies are just not in my “wheelhouse,” and instead of trying to think outside the box I automatically resort back to that which I am comfortable with. In light of this, I particularly enjoyed the practical ways the authors provided on external cuing – things which I intend to practice in the clinic Monday (watch out for the cones…)
Observational video analysis is also something I never employ unless it is during a running evaluation. This is another straight forward and easy application I intend to use more frequently with different tasks.
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Yeah Nick, I think Monday we should play around with some of these strategies illustrated in this article. I’m not quite sure about the external cue they give for the knee, “reach for the cone with your knee”. I’m guessing they mean the same as saying “point your knee at the cone”. Jay’s lecture at the conference really brought to light the importance of making therapy more enjoyable, more challenging and more fun. I feel like I keep doing the same things. I love the idea of the games and the technology for visual cues and feedback. My problem is, I don’t have the technology, or even a smart phone for that matter. So, I’m concocting a few inexpensive visual feedback apparatuses that involve a bicycle tail light (with “laser beams!”) with a Velcro strap and a clear tube with a ball inside. This should be fun. I’ll let you know how it goes.
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