Monthly Archives: July 2014

A Challenge…

I’ve been doing a lot of thinking lately…  Most of this thinking has resolved around what can I do to make myself a better PT, a better educator and actually a better person.  I’ll be honest, it’s  been a struggle to stay motivated and to stay upbeat sometimes.  I think that’s a natural phenomenon sometimes that we ALL go through.  It’s how we learn from those phases that will make us better at our craft and better people.

What am I doing to make myself better?

* Reading more… Not just rehab stuff, but other works as well. “Expanding my horizons”

* Reflecting on my career.  What have I do right, what have I done wrong and what needs improvement.

* Eating healthier.  This has always been my crutch… Good food and good wine.  I’m learning how to moderate and how to experience what I WANT without over doing it.  🙂  A BIG challenge.

* Reviewing ALL of my previous teaching evaluations.  What have my students and course attendees said?  Yes, I’ve already read them before and made significant changes, but it never hurts to go back.

* Planning my next educational route-  Looking like a PhD in Higher Education and Leadership.  Going to be a long road, but a good one.

* Started the EARLY phases of writing a book- stay tuned on this one.

* Clinical Education Pathway-  I want to finish 2 things over the next 2+ years:  My COMT and go through the DNS Progression.  I want to become a better Manual Therapist and I want to become better at Neurodevelopment.  I’ll also be doing more strength/conditioning education to get “outside my comfort zone” 

That’s just scratching the surface… There is more, but I won’t bore you with the rest.  The point of this blog is to help people realize, it’s OK to loose focus sometimes but it’s how you come out of those funks that really defines you as a person.  Make a list of what you need to do to make yourself better and I CHALLENGE you to stick to it, own it and become better at your craft and at life in general.

I hope this excites at least one of you to reflect and make some changes.  If this reaches one person, I consider it a success.

Happy Sunday Everyone!



The Top 10 Blogs on the face of this planet according to Rick…

Instead of writing about something specific today, it’s time to provide my TOP 10 List of the best blogs out there… (Actually it’s 11 because there is a tie for #1). Simply, these are the 11 that I utilize the most and read religiously.

You can agree with me or disagree with me. These are my opinions and my opinions are just that… My opinions. I apologize to any of you that I left off this list. Wait a second- scratch that… I don’t apologize because you should NEVER apologize for your opinions. Ok, so here we go from 10 down to 1.

***I took a very scientific approach to deciding on 1-10. It was all subjective and again, my opinion. 🙂

I hope you all enjoy these resources as much as I do. Have at it!

#10- PT Think Tank
* Great blog with advice from clinical to business to interpersonal skills. They have been around for a long time and always have good shiz.

#9- PranaPT
* Outside the box thinking and an very down to earth solid information. Good job keeping us all updated.

#8- The Student Physical Therapist
* Because new grads are just that… New grads. Awesome resource to help new grads enter the PT world

#7- In Touch Physical Therapy
* This guys is a MANual therapist among boys.

#6- Craig Liebenson
* Not really an official blog, but this guy is a rock star and could be considered “Dr. Functional”

#5- Evidence In Motion
* These guys are some heavy hitters with outside the box thinking backed up by, well, evidence…

#4- Girls Gone Strong
* Simply because nutrition, wellness, strength and everything IS part of the rehabilitation process. Just a rocking awesome blog with tons of info that I think EVERY clinician should know. Ok PTs- Get out of your comfort zone a little and expand your knowledge!

#3- Perry Nickelston
* Ok, again not a blog (remember this list is my opinion). He is a MUST follow. Website, Facebook, Twitter, etc. Just don’t follow him home- he could kick your ass. I am very luck to call Perry a friend and I have learned more stuff from him in the past 5 years than I can even wrap my mind around.

#2- Charlie Weingroff
* Where do I start. One of the best in the biz. His stuff is solid and is not afraid to call you out. One of my favorites of all time.

TIE #1– The Manual Therapist
* The most consistent source of information. Period. Interactive, informative, fun and guess what, practical!

TIE #1- Mike Reinold
* Mike is a superstar of sports medicine. His experiences alone should drive you to his site/blog. Again, solid, consistent, relevant, outside the box and always on top of new stuff

We could spend hours going into the diaphragm if we wanted to. For the purpose of today, I’m using the KISS principle (Keep It Simple stupid). Lets just start with the anatomy…

Diaphragm Anatomy

Think about some of the attachments for a second… Xiphoid Process, Inner Surface of Lower 6 ribs, Upper 2 or 3 Lumbar Vertebra… There are even some fibers that his Psoas Major. The point is as follows: If you are NOT looking at breathing at the very beginning of treatment, you are probably missing something huge. If you are NOT using breathing as the start of core stability- guess what… Your not doing right by your patient client. The diaphragm is an integral part of the “inner core”- Diaphragm, pelvic floor, multifidi and transverse abdominals. If any of these aren’t working- you’re dead in the water.

We must use the philosophy of regress to progress and what is the most basic of tasks that we do as human beings. Breathe. Start there, assess the persons ability to utilize their diaphragm and then move on. Some ideas- start by assessing in supine with their knees flexed and feet flat, move to legs elevated at 90/90, assess in sitting, assess in high kneeling, assess in half kneeing, assess in tandem stance, assess in single leg stance. Get the point here?

Now, let me preface this next part with the fact that I fully understand every individual has their own strategy for breathing based on the activity that they are doing, their body type, their history and how their nervous system functions… BUT- every single person should be able to lie on their back and isolate out the diaphragm and “belly breathe” without excessive use of the accessory muscle groups. This is basic core 101. If you cant isolate the diaphragm you have no business doing planks, get ups, or any other type of core work for that matter.

Most of the time all it takes is a little manual therapy to release the fascial surroundings of the lower ribs, abdomen and then some cueing for retraining to correct the neural pathways and BOOM- it will come back online and they will start to learn new strategies…

Now- take it a step further. What if you have T-Spine and/or L-Spine Mobility issues? Or Hip mobility issues? You’ve got to fix those first because as in my previous blog- mobility needs to come before stability. Once you have fixed all of the mobility (true mobility” issues (see the previous blog), get back to retraining the diaphragm, teaching proper strategies and initiating the progression of movements. One awesome way of locking in fundamental core stability is simply by using segmental rolling patterns and crawling patters… Stay tuned for the next blog which dives into ROLLING!

I hope this helps some of you and I hope this gets people thinking. And don’t forget to go visit and like the Medical Minds In Motion FB page:

It’s basic, it’s simple, there are never any absolutes but when push comes to shove- just breathe.

When is a mobility issue not a mobility issue?

Say what?!?!  When is a mobility issue not a mobility issue?  You read that right.  A mobility issue is not a mobility issue when it’s a stability issue. There I said it.  Soak that statement in and think about it for a few seconds before making any judgments (in either direction).

We know the human body is a wonderful and powerful tool.  We also know that the human body is the great compensator.  When you cannot move properly, the body will get it from somewhere else.  The epitome of robbing Peter to pay Paul.  The human body will also sacrifice quality over quantity.  I bet you that right now, you have movement dysfunction that you have no clue exists and there is a good chance you don’t have any pain associated with it…  Yet…  Eventually you will.  You can take that to the bank.

When the body reacts with pain signals- basically it’s saying to you, “Hey Idiot, do something. There is a problem somewhere”.  The problem is that a lot of practitioners are tricked by the pain and they start to “chase it”, as my good friend Perry Nickelston likes to say.  Just because there is pain in one location with a potential tissue lesion, does not mean that is the root cause.  We have to look at everything in order to understand 1 think.

Janda was way ahead of his time.  He stated that you must understand the motor system as a whole in order to understand individual impairments.  Damn that dude was smart.

So back to mobility issues not being mobility issues.  Do NOT take this as an absolute.  The only absolute is that there are NO absolutes (I can thank one of my students for that line).  Mobility issues must be consistent.  We know that and we understand that.  So having a patient/client fail a toe touch and then assuming they have tight hamstrings is putting the cart before the horse.  That’s only one way to look at movement.

1- Check toe touch in standing

2- Check toe touch in long sitting

3- Check active straight leg raise (needs to be greater than 70 degrees)

4- Check passive straight leg raise (needs to be greater that 80 degrees)

If you FAIL all 4 of those, guess what, there is a good likely hood you have a mobility issue or issues limiting you.  If you pass even just one of those, it most likely cannot be a mobility issue.

So what could it be?  It could be a lot of things but lets use this example.  A patient presents with a limited toe touch in standing and then a perfect toe touch in sitting.  One of the likely scenarios here is that this person has some fundamental core stability issues such as a lack of pelvic stability or diaphragmatic issues which is causing their hamstrings to contract in standing and stabilize the pelvis, thus causing a compensation.  You then have the person long sit- and BOOM they touch their toes.  What’s stabilizing the pelvis in this position- the FLOOR.  Hamstrings shut down, stop overworking and bingo, the person touches their toes.

Now- how do we go about fixing their toe touch in standing?  Stretch their hamstrings?  Mobilize their l-spine?  Nope. Not going to work.  Go to your days of Pediatric development and focus on rolling, crawling, half kneeling balance.  Maybe even before that you need to assess their breathing and teach proper diaphragmatic strategies.

One of the most powerful options to fix this issue is segmental rolling.  The next blog coming out soon is titled “This is How I roll” and will go in depth into segmental rolling.  Think about how we develop and think about what needs to stabilize properly in order to roll from your back to your stomach.  I have a few good videos that will accompany that blog which will demonstrate this.

The point is- develop proper fundamental core stability and you will clear up a lot of “mobility” issues.  Just remember this:  Mobility issues will be consistent.  If it’s inconsistent, you need to look at what stability problems are present.