Monthly Archives: December 2014

Meet Brent Brookbush and Why Functional Anatomy Is Important

I’d love to take this opportunity to introduce the MMIM Community to Brent Brookbush, PT, DPT, MS, PES, CES, CSCS, ACSM H/FS.  Brent is a breath of fresh air in our industry and even though he is a new grad to the PT world, he brings a ton of knowledge into rehab from his strength/conditioning background.  Brent has a unique skill set of taking daunting Human Anatomy and making it simple, and most importantly, functional.  Enjoy this 1st of many guest blogs from Brent where he introduces himself and lays the framework of why Functional Anatomy is important and critical.  As usual, for more Info on MMIM visit Medical Minds In Motion, LLC


“The Brookbush Institute of Human Movement Science was created to enhance the delivery of evidence-based, practical education in human movement science. Most of our content is concerned with exercise and technique selection, routine design, assessment, etc. – the very application of the science in our field. With that being said, the fastest growing section of our online education platform is the portion dedicated to “Functional Anatomy” (Introduction to Functional Anatomy & Integrated Muscular Anatomy). Despite the fact that I’m as drawn as you are to new and innovative techniques, I have come to realize that understanding when to apply those techniques, understanding the intent of those techniques, and comprehension of the concepts with which those techniques were developed, is dependent upon on a strong knowledge of anatomy. Just as anyone can swing around a scalpel, it takes a surgeon’s knowledge of anatomy to use that scalpel in a manner that is effective. It could be said that a repertoire of effective techniques and assessments lies just beyond a conceptual doorway, and that functional anatomy is the key to that door.

Why “Functional” anatomy over traditional “Anatomy & Physiology”: Functional Anatomy implies a bias toward the subcategories of anatomy that specifically apply to human motion. It’s one thing to know that the trapezius originates from the external occipital protuberance to T12 and inserts on the spine of the scapula, acromion and clavicle, but it is another to know that the upper and lower trapezius work synergistically with the serratus anterior to upwardly rotate the scapula and ensure optimal acromioclavicular joint arthrokinematics. Further, all 3 of these muscles have a propensity toward under-activity in those individuals who exhibit upper body dysfunction, and due to this propensity may be the target of activation, integration, neuromuscular re-education and taping techniques. Further, these muscles have an effect on other joints, nerves and fascial structures – knowing how these structures are affected by dysfunction that may have originated with a change in the length and behavior of the trapezius, may provide us with a list of additional techniques that improve carry-over, or may simply be necessary for the more “stubborn” patient complaint. And that’s just one long-winded example…

If I may say with the utmost humility and respect for what we do, most of the concepts we build our interventions upon are fairly simple. Reciprocal inhibition, synergistic dominance, movement impairment, altered activity, adaptive length change, relative flexibility, compensation patterns, recruitment, release, stretching, mobilization, activation, integration, neuromuscular re-education, taping, IASTM, dry-needling, etc… can all be explained in a paragraph or less and often can be summarized in a sentence or less. But again, the concepts are just the doors to learning a repertoire of effective techniques and assessments, and our knowledge of functional anatomy is the key.

Where does that leave us? Dedicating time to increasing our knowledge of functional anatomy should likely consume the same amount of time that we dedicate to reading and understanding research in the pursuit of evidence-based practice. In essence, research refines our practice of techniques, built upon a foundation of functional anatomy knowledge. As an educator, I am excited about the opportunities a partnership with MMIM will provide. I can continue to build upon our library of foundational material, providing Rick Daigle and his faculty with a resource they can refer workshops participants too – leaving more time for practical education and lab in live workshops. I also look forward to gaining insight from the ingenuity of his staff, as they provide the Brookbush Institute with more great techniques for our library of practical content.”

Brent Brookbush, President and Founder

Brookbush Institute of Human Movement Science

Why Developing a Niche is Critical to Private Practice Success

Medical doctors specialize all the time…  Orthopedic surgeons specialize is specific joints/body parts… Attorneys specialize… Real Estate agents specialize… Chefs specialize…

So why can’t Physical Therapists specialize?  Before I go any further, I want to clarify that while I will be discussing Niche practice and specialization, I fully understand and agree that you have to keep your doors open for business and taking a wide variety of patients is critical to that success.

I will outline here how I think developing a Niche practice will make your practice more successful.

In this day in age, there are almost as many PT clinics out there as Starbucks or Fast food joints.  How does a patient know the difference from one to the other? How does a patient know if Clinic A is better at something than Clinic B?  How does a patient truly know what place is right for them.  Personally I think these questions are difficult to answer, but with a few steps you can market your practice in a way that will give patients insight on what you are the best at what you do and why they should comes see you instead of Joe Therapist, DPT down the street.

There are many ways to do this, but one of the most successful ways is to develop a Niche program.  In other words, a specialty that sets you apart from the rest.  By developing a Niche specialty you will have the following opportunities:

1- Get patients in the door that might not have in the first place.

2- Once you have those patients in the door, they become a referral source for you.  They can refer others that are searching for what you are offering and they also become a referral source for any patient that might need Physical Therapy in general.

3- Direct Access.  Simply speaking, you get patients in the door before they enter into the system and before they have seen any other practitioner.  This way you can help expedite the process by either treating them or referring them to the right professional.

4- Strengthen your already developed MD relationships.  Now you have Direct Access patients who might need a PCP, or maybe you need to refer to an Orthopod for further testing.  This is a way to get patients to someone you trust and make sure they get excellent care.  This also will show your referral source that you trust them as well and value their opinion.  HUGE.

5- Strengthen your other referral networks.  Maybe the patient would benefit from seeing a Chiropractor, a Massage Therapist or maybe they need a Personal Trainer.  Now you can refer there patients to the appropriate professional, again that you trust and know will do a great job.

6- Your patients will thank you.  They will thank you for caring, they will thank you for helping them and they will thank you for taking them seriously.  They will also thank you for not wasting their time and helping them get to the bottom of their issues sooner rather than later.

I take this philosophy as very much the philosophy of “Good to Great”, By Jim Collins.  Don’t try to just be good at a lot of things, rather be great at one thing and then build it from there. Show the market place why you are the best at something and the rest will follow.

I hope this helps someone people think about some new marketing strategies and some new methods of how to get patients in the door.  The old school model was to visit MD after MD after MD and hope that you were able to convert a few patients from those cold calls.  The new school version is thinking outside the box and thinking like a professional.  Show value in your skill set and show how you can bring value to your referral sources.  In other words, work as a team.


Rick Daigle, PT, DPT

Ankle Dorsiflexion

Who do people lack ankle dorsiflexion?  Well, the answer here is quite simple:  There are a ton of reasons.  I’m going to outline for you here some of the biggest reasons a person will lack mobility of ankle dorsifelxion.

For starters, why is this motion so important?  Well, gait for starters…  Kind of hard to walk with a proper push off…  Also a little difficult to swing through without enough DF to pull through.  When an individual lacks proper DF range, we’ll see a multitude of compensatory patterns- especially at the hip/pelvis.  That excessive hip hike on the swing leg to give proper clearance to the foot can lead to bilateral hip dysfunction coming from the potential creation of a pelvic issue, it can cause QL to go into spasm leading to lumbar dysfunction, etc, etc, etc. This list can be endless…

With all of that being said- here are my top reasons what might be causing the lack of ankle dorsiflexion when it’s determined a mobility issue is present. (For the purpose of this little blog, we are ruling out any neurological issues or motor control issues)

1- Decreased posterior glide of the distal tib-fib joint.

2- Hypo-mobile Great Toe-  This and DF go hand in hand.

3- Restricted Soleus

4- Bony Lesion to the Talus causing a “block”