Besides exercise, never knew there were so many things you could do on a bike....

2. Dorsiflexion Stretch with the Shuttle MiniPress

For Shuttle MiniPress owners who would like to incorporate dorsiflexion into your training, here are some simple pointers:

• Sit with legs extended straight out in front and feet together.
• Secure one foot to the Foot Plate with the velcro strap.
• Bring toes toward body as much as possible for five seconds (dorsiflexion)
• Repeat movements and five-second holds for 10 reps

Tips: Do not bend knees - spread toes apart in dorsiflexion - maintain upright seated position - move only ankles during stretch

3. How to Get More Referrals

Photo by: Keith Allison

Regardless of how you feel about the New York Giants or the New England Patriots, any physical therapist worth their salt would find the most riveting news surrounding this year's Super Bowl to be the following exchange....

News Reporter: "Tom Brady, you're about to play in the biggest game this world has ever known, what are you going to do now?"

Tom Brady: "Um, I think I'll refer a friend to my physical therapist." 

In all the hype leading up to the Super Bowl, Patriot quarterback Tom Brady, took the time to talk about referring his physical therapist to hockey star, Sydney Crosby. And if that weren't enough, Brady stated that "if it wasn't for my [physical therapist], I don't think I'd be sitting here right now."

Most physical therapists would think at least a few seconds about deep sixing their mom to get such a referral.

Just imagine what it would be like to have somebody of that caliber, that notoriety, that power endorse your therapy services!

Well, we can't all have a celebrity recommend us to their friends on national TV, but we can work to create a practice that is worthy of such referrals. And how Tom Brady came to refer his physical therapist can be very instructive.

Alex Guerrero was the physical therapist from Utah that Brady referred to Crosby. Guerrero was instrumental in helping Brady make a speedy recovery from his ACL/MCL tear back in 2009. In an excerpt from a Boston Globe article, note how that therapy was described:

[Brady] also did plenty of core work. And he continued with an innovative shoulder program that he and Guerrero devised, something that’s off the board enough that Guerrero politely declined to describe it. What he would say was that Brady’s diligence with that work is a big reason the quarterback says he no longer gets the arm soreness he did earlier in his career.

To Guerrero, Brady’s ability to sustain the kind of hit Albert Haynesworth laid on him in the preseason – crumpling the quarterback under 350 pounds – was proof positive that the quarterback’s hard work was paying off. If he’d just worried about rehabbing his knee, the result might’ve been uglier. Because he worked his shoulder and core, it wasn’t.

What Guerrero called “the transformation’’ came in Week 4, when the Ravens visited Foxborough, and Brady completed 66 percent of his passes for 258 yards, a touchdown, and no picks.

“His confidence with his body was back, you could see it,’’ Guerrero said. “He’s totally confident with the program, how the knee feels, how his arm feels, how he’s going to feel after the game.”

Best-selling author and marketing guru, Seth Godin, states that if you want customers to make positive "remarks" about your service to their friends, then you have to be "remarkable". You have to be "worthy" enough for people to talk about you - to be willing to recommend you to a friend. You can't expect to get referrals if you're just offering standard physical therapy services to patients. 

Helping Tom Brady achieve a quick recovery was certainly remarkable. But note how Guerrero did more than just rehab Brady's knee. It was part of a more comprehensive approach. In fact, the therapy was unique enough that Guerrero wouldn't even divulge it - referring to it discretely as "the program". His therapy was unique, it was special, it was distinctive. And, it was proprietary.

Now, do you think Guerrero is practicing some kind of physical therapy that noboby has ever heard of?

No.

If nobody's ever heard of it... then we probably would have heard about it by now. Obviously, Tom Brady's talking about it - and with a little investigative journalism we could probably find out exactly what this therapist is doing.

But that's not the point!

You don't have to copy what Guerrero is doing. Your therapy approach does not have to be truly revolutionary. In other words, you don't have to be the only physical therapist on God's green earth that offers such therapy. It can be something that is unique to you, formulated in a unique way, perhaps with a unique focus or a different way of doing things.

The fact that you have a therapy approach that gets good results and is unique in some way makes it worth talking about. And people like to talk about things that are new and different - things that are remarkable.

Well, give them something to talk about - be remarkable! 

4. "I don't feel a day over 80...."

Great!!!

Now I'll have the kids - and grandma - fighting over the video games.

5. An Exercise Sequence for Progression in Balance Training

Noticed in the Journal of Strength and Conditioning Research where a study was conducted looking at An Exercise Sequence for Progression in Balance Training. They found that "balance performance decreased in response to an increased level of task difficulty introduced by narrowing the base of support and by limiting the use of sensory information."

Whether working with athletes or geriatrics, owners of the Shuttle Balance have found the same progression useful: bilateral, tandem, and unilateral stances (base of support) and eyes open and eyes closed (sensory information).

Of course, one thing the research did not incorporate was something that makes balance increasingly more challenging (and infinitely more fun for the practitioner):

Perturbation!!!

Kenji Carp PT, OCS, ATC...

is a competency certified vestibular therapist. He also is the founder of Cooperative Performance and Rehabilitation located in Eugene, Oregon. 

Kenji uses our Shuttle Recovery, Balance, and MiniPress and has developed a variety of innovative protocols for each. But perhaps the most intriguing work he has done is in regards to perturbation therapy using our Shuttle Balance.

Kenji has worked in the area of fall prevention and vertigo extensively. He has taken the approach that one of the best ways to prevent a fall is to first simulate a fall. And he can simulate that fall through perturbation therapy. This allows a patient to develop the sensory perception and neuromuscular capabilities to help prevent a fall in the future.

Kenji has also incorporated perturbation therapy in working on both injury prevention and rehabilitation. He uses the Balance extensively to strengthen and stabilize ankles, knees, and hips. But, he has also applied that same perturbation therapy to neck and cervical stabilization. Kenji incorporates a feed-forward approach to develop rapid neuromuscular control in the neck and spine.

Photo by: Nivet Dilmen 

Some are furious that the response hasn't been fast enough. Well, we've seen a flurry of assessment standards, treatment protocols, computer apps and congressional legislation over the last several months.

But, there are others who feel that the rush to protect an athlete's head has caused us to run away from the one body part that is best able to protect and preserve.  

We're talking the neck....

Ray "Rock" Oliver, Director of Strength & Conditioning for University of Kentucky, has made the neck a focus in training his football players. Oliver feels that by improving the strength and thickness of the neck, the absorption of force is that much better. In a recent ESPN article, he stated the following:  

“The No. 1 mechanism that’s absorbing a lot of the shock is the neck,

so we need to get that bigger.” 

Oliver said he wants to add "one-half to three-fourths of an inch" to each of his players' necks this year. And he does that with a combination of lateral raises, shrugs, and flexing exercises. 

"Remember looking at athletes 30, 40 years ago?" Oliver said in Training & Conditioning. "You could tell they were athletes because they had the big necks. Now, the legs are bigger, arms are bigger, chests, but not necks. I remember
one of the first things Kim Wood teaching me was that the neck is the number-one priority."

"Now, we spend all this time developing faster guys with bigger bodies and train them for these huge collisions," he continued. "Then we stand there and gulp and can't breathe when one of them can't get up for five minutes."

Here's a video of the Kentucky football's strength & conditioning program this summer. Note some of the different techniques Ray Oliver uses to strengthen the neck (at 7:13, 7:53, 9:04 in the video). Oh, and you can also catch a cameo of the Shuttle MVP somewhere around the 6:52 mark (it won't do a thing for your neck, but we still think it's a pretty awesome machine). Enjoy!

I like Bret Contreras....

He's a likeable guy: knowledgeable, sense of humor, and he's got a focus. He's known as the Glute Guy. And, while he can talk about all things Strength & Conditioning, he's made quite a study of how the glute and hip muscles contribute to superior athletic performance. So, when he writes about something that has application to our Shuttle machines, I take notice.

In a recent blog post, Bret talked about how many S&C coaches are trapped in the mental mantra of "sprint speed is determined by the amount of force you put into the ground." However, Bret references a study, Technical Ability of Force Application as a Determinant Factor in Sprint Performance, that makes the following distinction:

"The orientation of the total force applied onto the supporting ground during sprint acceleration is more important to performance than its amount."

What ideas do you have for using the Shuttle MVP to increase an athlete's speed? 

When you walk into Wright Physical Therapy in Twin Falls, Idaho, the first thing you notice is how tall everybody is....

I'm not talking about the staff or the patients. I'm talking about the physical therapists. They're huge! They're all so freeeeking tall!

Well, there's a good reason for it. They're all former basketball players. Therapists Tyler Billings PT, DPT and Michael Sprague PT, DPT both top out at a miniscule six feet eight inches. The owner, Bryan Wright PT, DPT, Cert. MDT, comes in at a wee six foot five (he's just a little guy in the clinic). 

Shrinking with age, I'm still trying to claim my high school height of six foot even. Standing next to the Wright PT therapists, I felt like a regular pygmy.

But, at least I knew that when it came to the game of basketball, these guys would know what they're talking about.

That's why one of the featured services offered at Wright PT is jump training. And, that's why they have a Shuttle MVP. They use it to help their basketball (and volleyball and all the other explosive sports) clients improve their jumping skills.

But, they also focus on developing good jump mechanics, helping their clients develop the technique and strength to avoid injury. Michael Boyle has talked about how with athletes, jumping is not the problem. Landing is the problem.

Well, Bryan Wright was kind enough to show me how they teach their athletes to land - how to land soft:

So, to all the tall people at Wright Physical Therapy - just want to say thanks. Thanks for using the Shuttle MVP. Thanks for sharing your expertise. (And thanks for not challenging me to a game of one-on-one.)

Although, I did read something about a free throw contest on your website... and Bryan maintains the current Wright PT free throw record at 59 in a row.

You guys letting the boss win, or what? 

Hip Strength Improves female jump mechanics

A recent study conducted by motion analysis expert Tracy Dierks of Indiana University demonstrated that by strengthening the hips of female runners, not only was patellofemoral pain (PFP) reduced, but the runners' gait was improved, as well.

 "The results indicate that the strengthening intervention was successful in reducing pain, which corresponded to improved mechanics," said Dierks, associate professor of physical therapy in the School of Health and Rehabilitation Sciences at Indiana University - Purdue University Indianapolis.

One of the interesting things about the study is none of the female runners were trained or coached on proper running form. It appears that the improved gait simply came as an added benefit to the reduced PFP.

While Steve DeLong, Head Athletic Trainer at Gonzaga University, is not using his Shuttle MVP to teach running technique, he is teaching his female athletes proper jump mechanics. For those athletes who struggle with the ability to control the knee and prevent the valgus tendencies that so often lead to ACL tears, he takes them through an MVP protocol that will both strengthen their hips and teach them proper plyometrics.

Here, Steve discusses why strengthening the hip will improve jump mechanics:

Then, Steve demonstrates his MVP workout with proper foot and knee alignment, landing technique, and exercise progression:

How are you strengthening hips and teaching proper jump mechanics with your female athletes? Please share with us in the comments below.... 

I read an especially moving article...

written by a woman whose 88 year old mother had experienced multiple falls. While injurious in and of themselves, these falls seemed to have caused an even greater damage to the aging mother's confidence. In short, the mother's prospect of walking again was based largely on her ability to overcome her fear of falling again.

It was an informative, and heartwarming, article that is well worth reading. 

The very term "fall prevention" naturally causes us to focus on the strengths and capabilities we try to create so that a fall will never occur. However, as this article points out, fall prevention also entails the reality of prior falls, the efforts to prevent further ones by increasing strengths and capabilities with the added challenge of restoring patient confidence.

But, perhaps this is no different from any other injury rehab process. When a patient has a torn ACL, you not only bring them through a very physical therapy, you also guide them through their own mental therapy. A fully recovered patient needs a strong knee - and the confidence to use it just as they did prior to their injury.

Physical therapy is so much more than physical therapy.

In the following video, Kenji Carp PT, OCS, ATC demonstrates some of the protocols he uses in working with those who struggle with vertigo, vestibular, or the very real fear of falling again:

Warren Anderson of Rehab Plus, Inc. and MakePlays.com in Phoenix, Arizona has worked with a variety of athletes.He's trained local high school athletes, college football players preparing for the NFL Combine, as well as professional athletes. 

In the following video, Warren demonstrates how he helps his baseball athletes improve their speed with a specific exercise on the Shuttle MVP. He calls it the "Kickback" - a variation on the typical hip extension exercise.

In the video, Warren discusses the mechanics of speed and the backside force that will propel the athlete and maximize stride length. In demonstrating the Kickback on the MVP, Warren also discusses:

• Proper body alignment
• Good leg extension
• Increasing stride length

Great stuff, Warren - thanks so much!

♦ What are you doing with your MVP to increase speed? Let us know in the comments below....

We've had a variety of different people on the Shuttle Balance - from patients to professional athletes. We've seen them do a variety of different things on the Balance - from game warm-ups to "shooting the duck." But we've never had someone practice yoga on the Balance. 

It kindly kicks the whole experience up a notch....

Johnny Gillespie has been described as a "revolutionary teacher of human movement." Both a Certified Strength and Conditioning Specialist (CSCS) and a Certified Personal Trainer (CPT), he brings a unique perspective to the blending of yoga and athleticism. Here, he brings it to the Shuttle Balance.

Mike Studer, PT, MHS, NCS and Brady Whetten, DPT of Northwest Rehabilitation Associates, Inc. will be featured presenters at the upcoming APTA Combined Sections Meeting in New Orleans. Their topic:

Intensity and Dosage in Geriatric Physical Therapy 

Their stated goal with this presentation is to "begin a conversation about dosage in PT. Increasing intensity and challenging patients to a level that will induce improvement in balance, strength, endurance and gait speed."

We caught up with Mike and Brady at their clinic in Salem, Oregon and had them demonstrate some of the different ways they are using dosage with their stroke and hip patients:

Mike Struder on Stroke Exercises

Brady Whetten on Hip Stability

Hip: Quadruped Position

Hip: Extensions 

How are you challenging your patients to induce improvement? Please share with us some of your ideas in the comments.