Brian Schiff’s Blog

Over the past several years, the trend in the health and fitness industry has been toward injury prevention and movement screening.  Gray Cook and Lee Burton have given us the FMS.  More recently, the Y-Balance test has emerged as another tool to assess asymmetry in the upper and lower quarter.

I am currently FMS certified and planning to attend the SFMA course next month in Durham.  I routinely incorporate the FMS in both our rehab and sports performance work at the APC.  I like many things about the screening exam.  It provides a consistent tool to assess baseline movement and record asymmetry on a simple 4 point scale scale.  It also has been shown to have good intra and inter-rater reliability.  Click here for a recent study published in the Journal or Orthopaedic & Sports Physical Therapy.

For those unfamiliar with the screen, it is 7 tests scored on a 0-3 scale as follows:

• 0 = pain
• 1 = unable to perform the movement pattern (or perform with marked dysfunction)
• 2 = performs the movement with a mild compensation
• 3 = performs the movement correctly

I would say on average, most of the athletes I screen score between a 12 and 15.  My highest score was a 19 (9 year old gymnast) and my lowest was a 9 (NFL lineman).  As screeners, we are charged with uncovering asymmetry and faulty movement patterns.  What do you see in the following picture?

Clearly, the dowel is not level, thus we score it a 2.  She also had some ER in the right leg when stepping over the hurdle.  She was a symmetrical 2 on the hurdle step test.  This is a Division I soccer player who scored 17 on the exam.

Most of the movements seem straightforward.  However, many question what the rotary stability test measures with respect to the ideal 3 score (ipsilateral movement)?  It assesses an unnatural movement pattern to be sure.  This athlete failed miserably on the ipsilateral pattern but scored a solid 2 with the contralateral pattern.

I have yet to test someone who can score a legitimate 3.  I have seen some get a 3 on one side and 2 on the other (asymmetrical and a red flag in FMS land).  As one who naturally questions things, I find myself questioning how many are truly capable of scoring a 3.

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Disclaimer: This post is a small rant from me.  I normally don’t use this blog as a medium for that purpose. However, I feel so strongly about this topic that I decided to share my thoughts on it.

I had an interesting email exchange with a health care practitioner (HCP) this past week.  She had some questions about one of my products and asked specifically if I had done a clinical trial comparing my treatment method to leading national PT organizations.  My answer was no.

I explained to her I am not a researcher, nor do I have the time (or money for that matter) for such things as I am in the trenches every day treating patients and training athletes.  Her response was very interesting.  According to her I was defensive, and she suggested I check out a DPT program so I could in essence become a better clinician.

Hmmm………  Suffice it to say I completely disagree with her on this one.  I graduated from PT school at the Ohio State University in 1996.  Their program was very well respected at the time (over 500 applied and they took 60 in my class) and two of my professors (Lynn Colby and Carolyn Kisner) wrote the text on Therapeutic Exercise that is still used in many curriculums today.  On top of that, I worked at the top outpatient ortho clinic in the city as an aide my junior and senior year in college.

At the time of my admission, OSU only offered a B.S. degree, so I never had a choice for more at that point.  The university quickly adopted a Master’s program shortly after I finished and later became one of the first institutions to offer the full DPT program.

Upon graduation, I went to work at the same top ortho clinic and spent 5 years working side-by-side with some of the brightest PT’s and next door to what was considered by many to be the best surgical group in town.  I saw surgeries, sat in on MD appointments with my patients, participated in journal clubs and worked at a feverish pace.  Let’s just say I saw lots of patients and gained what felt like a fellowship experience for 5 more years.

Now, as I reflect upon this email from said HCP, I can honestly say that I believe experience and results matter more than just those three letters behind a name.  That is in no way meant as a slam or any disrespect to the DPTs out there, clinical research trials or the doctorate degree itself.  Students today have no choice but to take the DPT route.  To be honest, they really only have (1) more year of structured curriculum than I had in my program.  They leave school with a lot more debt, and afterward they still have no clinical (real world) experience when they first start out.  You simply can’t buy experience in school.

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This is a quick post to announce that I have joined forces with Allied Health Education, a new company founded to provide relevant education for allied health professionals, personal trainers and strength and conditioning professionals.  It is a therapist owned company dedicated to delivering affordable evidence-based continuing education.

I will be doing webinars on SLAP tears (this one is open for registration now) and FAI as well as a live one day course in September on the knee (breakouts will focus on running, ACL and arthritis).  For more information and current course listings, visit them online at www.alliedhealthed.com.

It is clear that our society loves shoes and fashion.  The problem is that fashion often does not equate to good function.  Keep in mind your feet set the tone for the rest of your body’s biomechanics so it stands to reason that one would want to pay close attention to their foot structure and use the RIGHT shoes more often than not.

I treat and evaluate lots of runners on a weekly basis.  I use the FMS, selective testing and gait analysis to help them resolve mechanical issues, overuse problems and improve running efficiency.  However, when it comes to making footwear choices, I can only counsel them on what is best.

Recently, I wrote a column for Endurance Magazine on the impact of high heels and flip flops as it relates to injury risk.  At the end of the piece, I give some exercises to address shortened muscles and soft tissue.  I think all women who enjoy running (symptomatic or not) should give this a read.  Click here to read the article.

Well, after a silent stretch the past 2 weeks or so related to my study/preparation for the OCS exam, I am back to blogging! Today’s post is a pertinent one for runners and athletes suffering from lower limb injuries.

Static stretching has taken a bit of a beating in the strength and conditioning world in the last few years. Dynamic warm-ups and active mobility have taken center stage as of late.  While these active modalities are certainly superior for prior to practice, play and ballistic activity periods, I still believe stretching has a place in rehab and conditioning.

Interestingly enough, a study recently published in the March 2012 Journal of Strength & Conditioning Research examined the effects of static stretching of the calf and its impact on the strength/ROM of the contralateral side.  Click here for the abstract.

In a nutshell, the authors had two groups of untrained individuals: test group (6 male and 7 female subjects) and control group (6 male and 6 female subjects) who participated.  The test group did supervised active right calf stretching 3 days per week for 10 weeks (four 30 sec stretches w/30 sec of rest between stretches).  They stood on a beam 30 cm above the floor with the left knee slightly bent to offload the left leg as well as placing the hands on the wall while they leaned forward allowing the right heel to drop toward the floor until a max tolerable stretch was felt.  The knee was straight throughout on the stretch side.

Control subjects did no stretching at all.  All subjects were instructed to maintain their normal physical activity but refrain from any resistance training or stretching during the 10 week investigation.  The results:

• 29% increase in 1RM calf raise strength on the right
• 11% increase in 1RM calf raise strength on the left
• significant 8% increase in calf ROM on right
• significant 1% decrease in calf ROM on the left (non stretch side)
• No change in strength or ROM for control group

The authors conclude that the results of this study best apply to rehab settings.  For example, they suggest that this procedure may be an effective way to combat the loss of strength in limbs that have been immobilized after injury or surgery simply by stretching the mobile (unaffected) side.  They also point out that this may be a way to mitigate strength loss when access to traditional strengthening modalities are not readily available.

Clearly, athletes suffering an acute ankle sprain as well as runners suffering soleus/Achilles/lower limb overuse injuries would benefit from such a strategy. So why does this work?  Zhou in earlier work describes a cross training effect due to neural adaptations regulated in the spinal cord.

What does this mean for you and me?  Well, as someone who works with many runners I am always looking at eccentric control of the G/S complex as well as effective single leg heel raise strength.  The idea that stretching the uninvolved side to strengthen the involved side seems like a no brainer.  Clients suffering from tendonitis, plantar fasciitis, stress reactions, sprains and other injuries can use this as an early intervention without stressing the involved side.

More importantly, I like the idea of increasing neural adaptation and ROM in the stretch side through eccentric load as the dissipation of ground reaction forces will be more efficient in a calf that effectively handles eccentric loads through a sufficient range of motion.  This study definitely highlights the importance of stretching in novice runners and those with tight gastrocs. I am curious if the bent knee stretch would have had a similar effect primarily on ROM – perhaps they will investigate that further in the future.

As we move more toward mid and forefoot running gait, I believe the fitness of the G/S complex will be even more important than before as stress is transferred away from the knee and more toward the foot/ankle complex.  Clearly, we need more studies in trained subjects on unilateral stretching to determine if the same effects and degree of impact will be seen, but this study shows some promise for active static calf stretching in the appropriate populations.