Career Advice Article Archives

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A Foolproof Way to Learn More in 2013

A Foolproof Way to Learn MORE in 2013-1

Back in December, I reflected on what I learned in 2012.  One of them discussed the importance of online education and it’s impact on our ability to advanced our own education and development.  I wanted to expand on that thought a little bit and offer what I believe is a foolproof way to learn more in 2013.

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What if I were to tell you that you can add two weeks of more time to your year in 2013?

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We all want more time, right?

We all feel like there isn’t enough time in the day to get things done so we usually suffer ourselves.  Sometimes we skip exercise, or eat poorly, or neglect continuing education.

By carving out 20 minutes a day and dedicating it to personal growth and continuing education, you’ll accumulate 2 extra weeks of time during the year.  And that is just 20 minutes a day, 5 days a week – take the weekend off!  If you spend 20 minutes per day, 5 days per week, that adds up to over 86 hours a year, or more than two full work weeks of continuing education.

I think 20 minutes is the perfect length of daily education.  Studies have shown that pushing yourself a little bit each day, stepping away, and coming back results in better skill development.  You’ll have better retention, and you can mix and match different topics each day to whatever interests you today or to learn something specific to a patient or client you have coming in later that day.  You want to push yourself often, daily in this example, to create a habit of professional growth.  This stimulates your brain and I can almost guarantee will make you feel better about yourself, feel more confident, and ultimately happier in the long run.

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Finding 20 Minutes a Day

foolproof way to learn more in 2013So how do you find 20 minutes a day and how do you fill these minutes?  I’m glad you asked!  (OK, I guess I was actually the one that asked…).  Finding 20 minutes per day seems easy enough, but we all know how hard that can be at times.  My easiest recommendations for finding these 20 minutes are to:

  1. Schedule these 20 minutes.  Maybe it is at lunch, right when you get to work, while you are drinking your morning coffee, or whenever, but if you schedule these 20 minutes and make them part of your routine, you will be more likely to find time.
  2. Don’t check your email first thing in the morning.  Really, what exciting things happened during those 8 hours you were sleeping?  Nothing you can’t get to when you get to work or during a set time.  I try to avoid my email until after I accomplished a major goal of the day, so that way I am not distracted with little to-do’s before I get the most important task of the day out of the way.
  3. Disconnect from social media.  Studies have shown a certain amount of OCD is created by social media, making you want to stay connected throughout the day.  I would bet many of you waste away 20 minutes a day playing around pinning, poking, and tweeting all day (do we still poke?  Confession – I never knew what poking was…).

Rather than try to find 20 extra minutes a day, sometimes it’s easier to start with trying to multitask for 20 minutes per day.  How about while you are eating breakfast, or commuting to work, or waiting at the dentist?  Photo credit.

How to Use Those 20 Minutes

So now that you have found those magical 20 minutes, how do you maximize your ability to learn in these precious moments?  Here are some ideas:

  1. Set up a system to stay on top of website articles and journal articles as they become available.  You can use Google alerts, RSS feeds, and many more tools.  If you want to learn what I do, I have a webinar on setting up a system to stay on top of interests and evidence.
  2. Always have some articles you want to read readily available on your phone or tablet using an RSS reader like Google Reader, a read it later app like Instapaper, or a note taking app like Evernote.  Now, while you waiting in line at the bank, or for a haircut, or for your wife to get ready before you go out (because I know she’ll read this…).
  3. Listening to a podcast or audiobook while you are driving.
  4. Listening to a podcast or audiobook while jogging/walking/etc.
  5. Watching a DVD or online webinar while on a treadmill.  I rip all my DVDs to my iPad and then watch them at 1.5x to 2.0x speed.
  6. Watching a DVD or online webinar while commuting to work (assuming you aren’t the one driving).

A Call to Action

I really believe that current trends in online education can make you much better at what you do.  I started this thought in my article in December, but want to elaborate a little more.  I would like to propose the following call to action for us all to learn more in 2013:

  1. Attend at least one continuing education seminar a year.  This is designed to obtain a specific skill and should be dedicated to one with mostly hands-on learning and manual skill development.
  2. Attend at least one multi-speaker symposium each year.  This is to get several different views in a short amount of time and usually has a wide variety of topics.  Plus you get a great networking oppurtunity.  Downside of these symposiums is usually lack of hands-on time.
  3. Have one book to read that is NOT related to our clinical skillswork on your other skill sets, I try to read 1-2 per month.  HINT: You’ve probably figured it our by now, but most books like this have about 20% content and 80% stories to strengthen the content.  I don’t need the fluff, I read fast and get through more books this way.
  4. Watch one webinar a week.  Subscribe to a resource that has a diverse amount of topics that you can digest quickly, like RehabWebinars.com or my Inner Circle.  That way you can vary the topics but whatever is on your mind that week or whoever you have on the schedule that day.  If a webinar is more than 20 minutes, watch half one day and the other half the next.
  5. Read a couple of websites a day while drinking your morning coffee, eating lunch, or unwinding in bed.  I usually spend 10 minutes a day doing this and staying on top of what is been published on the internet.  As I mentioned earlier, you can read more about how to learn my system of staying current.

Think about it, over the course of the year you would attend at least 1 continuing education seminar, 1 symposium, read at least 12 books, watched 52 webinars, and read 100’s of online blog posts and journal articles.  There is no doubt this will serve as a great shortcut to overachieving and making great progress in your career.

Foolproof.

Now that you have gained all this time and know what to do with it, use these two weeks you gained to educate yourself more and start overachieving!

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Exercise Selection for Rehabilitation Programs

Today’s guest post is written by Dennis Treubig, PT, DPT, CSCS.  Dennis has some great thoughts and I couldn’t agree more with his motivation to push himself.   This is a concept I talk about all the time.  I love the first line below!   Thanks for sharing, I think this information and the “progress” Dennis has made is a great example of thinking outside the box, while justifying your thoughts with scientific rationale.  Good work Dennis, thanks!

Exercise Selection for Rehabilitation Programs

selecting rehabilitation exercisesI believe that from time to time any physical therapist should ask themselves, “Professionally, what do I do differently now than 5 years ago?”  If your answer to that is nothing, you are doing a disservice to yourself and your patients (and most likely aren’t reading websites like this).  If you answer that question with a lengthy discussion, then I commend you.  When I asked myself that question recently, I realized that one of the major areas I have changed is in exercise selection for my patients.  After thinking about it more and more, I feel that this is one area that separates the run-of-the-mill PT from the “advanced” PT – and that is why I decided to elaborate on my thoughts.

I think there are many physical therapists out there that bombard their patients with a slew of exercises thinking that more is better.  These PT’s will add new exercises without taking out old ones, they will prescribe “3 sets of 10” for each exercise, and rarely progress the weight/resistance.  These types of PT’s will also see a new, “cool” exercise somewhere and then, without proper discretion, try it with all of their patients.  While this is not necessarily a “bad” treatment, I believe that we, as PT’s, should be better than this.

When I came out of PT school, I was eager to jump right in and try all these new & exciting manual techniques and exercises (for the purpose of this article I will obviously focus on the exercise aspect).  While my patients were getting better, I found my treatment plans were loaded with exercises, making it difficult to know what was beneficial, which ones may have been causing soreness, and which ones weren’t even necessary.  In addition, it was also making each patient’s treatment rather lengthy, which is not ideal when you practice in Long Island, NY where most of my patients are “limited on time.”

So, I went back to the research, followed some new professional blogs, and read books from different fields (physical therapy, strength & conditioning, business success, etc.) to see how I could better serve my patients.  Here are some of the key points that resonated with me:

Selecting Reps and Sets

If the leading strength & conditioning specialists have their healthy clients doing only 3-5 main exercises (not including a little assistive work) when strength training, why would we put our injured patient through 7, 8, 9… exercises for “3 sets of 10?”

Since an injured patient is not going to be able to tolerate the volume of a healthy strength-training individual, we should be implementing volume less than that (and increasing it as necessary).  And since when did 3 sets of 10 become the only way to exercise in a PT clinic.  If strength & conditioning specialists constantly change the reps/sets to fit the needs of their client, why aren’t we?  We should be altering the sets, repetitions, and resistance of the exercises to fit within that desired volume.

The Pareto Principle (80/20 rule)

In case you are not familiar with this principle, it states that, for most events, approximately 80% of the effects come from 20% of the causes.  I believe this is applicable to rehab exercises – 80% of our results probably come from 20% of the exercises we give to patients (or should come from 20% of the exercises).  This means that if you focus on the appropriate 3-4 exercises and cut out the rest, you will get similar results.  And, I believe, better satisfaction from your patients.

Integrating Recent Research

Research articles that studied EMG analysis of therapeutic exercises have provided us with better information regarding muscle activity during each exercise.

Among others, articles by Reinold et al, Ekstrom et al, & Ayotte (references at end of article) have shed light on common exercises we prescribe.  This allows us to re-evaluate the exercises we use and pick the ones that elicit the most desired muscle activity.  And just because these articles looked at numerous exercises, it does not mean that we should pick every “good” exercise they looked at – be selective and choose the most worthwhile exercises.

The Jam Experiment

rehabilitation exercisesIf you are unfamiliar with this experiment, here is a brief synopsis (officially titled, “When Choice is Demotivating: Can One Desire Too Much of a Good Thing?”).  Shoppers at a grocery store were presented with two different displays of jam – one had 6 flavors and the other had 24 flavors.  The results showed that 30% of people who visited the display with 6 jams actually purchased jam, while only 3% made a purchase after visiting the display that offered 24 jams.  (Photo by @joefoodie)

So, you’re probably asking, “How does this relate to rehab programs?”  Here is where I first noticed this idea – anecdotally, when providing patients with a home exercise program, the more you give them, the less likely they are to perform it.  Soon thereafter, I also became aware of it with regards to the exercise programs my patients went through.  The more exercises they did, the less likely they were to remember how to do them correctly and the less intense they did them.

“Perfection is not when there is no more to add, but no more to take away.”

One day, I came across this quote from Antoine de Saint-Exupery and it definitely left an impression on me (personally and professionally).  All too often, I see new, more complex exercises being added to patients’ programs without taking the basic exercise out.  This becomes redundant, increases the volume, and lengthens the treatment time.  For example, if your patient is doing wall squats, sit-to-stands, and leg press for 3 sets of 10, cut out the more basic sit-to-stands and wall squats and focus on the leg press.  Do the leg press for 4-5 work sets and bump up the intensity.  I bet you’ll get similar results with less work.  This will free up time for important mobility/corrective exercises and more manual techniques.  And by no means do I think that my treatment plans are perfect, but this quote makes you think about things in a different way.

After taking all this into account, I began to “trim the fat” and re-designed my rehab programs.  I wanted my programs to be direct, efficient, easily understood, and reproducible (for after discharge).  So, I started giving my patients 3-4 exercises, frequently altered the reps/sets/weights as necessary (usually in the 4-5 work set range and 4-8 rep range), educated my patients on the reasoning/technique/progression of the exercises and…  TADA… the results were better than I had before.

Not only were the patients’ results better, but it also became easier for me to manage any problems that may arise.  And when fewer exercises were implemented, my patients were retaining the information and able to make decisions on their own.  Now, it’s not uncommon for me to tell my patient what exercise is next and after 5 minutes they’ll come up to me and tell me, “I warmed-up for 8 reps on 80 lbs, then did 2 sets of 8 at 100 lbs, 2 sets of 6 at 110 lbs and was only able to do 4 reps at 120 lbs.”  When your patients are making decisions (and the right decisions) without your help, you know you have done your job right.

I hope this article makes you think about how you design your treatment programs and sparks some discussion in your clinic.

 

References

  • Ayotte NW, Stetts DM, Keenan G, Greenway EH.  Electromyographic Analysis of Selected Lower Extremity Muscles During 5 Unilateral Weight-Bearing Exercises.  J Orthop Sports Phys,  2007;37:48-55.
  • Ekstrom RA, Donatelli RA, Carp KC.  Electromyographic Analysis of Core Trunk, Hip, & Thigh Muscles During 9 Rehabilitation Exercises.  J Orthop  Sports Phys,  2007;37:754-762.
  • Ekstrom RA, Donatelli RA, Soderberg GL.  Surface Electromyographic Analysis of Exercises for the Trapezius & Serratus Anterior Muscles.  J Orthop Sports Phys, 2003;33:247-258.
  • Ekstrom RA, Osborn RW, Hauer PL.  Surface Electromyographic Analysis of the Low Back Muscles During Rehabilitation Exercises.  J Orthop Sports Phys,  2008;38:736-745.
  • Ferriss, Timothy.  The 4-Hour Workweek: Escape the 9-5, Live Anywhere, and Join the New Rich.  Crown Publishing Group, 2007.
  • Iyengar SS, Lepper M.  When Choice is Demotivating: Can One Desire Too Much of a Good Thing?  Journal of Personality and Social Psychology, 2000;79:995-1006
  • Reinold MM, Wilk KE, Fleisig GS, et al.  Electromyographic Analysis of the Rotator Cuff & Deltoid Musculature During Common Shoulder External Rotation Exercises.  J Orthop Sports Phys, 2004;34:385-394.

 

About the Author

Exercise Selection for Rehabilitation ProgramsDennis Treubig, PT, DPT, CSCS.  Dennis received his Doctorate of Physical Therapy from the University of Delaware in 2005 and has been practicing at ProHealth Physical Therapy in Lake Success, NY for the past 6 years.  He is also a Certified Strength & Conditioning Specialist by the NSCA and a Clinical Instructor for the Hofstra University Athletic Training Program.

 

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4 Things I Learned in 2012

4 Things I Learned in 2012

At the end of each year, I always try to personally reflect on what I had learned over the course of the year.  “Learned” may not always be the most accurate word, as this list usually contains things that I have adapted, tweaked, or refined, in addition to learned.  I find that this is both a great personal tool to assess growth as well as establish new goals for the following year.

So here is my list of some things that I learned in 2012.

Assessment is More Important Than Treatment

I have spent A LOT of time reflecting this year of how to best enhance my assessment process.  I’ve looked into as many assessment “systems” that I could find from all over the world.  As our understanding of human function continues to improve, it seems like movement assessment systems are becoming very popular.  I talked earlier about how a proper assessment and reassessment process is one of the most important things we need to do.  If we aren’t reassessing our patients’ and clients’ limitations after our programs, than why are we even working with them?  How do we know what is working, and what isn’t?

It seems that most of the movement assessment systems I have looked into place heavy emphasis on mobility and symmetry, and I must say that this is what I feel may be the most limiting quality of these systems.  Specifically, if you don’t have a system in place to assess alignment first, then assessing movement is limited and even sometimes inaccurate.

To me, this is next phase of assessment we need to conquer – properly assessing alignment.  I recently discussed the importance of alignment when considering the scapula and how alignment influences how we should be stretching.

In my search for the holy grail of assessment skills, I have used and adapted pieces of many systems, and I encourage you to do the same.  Everyone is different and not every system is a fit for us all.  I for one, don’t like to rely on just one tool, and prefer to combine what I have learned from many different people and schools of thoughts.

It’s Not All Just About Technical Skills

Most of us can all likely say that we are guilty of focusing too much on enhancing our technical skills and knowledge, while neglecting developing some of our other much needed skill sets.  I stated this recently in an article where I summarized some of the great qualities of experts in our fields, but I really do feel like our education process should include developing some of these qualities.

Realistically, we all work in a service industry and are providing a product to a consumer.  To deliver this as effectively as possible, it takes far more than knowledge.  It takes the ability to connect with people to truly enhance what we do.

We Need to Work Muscles in 3D

This is a really simple thought process, but something that I tried to focus on more recently.  I have heard quite a bit lately that exercises designed to isolate a movement and work on muscle strength are not “functional” and thus not worth performing.  I couldn’t disagree more, especially when a specific muscle has been shown to be weak or inhibited.  The efficacy of simple strengthening exercises has been well documented.  My shoulder patients are going to perform sidelying external rotation if the infraspinatus is weak.  It is going to be hard to enhance a poor movement patterns if muscle weakness is part of the deficiency.

However, I believe that using isolated movements is just the beginning of our programming.  Once strength is improved, the next step is to now work on strength of the muscle in three dimensions, or 3D, to train a better movement pattern.  What does this mean?  Think of the function of each muscle in every plane of motion.  Yes, there are prime movements for each muscle, but each muscle has a role in all three planes of motion.

This is the next step that I progress to prior to jumping to just “functional” exercises.  Here is my sequence:

Isolated Movement –> 3D Movement –> Functional Movement

The hips are a great example, and there are many examples of functional glute exercises that utilize this concept.  Try to think of each muscle and how it functions in all 3 planes of motion, then work 3D exercises into your programming.

Online Education is Officially My Go To Learning Resource

Over the course of the last decade, online education has really taken off.  I have always been a fan and supporter, but I think for the first time I now believe that online education is now officially my go to learning resource.  I still attend seminars and conferences, as the hands on component and networking is always important.  However, I now feel that this is the supplemental component, and that online education is my primary means of education.

I feel this way because we are now able to learn SO MUCH more with amazing content at our fingertips 24/7.  Realistically, unless you live in a major city or are willing to travel to one, it is hard to engage in learning from a wide variety of experts unless you embrace online education.  And speaking from the experience of an author, by the time you read a book or journal article, the information is already outdated.

That is one of the primary reasons that I think RehabWebinars.com and my Inner Circle are so valuable.  You can sit down and digest a brief bit of currently relevant information and apply it to your tool box immediately.  I love watching a 30 minute webinar at lunch or reading a new article while I am waiting somewhere.

Really, our ability to learn is only limited by how much effort we want to put into it.  I challenge everyone reading this to try this sequence of self-directed learning that I have been following myself with just an iPad:

  • Have one book to read that is NOT related to our clinical skills, work on your other skill sets, I try to read 1-2 per month.  HINT: You’ve probably figured it our by now, but most books like this have about 20% content and 80% stories to strengthen the content.  I don’t need the fluff, I read fast and get through more books this way.
  • Watch one webinar a week.  Subscribe to a resource that has a diverse amount of topics that you can digest quickly, like RehabWebinars.com.  That way you can vary the topics but whatever is on your mind that week or whoever you have on the schedule that day.
  • Read a couple of websites a day while drinking your morning coffee, eating lunch, or unwinding in bed.  I usually spend 10 minutes a day doing this and staying on top of what is been published on the internet.  Click here to learn my system of staying current.

If you follow this system, you’ll read about 12 books, watch 52 webinars, and stay on top of all the new content being published each day on the internet.  Keep going to seminars and conferences, but implement this and you’ll set yourself apart very quickly.

OK, so that is what I learned in 2012, what did you learn?

How to Stay Current with Evidence

How to Stay Current with Evidence

The latest webinar recording for Inner Circle members is now available below.

How to Stay Current with Evidence

In this month’s Inner Circle webinar, I discuss how you can set up a system to stay on top of all the latest news, articles, and research.    This is essentially the system I use to:

  • Keep an eye on new news, articles, and journal articles
  • Get custom emails when journal articles I am interested in get publish
  • Utilize things like Tweetdeck, Pinterest, and Youtube
  • Organize all of this in Evernote
  • Access everything from any computer, phone, or tablet with internet

To access the webinar, please be sure you are logged in and are a member of the Inner Circle program.

Qualities of Experts that We Should All Possess

Last week I shared with you a summary of a recent Facebook discussion we had regarding what you thought was our most important quality.  I Intentionally eliminated knowledge, experience, and technical skill in the discussion, as I was looking for different types of qualities.  The response was awesome, and there was a lot of great feedback.

I summarized the top qualities we need to possess at the end of the post.  Today, I want to review these qualities again and related them to experts in our fields that do a great job of exemplifying these qualities.  Not all of these people are in the rehab or fitness fields, and I haven’t met them all, but each have helped me either personally or through their work.  Using these experts as examples will help you learn each of these qualities even more, and hopefully allow you to start working on enhancing these skill sets.

Consider this article an introductory course that we all should of taken in college!

Qualities of Experts that We Should All Possess

If you have’t read last week’s article, go back and read that first.  It’s quick but serves as a good introduction into this summary.

Mark Verstegen – Passion and Charisma

Mark VerstegenMany people know Mark Verstegen as the founder of Athlete’s Performance or one of the Men’s Health experts.  While this certainly gives Mark quite a bit of credibility, if you have never had a chance to see Mark in action on the floor with athletes, you have missed the side of Mark that is his most contagious, his passion and charisma.  I have had several opportunities to visit Athlete’s Performance, and watching Mark in action is always the highlight.  Even though Mark has so many responsibilities and so many coaches at Athlete’s Performance, he spends the day bouncing back and forth between groups of athletes doing what he does best – coaching.  He is nonstop all day bouncing all over the place and being involved with everyone at the facility.  And this is a good thing, as Mark’s energy, passion, and charisma is contagious.  He’s not walking around chit chatting with clients or sipping coffee in his office, he is on the floor impacting.

Take home:  If you aren’t passionate about what you do and can’t charismatically show this, your patients and clients are missing a huge source of energy.  No matter how big you get or how many people you hire to delegate to, remember that it is your passion and charisma that drives your facility or clinic.  These qualities are contagious to your patients and clients.

Ken Crenshaw – Open Mindedness and Humility

Ken CrenshawKen Crenshaw is the Head Athletic Trainer of the Arizona Diamondbacks and someone I am proud to have had many chances to learn from.  Working in professional sports, your goal is different that many other circumstances.  We need to get our athletes out on the field every night and we don’t care how we do this.  It can be through manual techniques learned from Mulligan, Maitland, MDT, or anything else.  It can be an IASTM technique like Graston or ART.  It really doesn’t matter, because it’s not about you, it’s about the athlete.  It doesn’t matter if you subscribe to a certain theory or technique.  Don’t convince yourself that there is only one way and that you know everything.  One thing I know for a fact is that much of what we think we know now will change over time.  Don’t put all your eggs in one basket.  As Crenshaw says, be a mutt.  Take in as many different thoughts and perspectives as you can, it will only make your better.

Take home: Don’t have tunnel vision and think there is only one way to skin a cat and everything else is wrong.  Be a mutt.

Michael Boyle – Adaptability and the Passion to Always Learn

Michael BoyleAs many of my long time readers knows, the passion to always learn is one of the qualities I try to promote the most.  This goes hand in hand with adaptability.  If you are always learning, you better be adapting.  This goes back to the above comment that we will probably look back at what we are doing now and have a nice laugh in ten years.  Heck, maybe our great great great great grandchildren will laugh at us for the thinking the world was round!  There is a big difference between innovating and adapting.  Realistically, there aren’t a lot of innovators.  There just isn’t going to be another Steve Jobs anytime soon.  But that doesn’t mean that adapting is a bad thing.  I’m sure there isn’t anything I ever teach that is 100% unique, but rather a combination of adaptions I have made over time.  This is a great quality that Michael Boyle possesses.  Michael does a great job taking information from a ton of different sources and puts it together in a logical format.  This is adaption at it’s finest.  Michael also loves to write posts and lecture about what he has learned and mistakes he has made.  Again, adaptation at it’s finest, and he isn’t afraid to laugh at himself for what he used to think.

Take home: You don’t always have to try to innovate, adapting is often times just as needed.

Kevin Wilk – Integrate Evidence and Always ask “Why”

Kevin WIlkKevin Wilk is a friend, but more importantly a mentor.  Over the years, I was a clinical student of Kevin’s, a postgraduate fellow of Kevin’s, and a colleague of Kevin.  We have done a lot together over the years and I have always tried to emulate his ability to integrate evidence into our everyday practice.  This is where I learned about the power of asking “why.”  One goal I have always followed was to always have a rationale behind everything I do, every exercise, every technique, every set, every rep.  Push yourself to never do something just because “this is how I have always done it.”  For anyone that has attended one of Kevin’s seminar, you know he doesn’t ever stop integrated new evidence.  One of the biggest complaints that Kevin and I get from our lectures is that our slides don’t match the handouts.  What you probably don’t realize is that the handouts are due weeks to months prior to the course and we both literally update our slides all the time, including on the flight to the seminar!

Take home: Don’t every be satisfied with what we know and do.  Don’t stop learning and applying new evidence.  Always ask why you are doing everything you do.

James Andrews – Great Work Ethic and Accessibility

James AndrewsDr. James Andrews could be the most famous sports surgeon to date.  He has literally operated on leading athletes in every sport.  There are several reasons he rose to fame, and you can’t deny it has a lot to do with skill and people skills.  But an often overlooked quality is accessibility.  Andrews has made a career by always being accessible.  I can’t tell you how many evening, weekends, and even holidays I have had to call him and talk about a patient, and he always answers.  His work ethic is also second to none.  During my time there, he worked all week, covered a high school football game Friday night, both Alabama and Auburn on Saturday, and then the Redskins on Sunday.  He is always on.

Take home: Do you email or text your patients or clients to check in on them?  Do you answer the phone when they call?  Do you consider yourself “off work” at 5:00?  There always needs to be a personal and professional balance, but your work ethic and accessibility are often things that can really help you differentiate yourself.

Dale Carnegie – Good Communication and People Skills

Dale CarnegieThis could probably be one the most important qualities on the list – communication and people skills.  This is especially true in service industries like ours.  Our biggest referral source is always going to be word of mouth.  The better your people skills, the easier this is going to be.  One trick I learned from Dale Carnegie (out of many) was to always try to think from the other person’s perspective.  People are going to tell you what they want, you just have to stop and listen sometimes.  Stop thinking of what you want and focus on what your patient or client wants.  This almost always leads to what we want in the end!

Take home: Read Dale Carengie’s How to Win Friends and Influence People.  This is the all time classic and a great place to start.  When you are done reading it, read it again.

John Maxwell – Positive Attitude

John MaxwellJohn Maxwell seems to publish a self-help book every other month!  While there are some typical leadership books,  one particular book that I really learned a lot from was The Difference Maker.  As you can guess, the difference maker is our attitude, and can be a positive or negative factor.  I’ll admit, I am from the northeast, we tend to focus on the negative.  For anyone that watched Seinfeld or listens to sports radio on the Boston area, you know what I am talking about.  So thinking negative and speaking negative is common and all around us, and not a good thing.  If you come to your clinic or facility with a negative attitude, who else do you think is going to have a negative attitude?  That is right, your patients and clients.  Attitude is contagious, start a trend of positivity and try your best to not let others around you bring you down.

Take home: Read Maxwell’s The Difference Maker and then make your positive attitude contagious.  Leave your bad day at the door.

Joe Ehrmann – Selflessness, Empathy, and Compassion

Joe EhrmannYou can see how qualities are starting to overlap a little bit.  Ehrmann, a former collegiate and NFL star, has written, at least in my opinion, one of the most influential books on coaching, InsideOut Coaching: How Sports Can Transport Lives.  In this book, Ehrmann details his youth and rise through the ranks of football, and everything that went wrong along the way.  During this journey he shares how his perspective changed and how influential coaches can be.  Don’t be fooled into thinking this book only applies to sport coaches, if you are a therapist, athletic trainer, personal trainer, or strength coach, you are coaching people too.  Now if only all the Little League parents and coaches would read this book, perhaps we would have less Tommy Johns on 12 year olds.

Take home: Read Ehrmann’s InsideOut Coaching and reflect on how your interactions with patients and clients aren’t temporary and can impact their lives for years to come.  This will certainly make you think about how you “coach.”

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Our Most Important Quality?

A couple of months ago, I posed a simple question on Facebook – “Other than our technical skills, what quality do you consider the most important asset that we should possess to succeed in our fields?”

Interestingly, we all put a ton of time into improving our knowledge and technical skills, and that is always a good thing!  But perhaps we sometimes need to take a step back and work on some of the non-technical aspects of our professions to take us to the next level.

 

Your Thoughts

The response from that Facebook post was great, with many people providing fantastic input.  Here is a screenshot of that discussion:

Most Important Fitness Quality

Most Important Physical Therapists Quality

Most Important Quality

 

Our Most Important Qualities

Based on this, it looks like the group vote would be that the below qualities (in no particular order) are really something we should all possess:

  • Passion and charisma
  • Positive attitude
  • Humility and open mindedness
  • Good communication and people skills
  • Empathy, compassion, and selflessness
  • Good work ethic and accessibility
  • Adaptability and a passion for self development
  • Habit of continuously asking “why” and integrate evidence

Wow, I wish I knew all of this when I started my career!  This should really be a class we all have to take in college.  Please continue this discussion in the comments section below, I’d love to hear what you think and any other ideas you may have.

Next week, I’ll discuss what I feel are some the of the best qualities that many experts in our fields possess.  As you can imagine, there will be significant overlap!  More importantly, I’ll try to suggest who we can emulate and learn from to enhance these qualities in ourselves.  Maybe this will be a “home study” version of that college class we should of all had to take!

 

 

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The One Thing We Need to Do With Everyone

I am often asked by students or people attending one of my seminars, “what is the one thing you do that you find works the best.”  What a loaded question!  I wish it were that simple that I could teach everyone just one magic technique.  I have been reflecting on this question for several months, planning on writing a post to provide an answer.  I took me sometime to figure out how I wanted to answer the question, but I think I might have an answer

 

The One Things I Do That Works the Best

The one thing that I would say that I do that works “the best” is probably something we should all be doing with everyone.  It’s not a stretch, it’s not an exercise, it’s not the latest fad in equipment, and it’s not the lastest manual technique.  It’s actually so simple, that it took me awhile to figure it out.  It is assessing and Reassessing.

A proper assessment and reassessement is by far the best thing we can do for every patient and client we encounter.  This is really the key to understanding each individual, what they need, and what works for them.   Everything should start with a proper assessment and then after treament or training, reassess!  Do it every time you work with that person and even multiple times a session.

[quote]Ask them, “what is your primary complaint?”  Assess it.  Quantify it.  Treat it.  Reassess it.[/quote]

This simple concept can have many meanings.  At the simplest level, imagine if you were working with a weight loss client and didn’t assess their body weight.  How would you know what was or wasn’t working?  How would you know how much improvement that client has made?

For the clinician, we have many evaluation and assessment tools – range of motion, joint mobility, strength, flexibility, and many many more.  But these measurements are irrelevant to the patient.  They don’t really care if they gained 10 degrees of motion.  They simply want to feel better and move better.

OK, your shoulder hurts.  When does it hurt?  What can you do to recreate that pain?  Great – you just established a baseline that you can reassess.  Don’t get me wrong, you still want to take objective measure, but you now have a real life baseline assessment that the patient can feel.

This is why tools like the FMS and SFMA are valuable – systematic methods of assessing movement.  This is especially true in the fitness fields, where assessments are even more limited.  Quantify the quality and feel of movement to assess changes.

FMS

Ultimately, this is going to always lead to better outcomes – instead of just applying treatment or exercise and hoping it works, assess what really works and adjust as needed.

 

Assess and Reassess

How do you apply this?  The wrong way would be to just start working on someone that complains “my back hurts.”  “Well, hop up and let’s start throwing some massage techniques and exercises at it.”  In this example, there was no assessment, just treatment, so what do you reassess?  Pain?  That is not always the best assessment.

Maybe a better way would be to assess when and how the back hurts.  What movements bother you?  What can’t you do?  Now, provide care to that person and reassess what you just observed.  Simple, yet a powerful message when a person stands up and says, “wow, I can now touch my toes, that really worked!”

Here is an example of a recent patient I evaluated with complaints of left sided diffuse mid thoracic and rib pain.  I provided a comprehensive evaluation, but I will just cut to the chase and outline the important details.  His primary complaint was pain.  I could of just started trying to treat the area to reduce sympotms and essentially “chase the pain.”  However,  my primary focus was on his limited multisegmental rotation to the left.

Multisegmental rotation doesn’t tell us enough, so I dug deeper.  He had a moderate loss of thoracic rotation to the left.  I could of stopped here as the location of his symptoms were in this area, but I again dug deeper.  I was fine with his hip mobility.  However, I found that his pelvis was shifted with a left anterior tilt, causing his entire pelvis and SI joint to rotate to the right.  Subsequently, his lumbar spine was orientated slightly to the right, meaning his “neutral” was actually rotated to the right slightly, causing what looked like limited rotation to the left.

Thoracic Spine Mobility ExercisesWith my assessment in hand, I went to work.  First, I wanted to start at the thoracic spine to see what the precentage of invovlement may have been.  I worked on soft tissue, joint mobility, and few thoracic mobilization corrective exercises.  Reassessment at this point showed a fairly large improvement of thoracic rotation to the left.  I could of again stopped here, but I also wanted to check multisegmental rotation to the left, which only showed approzimately a 50% improvement in rotation to the left.

If I just stopped here, I would have restored half of his dysfunction, and I bet he would have slipped right back to where he started.

I next went to the pelvis and with a few exercises and manual techniques improved his pelvic alignment.  Reassessment of thoracic rotation and multisegmental rotation showed normal symmetrical movement, and naturally a reduction in his complaints of pain.

That is the power of assessing and reassessing.  Not just once, but multiple times in one session so that I can narrow down the effectiveness of each technique as best as possible.

 

The Power of Reassessment

That was a pretty good example of how I really narrowed down and enhanced by treatments by assessing and reassessing.  To summarize some of the key points:

  • Helps you individualize and find what works.  This is the no-brainer concept, to see if there was an immediate improvement that can be directly correlated to what you just did to the person.
  • Helps you find out what doesn’t work!  Don’t underestimate this one.  By properly assessing and reassessing you also find out what doesn’t work, which is just as valuable so you can shift gears and try another approach.
  • This is also diagnostic.  By assessing what does and doesn’t work you may also narrow down the exact dysfunction.  Perhaps their limited thoracic rotation is related to soft tissue changes rather than joint mobility.
  • Helps buy in.  Lastly, but probably most importantly, assessing and reassessing helps build buy in, confidence, and compliance from the person.  They will see immediate benefit in what you do.

 

That is probably what I would consider the one thing that we all need to do with every patient or client we see – assess and reassess, what do you think?

 

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The Art of Cueing

There is a simple quote from Don Meyer, winningest basketball coach in NCAA history, that is often an overlooked art of coaching no matter what field we’re considering:

[quote]“The more they think, the slower their feet get.”[/quote]

Even in something like jazz piano, I can attest that the best way to screw up your improvisation is by thinking about where your fingers are and how they’re moving!  By no means am I an expert on cueing (or jazz piano for that matter…mediocre at best), but the more we look toward the emerging research on the “art” of cueing, the better chances our athletes have to succeed.

 

External and Internal Cueing

Art of CueingMuch has been written about the importance of external vs. internal cueing for sport performance.  The research is pretty conclusive that you don’t want athletes thinking too much about their internal mechanics as they’re performing their sport, or for that matter any other fast-paced movement if the goal is optimal results (e.g. Marchant, Greig, Bullough, & Hitchen, 2009; Freudenheim et al., 2010), including running (Schücker, Hagemann, Strauss, & Völker, 2009).  Coach Don Meyer must have been onto something!  But what about slow movements, weight room work, and what is defined as “too much” when it comes to thinking during movements?  (Photo by USACE Europe District).

“Too much” is relative and depends on your goal at the time.  There may be instances where you can trade thinking (and a slower, possibly less powerful movement) for better mechanics.  In the weight room, if a pattern is faulty, there is an advantage to breaking it down and getting the athlete to realize their movement dysfunction.  Here we are going from unconscious incompetence to conscious incompetence.  The next step as they are correcting the movement (conscious competence) is then followed by unconscious competence- or in other words performing the movement correctly without thinking.

Even for slow, near-maximal strength movements, I like to think that unconscious competence is the ultimate goal.  While it can be beneficial and necessary to remind athletes of a few cues here and there, ideally by the time they’re exhibiting max force on a heavy load, they have these movement patterns down and we are only fine tuning things.  This would mean a better carry-over into functional performance as well, because when athletes are practicing, moving, picking heavy things up off the floor (moving into their dorm rooms, etc.), they won’t be thinking about their form, nor would we want them to be.

 

The Trouble with Language

Unfortunately, when telling a group of 20 some individuals a particular coaching cue, it seems like half of them will take it to mean something different than what you want.  And that’s OK…it’s just inefficient.  You then have to start your alert, fast-paced walk around the weight room, as everyone breaks off, catching a few athletes just in time who are doing the movement incorrectly while others perform it incorrectly until you get to them!

Coaches who can demonstrate well while explaining are golden for the athletes, since athletes may not be the best listeners, but usually have good bodily-kinesthetic intelligence and awareness (thanks to genius psychologist Howard Gardner’s theory of multiple intelligences).  Additionally, they say a picture is worth a thousand words, so is a video worth tens of thousands?  One idea that I would like to implement in the near future is to take video during our important sets.  I recall seeing video of my baseball swing in college and noticing a few things immediately that I had not previously realized.  I know it has been done before in the weight room, but it’s obviously not commonplace yet.  Just having one of our other assistants walk around and film the athletes would be beneficial for anyone who may be struggling with a movement pattern.

 

Unconscious Competence

As your athletes move toward unconscious competence (e.g. the movement is becoming second nature), external cueing, or minimal thinking, appears to be best, again given your goals.  This is the time to say “jump up and reach the top of the vertec” (you’re getting them to focus on something outside of their body), as opposed to “hinge at your hips with some knee flexion and quickly extend as fast as possible to exert maximal force!”  Unless, of course, your goal is to just drop knowledge bombs on them…

Focusing the attention to something else will always be an external cue, and again the research is becoming pretty clear that this is better for performance than internal cues.  “Put force into the ground” is another common external cue for using the posterior chain while sprinting, and the good thing about weights and medicine ball plyometrics is that you can direct athletes’ attention to those objects as well.

“Put as much force into the bar as possible” as they’re getting ready to pull, or “move the weight from point A to point B as quick as you can.”

“Throw the medicine through the wall- try to break it!”

Obviously internal cues- focusing the attention in the body- have their place, and do have an important role when an athlete is in a learning phase (which is very often in my training programs for spring sport since I’ll start every athlete from square one in the fall).  However even with internal cueing, because of the different interpretations that each athlete may hear, I try to stick to the one main cue that each individual needs the most at that time.  If they approach the bar and have a bit of lumbar flexion I’ll get them into a neutral spine and work on one thing during that set.  Additionally, while we may think we’re all great coaches, nothing beats an “artificial coach” at explaining things without language.  In this example, raising the plates off the ground (so it’s easy for them to straighten their back), or putting them near a wall where they have to reach their hips back and touch the wall with their butt before starting the pull.  Eventually, if I have to remind them, I want to just say “neutral spine” to this athlete without saying anything else and have them recall what that means.  Then down the road I want to say “put as much force into the bar as possible and move it up as fast as you can!”

 

Conclusion

When I first started coaching athletes on my own as a graduate assistant, I was spitting out cues left and right- “hips back, chin packed, foot flat on the ground/back on heels, back straight…”  I now think about how confusing that must have been for the athletes!  Just like any other skill in life, they need to figure it out on their own, with our help where we can offer it.  Also, if you work with athletes, don’t forget about the importance of being a great demonstrator.  If you have to, check yourself out in the mirror (not bodybuilder style though!) to make sure you look how you want to come across.  And if you’re not a great demonstrator on an exercise (hey, many great/knowledgeable coaches aren’t), find an athlete on your squad who is, and explain as they demonstrate.

 

About the Author

travis owenTravis Owen, MS, CSCS, is entering his second year as an assistant softball coach at Northern State University in South Dakota.  Travis was an intern through the University of Louisville’s Sport Performance department, followed by a graduate assistant coaching position in NSU’s strength and conditioning department.

In Travis’ first year training solely the NSU women’s fast pitch squad, two players had reached a maximum deadlift of 295 lbs. with the team average jumping from 203 lbs. to 239 lbs.  Additionally, the team’s vertical jump had increased from an average of 17.5″ to 19.5″ in just a few months with one athlete hitting 26″.  The increased strength, speed, and power had shown on the field, with Northern State breaking several school records including wins, stolen bases, hits, doubles and RBI, and experiencing zero major injuries in the process.  As a former two-sport collegiate athlete, Travis understands the motivations of athletes and embraces their effort toward healthy and winning habits.  This year, Travis looks to increase his individualized nutrition coaching while continuing to help Northern State Softball improve both on and off the field.

Travis has a website at NSUsoftballtraining.wordpress.com

 

 

References

  • Marchant, D.C., Greig, M., Bullough, J., & Hitchen, D. (2009). Instructions to adopt an external focus enhance muscular endurance [Electronic version]. Research Quarterly for Exercise & Sport, 82(3), 466-473.
  • Schücker, L., Hagemann, N., Strauss, B., & Völker, K. (2009). The effect of attentional focus on running economy [Electronic version]. Journal of Sports Sciences, 12, 1241-1248.
  • Freudenheim, A., Wulf, G., Madureira, F., Pasetto, S., & Correa, U. (2010). An external focus of attention results in greater swimming speed [Electronic version]. International Journal of Sports Science and Coaching, 5, 533-542.

 

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