Career Advice Article Archives

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What We Can All Learn From a Barbershop

A couple of weeks ago I went to get my usual haircut from my local barbershop.  I tend to zone out or even dose off when I get my haircut, I guess I’m tired.  But for whatever reason, this time I didn’t and I couldn’t help but think to myself, sports medicine and fitness professionals could really learn some valuable lessons from a barbershop.

This is going to be written from the male perspective, I am sure it is a little different for women, but I think you’ll get my point.  For the guys, we basically have three options when we want to get a haircut – The chain franchise, the salon, or the barber shop.  Just like everything else in the world, there are exceptions to the rule, so don’t get mad at me.  Lets take a closer look.

 

The Chain Haircut Franchise

obtain fulfilling patientsWe’ve all been to one of the chain haircut franchises, there are a bunch of them now, but let’s refer to them as, oh I don’t know…  “SuperClips.”  Many people are perfectly content at SuperClips.  They offer a decent product at a low price, and if cost is your primary concern, you probably go to SuperClips.  But, I can’t help but feel rushed at one of these places, I’ve been in and out of a SuperClips in under 10 minutes.  The emphasis is clearly on volume and not quality – attention to detail is missing.  Have you seen how big those combs and scissors are?  You can cut my entire head of hair in three snips!  So, if price and speed are your primary deciding factors when choosing where to get your hair cut, SuperClips is the place for you, there is nothing wrong with that at all.  If you breakdown their model, here is what we have:

  • Emphasis on volume
  • Lower quality, though not awful
  • Fast service, but attention to detail suffers

Photo credit

 

The Upscale Salon

Now lets look at the other side of the spectrum, the upscale salon.  Again, for the ladies reading this, you may disagree, but this is geared more to the male perspective.  At the upscale salon, you walk in and everything is nice and pretty.  The atmosphere is upscale and classy.  Maybe the salon is named after someone, as if this person has found the magic secret to cutting a guys hair.  The stylists there spend time with you and pay close attention to detail, almost pamper you to an extent.  You probably get a lot out of the service and have many more options, such as shampoo, massage, coloring, etc.  But for many of us, we don’t take advantage of these extra services, but we still pay for them in the extra cost.  These salons are often in upscale areas as well, so their higher rent is also reflected in the cost.

  • Emphasis on the experience
  • Overpriced
  • Paying for the glitz and glamour
  • Good quality, but maybe not as much as you would think

 

The Local Barbershop

obtain fulfilling clientsLastly, let’s break down the barbershop.  Your barber is probably highly experience and specializes in cutting men’s hair.  While a typical barbershop is not glitzy like a salon, it’s environment is still pleasing for men, this probably why there always seems to be a couple of guys hanging out, drinking a coffee from Dunkin Donuts, and talking in the barbershop even after their haircuts.  Not a lot of glamour but there is a probably a good magazine and newspaper selection with some sort of sport or news program on the TV.  You’ll probably pay a little more than SuperClips, but not by much.  But the real difference here is the emphasis on customer service, attention to detail, and producing a quality product.

My haircut is always pristine and I never feel rushed.  My barber pays close attention to every aspect of the cut and assures that everything is lined up and perfect.  In fact, when I am forced to get a haircut while traveling, he can always tell and find the sloppy flaws.  He takes his time and I never feel rushed.  I’ll get a nice straight edge razor around the edges and he’ll make sure that he uses some nice aftershave and talc at the end.

Barber’s know that their best advertisement is word of mouth, not a glitzy ad campaign or a coupon in the mail.  My barber knows my name and I know his, we are both people, not just customers.  It is the perfect combination of price, quality of product, and customer service.

  • Emphasis on a quality product and customer service
  • A little more expensive than the “SuperClips” but much cheaper than the Salon
  • Attention to detail
  • A good experience without the unnecessary fluff – the glitz and the glamour

Photo credit

 

What We Can Learn From a Barbershop

I guess it all really depends on what your goals are if you are running a gym, performance center, or clinic.  To me, it is all about attracting the ideal client or patient – one that cares about what you care about – getting better.

There is nothing wrong with trying to just turn a profit, maybe that is your goal.  Everyone can tell when they are being rushed or when the quality of product or service they receive is sloppy.  We have all seen the trainer that is checking their phone when their clients are working out or the therapist that is starring off into space when performing an ultrasound.  But don’t complain about the type of client or patient you have, the one that doesn’t prioritize the quality of your product.  These will never be professionally fulfilling, except for your pockets.  But you’ll always have to hustle to get more people in the door.

There is also nothing wrong with trying to provide the glitz and the glamour, many people love this and will prioritize this over quality of product.  Just make sure it’s not just smoke and mirrors.  I would rather train or rehab with an expert that cares about me in their garage than at the most pristine performance center in the world if the quality of the product is sacrificed.  Good for you if you can afford all the best equipment, but if you can’t that doesn’t mean you can’t provide a better product.

If you really want to attract the fulfilling clients and patients, and you know the one’s I mean – the die hards, the fans, the ones that keep coming back and become part of the family – then learn from the barbershop.  Emphasize the quality of your product, attention to detail, and customer service and everything else will work itself out.

4 Things I learned in 2010

imageLast year around this time I published a pretty popular post, called “5 Things I learned in 2009.”  In this post I reflected on a few changes in thought that I had been progressing towards in regards to things such as posture and trigger points.  I am a fan of always evolving and publishing that post last year actually changed my thought process in 2010.  During the course of the year, I thought back to that post and challenged myself to learn new things in 2010.

Not everything below is rocket science, and I have been thinking about these for several years, but here are few small trains of thought I’ve had over the last year.

 

1. Asymmetry Might Not Always Be a Bad Thing

I have been preaching this a bunch lately, but I have openly questioned if we could really achieve symmetry, and if we could would we want to.  Everyone is jumping on this bandwagon lately and just like anything else, we are probably getting a little to dramatic with this and overanalyzing to an extent.  Let me explain.

imageThe human body isn’t as symmetrical as we all would like to think it is, specifically in regard to our internal organs and their impact on our core.  Realistically, our organs are not symmetrical, our diaphragm is not symmetrical, and it’s dynamic function on the thoracic cage is not symmetrical.  Thus, our scapula, pelvis, and everything else down the kinetic is not going to be symmetrical.

I first noticed this when I started to explore some of the hypothesized that have been proposed in regard to scapular dyskinesis and contralateral hip rotation in overhead athletes.

The two common theories in regard to postural imbalances and causative factors with injury are that the scapula is more depressed (well actually it is upwardly rotated, anteriorly tiled, and protracted, as shown in my article here, but we’ll simplify it and call it “depressed”) and that the contralateral hip is more internally rotated.  Both have been deemed “disadvantageous” and have been speculated to but athletes at risk for future injury.

I have 2 main issues with these statements, but make no mistake I am not refuting them, I am just questioning them.  First, these hypotheses have come from people observing injured athletes and making assumptions that what they see must then be pathological.  Second, when you look deep into the subject matter, the right scapula may be more depressed and the left hip may be more internally rotated in both right handed AND left handed overhead athletes!  I don’t have definitive data on this (yet) but have noticed this potential trend.  Obviously we see far more righties and lefties so, we assume.  This isn’t new information and the Postural Restoration Institute has some interesting info on why this occurs if you want to dig deeper.

Of course, huge asymmetries are undesirable, but realistically some asymmetries are going to happen when performing a unilateral sport or activity everyday, and these asymmetries are probably even desirable.  Food for thought.

What can you do to get better?

  1. Know the unique demands of the activities that your patient/client participates in.
  2. ASSESS, DON’T ASSUME – pretty simple

 

2. The Upper Trap can Wreak Havoc on Shoulder Function

imageI’ve talked about the effect that the upper trapezius muscle has on shoulder function and we discussed an articles about how imbalances between the upper and lower trap can cause impingement. How often have you noticed a patient or client is “upper trap dominant,” using their upper traps excessively when using their arm functionally?  I see it all the time.  This not only causes many soft tissues dysfunctions but it shuts down the lower trap and serratus.

So a goal of mine before I start any strengthening or advanced exercises with everyone is to re-educate them to not be “upper trap dominant.”  It actually isn’t that difficult but is often overlooked.  It is very similar to what Gray Cook says about restoring normal movement patterns, it seems like the motor pattern is still in our system somewhere, we just have to bring it back out.  Like riding a bike, you never forget.

What can you do to get better?

  • Before you try to enhance lower trap and serratus function, fix the upper trap motor pattern, otherwise you’ll be spinning your wheels.

 

3. Online Education Continues to Grow

imageI said it in this article last year, but I really do think online education is going to be the predominant continuing education source in the future.  I’ve been teaching online and performing webinars now for almost 8 years.  Over the course of the year, I have seen so many other opportunities – the NATA and NSCA are now doing webinars, there are other sites out there like mine, it’s amazing!

People are catching up, it took me WAY TOO LONG, but my online eval and treat of the shoulder program was just recently approved for CEU credit by the NSCA and APTA and I’m still waiting to here from the NATA  This learning experience is still growing and becoming excepted but we are getting there.

What can you do to get better?

If you haven’t gotten into any of these online programs and webinars, you are missing out.  I highly recommend you do and see how much you can pick up by participating in small bouts of clinical development more frequently in comparison to sitting in a hotel conference room for an entire weekend and zoning out.

Don’t get me wrong, there will always be a place for live and hands on learning, but online is going to continue to grow in addition to this.  I hope that very shortly live seminars will be at least 95% hands on and that lecture based seminars will be much more effective online.

 

4. Attitude is Often Your Most Important Quality

imageI don’t want to come across as a self-help guru with this last one, but I always try to save the last “thing I learned” for something personal, but that has direct impact on our professional development.  This year I was all about attitude.  Attitude can really make the difference between everything, and I can’t help thinking that this is the last place we all look when trying to make changes.  I had a challenging year but got through it because of my attitude.

What can you do to get better?

Alright, I’ll stop on that note and just direct you to the great John Maxwell and his book The Difference Maker (it is under $3 currently on Amazon).

Would love to hear from others on what they learned in 2010!  Please reply and Happy Holidays!

 

 

A Day with Anatomy Trains Author Tom Myers

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A couple of months ago I was lucky enough to spend a morning with Tom Myers, author of the amazing book Anatomy Trains.  Tom came to speak to my staff to review his research and theories on fascia and the anatomy trains concept.  We had an amazing day and learned a lot about Tom’s works.

He has a very unique understanding of how the muscles relate to one another as he has personally dissected many cadavers to specifically asses the fascial system.   One of the many take home messages that I took away that day included:

Muscles are only separate in photos in anatomy books.  In real life they are connected spiraling fascial tissue.

That is a great way of thinking about it.  Muscles are separated for simplicity when we discuss and learn about their function.  However, we really don’t learn the anatomy well when we look at the body from this simple approach.  This is an area that we need further research to better understand, but the next thought we should be focusing on is not just what happens at a joint when muscle contracts, but what happens to the surrounding and connecting muscles and soft tissue.

The other interesting point that stuck out to me, among the many, was Tom’s comment that:

Movement becomes habit, which becomes posture, which becomes structure

That’s a great way of putting the chronic soft tissue dysfunction that we are developing over time do to our poor postures and habits.

IMG_0044But we did more than just talk about fascia and the Anatomy Trains concept, we also practiced some soft tissue techniques.  Considering we have been talking about the pec minor so much the last few months (best pec minor stretch and new pec minor stretch, I wanted to share a techniques from Tom.  This is more of a deep tissue release but it’s all in the positioning.  With the patient supine, get down low next to the table with your forearm actually touching the table.  This will position you so that you force is directed inward but also superiorly up along to the rib cage.  You should then be able to slide your fingers in deep underneath the pec major to palpate and release the pec minor.  Pretty good approach.

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If you haven’t read the Anatomy Trains book, time to get on board and learn how muscles throughout the body interact.  Also, be sure to check out the anatomy trains website and Tom Myers’s own blog for more details.  Here is a quick video on some more info on the anatomy trains concepts:

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Anatomy Trains

The 5 Most Stupid Things I Didn’t Do Early in My Career

imageWe all make mistakes.  We’ve all done stupid things.  But since we don’t always learn from these mistakes, part of the motivating factor behind this website is to share with you some of MY mistakes so YOU can learn from them, especially for the students and new graduates.  Recently I had been talking with some of my friends about some of the stupid things we used to think we knew when we were just starting out in our professions.  It really motivated my to share this with you.

These are not things to be embarrassed about, but rather to grow from.  The doctors that used to smoke in the patient rooms 30 years ago, well, that is sort of embarrassing.  But who knows, maybe 100 years from now everyone will laugh at us saying, “wow, they used to think the earth was round, they were crazy!!!”

Part of growing is learning and adjusting from past mistakes.  The whole “you need to fail before you can learn” concept is true.  I hope I can help you cut some corners and you can learn from some of my mistakes!

 

The 5 most stupid things I didn’t do early in my career

Integrate Soft Tissue Work

image This is a topic I frequently discuss on this site and have stated in the past was something I regret not doing more in my early career.  I remember working with colleagues and sharing the thought process that “massage” was something for a “day spa” and more pampering than therapeutic.  Sure, I performed soft tissue work on many people, but I did miss the boat on integrating many manual therapy techniques into my practice.  If you are like I was, then this is something that if you change your attitude, you will see immediate improvement in your outcomes.  This is because:

  1. Soft tissue restrictions can alter the kinematics of the body throughout the kinetic chain.
  2. Performing soft tissue techniques allows for greater results from other manual techniques you may be performing, such as stretching, joint mobilizations, and even strengthening.
  3. Hands on time creates a better bond between you and the person you are working with, which in turn leads to better compliance and better outcomes

What do I do now and what can you do to get started?  I have personally progressed quite a bit over the last several years.  I use a combination of many different techniques including standard deep tissue work, transverse friction, trigger point releases, myofascial release, instrumented-assisted soft tissue, pin and stretch, muscle energy, positional release, etc.  They all have a use for different pathologies and all are popular based on my past poll of manual therapy techniques.

I am a believer of an integrated approach.  Use as many techniques as you need – try not to have technique tunnel vision!

 

Understand Movement

image When I first started as a new graduate, I had a very systematic and algorithm-type approach.  If X = Y then Z, or basically if strength test shows weakness then strengthen, or if range of motion shows tightness then stretch, for example.  This isn’t a bad approach and probably the most popular approach to rehabilitation.  But in itself, does not allow for a true understanding of dysfunction.

Over time I really sought to educate myself in biomechanics, or more specifically for me the understanding of arthrokinematics and joint kinetic forces.  You can see this in many of my presentations, writings, and throughout my book The Athlete’s Shoulder.  To truly be able to treat a specific joint or injury, you need to understand how the joint(s) should work.

Here is a good example using the shoulder – the person you are assessing has limited elevation with a shoulder “shrug.”  Taking the basic understanding I described above, you would likely want to stretch them into elevation, right?  Well, yes, and no.  You have to understand why the have a shrug, which could be:

  • Decreased inferior capsule mobility, causing the humeral head to migrate superiorly away from the area of tightness.
  • Insufficient rotator cuff function, losing the dynamic ability of the rotator cuff to central the humeral head during elevation, causing the humeral head to migrate superiorly due to the increased force of the deltoid and the lack of opposing force of the rotator cuff.

As you can see, stretching into elevation would not truly address either of the two proposed mechanisms of the “shrug.”  You would need to work on inferior capsular mobility or rotator cuff strength.  I spend quite a bit of time discussing some of this as it relates to the shoulder in my online shoulder seminar course.

But this is just a local view of biomechanics, the other view is more global and equally as important, but also keep in mind how other areas in the body impact the joint you are evaluating.  Taking this a step further, here are a couple of other reasons why someone may shrug, both further down the kinetic chain:

  • Denervation of the long thoracic nerve causing scapular dyskinesis and the loss of the ability to upwardly rotate the scapula, resulting in the humeral head to impingement into the acromion because it can not get out of the way.
  • Or maybe a more complicated example – tight hamstrings –> causing a posterior pelvic tilt –> causing a loss of lumbar lordosis –> causing excessive thoracic kyphosis –> causing the common forward head posture with an anterior tilted scapula –> causing a decrease in subacromial space and thus again impingement and shrug because the acromion can’t get out of the way.

As you can see, this global thought process is needed and often overlooked.  You may be able to notice the thoracic kyphosis and attempt to treat, that’s great, but keep looking further away to find why the thoracic deviation has occurred.  I don’t want to overcomplicate this, but obviously you can see that this approach is pretty neat and exciting when everything starts to click.

I’m not the biggest fan of the thought process that this is the end-all treatment approach, but it is definitely needed.  You’ve probably at least heard someone trying to extrapolate the effect of an ingrown toenail on your left foot on right shoulder dysfunction.  That may be a bit of a stretch in my mind.  Yes, they work together, but don’t overly emphasize.

ripple effectI think of the kinetic chain as a ripple effect when a stone is tossed in water:

  • The chain reaction is greater the closer to the stone –> the impact of the kinetic chain is greater with the closer joints, or the scapula impacts the shoulder far more than the toe, for example
  • The chain reaction is greater when the magnitude of the force is greater (i.e. a bigger rock is thrown) –> An ingrown toenail is going to impact the kinetic chain a lot more than a joint fusion, for example.

As you can see in my photo to the right (that took me like an hour to create, by the way…), A ripple from the hip should have a greater magnitude at the knee and low back than the toe or shoulder.  Just my thoughts and experience.  I am sure there are always exceptions but this is how I have operated.

This is a huge part of my Champion Performance Specialist program.  If we truly want to restore, optimize, and enhance performance, we need to understand how to assess and treat movement dysfunctions.

 

Understand The Spine

imageWhen I first started practicing, I worked in a fast paced orthopedic and sports medicine clinic.  We were so heavy on sports medicine, that we even had our own “spine” department that worked exclusively with spine patients while we worked with extremity patients.  I went a few years without even seeing a spine patient!

This was really bad for a couple of reasons.  One, I missed the larger picture on a few patients.  For example, the lateral epicondylitis patient that was actually being referred from the cervical spine.  More importantly, it took me a while to truly understand the spine.  I had a rudimentary understanding of the spine, but I had no experience.

Luckily, I identified this deficit and addressed it over time.  How did I do this?  Well, it took some time.  I started my quest in understanding the spine by search out books and continuing education courses.  I learned a lot, don’t get me wrong, but I continued to lack confidence in my ability to treat the spine.  It seemed like everything I was searching for wasn’t there and I would always leave a CEU course or finish a book with the thought, “OK, that’s it…”

It took me some time, but I now realize that you can’t treat the spine like you do the extremities.  There isn’t a simple clinical examination process that gives you a fairly definitive diagnosis and subsequent treatment program.  The spine is much more gray than black and white.  That is why I always felt something was missing after attending a seminar that recommended evaluating a patient, find the patterns of movement that cause symptoms, and then treating accordingly.  I would be the person asking, “why?”  And I never received a good answer, usually just, “we don’t know why and we don’t care!  I just works!”  That didn’t sit well with the scientist in me, especially the lack of evidence-based recommendations.

imageWhat I started to realize was that problems with the spine were usually the result of poor movement, posture, and stability.  Train this accordingly, and you solve your problem.  Trying to “fix” a disc bulge obviously isn’t going to produce good results!  Rather than try to learn how to exam and rehabilitate the spine, I learned how to understand the spine.

What can you do?  Don’t get me wrong, you need to know the foundation behind the spine and classification of dysfunctions etc.  You can start with some of the popular groups of thoughts such as Maitland or McKenzie, these are great places to start.  But I think you want to quickly advance your understanding of the spine by migrating more towards how the spine works and stabilizes and how to train the spine to work better.  I know this is when I made a significant step in the development of my understanding of the spine.

Try these resources below from Stuart McGill and Craig Liebenson, names I am sure you have heard of by now.  They do a great job breaking down spine function and treatment based on movement and stability.  Once you break free from the thought process of evaluating and treating an injury and focusing more on dysfunctional movement and spine pathology, you’ll see what I mean.

 

Network Outside My Clique

imageDo you know what happens when you always hang out with the same kind of people with the same thought process?  Not much.  No one is pushing and challenging one another.  I don’t like this.  I always feel bad for people that I meet at conferences that say they work by themselves in clinic.  It must be so hard for them to grow, no one to bounce ideas off, no one to push them.

I spent many years in this position.  I learned a lot from my network of like-minded individuals and continue to do so, but those that know me realize that I like to learn from everyone.  I attend PT meetings, ATC meetings, CSCS meetings, orthopedic surgeon meetings, everything.  I have discussed in the past how much I have learned from collaborating with people from the manual therapy, athletic training, chiropractic, and strength and fitness realms.  Understand that everyone has something to offer and learn from everyone.  Many people have different perspectives and collaboration is great for you but even better for your patient’s outcomes!  It will make you a better clinician in whatever field you choose.

Expand your pool of people to learn from.  Try to visit with other people in different disciplines.  Read up on some great websites outside of your primary domain, which the strength and fitness groups seem to do so well now.  And more importantly, network and collaborate with different groups.  You’ll be surprised at how people will challenge some of the basic thoughts that you take for granted.

 

Share and Learn From My Mistakes

Ah, ego can be a bad thing sometimes, don’t you think?  When you are just starting off one of the biggest things you lack (other than experience, of course) is lack of self confidence.  I’ve always been a big believer in attitude and the need to always focus on repeating your successes rather than your failures.  I recommend reading a good John Maxwell book called The Difference Maker, a book that discusses how your attitude can be your greatest asset.  I know, I don’t want to get too much into the “self-help” thing on this website, so take it with a grain of salt if that isn’t your thing.

But reflection is just as important as attitude, as long as you know that you are reflecting to learn from your mistakes rather than dwell on your failure.  This is one of the purposes of this series.  I am way past the point in my life and career to be embarrassed or too proud to admit mistakes.  But this does come back to attitude and self confidence.  I know that we all make mistakes and that this is how we learn.

I also think it is important to share my mistakes and recommend you do as well.  You will come across many people that may have been through a similar experience and may offer some great advice.

Well, I hope that helped a little.  We can all learn from our mistakes, I know I have, and I hope you can learn a little from mine too!

 

 

5 Habits of Top Rehab Professionals

In response to my post on the best career advice for students and new graduates, many people have emailed me asking for more information.  I like informative posts like this too and was excited to receive the below post from Cody West, PT.  Cody put together a list of the top 5 habits of top rehabilitation professionals.  It’s a pretty good list and a great complement to the advice given by some of the top experts in my past post.

Habit 1: They Have a Hunger to Learn

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In life, successful people never stop trying to learn new things, and that goes the same for top rehab professionals. John Maxwell in his book Talent Is Never Enough, says that successful people view learning differently and are open to new ideas. They never accept the status quo. Top rehab professionals do not accept that the approach they learned is the only approach in addressing a patient’s problem.

Wainright and others in their study of therapist’s use of reflection in learning and application to clinical decision making found that more experienced therapists used a reflection-on-action process than novice therapists.

Practicing evidence-based physical medicine requires an attitude of humility. Stanley Harris, an American journalist wrote, “A winner knows how much he still has to learn even when he is considered an expert by others. A loser wants to be considered an expert by others, before he has learned enough to know how little he knows.”

 

Habit 2: They Are Rooted in Biomechanics

clip_image004Top clinicians are able to use significant applications of biomechanics. I am afraid that we may have drifted too far from having to gain a solid knowledge of how the body moves and more in use of protocols or traditional approaches. I am not talking about fulcrums or knowing what a class 2 lever is. I am talking about knowing how to position a patient and instruct them on an exercise that isolates a specific joint action, fires a particular group of muscles or releases a tight muscle; an exercise that can’t be found in a software program.

Track coaches or weightlifting Godfathers of 30 years of experience don’t need a book. They can watch an athlete take a few jaunts or make a couple of lifts and can tell you exactly where the athlete needs improving.

Knowing how the lack of motion of a joint or weakness of a muscle will impact other areas of the body is paramount in our profession. Ever heard of ‘regional interdependence’?

 

Habit 3: They Know Principles Will Set You Free

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Successful clinicians are not solely guided by protocols or a system they learned over the weekend but practice using principles. There are a lot of talented rehab professionals today that espouse a certain rehab system or approach to rehabilitation. These programs are great for serving as a guide for treating diagnoses that you are not familiar or help you address a problem patient. Not to mention some surgeons will not let you deviate from their protocols.

However, top clinicians also learn the principles behind the system or protocol and are able to make a customized clinical decision. Relying on protocols or a system will constrain your creativity and ability to make sound clinical judgments.

Protocols or systems are good for implementing solutions in a box whereas innovation is creating an approach to a patient’s problem outside the box.

Following the principles that other master clinicians present in a seminar or DVD and adding a tweak may open a whole new world.

 

Habit 4: They Are Cross-Pollinators

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Successful clinicians are able to ‘cross-pollinate’ or mix ideas. Tom Kelley in his book, The Ten Faces of Innovation says that Cross-Pollinators are able to make connections or associations between principles that are seemingly not related. They are able to integrate ideas from outside industries to improve their current course of action or product. They are able to apply a principle or technique to a different situation. They are not afraid to mix ideas.

When was the last time that you learned a technique or exercise and applied it to another part of the body other than what how it was taught? When did you read about a study in a non-physical medicine journal and ponder how it can apply to your patient?

 

Habit 5: They Integrate Intangibles

clip_image010Jules Rothstein puts it succinctly, “Clinical expertise isa property that is held by all physical therapists who practiceeffectively; though they might not be able to define “clinicalexpertise,” they can demonstrate it. Among the characteristicsof the clinical expert is, I believe, the ability to identifyrelevant patient attributes, taking into account not only theexamination findings but the values and culture of the patient,attributes that can be used to guide patient management andthe application of evidence. In many ways, it is the behaviorof the physical therapists that takes them beyond the levelof automaton and allows for the integration of evidence andscience into the humanistic practice that has been the hallmarkof physical therapy since the profession began.”

 

References

Wainright SF, Shepard KF, Harman LB, Stephens J. Novice and Experienced Physical Therapist Clinicians: A Comparison of How Reflection Is Used to Inform the Clinical Decision-Making Process. Phys Ther. 2010; 90:75-88.

Rothstein JM. Editor Notes: The Difference Between Knowing and Applying. Phys Ther.2004; 84: 310-311.

 

Photos from istockphoto.com

The Best Career Advice for Students and Young Professionals From The Experts in the Field

image Some of the most common emails I receive are from students and new graduates regarding advice on getting started in their careers.  I wrote about 5 tips on landing a job in professional sports in the past but wanted to also provide more general advice.  Better yet, rather than just hear from me, I asked my friends and colleagues to also offer their best advice for students and young professionals.

I am lucky enough to share with you advice from many experts in the fields of physical therapy, athletic training, strength and conditioning, and manual therapy – an impressive group of experts including Ken Crenshaw, Brian Tovin, Rafael Escamilla, Leon Chaitow, Eric Cressey, Tom Myers, Sue Falsone, George Davies, and myself.  This is very similar to my Essential Reading Lists from expert clinicians that I published last year.  A collaboration of thoughts from amazing people in several fields around the globe.

Please share this with your colleagues and classmates.  Forward this along, stumble it, tweet it, talk about it on facebook, link to it on your site, and anything you can think of!  For my experienced readers, please reply to this post with your advice as well.  Let’s make this an impressive resource!  These are all unedited and straight from each expert.

image Ken Crenshaw, ATC, CSCS – Head Athletic Training of the Arizona Diamondbacks

I always encourage students to read, read, read as that will able a lot of information that may be applied to their profession. The desire to continue to learn beyond school is paramount. Think outside the box as there are many tools that may help in your future practice. Lastly communication and work ethic are 2 really big needs for me as they don’t seem to be taught in school and are very critical in our organization.

image Brian J. Tovin, DPT, MMSc, SCS, ATC, FAAOMPT – Founder & Owner of The Sports Rehabilitation Center in Atlanta

The best advice I could give is to develop your manual therapy skills…not just joint mobilization/manipulation, but soft tissue techniques, stretches, PNF, manual resistance,etc.  Patients will often assess how good a PT is by how good their hand are, stating, “He/she has the best hands!”.  There is a good reason for this as there is something special, or some may say “magical”, about the laying on of hands that is beyond psychosomatic. Make patients feel that coming to your clinic is different then going to a gym and seeing a trainer…this is what makes us different as physical therapists.  As a PT, I hear patients complain that I saw (a clinician) and “they never even put their hands on me!”.  Do not be that clinician.

image Rafael F. Escamilla, PT, PhD, CSCS, FACSM – Director of Research at The Andrews Institute in Pensacola, FL

Stayed focused, finish what you start, and be persistent.  I can’t tell you how many projects and studies that people start but don’t finish, or give up on.  Identify a line of research or area of study that you are interested in, set specific goals regarding what you want to achieve, and then stay focused and be persistent until you have achieved those goals.  Some of my research publications have taken 3 or 4 revisions (and 2-3 years) before they were finally published, and it would have been easy to give up after the first couple revisions.  Once you meet your goals, set new goals and start the whole process over.  Limit your goals and don’t spread yourself too thin by being involved in too many areas – stay focused. Be really good at a few things rather than mediocre in a bunch of things. Finally, be a glass half full type of person rather than a glass half empty type of person, and optimistic rather than pessimistic.  You will be more likely to endure the trials and tribulations you face, and come out stronger, more determined, and in the end, more successful in your endeavors.

image Leon Chaitow, ND, DO – Distinguished manual therapist, author, and educator. Honorary Fellow, University of Westminster, London and Editor-in-Chief, Journal of Bodywork & Movement Therapies

I recommend a thorough understanding of Hans Selye’s general and local adaptation syndrome concepts (some good info here). This suggests that whatever the actual health problem – and in fact the more complex the problem the more important this formula becomes – it is essential to appreciate that almost all health issues can be seen to represent failed/or failing, adaptation. Once this is understood it becomes important to consider which adaptive stressors can be identified – whether lifestyle, biomechanical, biochemical or psychosocial – and how these can be modified or eliminated. These adaptive stressors represent one facet of the therapeutic equation, which might involve postural, respiratory, nutritional, behavioral or functional factors. The other part of the equation that needs to be considered relates to way(s) in which functionality might be enhanced, so that the stress burden can be better managed. Aspects of this would entail improved strength, stability, flexibility and mobility – along with sleep, rest, exercise etc.

So the bottom line of this therapeutic formula boils down to – reduce the adaptive load, while improving function. The only other choice is to treat symptoms. Into this mix it is also critical that we tailor the therapeutic interventions to the ability of the individual to respond positively – so that treatment doesn’t become yet another stress burden.

Selye H: The stress of life, Philadelphia, 1976, McGraw Hill.

Chaitow L Blake E Orrock P  Wallden M  2007 Naturopathic Physical Medicine Elsevier

image Eric Cressey, MA, CSCS – Owner of Cressey Performance and my co-author of my DVD set Optimal Shoulder Performance:

My biggest piece of advice would be to recognize that a degree (or certification) is really just a foot in the door, and that the real learning begins when you are “thrown into the fire.”  Sure, it kind of stinks to hear that $200K+ in college expenses and 4+ years of energy spent merely gets you to the starting line.  However, it’s exciting because it’s a sign that all the work ahead is about establishing yourself as a “cut above” other professionals in your field.  When your goal changes from “the minimum standard” to “excellence,” life is more fun and the real learning and motivation begin.

In college, short of failing out, there really isn’t any pressure.  Universities don’t send you home because they don’t like your attitude, energy level, attendance/punctuality, or new haircut.  In the real world, though, you’ve got to step up your game.  A little mantra I live by with our staff is “Clients (patients) hire and fire you every day. You can’t have bad days.”

image Thomas Myers – Manual therapist and author of Anatomy Trains

There is one Advice God, but expressed as a Trinity:

1) Be clear in your intent. Knowing what you intend to do can inform your hands and inform the client / patient at a subtle level in such a way that makes up for your ignorance of exactly where everything is and what is going on in their tissues. The other side of that coin – mucking around hoping to find something that works (the ‘press and pray’ strategy) is occasionally a way of causing damage.

2) The contrary but still consistent advice is: experiment. When what you know is not working, make a conscious choice to explore in search of a new way. How else do you think all the things you know now were discovered? Most scientific discoveries are not made to the sound of ‘Eureka!’, but to the sound of ‘Hunh?’.

3) The 11th commandment: Thou shalt not bore God. If you are bored, you are doing something wrong. This is the most interesting profession going and it’s a largely unexplored area. If you’re bored, you got down a cul-de-sac, and you need to back out and go on in another direction. If all your sessions start looking the same, this is a good indication you are bored. Get help via mentorship or a new class.

image Sue Falsone, PT, MS, SCS, ATC, CSCS – Director of Performance Physical Therapy at Athlete’s Performance in Arizona

1) To be open to all ethical ideas, yet critical of where it fits into your personal practice.  No one has it figured out.  If someone did, we would all be doing it.  Just because someone uses a technique that you don’t, it doesn’t make you or them right or wrong.  It’s just different.  Maybe it fits into your practice, maybe it doesn’t.  And that is ok.  Even if you learn that you don’t want to use that technique, then you learned something that will shape you as a clinician.

2) Learn from everyone around you, and meet as many “big names” in the field as you can.  Introduce yourself to someone after you watch them speak, drop them a question via email about something they said in their talk, etc.  You’d be surprised at how many people will respond to you, and what doors these connections can open for you as you move along your path.

image George J. Davies, DPT, MED, PT, SCS, ATC, LAT, CSCS, ACSM-CET, APTA-CCI, SMAC, (REMT), FAPTA – The godfather of sports physical therapy:

Develop a passion for what you do, always keep the intrinsic love of learning, provide the best care to your patients based on the best evidence, it’s a profession (not a job), so contribute when you can, maintain a balance in life, and have “FUN” along the way.

image Michael M. Reinold, PT, DPT, SCS, ATC, CSCS – Head Athletic Training Boston Red Sox

1) Surround yourself with the best – that is what I did. If you like tennis rehab and you want to get into tennis, seek out the experts in that field, learn from them, work with them, and become one of them.

2) Work harder than everyone else. That is the American way, isn’t it? Our society will allow those that want to outwork others to do so, and this always results in good things. It comes down to the Pareto principle. You can apply it in many ways, but basically 20% of the people do 80% of the work. What percentage do you want to be in?

3) Always have a sound scientific, and hopefully evidence based, rationale behind each and every thing that you do. Every exercise, every set, every rep… Everything. Not only to provide rationale for your patients and clients, but also to challenge yourself to always update and enhance what you do. I have always been this way and you can see it in my articles, like the summation of many years of work that I published in JOSPT last year – The Scientific and Clinical Rationale Behind Exercise Selection for the Glenohumeral and Scapulothoracic Musculature.

4) Shape your practice on as many different thought processes as possible.  Or, better said, don’t get locked into one treatment pattern.  That is tunnel vision.  Take the best out of everyone and become yourself.

What else???  Do you have more advice you would like to share?  Please comment on this post with your contribution. Please spread this post on your websites, in emails, on facebook and twitter, or whatever way you can to help spread this great advice!

5 Things I Learned in 2009

image As 2009 comes to a close in the next few weeks, I would like to reflect back on a few things that I learned, or at least strengthened my understanding on, this year.  It is a practice that I try to perform each year and recommend you do as well.  I feel that it helps me focus my energy and prepare for the upcoming year.  Please comment on this and share with me what you learned this year.

 

1. Posture plays a significant role in upper extremity function.

Its been well documented that posture plays a role in function.  As an example, now that i have you sitting in front of your computer, slouch as much as you can (as if you weren’t already!) and try to elevate your arm.  How high do you go?  Now sit up straight and elevate your arm again, goes up all the way doesn’t it?  I get that, there is research to support changes in subacromial space, increased impingement etc.

image What I am talking about is function – how a simple thing like tightness of the pec can tilt the scapula, which inhibits the lower trap.  But let’s not stop there, try this one.  Sit in your chair and slouch again.  Now anteriorly tilt your pelvis.  Isn’t it amazing how you can not slouch when you pelvis is tilted?  Looking at the body as a whole is an amazing approach.  learn, understand, and apply the concepts of the upper and lower body cross syndromes into your patient care.   Read more about these concepts from Vladimir Janda in this nice article from Phil Page.

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 Figures from Chaitow: Muscle Energy Techniques, 3rd edition, with permission

image Another interesting note, I recently tried out this cushion that helps you sit more upright.  It’s called the Tush Cush, hilarious!  It helps you site with an anterior pelvic tilt.  It really works, you sit better and you back feels better.  A great product for those that drive or sit a lot that experience any spine or shoulder pain.  I am actually using it as I type this!

 

2. Trigger points are real and can be managed.

I am going to take some heat for this and I have already heard from people that disagree.  I have witnessed many soft tissue structural issues that occur from acute and chronic postural adaptations that respond well to trigger point therapy.  Haven’t you had a knot in your upper trapezius / levator that felt better and improved your neck and shoulder motion after you self-massaged the area?  I have.

There isn’t a lot of science behind the theories just yet, but there is more every year.  The Journal of Bodywork and Movement Therapies is working towards improving this as well.  I’ve mentioned it in my post on the Essential Reading List, but you really need to check out some of the work of Leon Chaitow.  He is not the only person with this thought process, there are many, many more.  But Leon does a great job putting the info together in a practical way in his books.  He also summarizes the available efficacy well.  Here is a good video of one of his technique:

3. There are a lot of great resources on the internet to learn new techniques and share ideas.

As I grew this website over the last year, I found many more great resources on the web.  The majority appear to be from strength and conditioning specialists, but there are a some by athletic trainers and physical therapists as well.  Some have a small cost (but are worth it) but most are free resources.

Take advantage of these resources, they are only getting better every day.

I try to share what I find each week in my Stuff You Should Read articles.  Be sure to fill out the form below to sign up for my newsletter.

 

4. Online continuing education is effective and a great way to further our skills.

image If you remember back to earlier posts here, I have been saying that I think online continuing education is the wave of the future.  Don’t get me wrong, the live seminar/lab structure will never be replaced, but more and more people will begin to explore online education.  There are many pros – study at your own pace, go back and forth as you see fit, combination of video, reading, and interaction, and the fact that you don’t loose a whole weekend!

I have started some webinars this (and will do more, I know it’s been awhile).  These are live presentations that I perform from a distance.  I have my past webinars recorded and available at AdvancedCEU.

I also just finished my first 7-week online continuing education program on the Recent Advances in Evidence-Based Evaluation and Treatment of the Shoulder.  I didn’t know what to expect but the response was huge.  This was a great experience and I will continue to grow this program, will likely start another one in either January or March (Let me know what you would prefer).  UPDATE: You can now start this program anytime at ShoulderSeminar.com.

See some of the responses from participants around the world:

  • “I’ve been a PT for 18 years and have grown confident in my treatment of all shoulder injuries. I have a strong reputation in the Cape Cod community as the shoulder PT. This course was humbling. I have never been as excited to treat shoulder patients then I have been during the past 6 weeks due to this course. Mike’s video presentations, assigned research reading, and knowledge on the discussion board made me think differently about how and why I treat shoulders the way I do. His knowledge has challenged me and opened my eyes to things I need to consider for evaluation and treatment and what I need to do better. He has fine tuned all my treatments. I’m a better PT now, and my patients will get better results. It’s amazing that I’m most excited about shoulder treatment now than at any other point in my 18 years experience. Thanks Mike.” – Jim Hawley, PT Hyannis, MA
  • “The course was FANTASTIC!!!!! I learned a lot and i hope there are more courses like this one! Great experience!” – Eduardo Corrêa – Salvador/Brazil
  • “Mike Reinold’s Online Shoulder Course is not one to miss. The information from this 7 week course is a great clinical foundation for all clinicians that see patient’s with various shoulder pathologies. You will definitely walk away a better clinician and provide better care for your patients after taking this course.” – Megan Eorio, DPT Danville, CA
  • “Mike’s course does a brilliant job of integrating the most recent evidence based practice with current surgical techniques and rehab of the surgical and non-surgical shoulder patient. He brings together a very organized learning experience that offers the participant the flexibility to move at their own pace and access to open discussion with a diverse, very knowledgeable cross-section of therapists. This course organized the approach I will take with my shoulder patients in the future.” –  Christine Panagos. Portland, Oregon.
  • “This online course was a great learning experience for me. It definitely expanded my knowledge on shoulder pathology and treatment techniques. I was able to interact with some of the best clinicians in the country without leaving my home. I highly recommend this course and look forward to future online courses taught by Mike Reinold.” – Christie Gaston, PT, DPT Homewood, IL
  • “This course provided an unbelievable amount of content, focused on recent research, regarding the shoulder joint. If you complete this course, with all presentations and readings, you will have a very thorough understanding of the shoulder joint. It was great to have the ability to review the material at any time, from anywhere, via the internet format. Also, the ability to interact with a leader in our field for over 6 weeks is incredible!!” – Carlyle Schomberg, Waynesville, NC

5. It is easy to get consumed by work, there are more important things in life.

You can thank my now 1 year old daughter for this one.  I am guilty of being consumed easily, not just in work but really anything I set myself to do.  My motto was always, “I’ll work hard now so that I can afford to slow down when I need to in the future.”  Well, that time is now.  My goal of 2010 is being consumed with the important things in life.  A friend of mine once told me, when our careers are all said and done, the only people that will truly remember you accomplishments are your family.

Have a great holiday season and an even better 2010!

 

 

Photos by bigpresh and thomasbrightbill

Michael Boyle’s 25 Mistakes in 25 Years

imageIt is with great pleasure that Strength and Conditioning Guru Michael Boyle has allowed me to reprint his magnificent article “25 Mistakes in 25 Years.”  I remember reading this when it was first published and being blown away.  I recently stumbled upon it again when I was browsing through Michael’s website StrengthCoach.com (which, if you haven’t checked out yet could possible be one of the best websites available on imageStrength and Conditioning).

This is probably a timely reprint of the post as Michael has just release a DVD of a presentation of the material in this article, called “Evolution of a Strength Coach,” available through Perform Better.

Thank you Michael for allowing me to share this with my readers, I know that this will be a valuable benefit for us all and if you’ve been living under a rock for the last 25 years, be sure to follow the links to learn more from Michael.  Strength and conditioning concepts are extremely valuable for rehabilitation specialists.

25 Mistakes in 25 Years – The Evolution of a Strength Coach

Michael Boyle, MS, ATC

Michael BoyleThis year I’ll enter my twenty-fifth year as a strength and conditioning coach. Last month I watched Barbara Walters celebrate her thirtieth year with a special called “30 Mistakes in 30 Years.” I’m going to celebrate my twenty-fifth anniversary by telling you my top twenty-five mistakes. Hopefully I’ll save you some time, pain, and injury. Experience is a wonderful but impatient teacher. And unfortunately, our experiences in strength and conditioning sometimes hurt people besides us.

Mistake #1: Knowing it all

I love Oscar Wilde’s quote, “I’m much too old to know everything.” Omniscience is reserved for the young. As the old saying goes, you have one mouth and two ears for a reason. I’d take it a step further and say the ratio is four to one: two eyes, two ears, and one mouth.

To continue down the cliché road, how about this one: “It’s what you learn after you know it all that counts.” When I was young I had many answers and few questions. I knew the best way to do everything. Now that I’m older I’m not sure if I even know a good way to do anything.

Mistake #2: Not taking interns sooner

I was so smart that no one was smart enough to help me. (See mistake number one.) My productivity increased drastically when I began to take interns.

Note: Interns aren’t janitors, laundry workers, or slaves. They’re generally young people who look up to you and expect to learn. Take your responsibility seriously. Remember the golden rule.

Mistake #3: Not visiting other coaches

God, it seems everything goes back to number one! I was too busy running the perfect program to attempt to go learn from someone else. Plus, when you know it all, how much can you learn?

Find the good coaches or trainers in your area (or in any area you visit) and arrange to meet them or just watch them work. I often will just sit with a notebook and try to see what they do better than I do.

I can remember current San Francisco 49’ers strength and conditioning coach Johnny Parker allowing us to visit when he was with the New England Patriots and then asking us questions about what we saw and what we thought he could do better. Coach Parker is a humble man who always provided a great example of the type of coach and person I wanted to be.

Mistake #4: Putting square pegs in round holes

The bottom line is that not everyone is made to squat or to clean. I rarely squatted with my basketball players as many found squatting uncomfortable for their backs and knees.

It killed me to stop because the squat is a lift I fundamentally believed in, but athletes with long femurs will be poor squatters. It’s physics. It took me a while to realize that a good lift isn’t good for everybody.

Mistake #5: Not attending the United States Weightlifting Championships sooner

My only visit as a spectator to an Olympic lifting meet made me realize that Olympic lifts produced great athletes. I know this will piss off the powerlifters, but those Olympic lifters looked so much more athletic.

I remember being at the Senior’s when they were held in Massachusetts in the early eighties and walking away thinking, “This is what I want my athletes to look like.” Understand, at that time I was a competitive powerlifter and my programs reflected that.

Mistake #6: Being a strength coach

How can that be a mistake? Let’s look at the evolution of the job. When I started, I was often referred to as the “weight coach.” As the profession evolved, we became strength coaches, then strength and conditioning coaches, and today many refer to themselves as “performance enhancement specialists.”

All these names reflect the changes in our job. For too many years, I was a strength coach. Eventually I realized that I knew more about conditioning than the sport coaches did, so we took on that responsibility. Later, I realized that I often knew more about movement than the sport coaches too, so we began to teach movement skills. This process took close to eighteen of my twenty-five years. I wish it had been faster.

Mistake #7: Adding without subtracting

Over the years we’ve continued to add more and more CNS intensive training techniques to our arsenal. Squatting, Olympic lifting, sprinting, pulling sleds, and jumping all are (or can be) CNS intensive.

I think I do too much CNS intensive work, and intend to change that. My thanks go out to Jason Ferrugia for pointing out this one.

Mistake #8: Listening to track coaches

Please don’t get me wrong. Some of the people who were most influential in my professional development were track coaches. I learned volumes from guys like Don Chu, Vern Gambetta, Charlie Francis, and Brent McFarland.

However, it took me too long to realize that they coached people who ran upright almost all the time and never had to stop or to change direction. The old joke in track coaching is that it really comes down to “run fast and lean left.”

Mistake #9: Not meeting Mark Verstegen sooner

Mark may be the most misunderstood guy in our field. He’s a great coach and a better friend. About ten years ago a friend brought me a magazine article about Mark Verstegen. The article demonstrated some interesting drills that I’d never seen. I decided my next vacation would be to Florida’s Gulf Coast as Mark was then in Bradenton, Florida.

I was lucky enough to know Darryl Eto, a genius in his own right, who was a co-worker of Mark’s. In the small world category, Darryl’s college coach was the legendary Don Chu.

Darryl arranged for me to observe some training sessions in Bradenton. I sat fascinated for hours as I watched great young coaches work. Mark was one of the first to break out of the track mold we were all stuck in and teach lateral and multi-directional movement with the same skill that the track coaches taught linear movement. This process was a quantum leap for me and became a quantum leap for my athletes.

This was my step from strength and conditioning coach to performance enhancement specialist (although I never refer to myself as the latter). The key to this process was accepting the fact that Mark and his co-workers were far ahead of me in this critical area.

Mistake #10: Copying plyometric programs

This goes back to the track coach thing. I believe I injured a few athletes in my career by simply taking what I was told and attempting to do it with my athletes. I’ve since learned to filter information better, but the way I learned was through trial and error… and the error probably resulted in sore knees or sore backs for my athletes.

Track jumpers are unique and clearly are involved in track and field because they’re suited for it. What’s good for a long jumper is probably not good for a football lineman. It took me too long to realize this.

Mistake #11: Copying any programs

Luckily for me, I rarely copied strength programs when training my athletes. This mistake might be beyond the statute of limitations as it was more than twenty-five years ago.

I think copying the training programs of great powerlifters like George Frenn and Roger Estep left me with the sore back and bad shoulders I’ve carried around for the last twenty-five years. What works for the genetically gifted probably won’t work for the genetically average.

Mistake #12: Not teaching my athletes to snatch sooner

We’ve done snatches for probably the last seven or eight years. The snatch is a great lift that’s easier to learn than the clean and has greater athletic carryover. Take the time to try it and study it. You’ll thank me.

Mistake #13: Starting to teach snatches with a snatch grip

When I realized that snatches would be a great lift for my athletes I began to implement them into my programs. Within a week some athletes complained of shoulder pain. In two weeks, so many complained that I took snatches out of the program. It wasn’t until I revisited the snatch with a clean grip that I truly began to see the benefits.

Just remember, the only reason Olympic lifters use a wide snatch grip is so that they can reduce the distance the bar travels and as a result lift more weight. Close-grip snatches markedly decrease the external rotation component and also increase the distance traveled. The result is a better lift, but less weight.

Mistake #14: Confusing disagree with dislike

I think it’s great to disagree. The field would be boring if we all agreed. What I realize now is that I’ve met very few people in this field I don’t like and many I disagree with. I probably enjoy life more now that I don’t feel compelled to ignore those who don’t agree with me.

Mistake #15: Confusing reading with believing

This concept came to me by way of strength coach Martin Rooney. It’s great to read. We just need to remember that in spite of the best efforts of editors, what we read may not always be true.

If the book is more than two years old, there’s a good chance even the author no longer agrees with all the information in it. Read often, but read analytically.

Mistake #16: Listening to paid experts

Early on, many of us were duped by the people from companies like Cybex or Nautilus. Their experts proclaimed their systems to be the future, but now the cam and isokinetics are the past. Just as in any other field, people will say things for money.

Mistake #17: Not attending one seminar per year just as a participant

I speak approximately twenty times a year. Most times I stay and listen to the other speakers. If you don’t do continuing education, start. If you work in the continuing education field, go to at least one seminar given by an expert in your field as a participant.

(Note: Mistakes 18-25 are more personal than professional, but keep reading!)

Mistake #18: Not taking enough vacation time

When I first worked at Boston University we were allowed two weeks paid vacation. For the first ten years I never took more than one.

Usually I took off the week between Christmas and New Years. This is an expensive week to vacation, but it meant that I’d miss the least number of workouts since most of my athletes were home at this time. I think the first time I took a week off in the summer was about four years ago. My rationale? Summer is peak training time. Can’t miss one of those weeks.

I think there’s a thin line between dedication and stupidity, and I often crossed it. I think in my early years I was more disappointed that the whole program hadn’t collapsed during any of my brief absences. I felt less valuable when I returned from a seminar and realized that everything had gone great.

Stephen Covey refers to it as “sharpening the saw.” Take the time to vacation. You’ll be better for it.

Mistake #19: Neglecting your own health

This is an embarrassing story, but this article is all about helping others to not repeat my errors. Every year in February I’d find myself in the doctor’s office with a different complaint: gastro-intestinal problems, headaches, flu-type illnesses, etc. I had a wonderful general practitioner who took a great interest in his patients. His response year after year was the same: slow down. You can’t work 60-80 hours a week and be healthy.

Like a fool I yessed him to death and went back to my schedule. After about the fifth year of this process my doctor said, “I need to refer you to a specialist who can help you with this problem” and he handed me a card. I was expecting an allergist or perhaps some type of holistic stress expert. Instead I found myself holding a card for a psychiatrist.

My doctor’s response was simple. I can’t help you. You need to figure out why you continue to do this to yourself year in and year out. I went outside and called my wife. I told her it was a “good news-bad news” scenario. I wasn’t seriously ill, but I might be crazy. Unfortunately, she already knew this.

Mistake #20: Not recognizing stress

Again I remember talking to a nurse who was treating me for a gastrointestinal problem. I seemed to have chronic heartburn. Her first question was, “Are you under any stress?” My response was the usual. Me? Stress? I have the greatest job in the world. I love going to work every day!

Do you know what her response was? She said, “Remember, stress isn’t always negative.” It was the first time I’d really thought about that. My job was stressful. Long days, weekend travel, too many late nights celebrating victories or drowning sorrows. A part-time job to make extra money meant working at a bar on Friday and Saturday until 2 AM, and that was often followed by drinks until 4 AM.

Sounds like fun, but it added up to stress. The lesson: stress doesn’t have to be negative. Stress can just be from volume.

Mistake #21: Not having kids sooner

As a typical type-A asshole know-it-all, I was way too busy to be bothered with kids. They would simply be little people who got in the way of my plans to change the world of strength and conditioning. I regret that I probably won’t live to 100. If I did I’d get to spend another 53 years with my kids.

Mistake #22: Neglecting my wife

See above. It wasn’t until I had children that I truly realized how my obsession with work caused me to neglect my wife. I have often apologized to her, but probably not often enough.

Mistake #23: Not taking naps

Do you see the pattern here? Whether we’re personal trainers or strength and conditioning coaches, the badge of honor is often lack of sleep. How often have you heard someone say, “I only need five hours a night!”

In the last few years I’ve tried to take a nap every day I’m able. As we age we sleep less at night and get up earlier. I’m not sure if this is a good thing. I know when I’m well-rested I’m a better husband and father than when I’m exhausted at the end of a day that might have begun at 4:45 AM.

There’s no shame in sleep, although I think many would try to make us believe there is.

Mistake #24: Not giving enough to charity

Most of us are lucky. Try to think of those who have less than you. I’m not a religious person, but I’ve been blessed with a great life. I try every day to “pay it forward.” If you haven’t seen the movie, rent it. The more you give, the more you get.

Mistake #25: Reading an article like this and thinking it doesn’t apply to you

Trust me, denial is our biggest problem.

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