Assess Don’t Assume

SFMAI was fortunate last week to swing by and watch my friend Mike Voight teach the SFMA in Boston.  I met Mike’s co-instructors Josh Satterlee and Brandon Gilliam and was impressed with the course.  I have been SFMA certified for some time but I wanted to hear Mike’s take on the system.

I wanted to share with everyone a key theme that was presented that I thought was worth expanding on and sharing.  During one of the introductory presentations, Josh talked about how important the assessment process was and without it, we are just guessing.  This goes along with what I always say, “assess, don’t assume.” [Click to Tweet]

One of the points that was made was that sometimes we get lucky.

Perhaps your client can’t touch their toes and you instruct them to stretch their hamstrings.  Now this person can easily touch their toes.  Take a guess what you are probably going to tell the next 50 people that can’t touch their toes to do?  Probably stretch their hamstrings, because it worked so well on that first person!

We have all been guilty of getting stuck in our box of techniques.  Every time we go to a new seminar or learn something new on the internet, we try it on everyone.  Perhaps we get lucky and hit a bullseye on a few of those people.

We all know there are dozens of reasons why you may not be able to touch your toes, and realistically, hamstring flexibility is not often the reason!  You can’t recommend hamstring stretching unless you have identified that this is the specific reason why your client can not touch their toes.

Don’t be guilty of being stuck in your box of techniques.  Just because it works on one person, doesn’t mean it will work on the next person.  Everyone is unique and has unique needs.

Don’t get stuck in your ways.  As Josh said, chiropractors are great at mobilizing already mobile people and physical therapists are great at stabilizing already stable patients.  I thought that was hilariously accurate!  It really comes back down to your assessment.  I do use the SFMA but also many other assessments techniques (you can see some of them in my Functional Stability Training system).  They help guide me towards what my client needs, I’m not satisfied with being lucky, neither should you.



Enhancing the Overhead Press, Optimal Breathing, and Smart Group Training

This week’s Stuff You Should Read comes from Steve Long and Jared Woolever of Smart Group Training.


Inner Circle Updates

Smart Group TrainingThis month is the first month that I am giving away a free product to a lucky Inner Circle Member and sharing a big discount for everyone else!  This month’s products are a few great ones from my friends Steve Long and Jared Woolever from Smart Group Training.

Steve and Jared have several great products that show their system on how to assess movement patterns using the FMS and then great customized group training programs.  Hence, “Smart Group Training.”  These are great for fitness professionals and rehab professionals even if you don’t exclusively perform group training, as you can apply the information to anyone.

They are offering huge discounts from 33-50% off on three of their programs just for Inner Circle members this month:

  • Smart Group Training – Volume 1: Assessment and Exercise Program Design Using the FMS (online version) – $50 off
  • Smart Group Training 365 – A collection of group training programming using the Smart Group Training system for an entire year – $100 off
  • Smart Group Training: Building a Foundation – A program to work on your fundamental movement patterns – $50 off

That is $200 in savings on great educational products just by being a member of my Inner Circle, which is still only $5 per month!  All members can get these discounts as long as the purchase by the end of the month.  Links to receive your exclusive discount are located in the Inner Circle Dashboard.

Congratulations to Magnus Vestergaard Petersen from Denmark on being this month’s winner!  New winners and new products will be announced each month.

My latest Inner Circle webinar was an update on how I set up my social media system to stay current.  This webinar overviews my system of monitoring websites, journals, and social media for all the latest information.   I never stop reading and trying to learn new things.  You can set up a similar system for yourself too.  The recording is now available below.  I’ll announce this month’s webinar topic and date soon.


[hr] Updates just published a new presentation on Hip Arthroscopy, by Bentom Emblom, MD of ASMI in Birmingham, AL.  This presentation discusses and demonstrates the surgical procedures for hip injuries like labral tears and femoroacetabular impingement.



3 Simple Ways to Incorporate Optimal Breathing

In keeping with the Smart Group Training theme, here is a post from them on how to incorporate breathing into your programs.



Building a Foundation for the Overhead Press

Here is another great example of the Smart Group Training system.  Steve and Jared breakdown some of the corrective strategies they use to build a foundation for the overhead press.



Assessing Overhead Arm Elevation

assessing overhead arm elevationOne of the many things I look at during my comprehensive assessment process is the movement quality of raising your arms overhead.  The information you gather on the person’s ability to perform such a basic task is often invaluable when designing someone’s rehab or training program.

[box type=”note” icon=”none”]UPDATE: I have posted my follow up of this article breaking down the scapular winging.[/box]

I have a video below of a recent assessment I performed.  This is an interesting case and something I wanted to share.  However, I want to try something completely different for this week’s post, let’s try to make this interactive!  I am going to post a video below.  Use the comments section, either on this website or using the Facebook comments section below, to tell me what you see and what you think is going on in this video.

I’ll be upfront, there are no wrong answers, just what you see!  And there are a decent amount of things to see in this one video, so don’t be shy.

I will give you a little history.  Patient is a competitor high school swimmer with insidious onset of bilateral generalized shoulder discomfort and fatigue in the pool after prolonged swimming.  Mostly posterior in nature but not specific.  Exam obviously reveals generalized laxity you would expect with a swimmer, however no significant structural pathology detected.


Comment below and let me know what you see and what may be going on in the video – remember there are a lot of things to see, so don’t be shy – there are no wrong answers!  I fully expect people to see things that I missed.  I’ll give everyone a couple of days to join in and then on Wednesday I will post and update and discuss more about what I saw, so check back here later in the week as well.

Hopefully this interactive post experiment goes well.  If you like this type of post, please join in and let me know in your comment, and share this with your friends to get more discussion going!

 [box type=”note” icon=”none”]UPDATE: I have posted my follow up of this article breaking down the scapular winging.[/box]



The Corrective Exercise Bell Curve

I’m going to admit something that may come as a surprise to you.  Corrective exercises don’t always work for me.  There, I said it, I feel liberated now!

Corrective exercises are one of those things that have seen a recent rage in popularity, in both the rehab world but probably even more so in the personal trainer world.  Everyone is now assessing biomechanics and movement patterns and trying to prescribe corrective exercises to address what they see.  This is fantastic.

I recently co-authored an article with Jon Goodman from the Personal Trainer Development Center on how physical therapy and personal training can collaborate more effectively.  We discussed this concept a little bit.  Jon took more of a hard stance against personal trainers performing assessments, for several reasons that he discussed.  I don’t feel as strongly Jon on the subject and welcome the development of systems like the Functional Movement Screen that all of us can use to look at movement patterns and communicate better between professions.  Anything we can do to individualize someone’s programming is awesome in my mind.  But there is a caveat…

[quote]There is a dirty little secret that I don’t hear a lot of people talking about – corrective exercises don’t always work.[/quote]

This has almost become like the story of the Emperor’s New Clothes, where people are a little afraid to admit that corrective exercises don’t always work.  Perhaps they think they aren’t skilled or intelligent enough to make the corrective exercises work!  Well, I am here to make you feel better.  Corrective exercises don’t always work for me, either, and understanding why they “don’t work” is just as important to understanding why the “do work.”


The Corrective Exercise Bell Curve

To better illustrate the spectrum of corrective exercise efficacy, I have developed the corrective exercise bell curve.  The corrective exercise bell curve explains why some people don’t respond to corrective exercises.  I am not 100% certain of the exact percentages, this is just a model, but a starting point for discussion at least.

corrective exercise bell curve

In this diagram, you can see that there is a certain percentage of people who are going to respond very favorably (and often rapidly) to corrective exercise.  These are the all-stars that we all love to work with, call them the rapid responders!

Conversely, there is a certain percentage of people who just aren’t going to respond to corrective exercises at all.  For these people, something is not allowing the correctives to work.  Perhaps its pain, pathology, malalignment, biomechanical, structural abnormalities, or even neurophysiological.  These people essentially need more than corrective exercises.

Then there is everyone else in the middle.  These are the people who may respond to corrective exercises, but it probably isn’t going to be a quick fix.  These people are going to take some time.


Applying the Corrective Exercise Bell Curve

This is all important to understand so you can begin to classify the people you screen.  If you are a personal trainer that just performed a movement screen, programmed some corrective exercise, and was able to clean up some poor movement patterns, congratulations!  That is awesome, you did a great job for your client and maybe even saved our healthcare system some money in the future!

For people who do not respond to corrective exercises, this is where I really see the benefit of personal trainers and physical therapists collaborating.  We can do much greater things together than alone!

For the smaller percentage that is never going to respond to corrective exercises alone, they need a full physical therapy evaluation and will need a combination of treatments including things like manual therapy techniques, neuromuscular motor planning techniques, and eventually corrective exercises.

But here is the really cool group to work with – everyone else!  This is the gray area that we could really collaborate well on to help people achieve their goals.  Notice in the middle group, I stated that corrective exercises MAY work or may take LONGER to work.  In this situation, if physical therapists and personal trainers collaborated more, we could really make a difference in a lot of people.

Physical therapy can work in tandem with personal training to help people achieve their goals faster by combining things like manual therapy with their workouts.

I’m lucky, throughout my career I have worked side by side with some of the best strength coaches and personal trainers, people who have made me better at why I do.  This is by far my ideal work environment and why I always try to team up with a multidiscipline group of people.



To better illustrate, let me come up with a a couple of examples.  Perhaps you notice someone has pretty poor squat mechanics.  Corrective exercises aren’t working.  This is a perfect person to collaborate with a physical therapists.  Perhaps their hip capsule is tight or their hips are not aligned well (just a couple of examples, it could be several things).  All they may need is just a kick start in the right direction with specific manual therapy and they may be good to go.

Or how about you screen someone with really poor shoulder mobility on one side.  They don’t really have many symptoms other than a general ache in their shoulder from time to time, but the corrective exercises don’t seem to be working.  I was actually referred a patient just like this last week from one of the personal trainers I work with frequently.  That specific patient had very specific glenohumeral capsular tightness that wasn’t going to get better with corrective exercises alone.

I do this all the time and can often times clean up someone’s patterns in a few sessions, sometimes even less, by using the right manual therapy techniques to address their concerns while they continue to train.  To me, that is fun.  Helping people achieve their goals faster through collaboration.

So next time you feel like your corrective exercises are not working, don’t feel bad about it.  You are not alone.  If you are a physical therapist or personal trainer, find a respective partner to collaborate with and remember the corrective exercise bell curve.





Ankle Mobility Exercises to Improve Dorsiflexion

ankle mobility exercises to improve dorsiflexionLimitations in ankle dorsiflexion can cause quite a few functional and athletic limitations, leading to the desire to perform ankle mobility exercises.    These types of mobility drills have become popular over the last several years and are often important components of corrective exercise and movement prep programming.  Considering our postural adaptations and terrible shoe wear habits (especially if high heels), it’s no wonder that so many people have ankle mobility issues.

Several studies have been published that shown that limited dorsiflexion impacts the squat, single leg squat, step down activities, and even landing from a jump.  These are all building blocks to functional movement patterns, so the importance of designing exercises to enhance dorsiflexion can not be ignored.  While I will openly admit that I believe that the hip has a large influence on ankle position and mobility, it is still important to perform ankle mobility exercises.  I will discuss the hip component in a future post.

There are many great ideas on the internet on how to improve dorsiflexion with ankle mobility exercise, but I wanted to accumulate some of my favorite in one place.  Below, I will share my system for assessing ankle mobility and then addressing limitations.  I use a combined approach including self-myofascial exercises, stretching, and ankle mobility drills.


How to Assess Your Ankle Mobility

Before we discuss strategies to improve ankle mobility, it’s worth discussing how to assess ankle mobility.  I am a big fan of standardizing a test that can provide reliable results.  One test that is popular in the FMS and SFMA world is the half-kneeling dorsiflexion test.

In this test, you kneel on the ground and assume a position similar to stretching your hip flexors, with your knee on the floor.  Your lead foot that you are testing should be lined up 5″ from the wall.  This is important and the key to standardizing the test.

From this position you lean in, keeping your heel on the ground.  From this position you can measure the actual tibial angle in relationship to the ground or measure the distance of the knee cap from the wall when the heel starts to come up.  An alternate method would be to vary the distance your foot is from the wall and measure from the great toe to the wall.  I personally prefer to standardize the distance to 5″.  If they can touch the wall from 5″, they have pretty good mobility.  I should note that my photo below has my client wearing minimus shoes, but barefoot is ideal.

Ankle Dorsiflexion Mobilty


This is a great position to assess your progress, and as you’ll see, I’ll recommend some specific drills you can perform from this position to you can immediately assess and reassess.


Ankle Mobility Exercises to Improve Dorsiflexion

As I mentioned previously, I like to use a 3-step process to maximize my gains when trying to enhance ankle dorsiflexion:

  1. Self-myofascial release for the calf and plantar fasica
  2. Stretching of the calf
  3. Ankle mobility drills

I prefer this order to loosen the soft tissue and maximize pliability before working on specific joint mobility.  Also, I should note that I try to go barefoot during my ankle mobility exercises.


Self Myofascial Drills for Ankle Dorsiflexion Mobility

One of the more simple self myofascial release techniques for ankle mobility is foam rolling the calf.  This has benefits as you can turn your body side to side and get the medial and lateral aspect of your calf along the full length.  I will instruct someone to roll up and down the entire length of the muscle and tendon for up to 30 seconds.  If they hit a really tender spot or trigger point, I will also have them pause at the spot for ~8-10 seconds.

What is good about the foam roller is that you can also add active ankle movements during the rolling, such as actively dorsiflexing the foot or performing ankle circles.  This gives a nice release as well.  Don’t forget to roll the bottom of your foot with a ball, as well, to lengthen the posterior chain tissue even further.  There is a direct connect between the plantar fascia and Achilles tendon.

Some people do not feel that the foam roller gives them enough of a release as it is hard to place a lot of bodyweight through the foam roller in this position.  That is why I often use one of the massage sticks to work the area in addition.  You can use a massage stick in a similar fashion to roll the length of the area and pause at tender spots.  I often add mobility in the half kneeling position as well, which gives this technique an added bonus.


Stretches for Ankle Dorsiflexion Mobility

Once you are done rolling, I like to stretch the muscle.  If moderate to severe restrictions exist, I will hold the stretch for about 30 seconds, but often just do a few reps of 10 seconds for most people.  The classic wall lean stretch is shown below.  This is a decent basic exercises, however, I have found that you need to be pretty tight to get a decent stretch in this position.

I usually prefer placing your foot up on a wall or step instead, as seen in the second part of my video below.  The added benefit here is that you can control the intensity of the stretch by how close you are to the wall and how much you lean your body in.  I also like that it extends my toes, which gives a stretch of the plantar fascia as well.  For both of these stretches, be sure to not turn your foot outward.  You should be neutral to point your toe in slightly (no more than an hour on a clock).


Simple Ankle Mobility Exercises

I like to break down my ankle mobility exercises into basic and advanced, depending on the extent of your motion restriction.  There are several basic drills that you can incorporate into your movement prep or corrective exercise strategies.

The first drill involves simple standing with your toes on a slight incline and moving into dorsiflexion by breaking your knees.  Eric Cressey shows us this quick and easy drill that you can quickly perform:

Tony Gentilcore shows another simple ankle mobility drill, which is essentially just a dynamic warmup version of the ankle mobility test we described above:

Kevin Neeld shows a great progression of this exercise that incorporates both the toes up on the wall, essentially making it more of a mobility challenge and stretch.  If you look closely, you’ll see that he is also mobilizing in three planes, straight neutral, inward, and outward:


Advanced Ankle Mobility Exercises

Jeff Cubos shares a video of the half kneeling mobilization with a dowel.  The dowel is an important part of the ankle mobility drill.  You begin by half kneeling, then placing a dowel on the outside of your foot at the height of your fifth toe.  Now, when you lean into dorsiflexion, make sure your knee goes outside of the dowel.  You can add the dowel to many of the variations of drills we are discussing:

Chris Johnson shared a nice video using a Voodoo Floss band to assist with the myofascial release and position the tibia into internal rotation:

For those that have a “pinch” in the front of the ankle of tight joint restrictions of the ankle in general, Erson Religioso shows us some Mulligan mobilizations with movement (MWM) using a band.  In this video, he has his patient put the band under his opposite knee, however you could easily tie this around something behind you.  In this position you step out to create tension on the band, which will move your talus posteriorly as you move forward into dorsiflexion:

As you progress along with your mobility, you may find that variations of these drills may be more effective for you.  You can combine many of these approaches into one drill, such as Matt Siniscalchi shows us here, combining the MWM with the dowel in the half kneeling position:

As you can see, there are many different variations of drills you can perform based on what is specifically tight or limited.  You may have to play around a little but to find what works best for each person, however these are a bunch of great examples of ankle mobility exercises you can choose to perform when trying to improve your dorsiflexion.

Integrating the FMS into Group Training

Integrating the FMS into Group Training

I have a pretty special post today that includes an interview of Steve Long, one of the co-founders of Smart Group Training, discussing how to integrate the FMS in group training.  More exciting, Steve was willing to give an exclusive discount on their Smart Group Training Assessment product for my readers only!

Steve and I have been chatting about stuff for a little bit and I was really impressed with how he and Jared Woolever created the Smart Group Training system.  As a physical therapist, I have always felt that one of the draw backs of the group training format was the lack of individualization.  Steve and Jared have essentially systemized an approach that solves this problem!

I have watched their latest DVD and definitely recommend it, especially with the special discount for my readers.



MR: Tell us what exactly is Smart Group Training and what made you want to create SGT?

SL: “That is a really great question actually. Smart Group Training is many things really. It’s a training system, an educational website, educational products, workshops, etc, but more importantly it’s a movement. It’s a movement towards increasing the quality of group fitness training, and a movement towards increasing the communication between trainers, strength coaches, and clinicians.

Myself and business partner Jared Woolever had been doing 1 on 1 and semi private training for many years when we decided to open up “bootcamp classes”.  We knew there were a lot of great benefits for clients mainly the price and atmosphere, but the quality of training was just not as good as semi private.

We knew from that point, that we had to either cut bootcamp or make it just as quality as semi private training. We dedicated ourselves to creating the best group training system available, and that is how Smart Group Training was born.  We just didn’t know at the time, what it would really end up becoming.

Our first product, Smart Group Training Volume 1 – Screening and Corrective Exercise, came about because so many people were asking us about our training systems, and how we incorporated the FMS into bootcamps. We created the product for our friends, and it has started to explode.”



MR: The corner-stone of the SGT system is the FMS.  I like how you integrate a system to customize the large group training programs.  Since you have probably seen 1000’s of FMS scores over the years, what do you tend to find are the most common deficits you see?

SL: “It probably won’t surprise you to find out that we see a lot more mobility issues with men, and more stability issues with women. So we find that a lot of the men start with 1’s on the Active Straight Leg Raise and Shoulder Mobility. We will typically see women start with 1’s on the Rotary Stability, Trunk Stability Push Up and the Deep Squat.

Almost everyone starts with a 1 in the following:

  • Active Straight Leg Raise
  • Shoulder Mobility
  • Rotary Stability
  • Trunk Stability Push up

These are the foundational movements that we spend the most time working on by far. These movements must be cleared before moving on to the functional movements like lunging, stepping, and squatting.”



MR: What are your top corrective strategies to address these common findings? 

SL: “The biggest thing is to make sure that people stop doing exercises or actions that could make it worse. Then we give them a corrective exercise strategy to correct the pattern. We find the weakest link on the FMS Hierarchy and attack that pattern with corrective exercise. We have the client do 1 or 2 exercises. Those exercises should be done pre workout, during the workout, and 1-2 times per day outside of training sessions. Some examples of exercises we use to correct the bottom four are:

  • ASLR: Pelvic tilts, pelvis repositioning, Leg lowering progressions, toe touch progressions
  • SM: Breathing, ribcage repositioning, reachbacks, cat cow, wall slides
  • RS: Rolling, bird dog progressions
  • TSPU: Elevated push ups, band assisted pushups”



MR: In your experience how long does it take to start seeing improvements in your clients’ FMS scores?

SL: “Our goal is to see changes in the first session. That’s definitely not always the case, but many times it is. Typically we want to have each movement limitation cleared within a few weeks at the most. If it takes longer than that we refer out.  The screen usually points you to the right spot to make sure that we are correcting in the right order. Most people who have issues with the correctives not working are not following the hierarchy.

For example, sometimes one set of leg lowering will clear a clients ASLR deficiency forever, and sometimes they have pathology that caused it to never be a 2 or 3.  Generally speaking however, it usually takes a couple of weeks.”



MR: What kind of carryover do you see in your clients’ general fitness goals by individualizing their programs and developing corrective strategies based on the FMS? 

SL:“They blast through plateaus! Clearing movement dysfunctions allows the clients to do things they couldn’t do before, it keeps them injury free, and a lot of times takes people out of a “high threshold life” which lowers cortisol and helps with fat loss. Moving good and feeling good, are huge for general population, and the FMS helps us with that.”


MR: When will we be seeing more SGT products?

SL: “We have so much great stuff coming out this year. I can’t even begin to explain how excited both Jared and myself are to get this stuff out!  We have asked thousands of trainers, PT, chiros, and strength coaches what they need, and we are producing it. We have close to TEN great products coming out this year.

A lot of the stuff that we are doing this year is based around program design and giving people “done for you” programs that you can use immediately.

Over the next few months, keep an eye out for:

  • Group Training University: Basically and MBA on starting and running a group training business.
  • SGT 365: This is an entire year of done for you group training program design based on the FMS, and SGT training systems.

These are our next two products that will be available over the next few months, but like I said, we have a lot of great stuff coming out all year-long. Check out our blog, and get on our newsletter list to stay up to date with everything that Smart Group Training is doing”.

Special $50 Discount for My Readers

Steve and Jared were nice enough to give me a special discount code for my readers to get $50 off their Smart Group Training Assessments DVD program.  Click the link or image below and be sure enter coupon code MR50 in the shopping cart to receive $50 off.  This is a limited time offer for this week only!  The discount ends at the end of the day Sunday.

Smart Group Training

Click here to purchase Smart Group Training Assessment DVD for $50 OFF



Steve has made quite a name for himself in the fitness industry, achieving many awards and acknowledgements for his accomplishments. He has trained a variety of clients ranging from ages 6 to 80 in 8+ years in the fitness and performance industry. He assists clients in many aspects of health, fitness, weight loss, performance training, nutrition, and more. Steve is known for his practical approach to training and blending the many benefits of corrective exercise into highly metabolic conditioning and fat loss programs. Among other things, Steve specializes in functional fat loss, sports performance, golf fitness, injury prevention/post rehabilitation, kettlebell training, and lifestyle coaching. Steve has been mentored by, and continues to learn from the best professionals in the industry, bringing the most cutting edge programs to his clients and fitness trainers worldwide.

Learn more at




The Rolling Pattern, Sprint Intervals, and the Nocebo Effect

This week’s stuff you should read comes from Perry Nickelston, Body in Mind, and Science Daily


Inner Circle,, and Update

My next Inner Circle webinar will be Monday October 29th at 10:00 AM EST.  I will be discussing how I use kettlebells for shoulder rehabilitation.  Technically, this is good for all upper quadrant rehab.  I won’t be discussing how the traditional kettlebell exercises like swings, get ups, and carries are good for your shoulder (which they are), but rather I will be discussing how I use kettlebells as a tool for specific shoulder rehab.  Going to be a good one.  Inner Circle members can register at the Inner Circle dashboard.  If you are not a member, click here to learn more about my Inner Circle.

Awesome!  The huge sale I am running on for the month of October was so popular that it totally crashed the server that this website and all the other AdvancedCEU websites run on!  Great work everyone!  While I HATE every second that this website was down over the last week or two, at least they have upgraded to a better server and we won’t see anymore issues (so they say…).

So, if you want to join in on the best educational program for the shoulder on the internet, don’t delay.  The huge sale for $150 off with free access to runs until the end of October.  Learn more about here.  It is an awesome program that has received fantastic reviews.  Plus, you can earn 20+ CEUs from home.  Win-win situation in my mind! added part 3 of Kevin Wilk’s webinars on ACL rehabilitation.  These webinars from Kevin are just pure gold.  These alone are worth the cost of the subscription.  Kevin has one more webinar on ACL rehab coming soon to complete the 4-part series, then we have a great ACL surgical presentation from Dr. Jeff Dugas in Birmingham to top it off!



Sprint Intervals Help Burn Calories

This is a great study, showing that 5 repetitions of 30 second sprint intervals on a bike resulted in 200 extra calories burnt per day!  Not bad for 2 1/2 minutes of work!  I don’t think I’d want to live in that lab during the testing, though…  But seriously, good study showing that interval training results in more calories burnt over the course of a day.



Breaking Down the Rolling Pattern

Perry Nickelston shares with us a nice video demo breaking down the rolling patterns.  Great video:




Flavia Di Pietro from Body in Mind discusses a recent workshop on placebo analgesia.  This is interesting stuff to me.  She notes that neuroimaging studies have shown that we create a nocebo response faster than a placebo response.  Interesting, we need to figure out how best to harness the power of nocebo and placebo analgesia.




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.


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?