Newsletter 9/15/10

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Welcome to my latest newsletter, a couple of cool announcements and specials this time plus a reader question in addition to our usual plays of the week and video of the week!

Assess & Correct DVD Special Offer

If you missed it on my website, my friends Eric Cressey, Mike Robertson, and Bill Hartman are offering my readers a special discount on their DVD Assess & Correct.  I have a review of the DVD package here but in a nutshell consider this a great resource for rehabilitation specialists to give you a ton of ideas on how to assess movement dysfunction and prescribe corrective exercises.  This is a huge area that we often miss.  I really mean it when I say that this DVD will give you a ton of new ideas to use with your patients and make you the envy of your clinic!  The special price of $97 (down from $127) expires on Friday but you have to use the link on this page.

Online Shoulder Program

I also announced the beginning of my next session of my online continuing education mentorship program on the recent advances in evidence based evaluation and treatment of the shoulder.  This is a 7-week online program where I walk you through treating the shoulder using a combination of online presentations, readings, and discussion boards.  The reviews of this program have been way better than I would have ever expected, it’s turned into a nice little program that allows you to get a lot of information and learn at you own pace.  Check out this page for all the details of the program but I will be announcing this to everyone on my website tomorrow and it will book up fast, I want to give my newsletter subscribers a first shot!  It’s already half filled.

Reader Question

Love the site Mike. Great work. I basically rely on coming up with an anatomical and biomechanical rationale to differentially diagnose or prescribe exercise as you do well. My question is regarding exercise repetition. Obviously the answer varies on pathology, but are there general guidelines on the number of exercises and number of sets you perform with a specific patient? Do you perform sidelying ER just below the fatigue/failure point, let them rest then do another set until fatigue? Does it differ between pure strengthening vs. re-education? I am familiar with the literature on working the cuff until failure using prone horizontal abduction with ER and the resulting excess superior humeral head migration to an (in many cases) already compromised subacromial interval. I certainly understand why that would NOT be beneficial, but let’s apply it to serratus punches at 120 flexion for example…or prone rows, lower trapezius re-educating etc. Thanks in advance for the response.

- Walt Lingerfelt, Clemson Sports Medicine

Walt, thanks for the questions, good ones.  Yes you are right, working the cuff to failure is a recipe for disaster and will cause more problems in the future.  Fatiguing the cuff into failure will hinder the cuff’s ability to center the humeral head within the glenoid fossa.  The result is often humeral head migration and impingement.  You do, however, need to train for endurance so the art of working on this without achieving “failure” is something to pay attention to.  I think a lot of time dysfunction comes from both strength loss and muscle imbalances, so when I choose my sets and reps, I try to achieve a balance specific for each person.  For example, many people are anterior dominant and need posterior cuff strengthening.  I would likely prescribe posterior to anterior cuff exercises in a ration of 2:1 and even 3:1.  I might still use something simple like 2 sets of 10 repetitions but will use 3 different ER exercises and only 1 IR, for example.  I do tend to stick to 2×10 for a core program, allowing me to add 2×12, 2×15, 3×10, etc for specific exercises to emphasize this balance.  But, instead of doing 3×10 of a couple of exercise, I would probably choose 2×10 of 3 different exercises to hit the muscle from various positions.  Hope this helps, thanks for reading!

- Mike

Plays of the week

• Mike Roberston has a couple of nice articles on understanding the role of the abs.  Check out both part 1 and part 2
• Patrick Ward has a video on soft tissue techniques for the erector spinae for people with an anterior pelvic tilt
• More information on how exercise enhances brain function.
• Phyisospot has a review of an article showing that thoracic manipulation was effective in reducing neck pain and improving posture.
• Bummer, some bad news on green tea.
• This book isn’t out yet and I havent read it but sounds interesting: The Science and Clinical Application of Manual Therapy.  Pretty good price too under $60.
• Rehab and fitness product company Exertools is having a “Labor Day Sale” for 15% off everything in their store with coupon code ExLabor10.  It says the coupon expires in January, so heck of a labor day weekend they are having…
• Craig Leibenson is running his seminar series on “Modern Spine Care” in Seattle.  Worth checking out if anywhere near there.

Random Thoughts

• Just got my LOST box set in the mail, can’t wait to watch the best show in TV history again with over 30 hours of additional video!  What a show.
• Is anyone else holding out on all these new Apple products until they are on Verizon and 4G???  Seems like everything this year will be obsolete in 6 months, but I guess everything is like that.  I’m using an HP TouchSmart laptop, it’s sick and has all the touch capabilities of an iPad but with with all the benefits of a loaded laptop.  Good enough for me until the Verizon 4G iPad comes out.

Video of the week

You know you’ve done this with a physioball…

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