Monday Memo 6/25/18

The Monday Memo

June 25, 2018                                                                           PITT DPT STUDENTS

Understand Your Athletes

 

Recently, I have had an increasing interest in adaptive sports. Fortunately, through the Physical Therapy department at the University of Pittsburgh, I have had the opportunity to get involved in a new and developing program working with the Pittsburgh Steelwheelers, a local wheelchair basketball team. An exciting part about working with these athletes is that we are able to work at high intensities while using typical, or more often, fun and creative exercises. Today I am going to discuss some major areas that we focus on training for a sport such as this. Also, as we begin to grow this program, we are lucky enough to have students such as the President of the class of 2019, Charlie Badawy, who has worked with the Mighty Penguins training program, along with many of our students, to offer us guiding resources. An example of our major training focuses come from these sources and are briefly discussed below.

 

  1. Trunk
    1. Mobility – Having proper trunk range of motion, in single and multiplanar movements, is vital for performance and injury prevention. Certain motions may be limited due to the nature of the sport, so it is important to screen athletes for deficits or hypermobility and address these issues in your training.
    2. Stability – Creating a solid base is important in everyday activities, but even more so in high-intensity athletic situations. Core stability is a major factor in the change of direction, athletic movements, and fundamental skills of wheelchair basketball, and can be trained for control, strength, and endurance.

 

  1. Upper Extremity
    1. Range of Motion – Proper upper extremity range of motion, especially scapulothoracic and glenohumeral range of motion, is necessary for decreasing the risk of traumatic and overuse injuries.
    2. Endurance – The literature has shown that rotator cuff injuries are prevalent in wheelchair basketball and other adaptive sports that have a large amount of upper extremity involvement. We try to address this by including endurance rotator cuff exercises that use small loads but aim to utilize high rep ranges or even reps for an extended period of time.

 

Understanding your athletes and the demands or their sport will help in guiding your training. Based on physical therapy principles, a lot of our training is not only designed to increase performance but also decrease the risk of injury. We try to address the most common injuries, whether from muscle imbalance, overuse, etc. and incorporate exercises to work on these issues every session.

 

-Jim Tersak, SPT, CSCS

June 25, 2018 |

Monday Memo 6/18/18

The Monday Memo

June 18, 2018                                                                           PITT DPT STUDENTS

 

Clicker Training and Task Analysis

 

A few weeks ago, 2nd-year president Jim Tersak wrote about learning a new skill and the ways in which we can break down practice to learn that skill. Not long after reading Jim’s memo, I heard an interesting podcast discussing the ways in which we learn. I highly recommend checking it out. The episode focused on the importance of the learning environment during the cognitive stage of motor learning, and the effect of an instructor’s feedback upon the learner. First, let’s talk about some basic principles of skill acquisition.

 

Table 1 outlines the principles of experience-dependent plasticity as taught in Neuromuscular PT. As clinicians, we help our patients acquire new skills and refine their movement patterns. It is imperative for us to carefully design the environment in which our patients learn, and control as many aspects of that environment as possible to avoid interference. Whether caused by environment, the student, or the instructor, interference can occur in response to a single experience during skill acquisition and negatively impact future training. In the podcast, Dr. Martin Levy discusses the role that feedback plays when training surgical residents. He explains how external feedback may be misconstrued by students early in the learning process, and that this negative emotional association can impede the ability to learn that skill in the future.

 

To remedy this issue, Dr. Levy has adopted a style of teaching which has long been used by animal trainers: a clicker. He uses a clicker to provide objective, external feedback when instructing orthopedic residents in various skills required for surgery. He prefers the technique because it removes the learner’s desire to be rewarded by the instructor. Instead, the students are rewarded by perfecting the movement. As soon as they perform the task correctly, Levy simply clicks and they move on to the next step. The system is binary: either the learner correctly performed the task or they did not. This allows the student to focus on intrinsic feedback (aka the information received from visual, motor, and somatosensory systems) when completing the training, which is then verified by the external feedback of Levy’s click. This emphasis on intrinsic feedback enables the students to correctly perform surgical tasks under a variety of conditions.

 

The key to appropriately utilizing this technique is to first perform an extensive task analysis on the skill being taught; the clinician must be able to break down the whole task into its smallest components, just like Jim discussed in his memo. Levy teaches each component until it becomes highly skilled, then manipulates his students’ environment to prepare them for real OR scenarios. We must be able to do the same for our patients and for ourselves as we learn. For example, when learning to perform joint mobilizations, our body mechanics are absolutely critical. We can effectively master this technique by breaking down the task into steps:

  1. Patient positioning
  2. Table height
  3. Clinician foot placement
  4. Clinician hand placement
  5. Direction of mobilization, force of mobilization, etc.

 

If we are able to effectively analyze a task to promote our own learning, then we can apply similar logic to educating our patients. By coaching a patient through the foot placement, then ankle, knee, hip, and trunk movement, we can effectively help them master a lateral step-down task.

 

Clickers may not be ideal in a physical therapy setting, and some patients could potentially be offended at the thought of using one. However, we can utilize the key principle that the clicker provides by simplifying our feedback and optimizing our patient’s environment. This allows our patients to focus more fully on the task at hand, so that you can make the environment increasingly more functional after they’ve mastered the basics. A simple ‘yes’ or ‘no’, or even a click, can go a long way.

 

-Joe Dietrich, SPT, ATC

 

References:

https://www.ncbi.nlm.nih.gov/pubmed/26369658

https://www-ncbi-nlm-nih-gov.pitt.idm.oclc.org/pubmed/18230848

https://www.npr.org/2018/06/04/616127481/when-everything-clicks-the-power-of-judgment-free-learning

June 18, 2018 |

Monday Memo 6/11/18

The Monday Memo

June 11, 2018                                                                           PITT DPT STUDENTS

Play Ball!

 

Summer is upon us, and that means it is time for outdoor activities such as baseball, softball, and volleyball. A lot of us have been cooped up all winter and are ready to get out there and start playing. Today we will go over the mechanics that contribute to throwing and provide tips on how to make sure you stay safe while performing these activities.

 

As we know, the stability of the shoulder is due to both active and passive structures such as muscle and bone, respectively. All structures that make up what we consider the shoulder joint contribute to both the stability and mobility of the shoulder. During throwing activities, both are needed. Without proper mobility, one will have trouble initiating and generating enough power for an effective throw. However, with too much mobility, one will not be able to control the motion available. Overhead athletes are known to be more susceptible to instability. Examples of instability include tears of the labrum, rotator cuff, or capsular injuries. Many labral tears that overhead athletes (swimmers, throwers, volleyball players) are susceptible to are due to overuse and can be recurrent.

 

Lesions can be treated non-surgically and have good results. However, the best way to ensure that it does not impact one’s athletic performance is to prevent these injuries. Whether it is a major league baseball player or a grandfather playing catch, throwing is an activity that involves the entire kinetic chain from the feet to the fingertips. Below is a chart describing abnormalities that may take place in the kinetic chain and the visible effect they may have on the throwing pattern.

Seroyer, ST et al. “The Kinetic Chain in Overhead Pitching: Its Potential Role for Performance Enhancement and Injury Prevention. Sports Health. 2010;2(2):135-146

 

Below are some tips on how to prevent common throwing injuries to ensure that you stay active all summer long:

 

  • Single leg stability: An effective throw starts at the feet, ensuring that the thrower has a stable base of support is critical. Working on single leg balance as well as hip abductors, quadriceps, and hamstring strength can ensure that you maintain a stable base during the initial phases of throwing.
  • Core stability: A lot of power involved in throwing comes from the core. The quick rotation that occurs during the stride/ late cocking phase of throwing is critical to generating adequate momentum. Working on abdominal and oblique strength can improve this.
  • Rotator cuff strengthening: The rotator cuff muscles contribute a great deal to stabilizing the shoulder during throwing. Performing internal and external rotation exercises are highly beneficial. However, making sure that you are doing them at 90 degrees of shoulder abduction will translate the best to an overhead throwing activity.

 

References:

 

Seroyer, ST et al. “The Kinetic Chain in Overhead Pitching: Its Potential Role for Performance Enhancement and Injury Prevention. Sports Health. 2010;2(2):135-146

 

Baker CL, Uribe JW, Whitman C. Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med 1990;18(1):25–8.

 

Bernstein N. The coordination and regulation of movement. London: Pergamon;1967

 

Special thanks to Adam Popchak, PT, PhD, SCS, whose lectures provided a great deal of information that contributed to this piece. 

 

-Layne Gable, SPT

June 11, 2018 |

Monday Memo 6/4/18

The Monday Memo

June 4, 2018                                                                           PITT DPT STUDENTS

Let’s Learn a Skill

 

Learning a new skill can be difficult and perfecting a skill can seem near impossible. Whether that skill is opening a jar or shooting a slapshot from just inside the blue line, moving through the ranks from beginner to expert can be a long and challenging process. One skill involves fine sensorimotor and upper extremity control, the other involves the ability to balance and transfer weight on the ice, with great force, while aiming a 3-inch puck at a 4-inch opening greater than 60 feet away. Interestingly enough, learning these different tasks can be approached the same way. Correctly identifying the type of skill and the level of experience of the patient or client can offer a clear guide to creating a useful and challenging exercise.

 

First, categorize the task at hand as discrete, serial, or continuous. Each is described differently, and when learning can be approached differently as well:

  • Discrete – a skill that has a clear and definite beginning and end.
    • Cartwheel, swinging a baseball bat, kicking a ball
  • Serial – a series of separate discrete skills completed in a specific sequence, ultimately creating one larger activity
    • Ex. – a place kick in football (including components of the run-up and the kick)
  • Continuous – have no distinct beginning or end, and are repeated continuously
    • Ex. – Swimming, walking, jogging

 

Then, using the information we have already, we can design an exercise by deciding how we want to break down the task if we want to break it down at all. Here we can decide if we want to do part vs. whole training, and blocked, variable, or random training.

 

Whole vs. Part training:

  • Whole – The whole technique is practiced without a break
  • Part – Separating a complex skill into its base parts

Blocked vs. Variable vs. Random

  • Blocked – Practice that involves repeating the same movement or task under the same conditions
  • Variable – Practice that involves repeating the same task or movement, but where one component of the action is changed after each repetition
  • Random – Practice that involves completing various discrete or serial tasks necessary for the overall skill, but completed in a random order unknown to the performer

 

Here is a good example of how exercises can be prescribed based on these principles. An example of a few levels of exercise are described, and it is discussed when each is appropriate or not appropriate to be used. Although these ideas may seem simple, if used correctly, they can help maximize the effectiveness of your training.

 

References:

 

-Jim Tersak, SPT, CSCS

June 4, 2018 |