jessephysio

 

Over this past weekend I had the opportunity to see Dr. Craig Liebenson present a course at SPC in Toronto. In this blog I will write a review of the course with some interesting take home points.

For those that don’t know, Craig is a chiropractor from Los Angeles. He is what I would call a revolutionary chiropractor as he has taken concepts from so many discipline and formed his approaches based on the work of physicians  physiotherapists, strength coaches, etc. He is well known for his ability to make us look at the body as a unit and not as separate parts that need to be fixed in isolation. He is a master at corrective exercise prescription and he understands movement better than pretty much anyone else I have ever heard speak. He is a strong advocate for bridging the gap from rehab to fitness…meaning manual therapy and modalities are great, but we must also teach our clients to move right to empower them to be able to heal their own pain.  HERE is the link to his personal website  where he literally gives away tons of information and printable exercise  sheets for patients. It is refreshing to know that he doesn’t charge for everything, and he doesn’t seem like he is in it for the money at all.

Craig started the day on a rather interesting “rant”. He told us we are in the midst of a rehab renaissance and if we fall behind, we will be lost. He encouraged us to see Pr Stu McGill, Grey Cook, and take DNS, kettlebell FMS, and SFMA courses to make us complete practitioners. Personally, I found this strange at the onset as he never said “good work” for taking a weekend and spending hard earned money to take his course. Instead he almost made us feel bad for not taking other courses. Towards the end of the weekend he rectified  this by thanking us all and saying how much he appreciates us in Toronto for having him back for a third time.

After his initial rant he went on to discuss societies failure. We as a society have become super sedentary and it’s reeking havoc on our health. He brought up an interesting slide that looked like this:
Obesity, High BP, and sedentarism
GP’s- medication, imaging
Ortho Docs- Injections and surgery
Gold standard: Manual therapy and Exercise

Essentially, we has physiotherapists, chiropractors and personal trainers (minus the manual therapy) are well positioned to educate the world about how devastating inactivity is. Dr. Liebenson told us we must be at the front lines of batteling this. I agree with him 100%!

We talked about the postural conspiracy and how poor kyphotic postures are causing lower back, neck, shoulder pain along with headaches and so much more.

We reviewed the joint by joint approach and we talked about the importance of micro-breaks for our office worker patients. To break the code and get people moving better, we can’t have them go back to sitting in a hunched position for hours at a time. This defeats the goals of corrective exercise. HERE is an exercise sheet I give to ALL my desk worker clients, regardless of their initial complaint. Throughout the weekend Craig had us doing Cat-Camels, Reach the ceiling, and bruegger’s exercises to keep us limber…he is a man that definitely practices what he preaches.

 

We discussed the overhead athlete and how shoulder impingement might be due to a contralateral hip internal rotation deficit. If a pitcher can’t post on his lead leg when pitching due to a lack of hip IR, he will ultimately have to use more force through the throwing arm to get the acceleration he needs. This over time can lead to a tight capsule and impingement.  Moral of the story: we must look at each client as a whole and not just treat the site of pain.

Breathing was also big. Long story short: we must breath through our belly and not our accessory muscles of respirations (pec minor, scalenes, upper traps) as this can cause chronic neck pain/tension.

Dynamic knee valgus was also discussed as a leading cause of ACL injuries in women (nothing new there).

Exercises to mobilize the thoracic spine such as the T4-8 sphinx, foam roller extension, and child’s pose positions open books were all discussed as ways to self-correct the kyphotic postures our desk jobs put us in….I should probably do some sphinx exercises right about now! We talked about squat training and how to from a goblet squat to a sumo squat and then to a potato sack squat with a kettle bell to train for a weighted squat with a bar…this was an excellent progression as I am always looking for better ways to teach my motor moron patients better progressions to squats with.

There was so much talked about on this course that is it very hard to summarize everything. I will say that the biggest take home for me was HOW we get our patients to buy in to the corrective exercise framework of rehab. I asked this question on the course….I wanted to know how we convince a back pain client who wants to get passive care to buy into an exercise based approach. This is how we should integrate this into our practice:

1) Find out what hurts (movement, ROM, specific exercises, ADLs…whatever!)

2) Find out what movements the patient is bad at that do NOT hurt (non-painful dysfunction)

3) Pick an exercise that helps correct #2  , which should also help with #1. You can pick ANY exercise you want, as long as it helps with the patient’s initial complaint. If you know the principles of movement, the method doesn’t matter as much. Just get the patient feeling better and moving better and they should feel better. If by doing the chosen exercise for teh non-painful dysfunction helps with the clients initial complaint, they are MUCH more likely to buy in.

(With all that said, I still think it will be impossible to get some of my patients to exercise…they just have ZERO interest in active care which is both depressing and frustrating as they are essentially denying them self a pain free existence due to laziness)

NOTE: Being able to tease out the non-painful dysfunction and then figure out which exercise to give that will help that dysfunction and simultaneously decrease their pain is hard. It takes practice and is the art of what we as manual medicine providers do. We must learn as much as we can about why we hurt and how the kinetic chain can become compromised. Once we know that, it becomes easy (as Craig said).

We left the course with this amazing quote by Karel Lewitt:

I am always aware of how many things which I taught in my long past have since been proved wrong. The most important attitude is therefore to be constantly aware that what you are doing and teaching now you will have to modify and correct in view of new facts. Thus you must keep an open mind for new knowledge, even if it sometimes shows that what you believed and taught before was wrong

Here is a small clip just to see what it looked like at the course. Enjoy: