Monday, February 20, 2017

Exercises to Eliminate Pathokinematics - Part III

Last week we talked about warm-up in some detail and this week we are going to focus on Dynamic stretches.  For the purposes of this blog, we will be covering mostly how this can be used in the clinic or in the gym.  The ACL Play It Safe Program uses some of these same concepts but applies them with sport to ensure maximal carry over in the later stages of rehabilitation or for performance enhancement or as a part of your injury prevention protocol.  We will cover this later in this blog series but stick to the clinical application at the moment.  Most importantly is that the concepts that are taught here should be implemented no matter whether you are doing this on the field or in the clinic. 

Dynamic Stretches:  The purpose of these exercises is to work on the flexibility of the athlete’s hips and lower legs in order to allow him or her the flexibility that is needed to participate in sport and to prevent injury.  Dynamic stretches are also designed to incorporate balance, strength and muscular endurance which will carry over to sport.  It is also critical that technique is strictly enforced.  Allowing athletes to perform the dynamic stretches with poor movement patterns simply reinforces bad movement patterns.  Poor movement patterns that will be carried over to remaining exercises and during athletic performance.

Dynamic Lunge:

Start by lunging out with the right foot, keeping both feet straight ahead.  Do not allow the right knee to go over the toes.  Bring the right elbow to the arch of the right foot, and hold this position for 3 seconds.  Extend the right knee to the straight position while bringing the left heel to the floor (make sure to keep feet and your hips pointing straight ahead).  Keeping the hands on the floor (the goal is to keep the palms flat on floor), hold this position for 3 seconds.  Lunge forward with the left leg while making sure to prevent moving into valgus and repeat the sequence on the left side.  Perform 10-15 yards or 8 repetitions on each side.



NOTE:   Several key positions to be aware of.  When lunging out, the contact with floor is controlled and not slapping the foot and controlling the knee.  With bring the elbow toward the arch of the foot, the thigh is kept in close to the elbow to push hip flexion and the hips are aligned straight and not allowing to roll out.  On side, hip position is maintained straight ahead.  Stride through is critical to control the knee and not allowing to go into a dynamic valgus.

Sumo Squat: 

Starting in a full squat position, grab your toes and pull up with each hand.  While continuing to hold onto your toes, fully extend both knees as far as your flexibility will allow.  Hold this position for 3 seconds.  From your hands on your toes position, walk your hands out to a full push-up position.  From this position, walk on your toes to bring your feet up to your hands.  Hold this position for 3 seconds, return to the starting squat position.  Perform 10-15 yards or 8 repetitions.


NOTE:   As instructed in the video, it is critical to maintain good hip and trunk position and stability during the push-up.  During the toe walk, the knees are kept straight during the entire walk up.      

High Knee Toe Ups: 

Standing with feet shoulder width apart, bring the right knee up toward your chest while grabbing with both hands and pulling to the chest as far as your flexibility will allow.  Simultaneously rise up into a calf raise on your left foot.  Pause and hold briefly.  Return to the starting position.  Repeat with the opposite side.  Perform 10-15 yards or 8 repetitions.



NOTE:  Some key points on technique is to ensure that the trunk remains upright during the hip flexed position.  This results in bringing the knee to the chest and not the chest to the knee.  Also important to make sure you are bringing the knee into straight knee flexion and not in a circumducted position (circular fashion).

Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis and author of a college textbook on this subject.  He serves as the National Director of Sports Medicine for Physiotherapy Associates, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training. 

Monday, February 13, 2017

Exercises to Eliminate Pathokinematics - Part II

Last week we started introducing the philosophy behind the exercises to reduce pathokinematics.  This week we will continue on this path with layout on the specifics of what will come in the coming weeks. 


The following series will provide you with instruction in:

  1. Warm Up.  In order to prevent injury, the athlete needs to first warm up the body, raising the core temperature.  Then he or she is able to do some dynamic (movement based) stretching to further loosen the muscles and prepare him or herself for more demanding work on each muscle group.  In some cases, it is also appropriate for the athlete to work on more intensive sprinting and plyometric activities to address speed and endurance. These also serve to further increase body temperature.  The Warm Up consists of:

·       Cardiovascular Warm Up.  Due to the endurance demands of sports, cardiovascular training is an essential component and should be built in to the training plan as a part of the overall performance program.  Our cardiovascular warm up routine will provide you with the most efficient warm up to allow the athlete to achieve optimal gains in the shortest period of time.

·       Dynamic Stretches.  Dynamic stretches provide athletes with a unique stretching routine that focuses on flexibility, balance, strength and endurance.  Dynamic stretches are NOT ballistic stretches.  These use contract- relax techniques which facilitate optimal gains in the shortest period of time.  These stretches include:

§ Dynamic Lunge

§ Sumo Squat

§ High Knee Toe Up

·       Sprint Training.  For those athletes needing to incorporate anaerobic speed or sprint training into their routine, this section will provide a detailed program to allow the athlete optimal gains in speed and anaerobic power, using the 40 yard dash.

·       Proprioceptive Neuromuscular Facilitation and Plyometrics:  Once we have ensured that the athlete’s core body temperature is raised and the muscles are loose, we can incorporate more intensive and targeted pre-stretch, proprioceptive neuromuscular facilitation and plyometric exercises in preparation for the Corrective Exercise Progression.  These exercises are:

      • Bilateral Hops
      • Single Leg Hops
      • Box Jumps
      • Lateral Box Jumps
      • Single Leg Lunge Hops
      • Jump Squats               
  1. The Corrective Exercise Progression (CEP). The exercises in this program will be categorized by the muscle and/or system being trained.  These exercises have been carefully chosen after a through literature review to ensure maximal outcomes.  Each exercise will have 3-7 levels of increasing difficulty within each progression in order to ensure they properly facilitate maximal gains in strength and performance.  Because of the size and scope of the CEP, will consume multiple blogs and devoted a section to each which follows:

The King and Queen of Exercise—The Squat and Lumbar Hip Disassociation

 

Squat Neuromuscular Retraining (SNMR)

Lumbar Hip Disassociation Exercise Series


Digging Deeper—Targeted Isolation Exercises


Gluteus Maximus Progression

                                               i.     Glut Max Press

                                             ii.     Leg Press

                                           iii.     Step Ups

Gluteus Medius Progression

                                               i.     Side Lying Gluteus Medius

                                             ii.     Side Step with Resistance Band

                                           iii.     Retro Monster Walk

                                            iv.     Standing Gluteus Medius

                                             v.     PNF Step Ups

Adductor Group Progression

i.      Standing Hip Adduction

ii.    Supine Adductors from Pike Position

iii.   Side Lying Adductors

Quad Progression

i.      Leg Extension

ii.    Standing Lunge—Alternating

iii.   Standing Lunge--Back

iv.   Walking Lunge

v.     Prone Place Running

Hip Flexor Group Progression

                                               i.     Single Leg Raises

                                             ii.     Head to Knee Pull-Throughs

Hamstrings Progression

                                               i.     Hamstring Pulls

                                             ii.     Modified Dead Lift

                                           iii.     Single Leg Dead Lift

Lower Leg Progression

                                               i.     Standing Calf Raises

                                             ii.     Seated Calf Raises

                                           iii.     Dorsi Flex Toe Ups

                                            iv.     Rebound Hops

Foot/Ankle Progression

                                               i.     Inversion/Eversion

                                             ii.     Standing Medicine Ball

                                           iii.     Bosu Ball Balance

Addressing “The Core” 

Abdominal Progression (Core Series)

                                               i.     Upper Abs on stability ball

                                             ii.     Obliques on stability ball

                                           iii.     Pike Position Lower Abs

                                            iv.     Side Bridge

                                             v.     Prone Bridge on Elbows

Lower Back Progression

                                               i.     6 Pack on stability ball

                                             ii.     Prone stability ball Leg Raises

                                           iii.     Good Mornings

Warm Up

Warm up exercises are an integral part of any exercise program.  With our program, we use cardiovascular exercise as an appropriate initial warm up step for athletes.  Warm up will consist of both aerobic exercises and anaerobic exercises.  The aerobic exercises will be used for general conditioning and the anaerobic for more sport specific conditioning.  The amount of aerobic and anaerobic conditioning for each individual is going to be determined by the demands of the sport.  For example, for soccer players and long distance runners, the aerobic component should be increased dramatically, while sprinters need more anaerobic conditioning.  At the end of the warm up period, we include a plyometric exercise component which further serves to warm up the muscles, joints and ligaments, as well as providing additional interval and power base training, which is proven highly beneficial in sport.


Cardiovascular Warm Up:  Cardiovascular training should include light aerobic exercise, which can consist of work on a treadmill, elliptical machine or stationary bike and should be at least 10-30 minutes in duration, depending on the aerobic demands of the sport for which the athlete is training.  This should not be a scheduled part of the program, but rather done on the athlete’s own time directly before the program begins.  This is accomplished by having them come in 10-30 minutes early to perform the cardiovascular warm up.  The exercise intensity should be gauged by the athlete’s heart rate (HR), which is determined using the Karvonen formula.



Training HR = [(HR max – HR rest) * .6 to .8] + HR rest


This formula gives you the targeted training HR in beats per minute, at 60-80 degree of the maximum target heart rate.  The final number can then be divided by 6.  This will give you the HR the athlete will measure during a 10 second count. 


Example:  If an athlete wishes to perform with a training HR of 120 to 138 beats/minute, dividing by 6 gives you 20 to 23 beats per 10 seconds.  So when exercising, the athlete takes their HR for 10 seconds to determine if they are within this range.  If the measured heart rate is too low, increase intensity (e.g., speed/pace, difficulty), or conversely, if it is too high, decrease the intensity of the exercise.

HR max  =  220 – age
HR rest  =  resting HR for 1 minute
.6 to .8 determines the relative intensity of the exercise and the number chosen should be based on the general conditioning level of the athlete.

Using this formula will create a much higher intensity than that at which many younger athletes are accustomed.  Therefore it is important that they are taught how to use this formula and how to take their own resting and exercising heart rates so that they can learn to monitor their own heart rate throughout the warm up.

Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis and author of a college textbook on this subject.  He serves as the National Director of Sports Medicine for Physiotherapy Associates, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training. 

Monday, February 6, 2017

Exercises to Eliminate Pathokinematics - Part I

Throughout the last several months this blog we have discussed pathokinematics and the impact they have on both performance and the potential for injury in athletes.  In one of the previous series, we provided you with several tools to assess movement and interpret the results of those assessments.  We also discussed how technologies could be leveraged to address.

 A movement assessment should be designed to assess movement patterns (pathokinematics) that are commonly associated with increased risk for athletic injury and reduced athletic performance.   The goal of the assessment should be to identify strengths, weaknesses, and tightness in the musculature and other structures of the body that cause or contribute to pathokinematic movement patterns.  Once these are identified, it is possible to “prescribe” corrective exercises that directly influence and improve those weaknesses and tight areas of the athlete’s body, making them stronger, more flexible, and more capable of transmitting power throughout the kinetic chain and lower extremity during sports activities.  It should be mentioned here that in addition to corrective exercise, there are many other techniques and manual interventions that clinicians use to correct deficits we see and identify using a movement assessment.  These are beyond the scope of this blog and will not be covered here but should be considered in a comprehensive treatment plan.

 In the series “How to Eliminate Pathokinematics” we reviewed some General Facts and Terminology associated with exercise and training in preparation for the information contained in this blog series.  Here we introduce the Corrective Exercise Program, or CEP.  The Corrective Exercise Program (CEP) is designed to directly and specifically address the components that contribute to pathokinematic movement patterns.  This is a movement specific program and not a sport specific program.  It is the concepts and methodology from all this body of work from which we developed the ACL Play It Safe Program.  However, each of the exercises included here will be the more clinical exercises and not the group/team interventions that are a part of the ACL Play It Safe Program.  Each of the exercises described here have levels of progression that increase the difficulty and/or endurance requirement of the exercise.  If prescribed and conducted correctly over time, these exercises will not only drastically improve the athlete’s movement patterns but will also improve overall athletic performance and reduce the likelihood of certain types of lower extremity injuries, specifically those involving the lower back, hip, knee, and foot/ankle.

In 2009 unpublished study 40 college athletes were placed on an exercise program to directly address weaknesses observed in a movement assessment.  The results of this targeted exercise program were phenomenal.  It was shown that when the athletes participated in the exercise program for 8-12 weeks, they were able to increase their vertical jump by and average of 4 inches and improved 40 yard dash time by 1.4 seconds.  In our current body of work, we are not only seeing dramatic decreases in overall lower limb injury rates but also huge health care savings for the university.  We are demonstrating an average savings of $30k to $50K per team per season in DI athletics.  In 2016, we continued this work with DI Football.  The results of this work is currently being written up for publication but preliminary analysis shows the lowest recordable injuries in 8 years and the team was nationally ranked for the first time in the colleges history.   

Using what we learned from this and many other similar studies, as well as years of experience working with athletes, we have developed a set of exercises that assist in reducing the potential injuries in the lower extremity and improve performance.  The program details follow, but it is important to remember that before beginning any exercise program, it is a good idea to have a complete physical performed on the athlete. 

This program is designed so that it can be used in many different ways and for many different sports.  For example, the CEP can be used for rehabilitation of an injured athlete when targeted exercises are chosen to address the injury or injuries.  The Physical Therapist or Athletic Trainer can “pick and choose” those exercises most appropriate to address the rehabilitation needs of the individual.  The CEP can also be effectively used to address pain issues associated with overuse, repetitive motion or pathokinematic movement patterns in athletes.  We have found that when the CEP is used to strengthen the athlete, either when used in a targeted fashion or as an overall exercise regime, pain with lower extremity activities is reduced.
applications.

Of interest to many in today’s fitness world is the use of this type of exercise program in athletic performance enhancement.  Our results show that athletes who use the Corrective Exercise Program in fact increase athletic performance, specifically in peak vertical jump height and sprinting speed as noted above.  This has also been validated in work by Myers, et al who have showed similar results.  The CEP can be used to improve technical ability specific to a given sport, strength, speed, endurance and power output.  Portions of the CEP can be used to target specific weaknesses or areas of tightness and inflexibility the athlete demonstrates in the movement assessment, or can be used in its entirety as a full and complete exercise program.

Because of the difficulty and intensity of the CEP, when adding it (or parts of it) to an already full training plan, it is easy to over-train the athlete.  Care must be utilized therefore in prescribing exercises in the CEP that involve the same body parts as those already being taxed in the regular training routine or sports activity.  They should instead be used to replace or substitute for those exercises, or enough rest should be allowed between them.

As discussed above, after a thorough assessment of the athlete, we now have an idea of where their individual weaknesses and tightness exist.  As with any exercise program, you and the athlete should be sure that they are physically capable of safely beginning or proceeding with a rigorous exercise program.  The exercises in this progression begin at a fairly difficult exercise level, requiring participants to have a basic level of fitness and flexibility.   Again, please be sure to have your patients/clients check with their physician before beginning this or any exercise program. 

Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis and author of a college textbook on this subject.  He serves as the National Director of Sports Medicine for Physiotherapy Associates, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training. 

Monday, January 30, 2017

Innovations in Movement - Blending Movement Science with Technology - Part V

Over the course of the last several weeks we have been discussing how to leverage technology for the assessment of movement and treatment of movement dysfunction.  Most of the technologies we discussed can be easily implemented into treatment and are relatively inexpensive.  Those that are used for the assessment of movement dysfunction can, many times, also be an additional billable service that can be added to your athlete’s episode of care.  To conclude this series, we will be discussing the use technology for HEPs and tracking of compliance with the athlete.

One of the first we will discuss is the ACL Play It Safe Program.  In full transparency, this is one that I have been personally involved in but have no financial tie to.  This is a program I developed to address the preventable non-contact lower limb injury epidemic in sports.  Although the name suggest this is ACL specific, this program is movement specific.  This means this addresses the biomechanics and movements that are associated with non-contact lower kinetic chain injuries, one of the most recognized of which is the anterior cruciate ligament (ACL) injury.  In addition to mitigating injury risk, these same movements are also associated with a decrease in athletic performance.  So, this program is specifically designed to improve the efficiency of athletic movement which results in reducing injury risk and improvements in athletic performance (specifically vertical jump and sprint speed). 

This program was developed in conjunction with Theraband® and Cramer®.  The ACL Play It Safe program is a comprehensive program that can be implemented with an athlete as a part of their home exercise program.  This program includes:

·       Gender specific kit – There is variance in the male and female athlete based on the peer reviewed literature.  The research indicates there are variances in strength and proprioception among the male and female athletes which is accounted for in the male and female kit.

·       Standardized equipment - This standardized kit is designed for the individual athlete.  Having standardized equipment ensures that the athlete is using the same equipment each time and has the equipment available for every exercise.  This improves outcomes since the athlete will not be using different equipment each time and/or skip an exercise because the equipment is not available. 

·       Equipment included – each kit includes the following:
o   CLX – this is the latest development in resistance band technology and was developed by Theraband®.  Use of the CLX allows us to perform very creative exercises like the spiral technique.  This particular technique allows us to perform single limb training while increasing Gmed recruitment during this activity. 

Spiral Technique

o   Padded Cuffs – allows us to perform closed kinetic chain gmed and core strengthening.
o   Stability trainer – allows us to work on single limb proprioception and core stability training
o   Biofreeze – to do the aggressive nature of this program, this allows us to control muscle soreness and irritation that may develop as a normal part of an athletic season.

·       Standardized program – the ACL Play It Safe Program is a progressive program that is designed to be implemented as a part of your team’s practice or training.  This program includes two very distinct parts.
o   Pre-practice routine – Neuromuscular resetting – this is designed to prep the system for movement or participation in sport.  This only includes three movements but are full lower kinetic chain movements that add in improving lower kinetic chain mobility while at the same time initiating the proper movement patterns.  This routine takes 3-5 minutes.
o   Post-practice routine – Fatigue state training – we know that most injuries occur later in the game and that athletic performance is negatively impacted by fatigue.  What the literature tells us is that training in a fatigued state will have a better carry over and impact to the athlete’s movement in a fatigued state.  This means they move better, are at reduced risk for injury and they perform at a higher level.  This routine takes 15 minutes. 

·       ACL Play It Safe App – as a part of the ACL Play It Safe Program, we have developed the ACL Play It Safe App.  Knowing the importance of proper instruction in movement and corrective exercises, we have found that providing this in a comprehensive video was one of the most effective means of doing so.  The ACL Play It Safe App was developed in conjunction with Theraband® and Cramer® and is an easy way to provide a video for every exercise included in this program in an app.  The ACL Play It Safe app can be found on IOS or Android by searching “PhysioSports” and is free.   The ACL Play It Safe app provides:
o   Level I – IV exercises
o   Specific order in which the exercise should be performed
o   Specific technique for each exercise
o   Number of sets and reps for each exercise

*Note – it should be noted that this is a web-based app due to the number of videos included.  This means that you will need access to the internet or cell service in order to run this app.*

In addition to the ACL Play It Safe App, another technology that is being used in home exercise programs for correcting of movement dysfunction is Fusionetics.  Fusionetics was developed by Mike Clark, DPT.  For those in athletics and familiar with movement assessment, Dr. Clark has been an innovator in the area of movement assessment, corrective exercise and technology.  Fusionetics is his latest innovation and is quickly becoming a great platform for distribution of quality research based content and provides a tool by which we can track the athlete’s progress and compliance. 

Fusionetics is a web-based platform that that provides some very unique features.  Once the athlete’s movement has been assessed, the athletic trainer, physical therapist or personal trainer can then build a profile in the software for the athlete.  This allows the provider to assign or prescribe exercises and the frequency at which these are done.  The athlete is then provided with a link that allows them to set up their individual profile and to access the Fusionetics App.  When the athlete logs into their individual profile on the app, they are then provided all the exercises the provider has prescribed to them along with comprehensive videos of each exercise.  Once the athlete performs the exercises, they then log in the app that the exercises were performed and how they are progressing with the exercises, the level of difficulty and if they experienced pain with.

For the provider, once they log into their account, they can instantly see all their athletes, which ones are doing the exercises, who they are progressing and whether or not they should be progressed on
their exercises.  This is an invaluable tool, especially for those of us who need to track multiple athletes or for athletes that we are only able to see occasionally or who travel with their team.  The Fusionetics platform provides the provider with some invaluable information and a way they can continue to engage the athlete throughout their training and season. 

As we have seen, there is a rapid progression of technology in the area of sports medicine.  The technologies that have been mentioned throughout this blog series is only a small portion of the technologies that are available.  In addition to the aforementioned technologies, there are additional telemedicine technologies emerging on the market.  One such technology is Player's Health, which is a mix between an athletic training EMR and telemedicine platform.  This technology allows the provider to have a much more robust engagement with the athlete, team physician, coach and manager/athletic director.  With the integration of their app, this allows:


·       Communication of information to the athlete about their care or physician appointments
·       Team physician to quickly see where each athlete is in the health care continuum and get updates
·       The coach to see which athletes on are on the DL, where they are in the process and their anticipated RTPlay date
·       The athletic director/manager to see what athletes are injured, how long they have been on the DL and their anticipated RTPlay

With the emergence of technologies such as this, it creates a greater level of transparency of care and improved communication.  For those of us involved in treatment of the athlete, we know how challenging this can be and how vital consistent and clear communication is.  These technologies simply allow us to do what we do but even better and with improved efficiency. 
We hope you have enjoyed this blog series and thank you for sharing the passion for movement and prevention.




Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >3000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training. 



Monday, January 23, 2017

Innovations in Movement - Blending Movement Science with Technology - Part IV

Last week, we started to investigate technologies that we could incorporate into treatment that would aid us in leveraging the latest in movement science with latest in movement technology.  This included looking at it from four destinct perspectives.
  • 2D video
  • Biofeedback
  • Resistance bands & product innovations
  • Tracking & compliance
Last week, we looked at 2D products that could be used in treatment as well as those that could be used for biofeedback.  Today, we will start our discussion by looking at product innovations.

Product Innovations

There has been quite a bit in the advancement of products that we use to treat movement dysfunction.  There is a plethora of these items available on the market and this list is not all inclusive but only includes the ones we are the most familiar with.  It goes without saying that there may be better products out there but these are just some of the ones that we have had experience with.


  • CLX - cross linked Therabands is the newest innnovation by Theraband (Performance Health, Inc).  The product we all know so well has gotten even that much better.   With the advent of the CLX, we are now able to cross link the entire closed kinetic chain to improve recruitment of the entire lower kinetic chain during functional exercises.  One technique developed is the "Spiral Technique" which increases Gmed recruitment during single limb performance.  Although this is a great adjunct to single limb training, it is also a great tool to add to our core training to aid in recruitment of the entire lower kinetic chain and core.  For more on the spiral technique, you can access the Spiral Technique Video or for information on the core training, you can access the Core Training Video.
You can also access the Theraband website for additional videos on some creative CLX exercises.  Below is one example of an exercise using the CLX that works on recruitment of the lower kinetic chain.



  • DS2 Platform - the DS2 Platform was developed by a Roland Rameriz, PT, ATC, SCS who is a physical therapist and athletic trainer in the NFL.  Roland developed this as a closed kinetic training tool for his athletes rehabilitating from injury as well as those looking to do some closed kinetic chain functional training.  The DS2 is a great tool for progressing single limb closed kinetic chain exercises and is also a great tool for progressing of core training exercises.  There are also some great videos in which Roland demonstrates the use of the DS2 for lower body training.


In this video, Roland demonstrates the use of the DS2 with lower body training and for the use with the core.  For more videos and techniques, you can visit his website at the link above.


  • Primal 7 - was initially developed by Brian DeMarco an NFL player who suffered a devastating career ending injury.  After being unable to move independently, let alone train, Brian came up with a way to start training (squats) with the use of some straps and bands.  Low and behold, the prototype for Primal 7 was developed.  Since then, Primal 7 has developed into an affordable suspension training system that allows athletes and non-athletes to start training movement in weight bearing reduced environment.  With the bands, you can modify how much body weight the athlete must resist so that you can gradually increase resistance as movement is perfected.  
In the following video, Brian talks you through the use of the Primal 7 and how this system can be used to help your athletes move better.


  • Hyperice Vyper Roller - the Hyperice Vper Roller provides deep vibration in combination with a roller.  When dealing with myofascial restrictions throughout the lower kinetic chain or muscle soreness, we have found this to be another valuable tool to assist us in achieving our goals, improved outcomes and an additional tool that our athletes enjoy using and "feel" a physical benefit from using.
In this video, the founder and developer of the Hyperice Vyper Roller shows what makes this product unique over your traditional roller.


  • RMT Club - this is another fairly new fitness product on the market that allows us to address movement in a way which increases the core recruitment while creating high levels of activation of the lower kinetic chain.
In this video, the author demonstrates the use of the RMT club for increased core activation.



This is by no means an all inclusive list but just a list of the ones we have had the most experience with.  We hope you found this helpful and next week, we will be discussing some movement technologies we can use to improve compliance with the programs we recommend.  



Dr. Nessler is a practicing physical therapist with over 17 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >3000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.