Monday, November 27, 2017

How Do We Know When It Is Time To Return To Sport - Part VI - Guest Blog

Last week, Eric Dinkins, PT, MS, OCS, Cert MT, MCTA took us on a journey to help us understand the impact on neuroplasticity in ACL rehabilitation and prevention.  This week, Eric will help us understand some ways we can influence this in our training.

What is my Inferior Temporal Gyrus? 
And why haven’t I up-trained this for my ACL Clients?

What we learned last week leads us to question how are we addressing.  What are we doing for enhancing visual feedback for our ACL or currently healthy clients? How are we up-training them visually in the attempt to prevent overload in the athletic environment?  If we know they can’t feel the knee like they used to….literally…how can we impose a greater demand on vision to help adapt more than there body, but also their brain?

Here are a few tips on how you can start addressing this need with your clients:

1)    Start changing our cues and attention to an External Focus (see our blog on external focus)
2)    Ensure that we are challenging our clients in an open environment, as soon as it is safely possible, performing dual tasks frequently
3)    Consider giving you and the client immediate visual feedback during skill training early in rehabilitation with a device such as the Motion Guidance Clinician Kit
4)    Consider taking visual feedback away at times during advanced mechanoreceptor training exercises to continue to challenge the body with different inputs.  This might be particularly challenging for the client on altered surfaces or to advance already mastered skills.  But imperative to help the athlete develop 'predictive behaviors' or feedforward skills in sports rather than relying solely on feedback mechanisms.

The two videos below demonstration how we can use visual feedback with the Motion Guidance Clinician kit during squat progressions.

Lower Chain Tutorial with Motion Guidance Visual Feedback

 Lower Extremity Dynamic Progressions

Hopefully this information has stimulated your own approach to rehabilitation of this challenging population.  We need to be aware of utilizing all possible body systems to maximize the ability of our clients to be ready to return to their best potential in their athletic or work environments.

-Eric and Tal

Motion Guidance

Eric & Tal - Thank you both so much for another great blog contribution.  As a physical therapist with over 20 years of practice, I am continually amazed by what we don't know and are continuing to learn.  The science is great at guiding us on what we should do but it is up to us as clinicians and practitioners to apply this in a way that captures the essence of the science in combination with the innovation and art of what we do.

Dr. Nessler is a practicing physical therapist with over 20 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 >5000 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.   He is also a competitive athlete in Jiu Jitsu. 

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