Two Legs or Four… That is the Question!

In William Shakespeare’s “Hamlet” the young prince is seemingly torn by the grave injustice which he perceives as his existence. So much so is he torn that he contemplates the alternative to his own existence, being of course the end of his own life.

A bit dramatic wouldn’t you say?

But such is Shakespeare, and such is the job of a playwright. To make a juxtaposition out of a molehill and wow the audience to the point of spending obscene amounts of money to see the “latest and greatest” coming soon to a theater in the round near you.

Why am I bringing this up in a health care/strength and conditioning blog?

The same holds true for much of the recent teachings of the self-proclaimed William Shakespeare’s of the lecture circuit in healthcare/s&c. But instead of holding a skull and professing to end a seemingly woeful life, they are holding a laser pointer and professing to have the secret to bullet proof this, and injury proof that.

“sigh”

One of the latest trends I have noticed, especially in patients with lower back and hip pain complaints, is “crawling” for the resolution of primitive reflexes.

First off, where in the brain do the primitive reflexes live? Frontal lobe? Cerebellum? Basal Ganglia? Thalmus? Mesencephalon? Brainstem?

If you do not recognize any of these regions of the brain and cannot explain what they do, then never mention the words “primitive reflex” again. You have not earned the knowledge necessary to tell a patient/client that you are fucking with their brain in any way, shape, or form.

Now back to crawling.

The crawling done in gyms and clinics around the therapeutic, and strength and conditioning world is intended to resolve a “primitive reflex”, in this case the symmetrical tonic neck reflex; flexion and extension. Now I understand that some reflexes may be present, but the ass-umption cannot be made that every Tom, Dick, and Sally can benefit from performing crawling when the test has to be performed to assess the appropriateness of the intervention. People!!! Rehab does not equal training and training does not equal rehab, unless you are a rehab professional rehabilitating someone, and them referring them to a trainer who will TRAIN them. In the adult population, the “holding on” of these reflexes can be so subtle and difficult to detect that it is virtually impossible to perform a neurological screening for this or any other “primitive reflex”. This is not the over simplicity of application afforded the FMS, and thus the over simplicity of the information gleaned from such a “screening”. This is REAL neurological dysfunction we are talking about here…nothing to fuck with, especially when you refer to cross crawling as a panacea of sorts to be included in every patients/clients exercise program.

If the STNR is so important and meaningful to “eradicate” in the vast majority of the human populous as though it were the new Ebola and worthy of its own STNR Czar, then why ignore the other players in this Shakespearean Neurodrama, for example… Moro (I believe he was a Capulet?), Asymmetric Tonic Neck Reflex, Tonic Labyrinthine Reflex (forwards and backwards), Palmar Grasp Response Reflex, Babinski (Babinski…that guy owes me money!), Spinal Galant Reflex (and his cousin from Mexico City, Spinal Perez Reflex). Why not test them all?

I suppose my point is, if you suspect a developmental lesion in one of your patients or clients, don’t try to treat them yourself if you are not very well schooled in the neurological basis of these reflexes. You may be doing more harm than good. Real and destructive harm, no joke. This isn’t foam rolling people (a topic for another post).

I know, I know, can crawling really be all that bad? Well, we developed into bipeds for a reason.

Serge Gracovetsky, PhD describes this as the “Critter Walk”, and outlines exactly what happens to the “spinal engine” during this activity in his book “The Spinal Engine”. To put it simply, the de-evolution of human, bi-pedal movement is not something to be undertaken on a whim, or because some “guru” in a seminar told you it was cool. Biasing the spine towards lateral flexion during horizontal plane movement does not a good movement prep make (does that sound like Old English?). As bipeds, our long and arduous time spent developing hip extensors (even without the benefit of such exercises as the barbell hip thrust, and the hip lift) has earned us Homo sapiens the right to walk on all two’s, and not hold us captive from an ambulatory perspective to our spinal lateral flexors during horizontal plane movements.

Is it possible that as strength coaches and rehab professionals we are making our clients/athletes less efficient in the running aspect of their athletic development?

YES

If it aint broke, don’t fix it…and while I am on a cliché’ roll…First, do no harm.

So next time you decide to have one of your trusting flock start crawling their way towards super-duper reflex eradication…think twice. Maybe three times.

Thank You, and in the immortal words of William Shakespeare…”Where for art thow Moro”?

 

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CHIRO-CONFUSION: ALL ARE NOT CREATED EQUAL

The most common question I get is “what exactly do you call yourself?”

The reason being I don’t perform only chiropractic adjusting, or only soft tissue, or only rehabilitative exercise, or only functional neurology, or only strength and conditioning, or only ARPwave treatments…or only…only…only…!

Truth is I don’t really know what to call what I (we) do.

The name of the blog is “Human Restoration”. All I can say is we do what has to be done in order to restore the patient or client to what they classify as their specific normal. Techniques and tools are only means to the end, which can be very helpful but in many cases with other practitioners, may be their hindrance or outright downfall.

I do ART, but am not an ART guy, I do functional training but am not a functional training guy, I work with the brain but am not a brain guy, I work with an ARP but am not an ARP guy, etc., etc.

The need for a “therapeutic title” is not necessary anywhere in the realm of rehabilitative science, only in the minds of those who don’t have the knowledge to determine the difference in application towards restoration of the human condition.

I had a patient come in after struggling with lower back pain for months which was preventing him from swinging a bat, and since he was a collegiate baseball player player, it was a substantial hindrance. I evaluated him, treated him, and made recommendations to his (“well known”) strength coach regarding changes to be made to his programming. This was met with animosity and insulting commentary towards my title as “just a chiropractor”. Long story short, the patient left that (“well known”) strength coach and has not had any lower back pain since, as well as continuing to play collegiate baseball at the highest level.

Lesson: I do not know what to call what we do. Simply put, we evaluate what is wrong, and what is good about a patients condition. Recommend a course of therapeutic action. Follow through with said course of action until resolution of the patients condition has been achieved. Patient smiles ; ) !

“I Can’t Believe They Let You Leave the House”

All first posts need a catchy title, eh?

At Marchese Sports Therapy, this is one of my favorite sayings when confronted by purely confounding descriptions of “why” a patient has what they have…well maybe I should rephrase that to read, what they believe is wrong with them as described by their (insert practitioner).  Somewhere along the line it became alright to use inaccurate and often downright “wrong” information to explain what is going wrong with a patients body.  Well, we are not about to perpetuate that, not in our clinical setting.

Example from earlier today…because this happens EVERYDAY!   A patient was told by their (clinician)…you are probably wondering why I am not naming the type of clinician in this case?  Because it is not important to disparage other professions, when there are excellent DC’s, PT’s, MD’s, DO’s, ATC’s, LMT’s, LiAcc’s, etc. everywhere. This is not a place to put down other healing professions, just inform, educate and hopefully restore the Human frame.  Sorry, sidetracked.  This patient was told the reason they had knee pain when performing a particular exercise (prescribed by the practitioner) was that they (the patient) were not stretching their IT band enough.  Now this patient is a surgeon…very familiar with the real, and only way to “release fascia”…cut it.  Her first instinct was to call the (practitioner) out, but being a non-confrontational type person she let it go and instead asked the question, “should I be trying to work through the pain in order to perform this exercise”, “is this exercise crucial to my recovery”? The (practitioner) answered, “it’s good pain”, and followed up with the ever popular “doctors make the worst patients”. In this case it is probably because the doctor is educated and the (practitioner) hates to try to pass off pseudo-explanatory BRO-vado bullpucky to anyone with an ounce of clinical knowledge for fear that his or her lazy, unsubstantiated “opinion” may be challenged.

So, in the above clinical case, what could the (practitioner) have said to the patient (MD) in order to sound relatively clinically competent?

Good question people, very good question.

With this blog, I hope to address a whole host of topics regarding clinical sciences, rehabilitation, strength and conditioning, and even the occasional case study from the “I Can’t Believe They Let You Leave the House” hall of fame vault. Some posts will be for professionals, and some will be more directed towards the lay person. Either way all the information will be useful to the Human being buried in each and every one of us.

Why the name Human Restoration Project? It’s a very long story, which will bore many and excite some…so I won’t take up time here to tell it.  After all the needs of the many outweigh the needs of the few…or the one (just channeling my inner Mr. Spock on that one).  Put briefly, the wonderful and positive trends in today’s healthcare and rehabilitative realms should be highlighted, and brought to the foreground of Human accessibility. Human Restoration is paramount, and should exist without bias…regardless of the practitioner, as long as the intervention is based in real science, and not opinion repeated over and over again until people actually believe it to be true. That’s what we are aiming for here.  A resource for Human Restoration from pain, dysfunction, injury, deconditioning, and anything else included in my scope of practice…CYA!

Be well, until next time

Dr. John