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Athletic development specialists dedicated to the art and science of excellence in movement

Notes from Dr. Charlie Weingroff's "Training = Rehab, Rehab = Training" Seminar

Last week we put aside our flooded house and made a trip to attend Dr. Charlie Weingroff’sTraining=Rehab, Rehab=Training” seminar in Phoenix.  One of our first thoughts when seeing water pouring from our ceiling last Thursday morning was, “Ain’t no way we’re missing this seminar!!” (Education >> Shelter) 

This workshop essentially brought to life Charlie’s epic Training= Rehab, Rehab = Training DVD series but with some updates.  This was a great opportunity to not only learn from Charlie but also from his teaching assistants Dr. Jimmy Yuan and Patrick Ward who helped guide the hands-on practical sessions.  Along with Keats Snideman and Clifton Harski as fellow attendees, there were a bunch of seriously smart dudes there!

Below are some notes from the weekend.   Sadly, these notes don’t capture the true magic of the weekend as I can’t replicate the synergy of the theory with practice. 

The theme of the seminar was just as the title indicates.  Charlie not only lifts heavy stuff, but is also one of only a few clinicians in the United States to achieve the highest level of certification with the Prague School of Rehabilitation’s Dynamic Neuromuscular Stabilization (DNS) curriculum.  Although we have been fortunate to receive some DNS exposure via a chiropractic friend who has studied in Prague four times, if there’s any criticism of DNS outside the clinic it’s the lack of formal progression into more dynamic exercise.  It’s powerful stuff but how do we transfer into training settings?

Enter Charlie...Within a day did an overview of DNS principles, explored these developmental positions and progressions, integrated into familiar corrective exercises, and then transferred these same concepts into the RKC lifts.  For me, this element was the most valuable part of the weekend without a doubt. 

General points

*Really strong people are doing the same thing as babies.  RKC-FMS-DNS continuum. 

*Look at everything as a competition – this helps clients and patients get better (Everyone raises their game)

*Unless you understand what it is like to challenge the body and have something personally invested in the result, you don’t “get it” as much (slight dig at rehab folks who don’t care about lifting heavy or running fast yet try to work with athletes)

*Know what is awesome and scale back.  Don’t just limit yourself by logistics. 

Biomechanics

*Gotten away from Sahrmann thinking – If you only care about cellular changes and biomechanics, you ignore the brain

*Sahrmann doesn’t audit large movement excursions (example: patient can only partially squat without pain, she’ll prescribe only partial squats…not practical or acceptable for athletic population)

*Biomechanics still matter though…first six chapters of Sahrmann should be required reading 

*BIOMECHANICS DON’T LIE…BUT THEY DON’T TELL THE WHOLE STORY

Education/Teamwork

*Team work – Doesn’t mean you have to be the one to do everything

*Still need to know what exists even if you don’t use it

*Good for non-clinicians to take medical con-ed courses…BUT what are you going to do when something goes wrong?  Even three years of PT school doesn’t give you those answers….

Core/Movement

*Trunk is ultimate compensator

*Mobility – what a joint system can do without external influence.  Example: rusty door hinge.  Maybe you’re OK with incomplete opening by door, but there will be problems if you force the door beyond it capable range.

*Capsular restriction doesn’t always respond to stretching.  Elastic and collagen behave differently than muscles

*Bony approximations can serve as stability in isolation…BUT train too much this way and brain gets dialed down (learns that it doesn’t need to do work for stability).  Packed neck example…fine to deviate on game day (do whatever it takes to get the job done at that moment)…no reason to train this way...unless you want to dial down nervous system!! 

*Be wary of EMG.  Don’t always want a big number.  Could mean the muscle is protecting.  Low EMG = you have more in reserve!!!!  Use EMG as backside (After the fact) confirmation, not frontside confirmation. 

*Spine does not stabilize until it knows it has to

*Core muscles used in standing function different than muscles used on ground (major part of the hands-on sessions was working through corrective exercise progressions to explore this concept in different positions)

*Brain spits out reflexive stability when it knows you have mobility

*Core can have stability without a muscle doing anything (example: seated skeleton on ground)

*Strongest core in animal world = giraffe (also consider whales).  Much to learn from animal nervous system and musculoskeletal system

*There is no great program design if you move like garbage

Functional Movement Screen

*Great part of this seminar was getting unfiltered and updated information on the FMS.  Like many things, the system is under continuous refinement, but that information is not always easily disseminated.  Further, formal FMS education often must “aim for the middle” as the audience can range from personal training interns through orthopedic surgeons in the same class. 

*Refining FMS scoring: Rotary stability…why is it in the screen?  We land on same side of body rolling as a baby.  RS screen is NOT some “arbitrary hard version of a bird dog.”  2’s on RS screen = ability to crawl.

*People don’t like the FMS because someone was smarter first

*Range of movements passable for 2’s.  Not demanding perfect symmetry as some misinterpret.

 *Sometimes on the FMS you don’t need to change 1’s and asymmetries…just don’t challenge them

*Don’t have to use the FMS…but if not, what are you doing to determine if you are the right person for that person at that time within a framework that honors the neurodevelopmental perspective while accounting for the effect of pain on motor control (do you treat people in pain differently than those not in pain?).  If you have something better, please teach it to us.  

*Movement can look brilliant with perfect biomechanical form…but you still may be using too much stability to compensate through the move (high threshold strategy)…FMS exposes this

*Role of the FMS = set minimum standard.  If you lack standard how do you know what is needed? High blood pressure not “bad”…blood pressure reading tells you where you should go next and what you should/should not do.  Someone with 200/120 BP gets sent to emergency room = blood pressure did its job. 

*Common way to start is most important – but lots of ways to follow up (good FMS score means you did something right…doesn’t matter how you got there or how you fix it…nothing says you have to use Gray Cook exercises…just make sure you audit your results).  

*Smart training can be corrective

More on Defining the Core

*Spine can be stable in any position, but this is often achieved via compensation

*We are separated from animals by drive for verticality.  Baby always seeking verticality and sensory input.  Uses stability points to help achieve this.

*Outer core = stakes holding up a tree (but what happens when the wind blows?).  Inner core = roots beneath ground (work on their own without external drive).  If you don’t have roots, more stress placed on stakes

*Inner core = anticipatory model

*People who do lots of crunches tend to not recover well or are mutants who can survive bad training

*Where did draw-in come from?  Research in low back pain patients showed that transverse abdominus fired late.  No evidence to suggest it is relevant for nonpainful population.  (But still does not validate draw-in for painful…does transverse adbominus fire voluntarily or reflexively?)

*Long distance exercise (low intensity) allows you to hide certain dysfunctions

Dealing with elite athletes

*Just because someone is an elite athlete doesn’t mean they have elite standards at all levels of movement.

*Best athletes aren’t necessarily working with best coaches/trainers…many just lucky to not screw up mutant talent.  Often overlook weaknesses because they don’t bother to look.

*Can’t make Lebron jump higher or be more explosive, but can get more years of durability or can learn to prime nervous system better to maximize physical resources

Motor Control

*Dysfunctional breathing is neurological.  Any stress changes breathing

*Crossed postures (upper/lower) are neurological constraints.  Brain cuts the brakes to get you to stop what you are doing

*Strong core = appropriate stiffness for desired movements

*Just because it happens on game day doesn’t mean you need to do it in practice.  Do whatever it takes on game day, but you‘ll have to recover longer in training if you do things wrong

*People try to turn methods into systems (ART = great tool but doesn’t teach system)

*Joint centration is musculoskeletal visual for neurological keyhole.  Joint not centrated causes neurological response (here's Sarhmann information still matters...).

*You can make something look right but may require “high threshold” strategy (too much effort for stability)

*Train MMA guys like golfers…not same exercises or workouts but same Titleist Performance Institute (TPI) thought process.  Better fundamental movement patterns allows for better skill development

*Poor motor control = always bracing = “high threshold.”  Need relaxation (RKC ying-and-yang of tension/relaxation = hardstyle, not “uglystyle” or constant tension)

*Loss of joint mobility is a stress.  If baby doesn’t have normal mobility it will not develop normally. People who don’t appreciate role of this stuff in probably didn’t have to hold child with cerebral palsy in clinic and see consequences of abnormal development.

*You can never call yourself a pediatric physical therapist until a child has barfed on you.

*Just because a muscle can do something doesn’t mean it should do something

*What we do as babies affects what we do as adults

*Muscles drive motions.  Motions drive joints.  Joints drive central nervous system

*Primitive reflexes = protective.  If you voluntarily reproduce primitive reflexes (think technical failure in workout), you are destroying central nervous system. 

*Flexed toes = tells brain “stop!”

*If biomechanics didn’t get you in trouble, how can you expect biomechanics to rescue you?

*Packed shoulder is a direction, not a position.  Overhead carries may resolve winged scapula 

*Bony landmarks are like antennae (used by babies and adults...this point was explored in great detail during the breakout sessions)

*Baby has no choice but to stabilize with body weight

*No one tells baby what to do…joint positions makes us stronger, more flexible, and recover better

Pain/Rehab

*Things that bring you back to normal in rehab are same things that bring you from normal to great in training

*The problem area is often doing everything correctly

*Fear Avoidance Base Questionnaire – can tell whether nervous system ready for more stress

*Pain is perceptive.  Everyone gets punched but who will get up first?

*Slow movement exposes limitations

*How to keep the window of opportunity open after therapy?  Load patients up.  Like hitting the "Save" button on your work.  

*Football training-  If you go to war on Sundays, don’t need to go thru war in the weightroom

*What are the best neuromuscular interventions to get a response starts with evaluation (Being great at evaluation is like being a magician who knows where to put the fishwire)

*No one is “weak” unless they can’t feed themselves.  Exercise is about motor control improvements, not merely strength

*Every rehab program needs an aerobic component.  Resets nervous system (not about aerobic capacity though)

*When someone has pain they are on lockdown

Autonomic Nervous System, Conditioning

*Power vs capacity tradeoff…train for KO in first round, or train to win a decision?

*Grip strength, heart rate variability, vertical jump, bottoms up kettlebell press = “lie detectors” = evidence based measures of autonomic system preparedness

*How do we know they are ready for the intervention = Can they breathe through the technique?

*Vision is window in to autonomic nervous system

*Body follows eyes

*Exploit fixed points – if you can’t perceive the floor you won’t be able to change to movement

*Corrective exercise is skill acquisition.  (not just what exercises are you doing, but how are you teaching them?  Exploiting motor learning continuum of unconscious incompetence through unconscious competence...apply this continuum for all exercises)

*Dr. Greg Rose's 4 x 4 matrix = Genius

*Skill acquisition occurs when the coach is gone

*Muscles are stupid, they don’t have memory.  Brain has memory

*Corrective exercise has no reliable programming pattern (not sets and reps)

*For corrective exercises to work, the person needs to be in the right state for it to happen

*Locomotion in all three planes offers new fixed points for exploration by feet (extroceptive input....again goes back to continuum of DNS w/ babies exploiting fixed points for stability to gain upright posture to RKC teachings of using ground to assist with tension)

*The higher the integrity of your fitness, the better your corrective exercise

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