A Balanced Approach to Core Stability

If you have picked up a health, fitness or training magazine recently, you can not avoid reading about the importance of “core stability”. Core stability is touted as paramount to maintaining a healthy back, however the idea of what “core” actually means, what muscles are involved and what exercises are best vary greatly depending on who you talk to. When you think of the core, the abdominal muscles inevitably come to mind. But that is only part of the picture.

Many of today’s popular ideas of spinal stability originate from research out of the Australian physical therapy group back in the 1990s. The research showed that the transverse abdominis (TA), a deep abdominal wall muscle and the multifidus, a series of spinal muscles, thickest across the lowest part of the lumbar spine, had unique behavior when injured. The transverse abdominis was shown to have a feed forward ability, meaning it turned on before other muscles did during a task that required stability. ^1,2. Further it was shown to have altered activity when there was a lower back injury, sometimes turning on late or not at all. The multifidus was shown to decrease in size and have increased fat content after injury local to the site of injury. ³ This deficit did not recover spontaneously, even if the pain went away and it was found specific exercise was needed to rehabilitate the area. ⁴ Therapists began to use very focused rehabilitative exercises to activate the multifidus and deep abdominal musculature.

The research became popularized, spilling over beyond physical therapy and other health disciplines to personal training and popular fitness culture. The rehabilitative concepts, while useful for addressing specific muscular deficits, grew beyond its scope shaping personal training and core conditioning programs. This may have led to an overemphasis of the deep musculature.

Researchers such as world renowned biomechanist Stuart McGill found that exercises used to activate many abdominal exercises particularly those that repetitively flex and extend the back, offer unhealthy loading of the spine and only work very specific muscles. Further he argues that emphasis on deep musculature can actually destabilize the spine (More on this next time). McGill’’s live and biomechanical modeling also showed that there are not necessarily muscles that were more important than others. All the muscles in the trunk are important at different times, with different loads, under different circustances.⁵ Movements in the body are almost never a result of one specific muscle, but a result of coordination of many muscles, or muscle systems. Muscles that are further away from the center of rotation (the spine) offer better mechanical advantage than deeper muscles. McGill’s approach is to take a broader stroke, training the movement, not an individual muscle. He developed exercises to address the trunk musculature more comprehensively, focusing on exercises that create adequate muscular challenge across a number of muscle systems while putting the least compressive load on the back.

These exercises are often distilled down to what is often referred to as the “Big Three”. (See the related article on our blog) These basic exercises are commonly used initially in lumbar spine rehabilitation. These exercises are also becoming popularized beyond clinical practice as well. (See the NY Times video here: http://video.nytimes.com/video/2009/06/17/magazine/1194841000095/core-values.html?scp=1&sq=core%20values&st=cse)

All patients are different and what is appropriate for one person may not be appropriate for another. But generally McGill’s basic spine sparing core exercises can be used across many patient populations. Clinically I typically pull from more than one school of thought. If there problems with joint mechanics or muscle adhesions, they are addressed with manipulative and soft tissue techniques. I may also look to identify overt muscular deficits such as multifidus or transverse abdominis issues. If present, muscular deficits are addressed and some basic motor control exercises are taught. However, I will usually progress quickly to include a broader and more balanced approach using various spine sparing exercises based on McGill’s research and concepts.

In our next newsletter, we will continue exploring spinal stability

References:

1. Cresswell, A.G, Thorstensson A. (1994) “Changes in intraabdominal pressure, trunk muscle activation and force during isokinetic lifting and lower. Eur J Appl Physio Occup Physiol. 68: 315-21

2. Hodges, P. W., Richardson C. A. (1997) “Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement.” Experimental Brain Research 114 (2): 362-370

3. Hides, J.A., Stokes, M.J. et al. (1994) “Evidence of lumbar multifidus wasting ipsilatreal to symptoms in patients with acute/subacute low back pain.” Spine 19(2) 165-72

4. Hides, J.A. , Richardson, C.A. et al. (1996) “Multifidus recovery is not automatic after resolution of acute, first episode low back pain.” Spine 21(23): 2763-9

5. McGill 2. M, (2004) “Linking latest knowledge of injury mechanisms and spine function in the prevention of spine disorders.” J. Electromyogr Kinesiol 14(1):43-7

Mark Pitcher DC, Msc

chiropractor, exercise physiologist

Graston for Ligament Repair

At the clinic, we've used Graston Technique for muscle and tendon injuries, but the recent research suggests that it may be useful for increasing the recovery time from ligament injuries as well. It is generally accepted that ligaments repair through repetitive scar formation rather than true regeneration. This can lead to mechanical weakness in the ligament and may be one reason that re-injury is so common in patients with previous ligament injury.

A study published this summer in the Journal of Orthopaedic & Sports Physical Therapy (1) examined instrument assisted cross friction massage (Graston) in an experimentally induced ligament injury in rats.

Four weeks after the injury, the treated ligaments were 43.1% stronger and 39.7%

Stiffer, able to absorb 57.1% more energy before they failed than the non-treated ligaments.

Twelve weeks after injury the differences between treated and untreated ligaments were minimal in terms of strength; however the treated ligaments were 15.4% stiffer.

Although an animal study, this study does support the theoretical basis of using early cross friction massage to speed repair after ligament injury. Although the differences in strength even out over time, lasting increases in stiffness could confer additional protection to the joint itself.

1. Lohgmani MT, Warden SJ. (2009)“Instrument-assisted cross-fiber massage accelerates knee ligament healing”. Journal of Orthopaedic & Sports Physical Therapy. 39(7): 506-514.

VIMG loves Lindsey Vonn

Kate Dekanich was out to represent VIMG at Vonn's Vail homecoming.

Spinal Stabilization Exercises:

New Study from Dr. Stuart McGill’s Biomechanics Laboratory at the University of Waterloo

As many of our patients know, we favor research based exercise and rehabilitation at our clinics. For many types of low back pain, spinal stabilization exercises are very commonly used. For patients with back trouble, the back’s load bearing capacity is often diminished so that many commonly prescribed exercises can excessively load the back and are usually inappropriate.

One of the exercise protocols we use for improving spinal stability while minimizing excessive loading is based upon research out of Dr. Stuart McGill’s laboratory at the University of Waterloo in Canada. I have had the opportunity to study with Dr. McGill and am always impressed by his ability to explain extremely complex physiology and biomechanics with clarity. The quality and sheer volume of his research has allowed him to construct an evidence based approach to lumbar spine rehabilitation.

Dr. McGill’s publishes exceptional papers more often than some people change underwear. But we found the recent article published this year in the Archives of Physical Rehabilitation titled “Exercises for spine stabilization: Motion/motor patterns, stability progressions, and clinical technique” especially relevant for patients and clinicians.

The article investigates three well researched and commonly used spine sparing exercises that are used in our clinics for spinal stabilization. Three exercises and their progressions were studied: (1) curl-up (2) side bridge, and (3) bird-dog (the “Big 3”). With these exercise, they studied muscle activation, 3D spinal mechanics and the effect of theclinician offering corrective input during exercise.

While I rarely see anybody doing the neutral crunch at the gym I do occasionally see the side bridge and bird dog. However when performed, they are usually done too fast and without the control, neutral spine posture, or attention to muscle co-contraction that is talked about in McGill’s methodology.

One of the co-contraction techniques widely used is an‘abdominal brace” where the patient contacts the abdominal muscles like they are bracing for a abdominal muscles like they are bracing for apunch. Not pushing the belly out or sucking the belly in. Dr. Mcgill’s research showed that raising the elbows off the floor during the neutral curl up increased rectus abdominis activity. Co-contraction with an abdominal brace during the neutral curl up increased the internal and external oblique to 30% of maximal voluntary contraction.

The studies involving the side plank exercise showed clear progression in muscle activation from ½ bridge to full bridge (with legs straight) with the most muscular challenge moving from side bridge to plank resulting in muscle challenge of 50% of maximal voluntary contraction in the rectus, abdominis internal and external obliques.

The bird dog progression was from the all fours position to just arm, then just leg and then both arm and leg, using abdominal bracing and then abducting the arm slightly. The study again showed a clear progression of muscle activation through the progression of the exercises.

When evaluating clinical guidance, factors such as addressing patient asymmetries and applying fascial raking (using firm fingers pressure on the abdominal musculature to add feedback and better activation) were assessed. The fascial raking resulted in increased oblique muscle activation and decreased rectus abdominis activation, therefore improving the neutral spine posture. It was also especially useful in decreasing the amount of twisting (or uncoupling) of the torso during the plank to side bridge.

Although we currently use employ feedback on abdominal bracing and clinical corrections for asymmetry during the exercises, strive for neutral posture and promote abdominal bracing, we have not used the abdominal fascial raking to any large extent. Given the findings of this study, I think patients should expect to start seeing our practitioners digging their fingers in some abdominal musculature during stability exercises.

Mark Pitcher DC, Msc

chiropractor, exercise physiologist

For additional information read Dr. McGill’s Books:

Low Back Disorders and Ultimate Back Fitness

Visit www.backfitpro.com for more information.

Back in the day with Shawn White

Honda Sessions circa 2005

Martin Cupka to go to Paralympic Games!

VIMG is proud to celebrate Martin’s 3^rd Paralympics! GO Martin!

http://www.vaildaily.com/article/20100217/NEWS/100219476/1078&parentprofile=1062

Dr. Joel and Dave Blanchard, MPT lecture at Olympic Traning Center

Just four short weeks before the Vancouver Olympic Games, we had a great opportunity to lecture for the CCSP post graduate course on assessment and management of extremity disorders.
What an amazing venue to speak at considering the upcoming winter games. Go Team USA!

Integrated Model Of Stability

There is often great confusion around the concepts of core and spinal stability. A simple but excellent model is the integrated model of stability described by physical therapist Diane Lee and clinical anatomist Andry Vleeming. Although initially developed to describe stability in the pelvis it is relevant for any mobile joint and certainly in the spine. They originally describe three factors that when operating together result in optimal stability in a joint:

1. Form closure

2. Force closure

3. Motor control

Form Closure describes the passive integrity of the joint system. “Form” refers to how the parts (joint surfaces) fit together. Ligament stiffness, disc health, joint alignment all contribute to this integrity.

Force Closure refers to active muscular component. Inherent muscle stiffness and appropriate muscle contraction applies tension to the joints in the spine like the guy wires of a tent. Tension creates joint compression maintaining integrity of the joint. Tension and compression in the spine must obey the “goldilocks effect”. Too little compression results in instability and too much compression results overloading the spinal structures; it needs to be just right.

Motor Control is achieved through coordination of the nervous system and muscle feedback to create appropriate amounts of tension. Tension needs to be applied through activating the right muscles at the right times. Unlike the tent pole, the spine has moving parts and changing demands requires near constant changes in muscle activation. Although mechanically the spine may act like a complex tent pole, muscle control is more like an orchestra. All the instruments have to work harmoniously to achieve the desired music. If one or more instruments are out of tune, or come in at the wrong time we don’t get the desired symphony, but noise. If the muscles don’t act harmoniously, then the forces exerted on the spine may not protect it when needed, or worse apply uncoordinated forces which may cause it to buckle under load.

These three systems must work together to achieve the conditions for optimal stability. They work in a continuum so if one system becomes compromised, the other systems can compensate. However certain methods of compensation are clearly less than desirable than others.

If the muscle activity or control are compromised and muscles are not activating when they should, or with inappropriate forces, then injury may occur causing damage to passive joint structures. Research has shown us that these deficits in muscle activation and control can also be caused by previous injury. Therefore motor control and muscle activation deficits can be both a cause and effect of pain. Over time, these deficits are compensated for by the damage and anatomical change to the passive structures. Degenerative changes in discs and joints typically results in instability, but the damage over time like drying out of discs and formation of bone spurs eventually increased joint stability. This stability typically comes only after years of pain and disability.

In the opposite situation where passive structures are compromised, muscle activity and good motor control able to compensate with far more favorable outcomes. For example, if there is disc degeneration and decreased disc height, then ligaments can no longer exert the same stiffness across the vertebrae and prevent undue movement. (You’d rather not rely on ligaments to do this anyways – but that’s another article.)The resulting instability can be countered by appropriately increasing the muscular tension across the involved joints. The only disadvantage with this strategy is that unlike anatomical decay, it is not automatic and requires exercise and practice. In people with previous injury, proper motor control often needs to be re-learned and repeated to become habit.

This integrative model is a very useful way to visualize how stability is achieved. Having good motor control, training multiple muscles and ensuring proper joint mobility and alignment are all important elements in maintaining and restoring spinal stability.

Mark J. Pitcher DC, Msc

chiropractor, exercise physiologist

If you have additional questions about core or spinal stability, or wish to make an appointment with Dr. Pitcher to address stability issues, please feel free to contact us at the clinic 970-479-6262, or by email at drpitcher@vailhealth.com

Adrian Fernandez

International racing legend Adrian Fernandez gives Dr. Dekanich an autographed book during a recent treatment over the holidays.

Dr. Joel attends Chicago Active Release Technique (ART) seminar.

Last week I spent 21 hours learning a soft tissue technique that has become one of the leading treatments for muscle and tendon injuries.

Active Release Techniques®

ART ® is a soft tissue management system that effectively treats soft tissue problems, which frequently do not respond to other traditional treatments.

The goal of ART® is to restore optimal texture, motion, and function of the soft tissue and release entrapped nerves. This is accomplished through the removal of adhesions or fibrosis in the soft tissues via the application of specific protocols. Adhesions can occur as a result of acute injury, repetitive motion, and constant pressure or tension. ART® eliminates the pain and dysfunction associated with these adhesions.

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Some of the more common conditions are:

• Carpal tunnel and other peripheral nerve entrapments
• Spinal pain and dysfunction
• Tendonitis and other soft tissue inflammatory disorders of the hand, wrist, elbow, shoulder, hip, knee, ankle, and foot
• Sciatica, TMJ, recurrent sprains and strains

Only a credentialed ART® provider can ascertain whether ART® might prove beneficial for your condition. To become proficient in ART®, it takes approximately two years of working with patients once a provider has taken the courses and passed the required examinations. Providers must attend annual update seminars to maintain their credentialed status and keep current of any new protocols and research.

ART® is sought after by nearly every professional sports team, Olympic athletes, movie stars and insurance carriers. This technique has filled a void in the management of soft tissue conditions.

Learn more at http://www.activerelease.com/

Merry Christmas and Happy Holidays from VIMG

VIMG celebrates the holiday spirit by giving to local families in need. Merry Christmas!

Ski and Snowboard Conditioning

The ski/snowboard season is just a month away for us here in the Vail Valley. Some of you may have already taken advantage of Loveland or A-Basin and started your season early. For many individuals your summer has been filled with tackling the mountain on a bike or your good ole two feet. Kudos to you for being active, but skiing is a different animal altogether. And if you have not already started preparing for the winter season, now is the time. Prevention is the key to avoiding injury on the slopes. A well rounded conditioning program consisting of five key injury prevention workouts will help prepare you for the mountain and most importantly help to decrease your risk for injury. What are those 5 key injury prevention workouts?

1. Cardiovascular Endurance

2. Muscular Strength

3. Muscular Flexibility

4. Muscular Stability

5. Plyometric Strength

Each key prevention workout and their effect on decreasing the risk of injury are explained below:

Cardiovascular endurance is vital when lasting on the mountain run after run. The cardiovascular system delivers blood and oxygen to your working muscles. A conditioned cardiovascular system allows muscles to perform longer before fatigue occurs. Fatigue is one of the number one causes for injuries when skiing. The majority of injuries occur at the end of the ski day, when the muscles have lost their ability to use and produce energy efficiently. Start building up your cardiovascular endurance now by performing 3-5, 30-45 minute aerobic sessions per week. Some of the best choices for training the cardiovascular system are running, biking, rollerblading, stairmaster, elliptical, or arc trainer.

Muscular strength is also important when preparing for the ski season. The muscles and particularly the joints sustain a great deal of stress when skiing. Increasing strength increases the ability to endure the high stress demands of skiing. Even though skiing is a total body workout, specific major muscle groups are often used more including the quads, hamstrings, calves, low back, and core. During skiing the majority of your joints (knees, hips, ankles, and back) are kept in a flexed position, putting several muscle groups in an anti-gravity or eccentric loading position. Incorporating slow, controlled, eccentric training for the hamstrings, glutes, quads, and calves can help to improve your performance in turn decreasing your risk for injury. Some of the best ski conditioning exercises includes squats, split squats, ball hamstring curls, bridges, and calf raises.

Building strength in the legs is important for skiing, but so is building the strength of your core and low back. Remember, when skiing you are in a bent position which can place a lot of pressure on your low back. Improving your core and low back strength will help to offset low back discomfort. Core strength refers to not only strengthening the deeper, intrinsic muscles of the abdomen, but also the larger superficial muscles. The intrinsic muscles provide a “girdle” type of support between the rib cage and pelvis. The superficial muscles provide support for larger movements. Having a strong core improves your stability and decreases your risk for low back injury. Some great core exercises to incorporate into your ski conditioning program include plank, side plank, superman, birddog, and the dead bug series.

Muscular flexibility is another key factor when preparing for the upcoming ski season. Muscles need to be pliable when skiing. Tight muscles increase your risk for muscular sprains/strains or even more serious injuries including ACL tears, or avulsions. Since skiing is a predominately fixed, flexed sport attention needs to be given to hamstrings, hip flexors, calves, low back, and chest. Some light stretching of these areas should be performed before hitting the slopes and then more time spent stretching these areas again after skiing. Beneficial flexibility effects occur when the stretch is held for 30 seconds or greater. Try and stretch each muscle group 2-3 times.

When skiing, the terrain is always changing; therefore you must have excellent balance and full body stability. Increased balance and stability decreases your risk for falling due to enhanced proprioception along with an increased reactive ability to self-correct changes in your balance. Balance training can easily be added to you ski conditioning program by using equipment such as dyna discs, BOSU’s, and stability balls. Try those same exercises suggested earlier in the muscular strength section, but on a BOSU.

Plyometrics can be incorporated with stability training. Plyometrics are explosive movements such as jumping, power squats, and split lunges. Plyometrics are very stressful on the body and should only be performed after you have built a strong cardiovascular, strength, flexibility, and stability base. Adding plyometrics to your ski training regimen will help you prepare for the rigors of landing after bumps, jumps, and moguls, by training you how to absorb impact with a less rigid frame decreasing your risk for injury.

Preparation is prevention. This winter you’ll want to spend your time on the mountain not on the couch with an injury. You now have 5 key injury prevention type workouts to help prepare you for this season…..so get to work!

Casey Charlebois MS, MPT is a physical therapist and personal trainer with VIMG. If you have questions, you can reach her by email at casey@vailhealth.com. If you wish to jumpstart you ski conditioning program and get you season started right, call 926-4600 to schedule an appointment.

USA Taekwondo Rocky Mountain Open

Dr. Joel Dekanich assisted with medical coverage for the USA Taekwondo Rocky Mountain Open at the US Olympic Training Center in Colorado Springs, CO November 7-8.

Chiropractic and Easing Back Pain For Soldiers

Fox news Interview with Brigadier General Becky Halstead -Chiropractic and Easing Back Pain For Soldiers - http://bit.ly/2Hm22s

Evening with Phil Jackson

The evening with Phil Jackson was a memorable one. A great night for a great cause gave us an opportunity to hear some life lessons from the “Zen Master.”






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Graston Technique for Olympians

When at the Olympic Training Center last summer I was introduced to a technique that has great results for soft tissue injuries like tendonopathies, strains and myofascial adhesions. I set out to learn this technique and since implementing this technique into our practice this year, we have seen excellent results. Unlike massage, Graston® Technique Graston® Technique uses stainless steel instruments to break down fascia and help re-align the muscle fibers.

The Graston® Technique, originally developed by athletes, is changing the way clinicians view treatment of acute and chronic soft tissue injuries.

Graston® Technique is an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. This technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.

The curvilinear edge of the patented Graston® Technique Instruments combined with their concave/convex shapes molds nicely to the various contours of the body. This design allows for ease of treatment, minimal stress to the clinician's hands and maximum tissue penetration.

The Graston® Technique protocol induces micro trauma to the area, which increases the amount of cells that are associated with wound healing. The damaged tissue is replaced with new tissue. Ice is then applied to reduce the pain and exercise is implemented to increase function and range of motion.


Dr. Joel Dekanich is Clinic Director at VIMG and practices out of the Edwards Location. You can contact the Edwards office at 970-926-4600

For more information on Graston® Technique research click here.
For frequently asked questions about Graston® Technique click here.

Dr. Mark's Applied Physiology article is now available in free full text version

The Journal of Applied Physiology Nutrition and Metabolism has made the article "Reliability of electromyographic and force measures during prone isometric back extension in subjects with and without low back pain" available in a free full text format. Check it out here!

PGA Tour

This past June I had the opportunity to work my first PGA Tour event in Milwaukee, WI. Formerly known as the GMO (Greater Milwaukee Open), the US Bank Championships have been a Tour stop for many years and just so happened to coincide with the British Open where Tom Watson had his ‘almost’ amazing finish. Many people want to know what the medical staff does at the PGA Tour and here is a quick answer. At each PGA event there are two double wide trailers available for players to have treatment, rehabilitation and therapy before and after a player’s round. Many players use the staff to get stretched out before a round and/or get an adjustment or therapy if needed on a particular issue they might be having. Some is based solely on prevention while others have true injuries that need attention. The staff is comprised of two excellent physical therapists and one chiropractor as each event and they work in concert to what the players needs may be. These ‘moving clinics and gym’ have all state of the art equipment for treatment and therapy. What is probably most unique is that players have such a wide range of athleticism, fitness and body types yet are all the best golfers in the world!

A typical day is from as early as 5:30 am to about 7:00 pm and about half the field (80 players) was treated for various needs and conditions throughout the week. All in all it was a great week (in my home state) and I look forward to working more events in the future with such talented staff and players.

Joel

Control Over Pain

Pain is created and transmitted in the body. It is an unpleasant sensation, a signal to the body that it has been damaged. Pain is influenced by our beliefs, culture, stress level, and genetics. Pain may cause change in heart rate, blood pressure, breathing rate, emotions and behavior. When pain becomes chronic (lasting longer than 3-6 months) some people will stop doing things they once enjoyed. They may limit social activities, stop doing hobbies or sports because of the possible pain those activities may cause.

People in pain may loose a sense of control over their bodies, mind and spirit, becoming a hostage to their pain. There are many alternative ways of managing pain such as meditation and breathing techniques. These various techniques teach patients how to develop a locus or center of control over their pain. A gentle exercise or movement therapy that is used is QiGong. QiGong is one part of a multi-faceted system of Traditional Chinese Medicine. Most hospitals in China include QiGong as part of their health care program. It is one method of cultivating chi, a term used to describe the body’s vital energy system that promotes all activity of the human body. QiGong is included in physical therapy rehab programs at VIMG for patients suffering from headaches, stress related injuries, balance dysfunction and chronic pain management. It is part of the NorthBay Pain Management Essentials program which she co-founded in Fairfield, California and she uses it here at VIMG. Instruction is based on the DVD from the National Qigong Association. It gives patients an introduction to Qigong and Miki provides community resources if patients are interested in persuing their practice further.

The Healing Wave Project is sponsored by the National Qigong Association and an effort to expose all people to the benefits of Qigong. Their website www.nqa.org has information on how you can receive the Qigong DVD and more information about practioners in your area

Miki Blanchard is a physical therapist based out of our Eagle Office. She can be contacted at 970-328-1200
Click here to read more about Miki.

Eagle Boot Days

On May 16th, VIMG sponsored a tent and ‘jumpy house’ for the Boot Days festival in Eagle. More than 1,500 participants took part in Eagle’s fun and sun along with the 10K Bone yard Boogie. Physical therapists’ Miki and Dave Blanchard along with Dr. Stanzel provided free injury assessments and consultations throughout the day. Most of these came from mid air collisions in the jumpy house!

And Miki rubbed her forearms and fingers raw while doing 5 (yes 5!) hours of free chair massage...which was as popular as the jumpy house...just older crowd!

Annual Chiropractic Sports Sciences Symposium

Last weekend I attended the ACBSP (American Chiropractic Board of Sports Physicians) annual sports medicine symposium in San Diego. Besides leaving four feet of newly falling snow into warm, sunny ‘beach’ weather, the seminar was packed with great speakers and relevant sports science updates. Of interest to me were the medical directors of the USOC (United States Olympic Committee) Mike Reed, DC, DACBSP and John Reasoner, MD discussing the new model of sports care at the USOC and primary care issues during international competition at the Olympic level. Having recently returned from Beijing, several sports chiropractors also gave presentations regarding specific cases from last summer’s Olympic Games. Having been at the USOC training facility in Colorado Springs the two weeks before Beijing, it brought back great memories of that environment. Drs. Tim Brown and Doug Anderson also gave their consistent great lectures. The annual conference is also a great time to hook up with great friends and colleagues of mine from around the country.

Joel Dekanich, DC, DACBSP, EMT, CSCS
Diplomate American Chiropractic Board of Sports Physicians

Arnold Palmer Invitational at Bay Hill

March 25, 2009

I had an opportunity to spend a morning with Scott Fonda, DC, DACBO in the medical trailer at this recent PGA Tour event. Scott has been on the staff for the PGA for the past 3 years. Days working as the staff chiropractor are long (5:30 am to as late as 7:00 pm) but he says that working with the PGA players is extremely rewarding. Many of the players are very interested in a higher level of fitness and health that focus on strength, agility and endurance. Golf (and travel) is very demanding on the spine so many players get worked on daily when at an event. The ‘team’ is comprised of two physical therapists, a chiropractor and the medical director.

Joel