Friday, April 25, 2008
Accepted!
If you are unfamiliar with the ScD designation as it relates to other doctoral degrees, I've included a Wikipedia reference to it. (Note: I don't make a habit of referencing Wikipedia, but it did offer a good description of the title.)
I'm sure there will be many challenges along the way and I won't always be this giddy about the process. Presently however, I am extremely excited about the opportunity and look forward to sharing my experiences along the way.
Thanks to all my family, friends, and colleagues who provided counsel to me in making my decision. You know who you are! Take care and see you at the next update!
Saturday, April 19, 2008
Rethinking Functional Training...again.
Back in 1995 when I was just entering the world of exercise science, functional training was rapidly becoming the latest craze among fitness professionals and strength coaches. Before you could say "bosu ball", every strength coach and personal trainer had their clients standing one-legged on a foam roller juggling three medicine balls...blindfolded. Not to be outdone, physical therapists also jumped on the bandwagon.
Nearly fifteen years later, we've finally tempered enthusiasm for this "new" form of training with the realization that motor control strategies and functional training may not always be in sync with one another. For a time it seemed we were drifting into a dimension of training-to-train more than training for skill acquisition and enhancement. While "functional" activities such as destabilization training on physio balls and dynadiscs seemed to serve some purpose, their role in enhancing motor control strategies fell under justifiably intense scrutiny.
Steven Plisk, MS, CSCS recently wrote a NSCA Hot Topic article titled, appropriately enough, Functional Training. It is certainly worth reading and has very strong implications for what we do as both as strength coaches and physical therapists. Physical therapists in particular can be a trendy lot and I think articles such as Plisk's can offer some much needed perspective on physical training as it applies to clinical and athletic performance. In fact, Plisk notes the distinction between athletes and non-athletes may not be so clear cut.
"...it’s helpful to rethink the traditional distinction between athletic and nonathletic activities. Indeed, many sport movements (e.g. running, jumping) are simply high-powered ADLs where the issue is one of degree more so than fundamental difference. Furthermore, considering how recreationally active many “non-athletes” are, the role of functional training becomes even more apparent for overall quality of life and injury prevention."
Plisk goes on to deconstruct the principle of specificity in a way I found to be very eye-opening. He breaks specificity down into mechanistic, coordinated, and energetic fronts, helping the reader understand the need to give more than just lip service to this key training principle. He follows with a very interesting perspective on development of motor learning throughout the lifespan:
"Training should, therefore, be viewed as a long-term curriculum where acquisition of movement competencies precedes performance. Movement mechanics and techniques, as well as basic fitness qualities (i.e. “general preparation” tasks) are priorities early on. The intent is to progressively automate these so athletes can focus their attention capacity on tactics and strategies (i.e. special preparation”) as they advance through the syllabus."
Although a fairly brief treatment of the subject, Plisk does a very good job of connecting the dots between functional training, motor learning, and skill acquisition. He concludes that functional training modalities play an important role in training and skill development. However we should not sacrifice basic principles of motor learning at the altar of functional training. Great stuff Mr. Plisk!
Friday, April 18, 2008
The Centralization Phenomenon: Prevalence and Predictive Value
In this study, centralization is characterized as "spinal pain and referred symptoms that are progressively abolished in a distal-to-proximal direction in response to therapeutic loading or movement strategies". Werneke points out that despite being a fairly well-defined concept, varied methods of classifying centralization lead to significant difficulty in comparing treatment outcomes. The objectives of the study were:
- Determine the association between age, symptom chronicity, and prevalence of centralization among cases of nonspecific cervical and low-back pain
- Determine if classifying patients into centralization and noncentralization subgroups can predict functional status, pain, and numbers of visits at discharge
- Compare clinically meaningful changes between patients placed in either the centralization or noncentralization subgroups.
The study examined 418 adults between the ages of 19-91 years of age (mean age of 58 and SD of 17 years). Two therapists performed a standardized examination, and patients were classified as either centralizing or noncentralizing. Patients in both groups were assessed for changes in functional status and pain reports. The authors discovered some very interesting findings:
- The prevalence of centralization was only 17% for the entire population
- The highest prevalence of centralization was seen in patients between 18-44 years of age at 30-32%.
- The lowest prevalence of centralization was seen in patients between 65-74 years (8-14%%) and over 75 years of age (0-1%)
- Patients with acute symptoms had higher rates of centralization (23-28%) compared to those with chronic symptoms (6 -11%)
- A higher percentage of patients who centralized had minimally clinically important differences (MCID) in functional status and/or pain intensity than noncentralizing patients.
The authors conclude that centralization was useful but declined in significance for older and more chronic patients. Secondly the use of an operational definition of centralization had predictive ability and associated with pain and functional outcomes in this study. Lastly, the use of centralization could improve clinical classification and assessment of outcomes.
This was yet another fine example of the positive direction our profession is moving with respect to research. It certainly doesn't provide all the answers we need to manage this population, but it provides a good foundation for further investigation into perhaps standardizing our treatment methods as well. As always, I welcome any thoughts or questions!
Werneke, M.W. (2008). Centralization: Prevalence and Effect on Treatment Outcomes Using a Standard Operational Definition and Measurement Method. Journal of Orthopaedic and Sports Physical Therapy DOI: 10.2519/jospt.2008.2596
