World Class Therapy Review – Part 5


Hence Rose’s appearance in the walking boot. They are trying somehow to get the pressure off of that foot. The problem is that this NBA schedule does not allow that to happen.

Measuring risk and looking at the big picture, it’s always better to appraise risk than to be paying for it later. Pressure mapping with equipment such as the Fscan and Pedar system is an effective way to see what is working, and what is not with gait analysis. Optogait is too crude and doesn’t get kinetic data, but it’s worth adding to get additional information, especially with the single leg drift test and repeat jump tests. Foot mechanics is so important to predicting injury. When Derrick Rose was suffering with turf toe it was a matter of time before additional problems would move up the food chain. Then you saw an array of injuries such as low back and groin, and eventually the ACL went. I was not the only one seeing this coming, and several medical people understand the need to address the underlying problems or be facing problems down the road. Like mentioned in the quote, I don’t know how much one can do with an NBA schedule as it ties the hands to staff, but putting pressure on a mat or inshoe system would have been prudent during rehabilitation as he is still not functioning properly based on video.

One experience I had was an athlete dealing with achilles tendonitis, an acute issue he had for a few days. Immediately I contacted the medical network, as it stemmed from a long outdoor competition schedule that I liked, and wanted to address the problem. The first analysis? Well the therapist in question was actually a chiropractor, and we traveled north to get manual therapy that was based on mechanics. I attended the workshop he did earlier and he and his colleagues were fantastic when I get a little beat up from travel or when I get some reclamation projects. We shut down all workouts that were running and would not run again until he would walk compensation free. I did video and watched to see that what was verbally stated wasn’t confirmation bias, and did a lot of olympic lifts and eccentric work with the manual therapy. Calcification did exist slightly, but not severe enough to see a long term problem. It was likely that before and during the olympics the problem was rising, but symptoms didn’t show until late September.

Local therapy was done to the medial part of the tendon and this was done for three days with some specific work to the foot. Isolated muscle exercises work great during rehab to keep the nervous system fed, but I don’t use them after as prehab except for a handful of exercises.

I included snatches in high volume to keep the forefoot loading at a minimum. If you have pressure mapping research on the olympic lifts, it’s interesting to see how so many claims that olympic lifting is magic to athletes or that heavy lifts transfer well. Remember that acceleration is forefoot dominant and olympic lifts and squatting is rearfoot and midfood driven. I have seen countless freaks on the platform get dusted on the track because they have no wheels. Barefoot training will not fix that issue, and those that promote it like rehabilitation are doing a lot of athletes a disservice. I think most people can be fine walking around but training that way must be taken with a grain of salt. We fault podiatrists for orthotics, but if we get glasses or lasik it makes sense. Imagine if we had a natural and naked movement in vision training and suggested that we stop wearing glasses or contacts? I would hate to be on the road watching the driving at night with that but the same can be said with foot training and forefoot strike changes. It’s best to be left to professionals, not gurus.

Treatment without testing is dishonest in my opinion. All therapists should have summary reports sent to coaches and athletes to show objective outcomes. Otherwise how do we know just rest was the solution? PRP injections, pills, therapy tools, therapeutic modalities, all treat symptoms but we need more biomechanics in sports medicine. I simply don’t see anything beyond movement screens. No wonder baseball still struggles and we need to look at results of interventions not skipping ahead. For example one therapist asked about blood analysis and I told him the value of getting a screen. He skipped ahead and prescribed vitamin d to all the athletes and I laughed. He thought he could save his team money by going to the solution without testing. His athletes were dealing with soft tissue injuries still and I asked how did he know the athlete was taking the pills? He felt that the return of the old bottle after 30 days was perfect for him, but he didn’t realize the guys let the entourage take them until a few facebook updates. Skipping to interventions is a bad idea. Test and retest.

Pressure mapping is not just walking and running. Some great research shows fifth metatarsal stress during soccer specific movements and you can drill down to different metatarsal heads while showing relationships with different muscle groups via EMG. Using TMG and Elastography, one can see patterns with use (EMG) and response (TMG) and soft tissue damage (Elastography and Thermography). I find it interesting when an athlete is injured people don’t use more objective indicators. Gait analysis is such a great tool, but limits do exist because we don’t have too many teams collaborating successfully.

Suggested best practice is to start screening during preseason to collect a baseline. Follow up 8 weeks later and collect the data again. Follow up another 8 weeks later to see a trend with three total tests. We are talking one total hour tops including movement screens and table tests. Injuries are far more complicated and I suggest working with a consultant or good podiatrist that has experience with EMG, Video, and pressure mapping with RSscan, Tekscan, and Novel products.

My final wrap up part 6 will go over resources and another entry about the case study in question.

Carl Valle

Carl Valle

Track & Field Coach
Carl is an expert coach who has produced champions in swimming, track and numerous other sports. He is one of the foremost experts in the fields of nutrition and restoration.
Carl Valle

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