Friday, June 29, 2018

Thoracic Outlet Syndrome Term Paper

          Thoracic Outlet Syndrome (TOS) is a pathological condition that is caused by the compression of nerves and blood vessels in the area between the clavicle and first rib, also known as the thoracic "inlet". This narrow gap is the home to nerves, blood vessels and muscles. TOS encompasses a variety of clinical problems that involve upper extremity pain, neurological, and vascular symptoms due to compression or traction of brachial plexus, subclavian artery, or subclavian veins. The anatomy of the thoracic outlet predisposes the body to this syndrome given the numerous essential structures that pass through a relatively small space.1

          There are three types of TOS: neurogenic, vascular and disputed. Neurogenic TOS is caused by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand. In the majority of thoracic outlet syndrome cases, the symptoms are neurogenic. Vascular TOS is described as compression of the artery or vein in the thoracic outlet. The final type, disputed TOS, contains no neurological deficits, however, the patients have TOS symptoms and pain. All health care professionals should be familiar with the presenting signs and symptoms of TOS, and include the syndrome in their differential diagnosis. TOS typically presents with aching-type pain radiating from the scapula down the upper extremity, with associated numbness or tingling. It is common in women between 20 and 50 years of age. However, TOS can cause Paget–Schroetter syndrome in young male laborers. This branch of the pathology is primarily an axillo-subclavian deep vein thrombosis (DVT) and is most often the consequence of a chronic compression of the subclavian vein at the level of the thoracic outlet.

FULL 12 Page - Thoracic Outlet Syndrome - Physical Therapy Term Paper In Google Doc

Wednesday, June 27, 2018

WOD Wednesday #76

Clean and jerk 3-3-3-3-3 reps

Few athletes will need to scale this lifting day. Experienced athletes can go as heavy as possible, while newer athletes can use this workout as an opportunity to drill the movements. Both the clean and the jerk are technical lifts that should be practiced in the warm-up.

Monday, June 25, 2018

Product Review: HIBR Sleep - Rich Froning Signature Series Mattress

Product Details:

My Review:
If you're looking for a soft, pillow-like sleeping experience, this isn't for you. But if you're looking for a mattress that offers good support and is still extremely comfortable, this is a fantastic option.

I am a male athlete with a more dense body than the average person- meaning high muscle to body fat percentage. I've noticed over the years What made me decide on the HIBR brand was the fact that it is targeted to an athlete's recovery.  The first few nights took some getting used to as my coil mattress was very old and out of shape. A week later, I am very pleased and getting great rest. I definitely notice a difference in less stiffness each morning, deeper sleep, and just overall more comfort lying in bed.

The bed is firm, but not too firm, and just soft enough to where I don't feel like I'm laying ON TOP of the bed, but rather slightly enveloped. The foam does not make huge indentions, which is nice because you don't sink in. It will be interesting to see the life of the bed and if it is worth the investment. The way it shapes around you is subtle, but I woke up this morning having slept better than I have in YEARS.

The cover of the HIBR mattress has a nice soft feel and also provides breathability.  The HIBR does a very good job at not sleeping hot due to the gel foam construction they utilize to help minimize heat retention.  The HIBR didn’t make us feel sticky or sweaty, which is often a problem for us as a couple with some traditional foam mattresses. Much better than most that we have tried by far.

This mattress provides good pressure relief as you sink in quickly to the top layer. If motion transfer is an issue this mattress handles that well. The motion transfer on this mattress is wonderful. I could not feel my spouse move around at night and nor could she feel my movements. It was like we had our own separate beds to ourselves.

One important thing to note is that this is an 11″ mattress whereas most competitors are only 9″ or 10″ mattresses. To me, this makes the bed feel more substantial – and my sheets fit on it better than most beds

You can order the HIBR mattress direct from their website. It should arrive in a week and come in a box just like other companies I have reviewed. HIBR mattress trial period is 100 night.

In Conclusion:
I love the HIBR RF Signature Series Mattress. It really does have a great feel. Firm and supportive but soft and cloud like at the same time. And I do feel better when I wake up after a deep sleep with many fewer aches than my old mattress so there may be something to the althete/recovery claim. If you are having a hard time making a choice, feel reassured that the HIBR is awesome!

Additional Testimonial From Taylor J.
"I am a night shift nurse who enjoys the high intensity training of crossfit. Being able to sleep is an important aspect for body recovery, especially after a difficult 12hr shift. Previously I had been sleeping on a traditional mattress. When I would go to bed my aching muscles and joints would keep my tossing and turning all night or day. After receiving my Hibr mattress I have noticed a dramatic change in the quality of my sleep. The 4 different layers allow my body to be cushioned and supported simultaneously. Some tradition foam mattresses sink half your body down into them and loose their elasticity over time creating large body indents in the mattress. But the Hibr mattress foam layers hold the body in a relaxing manner without the sinking effect of other foam mattresses. Compared to other foam mattress that tend to trap heat the Hibr allows heat to dissipate, keeping the body at a more conducive temperature for sleeping. Needless to say I have been sleeping deeper and much more peacefully"

ORDER YOUR HIBR Sleep RF Signature Series Mattress HERE

Friday, June 22, 2018

PT Pathologies: Medial Collateral Ligament Sprain - Grade II

The medial collateral ligament (MCL) connects the medial epicondyle of the femur to the medial tibia and as a result resists medially directed force at the knee.  The MCL is primary stabilizer of the medial side of the knee against valgus force.  This extra-articular ligament is a thick and flat band which attaches proximally on the medial femoral condyle and extends to the medial surface of the tibia approximately six centimeters below the joint line.

        The medial collateral ligament is comprised of two parts.  A deep part of the ligament attaches to the cartilage meniscus and the superficial part attaches further down the joint  A grade 2 injury of the MCL is characterized by partial tearing of the ligament fibers resulting in joint laxity when the ligament is stretched  A grade 3 MCL sprain would result in complete tearing of the ligament.  Often the medial capsular ligament is involved in a grade 2 sprain MCL.

        Individuals participating in contact activities requiring a high level of agility are particularly susceptible to a MCL injury, particularly skiing, soccer, and football.  Mechanism of injury is usually a blow to the outside of the knee joint causing excess force to the medial side of the joint.  The MCL can also be injured by twisting of the knee.  Muscle weakness resulting in poor dynamic stabilization may also increase the incidence of this type of injury.

        A patient with a grade II MCL injury will likely present with an instability to fully extend and flex the knee, pain and significant tenderness along the medial aspect of the knee, possible decrease in strength, and painful limp.  There is typically instability with the joint, and slight to moderate swelling around the knee.  More severe swelling may be indicative of meniscus or cruciate ligament involvement.

        MRI is a noninvasive imaging technique that can be utilized to view soft tissue structures as ligaments.  The imaging technique is extremely expensive and therefore may not be commonly employed on an individual with a suspected MCL injury without other extenuating circumstances.  A valgus stress test is a technique designed to detect medial instability in a single plane.  The examiner applies a valgus stress at the knee while stabilizing the ankle in slight lateral rotation.  The test is often performed initially in full extension and then in 30 degrees of flexion.  A patient with a grade 2 MCL sprain may exhibit 5-15 degrees of laxity with valgus stress at 30 degrees of flexion.

        ACL and or meniscal damage often accompanies a grade 2 MCL injury.  As a result it is often prudent to perform special tests directed at these particular structures.  The MCL normally has a good secondary support system with weight bearing forces compressing the medial side of the joint and adding to the overall stability of the joint.  This allows the structures to be protected after injury along with the use of a brace.  Physical Therapy intervention should be directed towards increasing range of motion in the involved extremity and beginning light resistive exercises.  Range of motion exercises may include heel slides or stationary cycling without resistance.  Resistive exercises should be directed towards the quadriceps and may include isometrics and closed kinetic chain exercises.  Functional activities such as gait and stair climbing should be incorporated into the treatment program.

        A grade II MCL sprain should progress fairly quickly if no other structures are involved  A patient should be able to return to their previous functional level within four to eight weeks following the injury.  Proper healing time and rehab management should allow the patient to return to all forms of activity once the patient demonstrates full range of motion, ambulation without a limp, no visual swelling, and competence with all agility testing. If the patient has residual laxity from the injury the patient may be susceptible to reinjury.

Tuesday, June 19, 2018

WOD Wednesday #75 - Powered by Treign Apparel

Partner Workout:  (I go, You go style)
8 Rounds Each:
- 12/9 Calories on conditioning equipment of choice (C2 Rower or Assault Bike)
- 10 Burpee Box Jumps - 20 inches

Commit, burn the ships!

Treign active wear was established in 2016 for athletes committed to pursuing their passion and overcoming obstacles to achieve their goals. Treign is one of the fastest growing new athletic apparel companies in the United States. Created by athletes and coaches, Treign athletic apparel is designed for maximum performance while maintaining comfort and style. Treign’s versatility allows for exceptional wearability, whether you’re crushing it on the court or cheering from the stands. We use high-quality materials and clean designs to convey the theme of the dedication it takes to pursue your dreams.

Our motto at Treign is "Commit, burn the ships!" Alexander the Great and Hernan Cortes supposedly gave this command to their men when they charged into their conquests so that retreat was not an option. At Treign, we believe that every hero’s story starts with a commitment to be victorious and to burn the ships.

Our company is dedicated to helping others pursue their dreams and overcome obstacles, and we believe it is extremely important to give back. 10% of Treign athletic apparel profits are donated to groups that provide food, clothing and shelter to those in need.

Monday, June 18, 2018

PT Pathologies: Complete C7 Tetraplegia

A complete C7 tetraplegia suffers primary damage to the spinal cord and surrounding tissues at the C7 level.  This occurs through disruption of the membrane of the spinal cord, displacement or compression of the spinal cord, and subsequent hemorrhage and vascular damage.  This type of spinal cord injury can occur in a few different ways.  The most common cause is trauma, such as a sports injury or motor vehicle accident.  It can also occur by a disease, like polio, or by a congenital disorder, such as muscular dystrophy.  All of these causes result from compression, flexion, or extension of the spine with or without rotation.  When dealing with a complete C7 tetraplegia, the first symptom is motor or sensory impairment to the arms and legs.  Sensory loss can manifest itself as numbness, reduced sensation, or sore burning pain.  This results in spinal shock, which is total depression of all nervous system function below C7, and occurs immediately after the injury has occurred.  In addition, they will also present with an altered breathing pattern, impaired cough and ability to clear secretions, and poor endurance.  They also might experience some loss, or  complications in controlling their bowel and bladder, orthostatic hypotension, pressure sores, spastic muscles autonomic dysreflexia, sexual function, and digestion issues.  Once they symptoms have been noticed, an x-ray will confirm the involved vertebrae and rehabilitation will begin immediately.

The acute rehabilitation phase begins right after the injury occurred.  This phase includes treating the spinal cord injury and medically stabilizing the patient.  The spinal cord will be immobilized to prevent further damage, while medical personnel stabilize the patient's heart rate, blood pressure and their overall condition.  In addition, Methylprednisolone, is given to the patient to help prevent the spread of damage and improve the neurological damage.  Surgery may also be needed to relieve pressure on the spine from bone fragments or foreign objects.  Additionally, surgery may be used to stabilize the spine.  Once these interventions have taken place and the patient is stable, physical therapy takes place.

Physical therapy for complete C7 tetraplegia focuses on range of motion, strengthening, pressure relief, wheelchair and transfer skills, and integration of the patient to society.  Passive range of motion exercises are important because they maintain the lower extremities to be compatible with the C7 level.  The also prevent contractures and maintain functional capacity.  Range of motion exercises should be done at least once a day and if the patient is experiencing spasticity then perform the exercises 2-3 times per day.  When it come to strengthening, it is important that the patient is doing exercises for their upper extremities and prescribed as soon as possible.  Doing these upper extremity exercises will assist the patient in performing independent transfers.

In addition, you will have to teach the patient to move in bed independently to prevent pressure ulcers.  Pressure ulcers mos frequently develop on the sacrum, ischium, trochanter, and superior aspect of the heel.  Most of these can be prevented by changing position frequently and performing range of motion exercises.  Wheelchairs are important tools for a complete C7.  The therapist needs to educate the patient on stability and strength for sitting and transfers to the wheelchair from bed.  Range of motion and stretching exercises are performed first and the once the patient can tolerate sitting up then they can begin static and dynamic balance training.

Lastly, the therapist is responsible in making sure the patient can integrate into society.  They must make sure the patient has maximum independence related to the C7 level.  Typical outcomes of physical therapy include independence in feeding, upper extremity dressing, bathing, bed mobility, transfers, and manual wheelchair mobility.  Although the majority of people will experience ongoing musculoskeletal and cardiopulmonary deficits, engaging in physical therapy will greatly assist in the patient's independence.

Saturday, June 16, 2018

RECIPE: Bacon and Egg Burger on Mixed Greens.

Prep Time: 22-25 min
Serves: 5

Fat (g)
Carbs (g)
Protein (g)
2 lbs. ground beef
1 red onion, roughly chopped
2 cloves garlic

1/2 c. green olives with pimentos
1/2 tsp. red pepper flakes

1 egg, slightly beaten, plus 6 more
6 slices of bacon
5 TBS Guacamole

1 Bag Mixed salad greens
Per Serving

Preheat grill to medium high.
Place onion, garlic, olives, & jalapeno, in food processor and pulse until finely chopped but not pureed.
In a large bowl, add beef, onion mixture, red pepper flakes, and egg. Use your hands to thoroughly combine.
Form mixture into 6 patties.
Wrap one slice of bacon around a burger, overlapping ends about 1 inch. Trim excess bacon and reserve for another use. Repeat with remaining burgers.
Grill for 4-5 minutes on each side, or until bacon is cooked through.
While burgers are cooking, fry or poach eggs.
To serve, place mixed greens on each plate. Top with burger, egg, guacamole, and salsa.

Friday, June 15, 2018

How to Scale or Substitute an Exercise/Workout (Home Gym Athlete)

·         All workouts can be scaled to better match your current fitness level, technical abilities, or for equipment restrictions.  Scaling ideas can be found online, or referencing suggestions below.

·         PLEASE NOTE: Scaling is the responsibility of the individual to change the workout based on ability level or equipment available to provide a safer workout stimulus/environment.  Any questions please contact a health professional before completing a workout.

·         Workout scaling options include REDUCING the number of repetitions for a particular movement, REDUCING the number of rounds for a particular workout, REDUCING or REMOVING the weight/load of an exercise or REDUCING the total time of a workout period.

o   For example a workout could be scaled such as

Complete 4 Rounds for time:                   
Run 400m                                                   
30 Kettlebell swings                                   
30 Kettlebell goblet squats                  
Complete 3 Rounds: (reduced rounds/time)
Run 300m    (reduction of distance)
20 Kettlebell swings  (reduce reps)
30 Air Squats  (removal of weight/loading)

·         Likewise, specific exercises may be scaled or substituted if they are too challenging or certain
pieces of equipment are not available (such as a pull up bar, box for jumping, or jump rope)

Substitution Options (choose one)
Pull Ups
·         Ring Rows/TRX/ Inverted Rows
·         Single Arm Kettlebell Rows
Double Unders
·         Single Unders  or Line Hops
Hollow Holds/Rocks
·         Dead Bug Progressions
Hand Stand Push Ups and Holds
·         Over Head Kettlebell Hold
·         Kettlebell/Dumbbell Shoulder Press
·         Push Ups
·         Downward Dog Hold
Toes To Bar
·         Leg Lifts with Hold
·         Knees to Elbows
·         Hollow Rocks
·         Sit Ups or V Ups
·         Single Leg Squats to a chair or box
·         Air Squats or Lunges
Step Ups
·         Lunges
·         Chair Dips or Ring Dips
·         Kettlebell or DB Tricep extension
Push Ups
·         Knee or Ring
·         Burpees
Kettlebell Snatches or Clean and Jerks
·         Kettlebell swings (American)
Kettlebell Thrusters
·         Goblet Squats
L Sit
·         Planks or Hollow Holds

·         Workout Movement Substitution Example (due to difficulty of movements and not having access to pull up bar):
20 Minute AMRAP                                           
5 Pull ups                                                           
10 Push ups                                                       
15 Toes to Bar                                                 
20 Minute AMRAP
5 Single Arm Kettlebell Rows (5ea side)
10 Knee Push Ups
15 V Ups

Wednesday, June 13, 2018

WOD Wednesday #74

4 rounds for time of:
60-second handstand hold
60-second static hang
15 dumbbell shoulder presses
15 weighted pull-ups

Men: Use 2 50-lb. DBs for presses, 1 for pull-ups
Women: Use 2 35-lb. DBs for presses, 1 for pull-ups

Reduce the static movements to something that can be done unbroken for at least the first round. The presses and pulls should be challenging. You may be able to complete them quickly in the early rounds, but they should be hard enough that they will need to be broken up in the later rounds.

Intermediate Option4 rounds for time of:
45-second handstand hold
45-second static hang
15 dumbbell shoulder presses
15 strict pull-ups

Men: Use 2 40-lb. DBs for presses
Women: Use 2 30-lb. DBs for presses

Beginner Option4 rounds for time of:
60-second bear crawl hold
60-second assisted static hang (toes on the ground)
10 dumbbell shoulder presses
10 ring rows

Men: Use 2 20-lb. DBs for presses
Women: Use 2 10-lb. DBs for presses

Monday, June 11, 2018

Product Review: RAD Roller and RAD Helix

Product Details:
Based on the bio-mechanics of the spine, the RAD Roller was carefully designed to create change in the posture safely and effectively. Use it to create movement and free restrictions in the spine, or use it to free up muscle tissue and myofascia. The RAD Roller will help empower people to work on their own bodies to create effective, long lasting change on tissue.

The RAD Helix flushes out toxins and enhances your back’s range of motion with its anatomical shape that’s designed to protect the spine. Your foam roller definitely can’t do that. Oh, and did we mention it’s also killer on calves, quads, hamstrings and hips?
  • Dimensions: 12.5" x 3"
  • Materials: High-density foam
  • Color: Gray
  • Unit weight: 1lb.
My Review:
One of the things I love about the Peanut and Lacrosse Style Mobility balls: they’re small yet crazy effective. The small size allows you to get into those tight areas you normally wouldn’t be able to with a regular-sized foam roller, and doesn’t force you to hold up your body weight the whole time. They’re also small enough to fit in your bag, making them perfect for travel. I seriously have bought about a half dozen mobility balls to keep in each bag, backpack, car etc just so I make sure I always have one where ever I am!

Original RAD Roller:
This little rubber peanut ball-thing is perfect for getting into those tight spots in your calf, feet, neck, hip flexors, glutes and shaped to fit right on each side of your spine. So far my favorite use for the Mobility Balls is to break down the fascia in my feet, to help eliminate the painful areas and inflammation from training for OCR and on my upper back (tspine) to allow my shoulder to get into a better position when throwing or lifting overhead and to counteract the effects of sitting in class for hours ever day.
RAD Helix Foam Roller:
The best hollow roller I've found. Great for travel because I can strap it to the outside of my backpack or duffle, so it essentially takes up zero space. I like that the surface is formed to the back and spine, I'm not a fan of the half large/flat, half small and spiky. The foam itself is somewhat soft, so it provides adequate cushion, but since it's not overly thick, the roller is still good and firm over the PVC core.

I have a couple of rollers (Rumble Roller black) and a couple of other Trigger Point products and this is the one that gets used the most. It seems to have a good balance of firmness to get to most sensitive muscles when the Rumble Roller is sometimes too intense. I like how small and compact this roller is, however the only drawback is the small size when I am looking for alittle more intensity but that is where RAD's new AXLE roller comes in to play.

Fantastic for tightness in your back, hips, quads, hamstrings and calves. It hits all of the spots that are really hard to relieve with just your bare hands. Its shape is perfect to protect your spine whilst massaging your back, and also perfect to attack 2 areas at once. For example, it can be used both on your medial and lateral quadriceps muscles at once.

It also slides along the ground very easily when you use it, unlike other massage tools, which makes it easy to manoeuvre it. I love the fact that it is made of soft material also, meaning that you can get maximum relief without skin blisters to go with it!

These products are stand alone some of the best mobility items I have used. Cost effective, high quality, and they provide great content on how to use them. I believe every person should have a set of mobility balls and a foam roller at the minimum for basic maintenance.  

Friday, June 8, 2018

RECIPE: Crockpot Ranch Pork Chops w/ Tomatoes Au Gratin

Prep Time: 8-10 min
Serves: 4

Fat (g)
Carbs (g)
Protein (g)
• 6 thick pork chops, boneless or not is fine
• 1 ranch seasoning packet
• ½ C Heavy Cream.
• 2 tbsp of Traditional Greek Yogurt
• 2 tsp Salt


• 4 medium tomatoes, cut in halves
• 3 tbsp. butter, melted
• 1 tsp. minced garlic

• ¼ c. Parmesan cheese
• Salt and pepper, to taste

Per Serving

• Combine ranch, Heavy Cream Yogurt, and Salt in a bowl and whisk well.
• Put Pork Chops in the Cock Pot and Pour over pork chops.
• Cook on low 4-6 hours.

• Preheat oven to 450 degrees.
• Place tomato slices on foil-lined baking sheet and set aside.
• In a small bowl, combine butter, garlic and Parmesan.
• Season tomato slices with salt and pepper.
• Spoon the butter and cheese mixture over the tomatoes.
• Roast in the oven for 10-12 minutes or until golden brown.