Friday, November 16, 2012

Upper Quarter Y Balance Test

The Upper Quarter Y Balance Test

How do you measure upper extremity dynamic stability? The recently described UQ-YBT offers a reliable way to objectively measure upper trunk stability and mobility in a closed kinetic chain position. The UQ-YBT allows us to measure limb symmetry and identify potential limitations that could contribute to an individuals injury risk. Limb Symmetry Index: The LSI provides a ratio comparing the performance between 2 lower extremities of the same individual; this is clinically useful in determining lower extremity asymmetry.J Orthop Sports Phys Ther 2001;3 1:145-151.

The video link below gives a quick over view of how to perform the Upper Quarter Y Balance Test.

UQ-YBT Video

Test, Don't Guess.

Thursday, October 18, 2012

Return to Play- Mental Preparation of Athletes

As Athletic Trainers we spend a great deal of time and effort preparing our athletes physically for their return to sport participation after injury & surgery. Another aspect that we need to address is their mental preparation. Having a better understanding of the individuals expectations and concerns creates an opportunity for us to do a better job of facilitating a smoother transition back to sport. Dr. Weiss, PhD., ATC has prepared a great primer on this topic:

Mentally Preparing Athletes to Return to Play Following Injury

Windee M. Weiss, Ph.D., ATC
University of Northern Iowa

Wednesday, October 17, 2012

When Should we Return Athletes to Sport?

As Athletic Trainers and Sport Clinicians we are in full swing of treating post surgical athletes. What conversations are we having with parents, athletes and coaches about the athletes return to play expectations and timelines? What objective measures and tests are we using to base those decisions on?
Here is an article from JOSPT (Journal of Orthopaedic & Sport Physical Therapy) that sheds light on what we should be doing.

Keep up the good work!

Wednesday, September 19, 2012

Tuesday, September 11, 2012

Are you Testing? Return to Sports Decisions

Athletes frequently get re-injured because they return to the field too soon. Extend players’ careers by testing and correcting the risk factors before sending them back out.

Wednesday, September 5, 2012

Why I do what I do

Why do I care so much about how we perform Pre-Season Screening and Return To Sport Testing? Passion, I believe that we can change the current "way of doing things" by questioning our current system and challenging our old beliefs.
What do I think we can accomplish together?
A Paradigm Shift, I believe that together as passionate sports medicine professionals we can reshape the approach to screening and testing of athletes, soldiers and police & fire personnel. 
How will this be accomplished?
By Daring to Dream & A Commitment to Lifelong Learning.

I dream of a way to improve the objectivity of how we in the sports medicine community determine if and when an athlete is ready to begin or resume participation in competitive sports & physically demanding occupations. I spent my early years in the sports medicine community watching and listening to experienced clinicians, physicians, athletic trainer's  and coaches debate and argue about if and when an individual was ready to return to action. These heated debates taught me that passionate debate about gut feeling really got us nowhere. We had little more than our opinion of what we thought was in the best interest of the athlete and took an educated guess about what the chances of re-injury/new injury were to that athlete is they went back to soon.

Test Don't Guess
My dream is centered around the idea that we use an integrated & collaborative approach to determine objective tests and measures to help us determine if an individual is ready to participate.

We have a tremendous amount of information available to us from  some of the greatest researchers of injury prediction and little collaboration or integrated communication between them, all the while the majority of our colleagues (Sports Medicine Professionals) continue to  "do what we have always done" because no one has taken the initiative  to lead the necessary conversation to get the ball rolling.  When we test pre-season we Gain the advantage of foresight. If we test/screen pre-season we will know who is ready and who is not. We gain the opportunity to proactively take action, to stop saying "I wish I knew about__________ before the  season started, I would have done something about it". We gain the ability to target our resources to the appropriate athletes. We gain the knowledge needed to make an informed decision regarding when to return an athlete to participation.

A Call To Action
Why do you do what you do? What's next?

Wednesday, August 29, 2012

Return to Sport Decisions?

As a Certified Athletic Trainer I have had the opportunity to  cover high school and collegiate sports; and had to make the "Hold 'Em Out, or Let 'Em Play" decision based on little to no science but rather my best guess as to if the athlete was really ready. I long desired a better way to objectively determine when an athlete was ready to participate after an injury or surgery. I dreaded confronting athletes, parents, coaches and physicians with "My Gut" answer to How long are they out?, Why are they held out?. How do you confidently answer these questions and what makes your stomach churn?

By The Way; we have objective science now that helps us answer these questions confidently.

Friday, August 24, 2012

Test Don't Guess

When Pre-Participation Physicals Become Return to Sport Testing
High School and College sports are in high gear, your the only ATC or Sport Physio at the school and now in addition to having to cover 3 levels of football, 2 soccer teams, volleyball, cross country, & fall tennis you have  a few club sports that are requesting that you help out with an injured athlete; oh I forgot that the initial injuries that are coming in the doors to the training room to be assessed/evaluated and treated.

How do you determine when to return athletes to play?

Athlete "Can I play today?, Friday night?, When?."
Coach " When will they be ready?"

Your Answer"______________________"?
My answer "When Your/their LQ-YBT and FMS scores return to baseline or better and you/they no longer have pain".

Do you have an objective baseline measure that indicates level of injury risk (any objective measure for that matter) from Pre-Season Physicals that you can use to answer the above questions? If not you should.

Test Don't Guess!

Tuesday, August 21, 2012

Sports Physicals: We can do better

Thousands of high school, college & university athletes are returning to campus this week and most of them are going to go through mass screening and testing for their Pre-Participation Exam (PPE/ Physicals). Depending on which state these athletes are in (USA) they may be subject to different rules and regulations for what must be included in the physical. Individual institutional requirements may also vary within a state depending on who is in charge of the sports medicine program and what research lines are currently in vogue at that institution.
Governing associations may add another layer of complexity to the paper trail. Most of these PPE's consist of check list(s) that meet legal requirements at best and add little value to efficiently identifying and categorizing athletes for future injury risk.

Currently there is little consensus in the sport medicine community about what should be (must be) included when determining the readiness of our athletes to begin/ or return to participation in competitive sports.
How do you answer these questions?:
             Who decides what constitutes a thorough Pre-Participation Physical?
             What objective tests and measures are included?
                   Which ones are meaningful? Which ones (risk factors for future injury) are modifiable?  
             When are physicals scheduled? When do we re-test prior to Return to Sport?
             Where do we conduct the testing/screening? Why?
             How does the information collected help the athlete, coach & medical staff?
             Why do we do what we do?
                   Does the PPE add value to our athletic program and sports medicine team?
                    Or does it just meet a requirement and drain the resources and energy of the staff?

I believe it is time for us to offer better than a check list to our athletes.

Wednesday, August 15, 2012

Pre-Participation Physicals: FMS the Reasearch

Dr. Robert Butler of the  Duke University K-Lab has put together an updated summary of the research that has been published on the Functional Movement Screen , it is a great quick read. Here are some of the highlights:

"Current research on the Functional Movement Screen suggests that the test is a reliable way to objectively measure fundamental movement patterns that are modifiable and indicative of an elevated likelihood of sustaining a musculoskeletal injury." KEY POINT the FMS helps us identify modifiable risk factors.  We as Sports Medicine professionals have been searching for a meaningful approach to clearing athletes for competition for a long time, this is a great start.

"The average score in 20-40 year olds is approximately a 15......; approximately a 1.2 composite decrease for the 50-59 year old group and an additional 1.2 composite decrease for the 60+ group." KEY POINT we can reasonably expect that FMS scores are different for different age groups. This helps us make appropriate comparisons when interpreting scores.

" ;..... it is likely that not all corrective exercise programming or strength and conditioning programming may results in a change in FMS scores." KEY POINT corrective exercise programs and performance improvement programs should be individualized; a One Size Fits All program approach does not yield optimal results.

When discussing how the FMS relates to specific sport or skill performance: "The primary take home message across these studies is that a single performance effort is not strongly correlated with FMS scores." KEY POINT the FMS allows us to assess different aspects human movement that contribute to athletic skill. 

"In summary, the Functional Movement Screen is a reliable tool that can be used to identify individuals who are more likely to become injured." KEY POINT we can identify limitations and asymmetries that have the potential to contribute to future injury.

"It has also been observed that improvement in the composite FMS score can occur through some movement related training programs." KEY POINT  we can make a meaningful difference for our athletes and clients by lowering their potential for future injury by applying an individualized approach.

Thank you Dr. Butler for summarizing the research.


Tuesday, August 14, 2012

Pre-Participation Physicals: Upper Quarter Y Balance Test

As we continue to develop our approach to testing and screening here is a look back at some of the topics covered:  Hop Testing, Lower extremity Balance Testing, Movement Screening, Ankle range of motion testing, Painful Athletes.

Our next stop on this journey:
The Upper Quarter Y Balance Test (UQ-YBT) is a relatively new test that looks at the upper extremities in a closed kinetic chain posture. The test is performed starting from the "Up" position of a push up; the athlete maintains single hand balance (the stance hand) on one side while simultaneously reaching to the edge of their ability (stability) with the other in 3 directions. The test is then repeated on the other side and results are compared for symmetry and against their peer group (same age, gender, sport, & competition level). 

It can be a challenging test for many as it can quickly identify an individuals Right/Left differences (asymmetries) and add to the objective measures we are basing our Pre-Participation & Return to Sport recommendations on.
Here is a quick video demonstrating the UQ-YBT (Upper Quarter Y-Balance Test)

Friday, August 10, 2012

Creating Change: Return to Sport and Pre-Participation Physicals

Join me in creating a better system for evaluating and assessing athletes prior to Sports Participation &/or Return to Sport post injury/surgery. Seth Godin has given us a fantastic example (found here) of how we can work together in a short period of time to foster the growth and development of ideas by taking risks and working together.

If you are part of the sports medicine team and desire to improve our current system for determining readiness of individuals for athletic participation (injury prediction & prevention), please comment &/or contact me, together we can  go further faster.


Saturday, August 4, 2012

Pre-Participation Physicals: Hop Testing

As we continue to develop our comprehensive approach to Pre-Participation Physicals; & Return to Sport(RTS) Testing more on RTS to come; Hop Testing is our focus today.Let's start with LSI.

Limb Symmetry Index: The LSI provides a ratio comparing the performance between 2 lower extremities of the same individual; this is clinically useful in determining lower extremity asymmetry.J Orthop Sports Phys Ther 2001;3 1:145-151.

Hop Testing has been in the research literature for some time and performance described in term of limb symmetry. An article from 1990 : describes the testing method and begins to define normative measure for individuals who were ACL deficient  and compare them to a healthy population. We administer the Hop Test by comparing single limb performance, Right versus Left, of one individual in a Single Hop for distance, Triple Hop for distance, Triple Crossover Hop for distance and a Timed Hop (covering 6 meters). We then use the LSI we discussed above to give us a better picture of that individuals performance, Right versus Left lower extremity. After completion of the Hop Test, & other objective measures we have been discussing, we enter the data into Move2Perform in order to compare them against their peers. When making PPE and RTS recommendations we must consider the peer group. What is a persons peer group you ask:An individuals Age, Gender, Sport & Competition Level are all parts that make up a peer group. From many other studies, many using the SEBT, we know that athletes of different ages, genders, sports and competition levels perform differently.

A few recent articles go further than the early studies to suggest that 85% and even 90% LSI may not be stringent enough criteria when determining an individuals readiness to return to activity.
Myer et. al. & Grindem et. al. 

Hop testing is another great objective measure to include in your screening and testing of athletes and individuals prior to beginning or returning to activity and sport. Later we will discuss why we utilize many different tests and measures in musculoskeletal screening.

Sunday, July 29, 2012

Pre-Participation Physicals: Closed Chain Dorsi-Flexion

CKC DF is another part of a comprehensive Return to Sport Testing & Pre-Participation Physicals. Below are a few highlights of the CKC DF test.

Hoch et. al. 2011 & Hoch et. al. 2012: The weight bearing lunge test (WBLT) explained a significant portion of the variance within the anterior reach distance signifying this direction of the Star Excursion Balance Test (SEBT) may be a good clinical test to assess the effect of dorsiflexion range of motion restrictions on dynamic balance. The Y Balance Test was developed in order to improve methodology and testing efficiency of the SEBT.

Marcrum et. al. 2012 Results- Altering ankle DF starting position during double leg squat resulted in increased knee valgus and medial knee displacement, decreased quad activation & increased soleus  activation. These changes are similar to those seen in individuals with PFPS.

Keep up the great work; Your building a better testing system.

Saturday, July 21, 2012

Behind the Scenes at TankGym- filming day

up next: Side Sit Bridge

 We had a great day filming today. Thanks to Tom Gorman & Back Light Pictures for all their work today.  I am excited about getting the first few videos loaded up and out for you viewing. Stay Tuned.....

Ready to FMS

Back Light Pictures

Tom checking sound

Friday, July 20, 2012

Dynamic Shoulder Stabilization

Tomorrow we will be shooting footage for the continuation of our Dynamic Shoulder Stabilization project.
Part 1 was the webinar with

Part 2 was the follow up podcast with Joe Heiler at

Part 3 is our video series that will complement and expand upon the material.

I'll keep you posted on the progress and be on the look out for updated and new videos on TankGym TV on Youtube

Wednesday, July 18, 2012

Pre-Participation Physicals (What if the Athlete is in current Pain?)

Thank you for checking in with me again. Today I want to take a minute to make a distinction between painful and non-painful movement.

When I am talking about Pre-Participation Physicals I am describing what we do with all athletes to identify movement limitations/asymmetrical patterns in the non-painful athlete. These screens and tests allow us to categorize an individuals musculoskeletal injury risk (that is there potential for future injury compared to their peer group) . As we test individuals we include pain provocation tests to help us capture outliers, those that may have unknown or un-diagnosed pathology. When we identify pain in an individual we evaluate them differently and here is a great link to help you understand why: The Influence of Pain on Movement, by Dr. Kyle Kiesel. 

Sunday, July 15, 2012

What's Next? Pre-Participation Physicals and Return to Sport testing

Keep up the good work, you are on the right path to make a major improvement in how you prepare athletes for the upcoming season. You are also about to revolutionize your decision making ability and optimize your most precious resource: Time. By utilizing a well thought out plan and objective measures you will quickly and accurately determine what an athlete needs  and directing them to the correct professional.

You will be able to deliver the Right Intervention, to the Right Person, at the Right Time. And to top it off you will communicate confidently to the athlete, parents, coaches and sports medicine team about the recommendations and follow up needed for each individual.

So, our next step to to begin to introduce you to the Functional Movement Screen. Dr. Lee Burton, co-developer of the FMS, has put together a great intro video that is must see tv: check it out Here

Saturday, July 14, 2012

Return to Sport Testing- focused on the part and missing the Athlete in front of us

I get it, I really do. I too only want to research and write about what I think the cool thing is but we really as a profession (pick your favorite or not so favorite sports medicine professional) have to do much better.I Just read another hot off the press peer reviewed pub about a singular injury/surgery, Why are we still selling the sex and sizzle of the Return to Sports Testing and criterion progression for (......................) fill in the blank injury/surgery?
I treat ATHLETES not injuries/surgeries, I treat athletes after injury, I treat athletes after surgery and I test all the athletes using the same EVIDENCE BASED, INJURY PREDICTION TEST(S) AND ALGORITHMS, and then I compare them to the SAME: AGE, GENDER, SPORT AND COMPETITION LEVEL;  not the same surgery group, unless of course they are returning to the All Girls, 14y/o , previously reconstructed ACL, Freshman high school soccer team.  

Large Group Pre-Participation Physicals

A few days ago I told you that the military is beginning to adopt a new way to screen movement in the Warrior Athlete and here is a link to check out how we are contributing to that.Automation to Improve Efficiency of Field Expedient Injury Prediction Screening.  You can replicate this with your high school and college athletes, all of them, in a day, really half day if you want. And to make things even better you can know exactly who you need to send to the Ortho doc for follow up, who to send to the athletic trainer/physio for rehab, who to train one on one and who to turn loose with a few individualized corrective exercises.
If you have not already checked into the Y Balance Test  videos to see how fast and easy it is to test an athlete you owe it to yourself to do so. Again, part of my goal as a Certified Athletic Trainer is to provide a better, more meaningful way to contribute to sports physicals. For several years I covered a large Indiana high school and had to plow through hundreds of athletes during a mass physicals nightmare. We did what every other school did, the check list. At best the form covers Past Medical History; and previous injury is by far and away the leading predictive variable of future injury, no doubt. But we can not modify previous injury, we need information that allows us to be proactive, we need to do better than a check list for our athletes.

Thursday, July 12, 2012

Pre-Participation Physicals continued

Our Team

Great work so far! We are covering alot of ground quickly in an effort to get you up to speed to the fall school/sports year so hold on tight. By now I hope that you have checked out the Y Balance Test . I also hope that you have looked around the web, read other pre-participation screening research, talked with your colleagues and started to formulate your own thoughts about what we should be looking at in our physicals. My hope is to provide a template for Standard of Practice for the screening of athletes from pre-season screening to return to sport testing. Lets strive to provide objective measures to our clients that are meaningful, lets show that our "sports enhancement/performance improvement/jump/landing/speed/agility/skill/fancy name" make you a better athlete training program really makes you better by lowering your individual injury risk classification and I will continue to guide you to the tools that do just that, we have the research to to it. By the way this is also the leading way to test the Warrior Athlete to help predict musculoskeletal injury risk.

Sunday, July 8, 2012

Pre-Participation Sports Physicals

Holy cow, I want to change our physicals but have no idea where to start, Sound familiar? .......If you have read a few of my previous posts you already have taken the first few steps. Next, Learn the Upper and Lower Quarter Y Balance Test here...get a kit and start testing your athletes/clients prior to training or discharge from therapy.

How to perform the test is in the link above; How to begin to utilize and begin to interpret the UQYBT test can be found in the links provided; How to utilize and to interpret LQYBT. I gave you alot of homework, take a few days to look it over, ask lots of questions. And remember your goal should be to change how you practice and test athletes first. Change the rest of the world sometime after that.

Saturday, June 30, 2012

Where to begin- improving sports physicals

Ok here we go, you decided to improve the pre participation physicals you offer to athletes in you hometown. Next get a copy of the required form for your state and governing association. Look it over and make sure you are able to meet the required minimum. Recognize that most things on the form are not modifable risk factors, understand that as a profession we are getting much closer to being able to offer accurate, efficient and affordable cardiovascular screening in mass testing, but we are not there yet. Neurocognitive testing is currently accurate, efficient and affordable and should be included in your physicals. Musculoskeletal screening has traditional consisted for performing orthopaedic "special tests" which when positive, are not modifable unless you are a surgeon. This is where we,, come in. Accurate, efficient and affordable Musculoskeletal screening is available & you should be performing these measures on your athletes: Functional Movement Screen, Upper and Lower Quarter Y Balance Test, Hop Testing, CKC Dorsiflexion; and you should be comparing your athletes to the same peer group (age, gender,sport,competition level).  All these matter! You should be giving your athletes an "Injury Risk Classification". We are here to help you do that. I know it can be a daunting task, I know what it is like to have 400+ athletes and only be given an hour or two each year to perform physicals and I know you desire a better way. Again check out and stay tuned as I will continue to walk you through the steps. You can screen 200 athletes in a few hours and give them meaningful classifications, and individual corrective exetcises, and correctly identify who needs orthopaedic consult, who needs athletic trainer attention, who needs the strength and conditioning coach. You can do better.

Thursday, June 21, 2012

Changing Pre-season physicals- long and lonely process

Step one- admit that we are capable of offering our athletes a better service. Step two- question everything currently on your physical form. Step three- make change. Don't worry, I know that it is really not that easy, but I also know it can happen. One of my goals is to help you. I will continue to walk you through the steps we took, the mistakes we made and the evolution we are driving. #sportsphysicals

Tuesday, June 12, 2012

Time for a meaningful Pre-participation Sports Physical

As a Certified Athletic Trainer, I have guided thousands of athletes thru their pre- season screen. Seven years ago my colleagues and I turned high school physicals on its head. We questioned the utility of the physical form required by our state and wanted to make our participation meaningful. We wanted to identify those at greater injury risk, and do.something about it BEFORE THE SEASON. Most states have a check list for physicians to sign off on that does  little to nothing to prevent or even modify future injury risk. We changed that. We started a research line that has shown tremendous promise; We can now accurately identify musculoskeletal injury risk; and prescribe the correct interventions for each individual, on the same day of the physical. I challenge you to make a meaningful change to your athletes pre-screen. Stay tuned to learn more about our history and how we developed our approach. If you can't wait:  

Sunday, June 3, 2012

Corrective Exercises

The Right exercise, given to the Right person, at the Right time.
How do you ensure that you are offering this to clients in your program design?
Answer: Standard Operating Procedure. The Functional Movement Screen.

Wednesday, May 30, 2012

Excited about an upcoming video project

I am excited to be plannning an up coming video shoot that will expand on and better demonstrate our Dynamic Shoulder Stabilization progression from TankGym. I will keep you posted on our progress and encourage your feedback and request. It will be answer on the webinar we gave in Dec '11 with

Wednesday, April 18, 2012

Y Balance Test- newest research

Latest research on the Y Balance Test: LQ-YBT as well as the UQ YBT.
More great research coming from our very own TankGym training staff.
If you are not familiar with the Y Balance Test and you are in fitness or rehab these tools should be in your client/patient pre program design and included in return to sport testing.
To learn more about Y Balance Testing check out all the latest on Move2Perform . Here you will find all the information to help get you started utilizing this valuable tool that will help give objective information to the effectiveness of your clients program. To get tested contact us at