The 10 pound Straight Leg Raise

This is me attempting 15 reps of a 10lb straight leg raise.

How’s my form? Let me tell you, that is hard to do. I have been wondering why my patients continue to struggle with 10lb SLRs, and remembered that it has been about 2 years since I actually did one.

I do not have any hip or knee pathologies, I am a gym rat, and I run routinely, and I still have trouble completing one set of 15 repetitions.

I am not saying that we should get rid of the straight leg raise, but I believe that there are other effective methods to address VMO/quad and hip flexor strength, that do not possibly cause as much hip discomfort. Personally, I am in favor of SAQs and SLRs up to 5lbs. At this time I progress my patient’s to TKEs and double leg squats, ensuring that form is always correct (also dependent on diagnosis).

Let’s start to think outside the box, and off the table.

One Question, Many Answers

I decided to ask a bunch of people the same question and see what happened. This post is as simple as that. I hope I get some good feedback from this so I can continue with it each month – to keep the masses informed of course.

I asked:

In two sentences or less, what is one tip to help people maintain/start a healthy lifestyle? Clearly two sentences with a loose guideline.

They said:

Snippetphysther – “To maintain or even start a healthy lifestyle means you have to believe in yourself and take action – no more thinking about it, no more planning and no more forgotten new year resolutions.  Implement change one step at a time until you are where you want to be.”

 www.twitter.com/SnippetPhysTher

David Sandel – “Pick a goal, write it down, and look at it every day. Everything starts with a goal and it must be clearly defined so you know how to attack it with all your passion and energy in order to achieve it.”
 
www.athletecreator.com
www.twitter.com/AthleteCreator
www.facebook.com/david.sandel
www.youtube.com/AthleteCreator

Ken Zelez – “It really is easier than you think.  Make daily (healthy) choices that help you to reach your goal(s).”

www.TheStick.ca
 www.zealousvitality.wordpress.com
www.twitter.com/zealousvitality
www.facebook.com/pages/The-Stick/106546661423?ref=nf

Patrick Ward, MS, CSCS, LMT - “Just get started!  People tend to obsess about all the little things – What should my diet be? Should I stop eating carbs? Weights before cardio? Cardio before Weights? Etc.  These people never get started, as they are always waiting for all the information or for the “right time”.  I say just jump it.  Just get going right away and don’t waste time obsessing.”
 
 www.optimumsportsperformance.com
http://www.facebook.com/group.php?gid=49972087710
http://twitter.com/OSPpatrick

Christina Quinn - “It starts at home. Drop bad habits. When you go grocery shopping, stay away from sweet treats, foods high in fat or things that are easy to pop in your mouth & overindulg in.  Purchase fresh vegetables, lean meats, etc that you can cook at home! Try cooking your meals, or making your lunch for work to avoid temptation.”

www.twitter.com/thefitalian

Mark Young – “I think the first step is to write down all of the individual behaviours you need to do to reach the goal you’d like to achieve.  Then write down all of the barriers that would normally prevent from you accomplishing these behaviours and work towards solutions for each one.”
 
www.markyoungtrainingsystems.com
www.twitter.com/markyoungtrain

Steven Bubel – “Start by setting small, measurable, and achievable fitness and dietary goals. Once achieved, establish new and more challenging ones.”

www.stevenbubel.com

Matt Johnson, M.S, CPT, PES, USA W SPC & Club Coach Level 1 - “One tip I highly suggest is to train for optimal posture.  In my opinion, a healthy lifestyle starts from leading a pain-free life. Pain in the body causes a lack of motivation.  When diet and exercise are recommended, poor motivation will hinder your results. On a daily basis nearly every movement we make is anterior plane dominant such as typing on the computer, eating meals, driving our vehicles and vacuuming. This is the reason why so many people suffer from low back pain.  Take time to train the posterior chain because without a pain-free body you can’t take the steps toward a healthy life.”

www.strengthcoachconceptsblog.com
www.twitter.com/StrengthCoachMJ
www.facebook.com/CoachMatthewJohnson
matt.johnson521@gmail.com

Jeff Cubos, BPHE, MSc, DC, ICSSD, CSCS - “It’s simple and it all comes down to one concept…MOVEMENT.  In my next life, I am going to rally Lance, Obama, and Oprah to help me create a non-profit organisation aimed at eliminating escalators from this world.” http://www.youtube.com/watch?v=-K2uynhul2E

jcubos@gmail.com
www.jeffcubos.com

Brooks Tiller, DPT - “Living a healthy lifestyle brings many challenges and often failure, but it is how we treat the failure that will determine our final outcome.  If we fail and stray off course, it is vital that we don’t give up and count it for naught but get back on course, develop a plan to avoid similar pitfalls in the future, and succeed!”

www.drbrookstiller.com
http://twitter.com/drbrookstiller

Mike T. Nelson, MS, PhD(c), CSCS, RKC - “Do joint mobility work.” (I love the simplicity)

www.ExtremeHumanPerformance.com

Mike Young, PhD - ”Nike had it right when they said “Just do it.” You never finish something you don’t start.”

www.twitter.com/mikeyoung
facebook: facebook.com/mikeyoung
http://www.elitetrack.com/blogs/author/mike-young/

Joe Bonyai, M.Ed, CSCS  – “Write everything down on paper. From daily goals to your grocery list, writing things down will help you make better decisions instantly.”

jjbonyai@hotmail.com
www.empowerathleticdevelopment.com
www.twitter.com/JJBonyai
www.facebook.com/JJBonyai

Jesse Dimick, LACT, PTA – “Maintain a structured schedule.  It is to easy to get out of a routine.  Once out of a routine it is very difficult to start again.”

www.twitter.com/jdimick

Carson Boddicker - ”Start today, repeat tomorrow.  Consistency is the name of the game.”
www.BoddickerPerformance.com
twitter.com/cboddicker

ME! (Mike Scott, DPT) – “We don’t get that much older, we just learn that many more excuses. Hold yourself accountable for your own health, and don’t depend on drugs or shortcuts to lead you to where you want to be; shortcuts are a great way to get lost.”

www.twitter.com/mscottdpt

http://mikescottdpt.wordpress.com

mikescott.dpt@gmail.com

Well there ya go folks, 14 masters of their crafts (and me) all answering one simple question. I think it is easy to see that setting goals and finding motivations are the easiest way to stay on track to a healthy lifestyle. Let me know if you found this helpful, or would like any other questions answered.

Happy Holidays.

Tis the season.. bah humbug

Close your eyes. Imagine the cool rush of alpine air flooding your lungs as you take a deep breath. There’s not a cloud in the sky the morning after two feet of fresh power fell the night before. The anticipation in your body to hit the slopes can be felt as pins and needles crawling over your skin.

Getting off the lift for the first run of the day is like getting off the bus to go home on the last day of school, every flake is another great experience waiting to happen. Your legs feel full of energy, and your turns are as smooth as butter.

Then. Ice patch. Then. YARD SALE.

Studies and statistics exist stating the number of  serious ski injuries per 1000 skier visits is roughly 2-4 (in the USA).  Sure, these rates seem pretty low, especially compared to other sports, but considering over 50 million visits are made to ski/snowboard resorts each year thats between 100,000 and 200,000 major injuries each year. These major injuries primarily include head injuries, fractures, ACL/MCL tears, joint dislocations, and death.

This being said, I must share with you some pointers on “the art” of falling that I came across recently:

Keep your knees flexed, and don’t try to straighten them during a fall since a straight leg provides a longer lever force against the knee.

When you’re down, stay down; don’t try to stop the fall. You can not predict which way your leg is going to twist.

Fall forward. Don’t land on your hands backward. Keep your arms up and forward. Falling backwards places abnormal forces across the ACL.

Don’t plant your poles.

Don’t jump unless you know where and how to land. Land on both skis and keep your knees flexed

(Via jointhealing.com and ifyouski.com)

So, tis the season for outdoor winter sports and all their concomitant injuries. Let’s make sure that the snow is the only thing that is seriously falling this Winter.

“And please remember to shut off your cell phones.”

Today’s Theme - watch this video

I know we live in a time where we need instant access to everything, but at what expense? When I first began my journey into physical therapy 10 years ago (as a patient), I did not see one person on their cell phone during a treatment session. This is not a rant on technology being evil, blah, blah, blah. It’s a post about needing to slow down for a second and help ourselves out once and a while.

I often get told, “I love coming to physical therapy because I can work hard, and see improvements in MYSELF. PT is all about ME.” It’s odd but not once have I heard someone who totes a cell phone into their treatments religiously say anything remotely like that, usually because they are too busy talking on their phones.

My father has always told me that if something is worth doing, it’s worth doing right. Why would this adage not go for one’s own course of treatment? If you are not concentrating on what you are doing, and focussing on yourself while trying to get better, you are not going to get optimal results.

The holidays are rapidly approaching, and everything is about giving, and caring for others, WHICH I AM ALL FOR, but you cannot do this if you’re not first thinking about taking care of yourself. Sometimes giving an hour of your day to yourself will allow you to give a lot more to others in the end.

How can you truly help others if you do not help yourself first? I know these all sound like clichés but they are all true  when it comes to physical therapy. It is often seen when some of my patients are more concerned about their jobs, or family situations, than their own well-being. The truth is, that if these people are worried about their jobs or their families, they should want to devote the hour once a week (treatment sessions) and 20-30 minutes every day (home exercise program) focussing on getting themselves better. Because, if they are getting worse, or not recovering, then they truly cannot work, or be there for their families. So just remember during these stressful times, that if you’re feeling worn down, or stressed out, maybe you need to take some  time for YOU. Believe me, you will much happier and healthier in the end.

Interview with Ian Manning, MSPT, TPI Certified Instructor

Ian Manning, MSPT

Ian Manning, is an MSPT and TPI Certified Instructor practicing in Boston, and Waltham, Massachusetts. I was fortunate enough to play a round of golf with Ian recently, and became intrigued with his knowledge of the kinetic chain, and also his application of this knowledge to his PT practice. The following interview took place later that day via e-mail.

 

MS: What is your physical therapy background? (why you got into it, education, job experiences, etc)

IM: I always knew I wanted to be in the medical world, but also knew that I didn’t have the attention span for medical school.  When I was a senior in H.S. I sprained my ankle a lot playing volleyball and spent time in a PT clinic. It fascinated me how they could ask some questions, then feel around, and know what was wrong and how to fix it. I went to Northeastern University for my M.S.P.T. and have been working [with the same orthopedic/outpatient company] since I graduated.

 MS: What is the TPI certification?

IM: The TPI certification is gained through Titleist and there are two different screens that I have been taught.  Both screens highlight restrictions and weaknesses in the body that can lead to pain and certain swing faults. The fitness screen helps to improve your body so you can strike the ball more consistently and hit the ball further. The medical screen will highlight where any pain is coming from and where you should focus your rehab.

MS: Why did you decided to get the TPI certification?

IM: I love what I do with PT and I love golf so I decided to combine the two to be able to treat golfers better.  Hopefully, some day I will be able to open a golf specific practice.

MS: How long did the process take? 

IM: The courses are 9hr/day weekend courses.  The info is intense but it is fun to learn.  After each course you have to take a certification exam.  To obtain your medical certifications you have to do case studies and submit them.  The courses are given throughout the year.  Usually you want to take some time after each course to practice what you have learned.  It has taken me two years to get to Level 2 and I will be taking the Level 3 course in sept of 2010

MS: Do you feel that it is important for physical therapists and health/fitness professionals to be certified in specific areas beyond general practice, or at least pursue continuing education (CEUs are currently not required in MA)?

IM: I think it is important to pursue continuing education because there is always something new coming up through research that is going to help you improve the treatment of your patients.  I don’t think you have to get specific certifications if you aren’t interested in the area.  I went for the golf certification because I love golf.  Someone who doesn’t like golf would have hated the courses I took.

MS: How has the TPI been useful in your evaluation and treatment techniques for the general population?

IM: It has shown me different ways to approach patients, and also helps point out what is truly tight and what is truly weak.  It has also taught me more about the kinetic chain and how a back problem could be coming your hips or trunk or shoulder rather than truly at the back.

MS: Has your own game improved?

IM: I kill the ball!  Just kidding.  It has made me a better ball striker and more consistent.  I also don’t slice the ball anymore. 

MS: Who would win the round: You playing lefty, or me on my best day?

IM: OOh tough one. If handicaps were in place you would probably win but it would be close.

Please contact me at mikescott.dpt@gmail.com if you would like to be in contact with Ian. 

 

How to: Be a terrible therapist

One word: HUM-MER-S – Meaning Hot packs, Ultrasound, Massage, and Stim.

Source: http://tinyurl.com/ybg3cfq

DISCLAIMER: This post was not written about any therapists that I have worked with, currently work with, or even about myself. The idea for this post comes from a discussion with a previous professor of mine at Northeastern University who introduced me to the following term and also held me in discussion about the other issues dealt with in this post.

The art of the hummer is born out of pure hatred for ones job. The ability to provide a well thought-out treatment plan is well within the therapist’s reach, but they just do not want to think that hard. We work in an environment where people come in to be treated mainly due to movement disorders. Clearly, it is a good idea when people are not moving properly to have them move less, preferably not at all, especially while at PT. A good hummer starts with making sure the patient never gets off the table. The therapist proceeds to have their assistant or aide grab a hot pack and heat up whatever area is plaguing the patient.

Ultrasound is next to follow, probably for only 3-4 minutes on whatever settings the machine is already on to make sure it is not effective. Make sure you move the ultrasound at a hundred miles an hour, and definitely don’t pay attention to what you are doing.

Massage always feels great and is definitely least effective if you go into it with no intentions. Increasing circulation? Nah. Myofascial release, What the heck is that? Creating an inflammatory process with cross friction massage, “I don’t want my patient to ever be uncomfortable”. Just rub that knee because it hurts. Clearly if the knee hurts that’s what needs the massage.

Stim- One word: Pre-mod. Set it and forget it baby.

Once you become adept at giving HUMmerS you are a little more free to work on your other skills such as not changing treatment programs for 3 weeks. You will also have a ton of time to complain about how terrible all chiropractors (money hungry) and accupuncturists (voodoo) are. Also, with all this free time you need to make sure you are well read. But make sure no article you read is more recent than 10 years old.

God-forbid you actually have a patient do some rehab, it is in your best interest to keep them around for as long as possible (you need the co-pays, Wall Street is down). Make sure they can do at least 10 pound straight leg raises, and push the whole leg press rack, I don’t care if they are here for their rotator cuff. This patient has been around so long they might as well have a company shirt and work for their co-pays.

Do you remember the song “the knee bone is connected to the hip bone”? Well clearly this song has its flaws. If you had to write it all over again it would go ‘the knee bone is connected to the….knee bone”. Thats right, as I stated earlier, the knee clearly hurts because of whats going on at the knee and only the knee (sometimes this is actually the case). Why would you ever look at the hip or ankles if the knee hurts?

What the heck is a goniometer? (see physical therapy section)

Always remember that an attractive woman/man needs twice as much attention as everyone else. Because they definitely don’t get enough.

You must frequently say the following phrases throughout your work week:

• I can’t wait for Friday (Okay, I’ve said this once or twice)
• They are going to be late? Heck no I won’t see them (to the admin. assistant)
• Physics was pointless
• Do 50 crunches
• When’s lunch?
• Why don’t people just get better?
• Just do a bunch of those
• “Why do you have me doing this?” That’s how I’ve always done it

Take a look around. I’m sure you’ll see a few therapists you can learn from. Just remember to not try that hard because people might get the feeling you care if they get better, and then you’re in trouble. And lastly, do not to forget to show up late every day.

And once again, this post in no way reflects any PT that I have ever encountered, but I do know they are out there.

I Am: Mike’s Posterior Tibialis

I am Mike’s Posterior Tibialis, and I am not happy. You see, I am a work-a-holic. If Mike inverts his ankle I have to work, if Mike points his foot I have to work, if Mike’s foot is on the ground I have to work (my unstable friends the ankle and arch always need a little “support”, if ya know what I mean). I am sick of never getting a rest. However, my biggest problem is that I can’t stand change. If Mike changes his running mileage too fast, if Mike changes his average pace, if Mike changes his shoes, or if Mike changes his running surface I get ticked off.

What Mike does not know is that I can reach the end of my rope really fast. Sure, first I’ll let him know I’m a little mad,  some tendonitis here, some shin splints there, and most of the time he gets the point. But, that time he doesn’t pick up what I’m laying down, he’s going to pay. Without my needed rest, I’m going to be a little stressed out (see medial tibial stress reaction) and then it’s on. If Mike happens to say, “I don’t care, I’ll do what I want,” I’m going to crack, literally ( see stress fracture). The tibia just happens to be my closest companion; therefore, my closest punching bag. When I lose it, it will be the first to know.

At this point I can expect 8-16 weeks of sweet rest, and when Mike decides to return to running or activity it can only be  50% of what he was doing before (at most). But let’s hope it doesn’t get to that point.

I am Mike’s Posterior Tibialis, and I’m a work-a-holic.

For more on the Posterior Tibialis click here.

My Nike Free Everydays

After 5 months of wear

Purchase Date: End of May

Price: $50 – A steal

Bought at: Niketown- Boston, Ma

As you can see, my Nike Free Everydays have seen their fair share of miles. I’m not here to push the barefoot running movement on you, or suggest that everyone go out and get them. I actually bought them because my wife liked the way they looked. I just thought you might like to hear a physical therapist’s opinion on this outside the box running shoe.

I actually bought these for gym shoes, more for the days that I would not be running, and for occasional light days at work. However, after reading up on them and talking to a few other PT’s, I decided I would take them out for a spin, a short 5 minute spin.

There was no A-HA moment and it wasn’t like running on a cloud; in fact it was nothing special. I continued to pepper in these short warm up runs, adding a minute or two at a time with my Frees, until I actually made it to around the five to six mile mark. Side-Note: You look crazy switching running shoes at your treadmill.

So there was nothing special about the shoes, but there was something. My feet never felt “beat up” after my longer runs. No arch pain, and no ankle pain which plagued me since the beginning of high school. The only thing that I legitimately changed over the past few months was my footwear. Crazy, the Nike Free Everydays seemed to help ME Like I said before, I’m not saying everyone should go out and buy these. (Besides the Everydays, there are also Nike Free 7.0, 5.0 and the discontinued 3.0, all with decreased stability respectively).

I’m not going to give my opinion on whether or not these shoes are good for this type of foot or that type of foot (it’s too loaded of a subject), but I will say I have a neutral to slightly supinated gait pattern that is uncompensated. Also, I have a 4/6 joint laxity in both ankles.

Nasty

Ratings

Looks: (B+) Not loud enough for me. I once bought banana yellow Mizzunos, but my wife thinks I look good in black.

Day-to-day Comfort: (A-)

Running Comfort: (B+)

Motion Control: (F)

Cushioning: (C+)

Durability: (A) I have probably logged 300+ miles running, and hundreds more wearing them to work

What they are for: I would not suggest them for running more than five miles, but that is my foot, everyone’s are different.

So in the end, I have enjoyed my time in the Everydays, BUT the most important part is that I kept my wife happy.

*On a side note, I switched back to my ASICS only three times over the past two months, and my feet killed after roughly 3-5 miles (probably due to the fact that my ASICS are ten months old, and I have no idea how many miles are on them). This is kind of disappointing because my ASICS felt great in the past.

E-mail Interview with Jesse Dimick, PTA, LATC

The man. The Myth. The legend?

Jesse Dimick is a dual certified physical therapist assistant and licensed athletic trainer in the Boston, MA area. Jesse currently works in an orthopedic outpatient physical therapy clinic, but also is the athletic trainer for the boys’ and girls’ hockey teams at Wellesley High School in Wellesley, MA.

Jesse’s dual certification has allowed him to gain extensive knowledge and experience in the diagnosis of acute injuries, along with progression of those injuries through a comprehensive physical therapy regimen, and ultimately back onto the field.

MS: First, why did you get into athletic training?

JD: My love for sports and science were my main reasons for choosing athletic training.  My interest was further sparked when I had a scope on my knee in high school.  I received some PT after and became intrigued with the job.  So my junior and senior year in high school I did a lot of job shadowing. 

MS: What is your favorite part of your job?

JD: Being part of the acute intervention.  I am with the athlete seconds after an injury occurs.  Seeing the mechanism of injury makes diagnosing and treatment a lot easier.  Also, there is no greater feeling than seeing an athlete step back in the field for the first time after suffering an injury.

MS: Do you have a preference of working in the clinic or on the field?

JD: I enjoy one as much as the other.  Field work can be boring at times, as there can be a lot of down time if no injuries occur.  Progressing and developing rehab programs is one of the great parts of working in the clinic.  I’m always looking for new and advanced rehab protocols to help my athletes recover faster and prevent further injury.

MS: Why do you think it is beneficial to have a licensed athletic trainer working in a physical therapy clinic?

JD: In an orthopedic outpatient PT practice, athletic trainers can bring a wealth of knowledge to the table for patients and other practitioners.  There is way more to being a LAT than being able to tape an ankle.  We poses evaluation and treatment skills for all orthopedic injuries.  We also have an in-depth insight to mechanisms of injury.  We are often on the field to witness injuries as they occur which helps us implement acute intervention safely and effectively.  Acute intervention with injuries provides a seamless transition in recovery.  Knowing common injury mechanisms allows us to instruct patients in proper techniques or exercises to safely return to their sport, job, or hobby without risk of re-injuring.  This knowledge combined with a PT’s evaluation skills and treatment plans can provide patient care unmatched by a single health care provider.   

MS: Which diagnosis or body part is your favorite to treat?

JD: I tend to like any lower extremity injury.  Our lower extremity is the power center for all sports.  Agility, power, strength,endurance and flexibility of the lower body require constant tuning to stay healthy and at the top of our game.  Knee, ankle or hip injuries allow for me to incorporate a ton of sport specific training techniques, which tend to be more involved and exciting to implement than bicep curls or rotator cuff strengthening.  

MS: What is your dream job?

JD: I’m doing it.

To contact Jesse Dimick:

Email: Jdimick@sportsandpt.com

Twitter:@jdimick

Article Review: The Myth of Core Stability

I was recently engaged in a conversation with Mark Young of Markyoungtrainingsystems.com about the preventablility/reduceability of low back pain, which morphed into talking about the transverse abdominis (TrA) and multifidi (M).  He sent over an article which I was vaguely familiar with titled “The Myth of Core Stability” by Professor Eyal Lederman.

I must state that the following review will probably sound like I am against what Professor Eyal Lederman has to say. This is not the case. I am only presenting my general thoughts or commenting on those ideas that I do not agree with, and the things that truly apply to us rehab/strength & conditioning professionals.

For the most part I agree with Prof. Lederman about the role of the TrA, the timing issue, and the strength issue. I start to find some problems with The single/Core muscle activation problems section.

• As health/fitness professionals we need to make sure the TrA and M are actually firing to ensure tha no dysfunction arrises between the local and global systems. Once TrA and M are firing, complex movement(s) can be added to reinforce proper coordination between the two systems
• Performing any exercises without trunk muscles is like performing a squat without the hip rotators/stabilizers in my mind. It can probably be done, but it will be very dysfunctional. I actually train a woman who has a diastatis recti from previous surgeries and her ability to perform some exercises is severely limited due to her weakened “core” muscles.
• As stated earlier in the article, “Just because in healthy subjects it [TrA] kicks off before all other anterior muscles, does not mean it is more important in any way. It just means it is the first in a sequence of events.” However, like a chain, when one link is missing, the rest of the sequence just does not work correctly. What happens when the mid and lower traps do not fire/are too weak? The upper trap becomes dominant and dysfunction arrises (neck pain, shoulder pain, etc).
• By ensuring that the TrA and M are firing, we can make sure that future dysfunctions may not arise. (I’m not even saying the dysfunction would be back pain).

CS and training in relation to motor learning and training issues

• The authors makes it seem like most trainers have most clients/pts train solely on their back. We all know this is not true.
• “Is it possible to train the trunk control to specific activity? Yes, and it is simple – just train in that activity and don’t worry about the trunk. The beauty of it all is that no matter what activity is carried out the trunk muscles are always specifically exercised.” But are they emphasized? Does this also apply to the upper and lower extremities? If to strengthen your core muscles all you have to do is your specific activity why do sprinters lift, why do pitchers lift, and why do jockies lift? Shouldn’t they just run, throw, or ride to improve their performance?
• “One wonders if David Beckham thinks about the ‘core’ before a free kick or Michael Jordan when he slam-dunks or for that matter our patient who is running after a bus, cooking or any other daily activities. How long can they maintain that thought while multitasking in complex functional activities?” I know the author must know this, but when motor learning progresses to the point where you do not need to think about the task any longer it then becomes a skill. It is known that when someone is a pro athlete they MOST LIKELY (not always) no longer have to think about their core, they just do it. When retraining a patient who has suffered a stroke, often “skills” cannot be performed without constant internal focus, and thinking about what muscle needs to be fired next. Skills such as feeding one’s self are digressed to “functional tasks”. Most patients/clients (not just post-stroke) are not considered “skilled” in their performance of CS, therefore; there does need to be much internal focus while initially training.

For the most part I actually agree with Prof. Lederman, but overall I just found this to be a strange paper. Was he writing to be controversial? Probably not, because he makes too many good points. But as Patrick Ward of Optimum Sports Performance in Tempe, AZ stated about this article, “if there is a better way to do it, then what is it?” If anything, this article will make you re-think the reasons for your training program.