My father was a football coach and a health/physical education teacher so I’ve always been around athletics and the weight room. I’ve always been interested in how the body functions. I had my share of injuries when I was younger too so I’ve spent time in physical therapy. Luckily I worked with one of the best PT’s around, and she was way ahead of the times so I got to do some pretty cool things that really made it interesting for me. I knew from 9th grade that this is what I wanted to do.
I graduated from Grand Valley State University with a B.S. in Health Sciences and then from Central Michigan University with a M.S. in Physical Therapy back in 1998. I currently work at Great Lakes Orthopaedic Center in Traverse City, Michigan practicing orthopaedic and sports physical therapy. About two years ago I started the website SportsRehabExpert.com and my life has been crazy ever since
2. What, in your opinion, is the biggest problem you see within the Physical Therapy field today?
I can’t speak for other specialty areas, but in the world of orthopaedics and sports medicine, we aren’t trained to look globally and assess patterns of movement. We learn in isolation, maybe because that is an easier way to break things down, but ultimately it needs to be integrated into a more regional interdependent approach.
By regional interdependence, I mean how impairments in one region of the body can influence the next, or even two or three joints away. I think many of us realize that this is occurring but we need a system that will help us to identify these relationships in our evaluation, and then guide us when developing our plan of treatment. This is why I’ve gravitated toward the works of Gray Cook and company, with the Functional Movement Screen and Selective Functional Movement Assessment. It’s a constant reminder that the site of pain is not necessarily the cause of that pain. It’s ok to treat the pain using modalities and manual therapy, but we also need to identify and treat the source(s) of the pain for long term success. Looking at patterns of movement help us to do this.
I am glad to see that this idea is gaining much more footing over the past few years especially within the American Physical Therapy Association, but it still frustrates me that physicians order VMO strengthening for everyone with knee pain and physical therapists still go along with it. As if strengthening one muscle will solve everything. I haven’t isolated out the VMO in years and my patients with knee pain do just fine.
Now that more people in the medical profession and sports performance arena are catching on, the next big thing has been “strengthen the gluteus medius”. Sufficient gluteus medius strength is necessary to prevent femoral internal rotation and adduction (valgus collapse) which is a step in the right direction compared to training the VMO. It’s still not enough though.
We need to take it a few steps further and realize that inner core function is needed for segmental spinal stability, the outer core can then do its job to stabilize the trunk and pelvis, and now the gluteus medius has a stable base from which to control the femur. Did I mention having full spine and hip mobility is a prerequisite as well? That’s a whole other can of worms that I won’t get into right now, but hopefully you can see where I’m going with this.
3. Could you give my readers some insight into your typical day?
Work is relaxing for me. I’ve got three young kids so when I’m home its total chaos!
I’m usually working on my site or reading from 5:30-6:30am and then again 9-10:30 or so at night. I also put in 40 hours a week in the clinic. I’m in a great situation in that I get to work closely with a group of orthopaedic surgeons, and a great group of like-minded and driven therapists. We put a lot of emphasis on treating patients one on one, and have ample time to do more in-depth evaluations. From time to time I’ll run some strength and conditioning clinics, do FMS testing with some of the local athletic teams, and I’m the strength and conditioning coach for a local football team.
Keeps me plenty busy, but that’s good. I’m fanatic about always learning more and then trying to implement that knowledge into what I do for the best possible results.
4. Sometimes there seems to be a huge gap between some physical therapists and strength and conditioning coaches. How in your opinion can this gap be bridge?
We just need to communicate better, and put egos aside to do what is best for the athlete. It goes both ways where either side doesn’t want to take the suggestions of the other. I do some of both but I’m a physical therapist a whole lot more than I’m a strength coach, and I know I better listen to their concerns. I’m not in their weight room all day, or in their class with 40 kids at a time. I may have the best exercises in the world but if it doesn’t fit in with what they have available and time constraints, then it really doesn’t matter.
I do think the knowledge gap is closing though on both sides which is great. Sites like Mike Boyle’s – Strength Coach.com, hopefully my site, and organizations like the NSCA are really trying to bring both groups together. There is a lot of overlap between rehab and performance training, and it’s that common ground that we need to take advantage of. I think there are certain principles we can all agree upon.
5. Who has had the biggest influence on you as a therapist?
I would have to say Gray Cook. I’d been searching for the answer to the question, “why isn’t what I learned in school and these other courses I’ve taken getting me the results I want with my patients and athletes”? I heard Gray speak at the Perform Better Summit about 5 years ago and knew I found my answer. I bought his book right then (Athletic Body in Balance), and luckily ran into him in the airport on the way home. He was nice enough to answer a few of my questions and since then I’ve been picking his brain as often as I possibly can.
I use the Selective Functional Movement Assessment with just about everyone who comes in the door, and the FMS with all of the athletes returning to play. I’ve just had good success using these programs, and Gray is a guy that never stops trying to learn and improve on things.
6. What are you all-time favourite books in the following areas:
Strength Training: I grew up in the Arnold Schwarznegger era so the “Encyclopedia of Body Building” was my favourite. Probably not the politically incorrect answer but that was my guide early on in my training days. Nowadays, I would say anything from Mike Boyle. I already mentioned “Athletic Body In Balance” from Gray and also his “Secrets” DVD series along with Brett Jones and Lee Burton.
Physical Therapy Rehabilitation: “Diagnosis and Treatment of Movement Impairment Disorders “– Shirley Sahrmann/”Ultimate Guide to Low Back Performance” – Dr. Stuart McGill
Nutrition: “Fast Food Nation” (scary stuff), otherwise I don’t read too much on the subject. In this country it’s hard to know whom to believe, and I think a lot of the research is influenced by outside money and interests. Besides, if you know fruits and vegetables are good and processed foods are total crap then you’re on the right path. There’s my mini-rant for the interview.
Business: “Think and Grow Rich” – Napolean Hill. I need to read more in this area for sure and am planning on looking at Thomas Plummer and Alwyn Cosgrove’s stuff. I’ve heard Thomas speak and he is a riot!
Random: The Seven Habits of Highly Successful People - Stephen Covey, and Fighting Back – Rocky Bleier (had to throw in a good true sports story)
7. What do you do to for your continuing education (Seminars attended etc)?
In the past year I’ve taken the Level II Selective Functional Movement Assessment from Gray Cook, did the week long Rehab Specialist Mentorship at Athletes Performance in Arizona, hit the Perform Better Summit in Chicago, and most recently Dynamic Neuromuscular Stabilization ‘A’. The DNS course is based on the work of Pavel Kolar, and is taught by an American PT and a therapist from the Prague School in the Czech Republic. It was a fantastic course and in my opinion, really builds on what Gray and Dr. McGill have been teaching.
This next year I plan on doing more with the Prague School and also with Titleist Performance Institute.
8. What resources that are out there, would you recommend to young up and coming coaches (Podcasts, Websites, Blogs, Products)?
Functional Movement Screen (functionalmovement.com)
9. If you could pick one exercise, and one exercise only, what would it be and why?
Correcting the individual’s respiratory pattern would be the number one exercise. We know that proper diaphragmatic breathing enhances activation of the inner core (transversus abdominus, multifidi, pelvic floor, and deep cervical flexors). If stabilization cannot be achieved at the most basic levels then all other patterns of movement will be adversely affected. I love single leg squats but how effective are they if the athlete collapses into flexion with each rep? I also really like Turkish Get-Ups and other kettlebell over head exercise, but again we’re asking for trouble if the spine is cranked into extension every time the shoulder flexes. Stresses increase in the lumbar spine, stability is compromised in the shoulder, and power is lost.
Was that cheating naming my other favourites?
10. Could you give my readers a basic summary of what your methodology on rehabilitation is (eg. FMS, SFMA, Janda)?
I use the SFMA as part of my evaluation process because I believe that an understanding of regional interdependence is crucial to getting patients better long term. Local approaches can be used to improve the situation quickly, and there is nothing wrong with that. Personally I like a lot of what Shirley Sahrmann does and when it comes to backs, I’ll use some of Dr. McGill’s methods. But to solve chronic pain issues and to prevent future injuries, we need to implement strategies that enhance patterns of movement. These patterns of movement are what connect distant regions of the human body, and they happen all day every day.
I spoke about it earlier concerning treating the knee. Sure I could strengthen the VMO and glute medius and tape the patella medially and I probably could get some immediate relief. That athlete will probably return to their sport, but the pain will be back. I know ultimately we’re in this to make a living, but ethically we need to do what is best for our patients. Solving their problems long term is in their best interest. I think addressing patterns of movement (using the SFMA model) is that answer.
So, in a nutshell, restore mobility where mobility is lacking. Then stabilize the segments that need to be more stable. That is how we restore functional movement.
11. Last question, what advice would you give to physical therapists, like myself getting into the field?
Read as much as you can, take continuing education courses, and make connections with other clinicians, coaches, performance enhancement specialists, etc. You have to have a love of learning and a desire to be the best you can be to be. Part of this is being smart enough to realize that there is always someone out there who knows more than you. Seek out those people in your field. Michael Boyle said something a few years ago that has stuck with me: “if you read one hour per day for an entire year, you would be more knowledgeable than 99% of people in your field.” I think he is absolutely right on, and it’s something we should all aspire too.
RB: Joe , thank you so much for your time. Where can my readers find out more about you, and any projects that you may have coming up?
JH: Check out http://www.sportsrehabexpert.com/ for more information on the Functional Movement Screen and Selective Functional Movement Assessment, Dynamic Neuromuscular Stabilization, interviews with guys like Stuart McGill, Eric Cressey, and Mike Boyle, corrective exercise videos, and lots more. It’s only $1 to join for 14 days so you can’t lose for giving it a try. Stay on for only $9.95 a month (that’s only $.33 per day). That’s pretty much my project for now, trying to stay on top of what is new and exciting in the world on sports rehab and injury prevention.