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Dr. Zak Gabor — DPT, CSCS  Simplifying Physical Therapy and Empowering Humans Founder @thelevelupinitiative Educator | Speaker | Motivator | Haver of Fun

http://thelevelupinitiative.com/

Listen up physio peeps, and learn you somethin' good 'bout training youth athletes.
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Training kids DOES NOT damage growth cartilage...the research is just simply not there. The official @nscaofficial position statement supports training youth athletes, and they did a fantastic job of debunking the myth that training kids would be a greater harm than the inherent danger of sports. *Coughs* Running can generate 3xBW *Coughs again*
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I'm not out here saying you need to have little Timmy slap on 4 wheels and go for the gold. But if the human organism (even mini humans) was so fragile that it couldn't lift weights, then how the heck does it hold up running, jumping, landing, and absorbing forces that are multiples of body weight...When you look at the data lifting has roughly a 0.7% injury rate per 1576 injuries, compared to football with a cool 19% (Feigenbaum et al., 2009) .
What the numbers do tell us about injury to kids from lifting is that it isn't even the kids fault...it's the ADULTS in charge of them. Of those studies published in the 70's and 80's that said that lifting damaged growth plates, the NSCA found that most of those injuries reported were actually due to lack of proper technique, inappropriate load, or lack of ADULT supervision. We can't stand for youth athletes getting hurt because of the lack of coaching, programming knowledge, and ignorance of the adults in charge. *Deep breath, rant over* (Physio nerds, I'm fired up so thanks for bearing with me 💪)
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Here are some key take aways for clinicians/coaches working with kids from the NSCA's position on youth training:
🔹Strength helps plyos. Beefing up that neuromuscular connection will pay dividends out on the field. Kids just playing puts far greater load than a weight will, so wouldn't we want to give them the tools to help manage that load?
🔹Obese youth athletes benefit the most. Body weight for them is too great a load. Loading them up with %BW movements using weights is a great way to get them strong and help loose weight safely.
🔹Kid will find a way to train without you, they watch the crossfit games on TV and read about athletes training in magazines. Teach them right once...

If posture does not equal pain, how do we proceed?

COMPREHENSIVE MANAGEMENT

We do not simply “throw posture out,” however, we must be able to understand how it applies CONTEXTUALLY. Below, is a great starting point for putting together strategies to address neck pain (but truly, pain in general).

A recent theoretical framework proposed by Tousignant-Laflamme et al. suggests breaking down into 5 main categories (which are representative of the current best research):
1. Nociceptive drivers (pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors)
2. Nervous system dysfunction (NSD) drivers (AKA pain that arises secondary to nervous system hypersensitivity)
3. Comorbidities drivers (presentation of concommant MSK/mental health issues which influence pain)
4. Cognitive-Emotional drivers (Maladaptive behaviors, Maladaptive cognitions which influence pain) (iatrogenic effects anyone?)
5. Contextual Drivers (Occupation related contextual drivers, Environmental related contextual drivers which influence pain)

So how do we take all of this information and apply it practically?

Step 1️⃣: LISTEN...Take into account how each individual’s history may fit into these respective categories! This is where we understand the Comorbidities, Cognitive Emotional Drivers, and Contextual Drivers. However, we can often pick up on movements/activities that influence their symptoms here as well (like spending a lot of time in one specific posture)! These will be critical in forming communication and education strategies you employ! (Ps- listening helps gain trust)
Step 2️⃣: Rule out red flags (Hence why we need to know biomedical really well!)
Step 3️⃣: Assess for movements/activities that influence (both +/-) their nociceptive drivers/NSD
Step 4️⃣: De-educate on counter productive beliefs that are unsupported by the literature in a way that validates their experience, and builds a 🔥 therapeutic alliance.
Step 5️⃣: Create a COLLABORATIVE plan on managing RELEVANT stressors and building up some robust multi-faceted capacity! Work together on creating a plan getting them back to activities meaningful to them!

Where my Eric Thomas ( @etthehiphoppreacher )fans at?? Man, he’s intense but he get me FIRED UP!! 🔥🔥🔥

This quote in particular is so important to keep in the back of your head at all times, ESPECIALLY the tough ones!

Safe to say, we ALL go through adversity, challenge, and FAILURE. The key is, how do you respond?

Overcoming these adversities is what helps define our character. Don’t fear failure, EMBRACE IT. That’s how we shine baby 😎💎

#TheLevelUpInitiative

Grateful to contribute to my STUD friend and colleagues “28 days of hips.” If you don’t know Sam, make sure you check him out.

#Repost @thestrengththerapist
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28 Days of Hips: Tri Planar Hip Matrix with @simplestrengthphysio
This @ZerenPT -Esque drills is one of my favorite high level single limb hip control drill.

1️⃣ Lat Toe Tap to Hip March
2️⃣SLDL to Hip March
3️⃣Curtesy Tap to Hip March

Truly, all three of these movements require excellent expression of motor control across all three planes of motion.

What I look for as a coach:

-Smooth, cooridinated movements. Try to keep a consistent tempo. For you crazy cats out there, try using a metranome to accomplish this.
-Ability to keep stance hip engaged throughout with a soft hinge as the client/athlete descends into the various positions. Followed by full hip and knee extension into a march without lumbar hyper extension. (Think push the ground down and get tall)
-Ability to express cooridination side to side. (This tool can be regressed and be diagnostic in nature)

You can use this for so many things in "rehab" and it is a great demonstration of executing the basics, and creating a template to be creative and MOVE.

Check out this study reviewed by @evidencebasedmvmt ill be going over application tomorrow. Stay tuned!!

Research Review
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So as we saw on ⬅️Tuesday, neck pain is a serious burden that we don't seem to have a good answer for! While various risk factors have been suggested, none has been more common than that of our favorite scapegoat…posture! At this point unfortunately, this relationship is unclear. So what did this week’s study have to say about posture / pain?
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Well, when looking at the results we see that ❌NO significant pain differences existed amongst various sitting postures, thus ARGUING AGAINST the commonly held belief that posture is a driving cause of pain! Even though ❌NO significant differences were found, it’s interesting to note that the GREATEST % of subjects reporting pain were those w/LEAST amount of thoracic flexion / forward head! Can you guess which group had the LEAST % of subjects reporting pain? Those w/GREATEST amount of thoracic flexion / forward head!
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While this week’s findings parallel that of 2 systematic reviews (Brink 2013 / Silva 2010), can you think of any other factors that we have ❌not yet mentioned? Remember those psychosocial in nature such as stress / depression? Since these factors have been shown to be associated w/neck pain (Diepenmaat 2006), the authors of this week’s study concluded that we should consider treating from a more biopsychosocial vs. biomechanical approach! Keep in mind that subjects were limited to Australian adolescents as well as the fact that this study only represents a snapshot in time (as opposed to assessing pain over time w/changes in posture). ————————————————————
Richards, K., Beales, D., Smith, A., O’Sullivan, P., & Straker, L. (2016). Neck Posture Clusters And Their Associations With Biopsychosocial Factors And Neck Pain In Australian Adolescents. Physical Therapy, 96 (10), 1576 - 1587.
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This is ❌NOT medical advice. If you're in pain, see your local physical therapist by visiting www.moveforwardpt.com

💥Study to understand, not to ace the test💥

Easily one of my favorite quotes of all time and one of my biggest pieces of advice to students! Also an extremely important core principle to @thelevelupinitiative.

Students that study to memorize are the ones that generally struggle through PT school, on their boards, and ultimately in real life as a clinician.

While studying to understand takes more cognitive stress and effort, it yields bad ass returns in the brain gainz department 🧠💪💪💪. It allows you to become a beast of a critical thinker🧐 (you might even earn monocle rights if you practice enough). In my opinion, the most essential skill for crushing school. Studying to understand and not just memorizing is another characteristic of having a growth mindset.📶⬆️

Nothing is un “understandable.” Sometimes it just takes finding the right study partners, mentors, and professors. Shouts to Carol Dweck for this gem from her book “Mindset.” Stay hungry my friends!

#TheLevelUpInitiative

Pumped to be working with @evidencebasedmvmt on a DOPE topic. I’ll be writing the application post for Friday, make sure you check them out. They do a great job making research digestible and applicable!
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Research Preview———————————————————
According to Vos et al (2012), neck pain is the 4th leading cause of years lived with disability! When combined with low back pain (the 1st leading cause), a recent study by Dieleman et al (2016) found that in the United States ALONE this costed around $88.1 billion in 2013, a significant ⬆️from $30 billion which was estimated to have been spent in 1996! With those stats in mind, neck pain risk factors that have been suggested include those related to...
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1️⃣Lifestyle
❗️Computer Time - Straker 2007
❗️Time Spent Sitting - Ariens 2001
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2️⃣Psychological Components
❗️Depression - Diepenmaat 2006
❗️Stress / Distress - Croft 2001 & Walker-Bone 2004
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3️⃣Physical Characteristics
❗️Muscular Endurance - Lee 2005
❗️Posture - Harrison 2004, Lau 2010, Silva 2009, Osmotherly 2008, Yip 2008 & Brink 2013
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With the ⬆️sedentary lifestyles people have, one of the most highly debated topics nowadays is “does poor posture correlate to pain?” At this time unfortunately, things are unclear as you have some such as Yamamoto (2015) who argue that YES “faulty” posture can be linked to pain (such as forward head being the cause of neck / shoulder pain). On the other hand, those such as Straker (2009), Edmondston (2007) and/or Szeto (2007) would say otherwise. While we hope to add to the discussion this week, what do you guys think about all of this?! 🤔🤔———————————————————–
Richards, K, Beales, D, Smith, A., O’Sullivan, P., & Straker, L. (2016). Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain In Australian Adolescents. Physical Therapy, 96 (10), 1576 - 1587.————————————————————
This is ❌NOT medical advice. If you're in pain, see your local physical therapist by visiting www.moveforwardpt.com

Big thanks to my friend and colleague Jay over at @cvasps for having me on his podcast 🙏🏻. If you are unfamiliar with his platform, it is an unreal resource for strength and conditioning con ed. *cough PT STUDENTS cough*

Especially for my strength coach followers, we get into one of my favorite topics: updating your language for improved outcomes with your clients/athletes. Link in bio!

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#sportsmedicine #recovery #physicaltherapy #wellness #rehab #rehabilitation #movement #performance #sportsrehab #sportsrehabilitation #orthopedics #dryneedling #health #fitness #running #strength #training #exercise #athletes #dpt #dptstudent #pt #physio #clinicalathlete #sportsmassage

💥Mission Statement💥

The Level Up Initiative is a student and clinician run movement dedicated to restructuring the current Physical Therapy education with the ultimate goal of improving patient care. Through online mentorship groups and educational modules, students will be challenged to embrace a growth mindset and develop skills necessary to inspire future generations of Physical Therapists to create positive change in a profession that is rooted in serving people.

The last part of this mission statement really gets me fired up🔥, and I hope it gets you fired up too🔥🔥🔥, lets take a look 👇

We are in a profession that is ROOTED in SERVING PEOPLE.

We are NOT in a profession that is ROOTED in SERVING OURSELVES.

Though well intentioned, our current schooling is very biomedically based. The issue here is two fold:

1️⃣The evidence DOES NOT support a lot of the biomedical narratives of why we have pain or how certain techniques work. (Therefore, it is unfair to use these narratives when educating patients)

2️⃣The evidence DOES support how these very narratives actually CONTRIBUTE to critical issues in our healthcare model! (Biomedical model is WITHIN the Biopyschosocial model, therefore, we would not be getting rid of anything, simply updating!)

I LOVE this profession, and am immensely grateful for all the things I’ve learned! But there’s too much evidence staring us in the face that dictates improvement! Change is both difficult and scary. But when it comes down to it, we are a medical profession that serves people. We can't let the fear of all of the time, energy, and bruised ego's it will take to do so! We need action, urgency, and humility.

Ultimately, I want people to feel comfortable being uncomfortable. I want people to EMBRACE struggle as it leads to growth. I want people to focus more on a beastly ability to critically think, rather than taking material at face value. Through this platform, we will be able to equip students and colleagues with these values that will push the profession forward, and they will equip the next cohort of students and new grads. We dont have any other choice except to level up. You with it?

#TheLevelUpInitiative

Sorry peeps...the guy at the supplement store that sold you a 55 gallon drum of raspberry ketone pills, telling you that they'll get you shredded forgot to let you in on some hard facts...(I can hear your wallet crying 😢)
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Hard work, consistency, and discipline = keys to that rocking' bod. No amount of miracle fat loss pills could ever replace good old fashion work. The upside is that the alternatives (training hard, consistency, discipline) are on sale right now for the low price of Free-99 (just pay S&H 😜) .
Physio nerds may be thinking, "but wait...what the heck does fat loss have to do with my patients?" Great question, and the short answer is it's an important consideration in the long run for your patients. Think about it, even people not in pain will benefit from better function of insulin, improved GH & IGF-1 profiles, and overall badassery🔥This shouldn’t be inappropriately brought up, nor the focus of your care, but getting them to buy into positive lifestyle changes can be a great way to promote empowerment and longevity!
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The skinny on fat loss for clinicians...(that was a lay up, so you gotta give me that one physio nerds)
🔹Frequent training sessions - (things they can do when they aren't seeing you) training multiple times per week will almost always help build robustness and allow them to be in a calorie deficit to loose weight.
🔹Short training sessions - 45-60 min is plenty of time to get in a great fat loss session. Short and sweet is always better than long and arduous, and allows people flexibility to fit training in to a busy schedule.
🔹Fast paced - Rest periods <60 as we are training for fat loss. You want that metabolism stoked and keeping rest short is the perfect way to do that.
🔹Effective Exercises - Programming is limited only by your imagination and is a great opportunity to program fun, functional exercises to build on what they did in PT. 🔹Variation - Ohh schnitzel that's right variation...😱 Does there need to be some guiding periodization...hells ya. But progressing movements keeps things spicy. -Nick Calandra (@strengthcoachstudent)

Just an absolute gem from a guy who did exactly this for me - @lewishowes

Take action, do the things that inspire you. Side effects include: inspiring other humans to go out and GET IT. #saturdaymotivation

#TheLevelUpInitiative

💥Vision Statement💥

“Inspiring generations of forward thinking humans.”

On forward thinking:

“Forward thinkers don’t copy. They don’t compete—they create.” - @grantcardone

I want to inspire people to create, not to be petty about others success and to be constantly “competing.” Create the best version of yourself. Period.

There is a never ending abundance of awesomeness to go around. It just takes the right mindset to lock in and kick some ass. You would be surprised at what you are capable of!
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On inspiring “HUMANS,” The reason is two-fold:

To make the paradigm shift away from a purely biomedical model that treats “patients,” and empower PTs to embrace the concept of treating HUMANS.

To inspire ANY and ALL humans to level up, and to fear-less in the pursuit of their goals.

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Maybe I am a dreamer for thinking we can have a world filled with forward thinking go-getters, but dreams are supposed to be massive! I for one, want to lead in taking ACTION of the things that set your soul on 🔥🔥🔥. Let’s get it.

📸: @chrisgoetchiusprofessional

#TheLevelUpInitiative

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