Professional Development - Manual Medicine

Professional development can be what you choose to make it.  Stick close to home (i.e. what you know) and you will reinforce to yourself how much you know and how deep your wisdom runs (please note the tone of sarcasm!).  On the other hand, stretch yourself and you will undoubtedly find bodies of knowledge that will enhance your core skill set and enable you a greater capacity to work with other professionals as part of an elite team.

Recently I’ve been working through a text called Principles of Manual Medicine and I thought it might help some coaches out there to share some of my observations.

My foremost reason for reading this text is to extend my background knowledge of techniques used by physiotherapists and other manual therapists e.g. massage therapists.  I work as part of a team, and it is my responsibility as the leader of that team to understand with as much clarity as possible the effectiveness and implications of the interventions my staff deliver.  Beyond that, at a personal level I believe the correct delivery of manual medical techniques can enable physical capacity and performance in the athlete, and without question support and enhance the training based interventions I use.

Manual Medicine draws strongly from osteopathic influences.  Five core concepts:

Holism - the integration of the human organism rather than the summation of its parts (In my opinion most physiology based Sport Science degrees overlook this idea much to the detriment of their graduates.  It takes a long time to get them thinking holistically once in the wrokplace).

Neurological Control - all elements of the body are under control of the nervous system which is constantly responding to the internal and external stimulus (Again as above, I believe Sport Science education glosses over the neuroendocrine impact on performance).

Circulatory Function - highlights the complex interaction of the circulatory system with the musculoskeletal system, particularly the low pressure circulatory systems of the venous and lymphatic systems.  Much focus is on the diaphragm as an interface between the musculoskeletal and circulatory systems (This concept looks at the functional interaction of the skeletal system with the diaphragm, particularly via the phrenic nerve and intern its interface with venous and lymphatic circulation - interesting when you start to look at diaphragmatic breathing as a recovery tool!).

Energy Expenditure - At over 60% of the human organism, the musculoskeletal system is the single greatest expender of energy, therefore its efficiency places significant demand on the entire body.

Self Regulation - the notion that any intervention to or within the human body has the potential to disrupt the body’s self regulatory functions.  The practitioners intent must always be to restore these functions.

With clear base concepts outlined, the principles of a diagnostic system are outlined by the Diagnostic Triad for Somatic Dysfunction - A.R.T.

Asymmetry - structural or functional imbalanced dysfunction observed or palpated. 

ROM - excessive or restricted function around a joint, series of joints or regions.

Texture - abnormalities in the skin, muscle, fascia, ligaments etc determined by observation or palpation.

I found the Diagnostic Triad for Somatic Dysfunction very similar to current thinking in the S&C world with respect to the evolution of the FMS and similar systems i.e. asymmetry & ROM, with the obvious exception being Texture.

A lot of my study years ago on the legendary Charlie Francis, identified that he was a proponent of assessing the level of tone in his sprinters musculature via manual therapy techniques, often quoting that “low muscle tone was as bad as high muscle tone”.  This type of approach is often seen in track and field.  While football codes can hardly aspire to playing in perfect physical condition given the short turn around between matches, the concept of having a “manual” component to monitoring your athletes is integral to finding out the things “the athlete doesn’t know” about their physical status.

In recent years I have been involved in a case where the observation of sequential days of low muscle tone was central to the accurate programming of training loads for an individual, resulting in a short turnaround in time to return to compete at the highest level.  Had that observation not been made I am confident the time of recovery for the athlete may have been much greater due to further injury as competition would have easily exceeded the capacity of the muscle in the state it was in.

As with any part of monitoring I never take "texture" feedback as a singular defining variable in making a call on intervening in a player's program.  But it certainly is a component of building a case, and more so I think it plays an integral role in the evolving picture of the athlete i.e. identifying persistent or changing trends.

Internationally, you only need look as far as facilities like The World Athletic Center in Arizona, under the guidance of track and field great Dan Pfaff, and prolific speed-power coach Stuart McMillian, as evidence of a high caliber program integrating intuitive manual therapy with high performance physical development.  Manual Medicine techniques and philosophies are being applied at the highest level of performance.  Understanding how these interventions interact with physical development models is critical to administering a comprehensive high performance program.

The goal of adjusting somatic dysfunction via manipulation is to restore maximal, pain-free movement of the musculoskeletal system to postural balance.  This unquestionably aligns with the common S&C practices of integrating soft tissue manipulation via rollers, trigger point devices and yoga derivatives.  There is no doubt in my mind that these practices play an integral role in self regulation, however the application of Manual Medicine techniques by experienced practitioners takes the athlete’s capacity to another level that cannot be achieved solely by the aforementioned methods.  I've worked with some great practitioners over the last twenty years and I am absolutely convinced of the this.

I hope sharing some of my work in my own professional development helps you.

Coach well!

JW

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