The young soccer player I evaluated at the end of last week is doing very well.  His treatment along with some running thoughts are listed below.  Would love to hear feedback as always.  I will say that I have been heavily influenced by Gray Cook and Charlie Weingroff with regards to transitioning to fitness and performance as the end goal.  Manual therapy opens the window to acquire new skills and/or develop fitness or performance.

Visit 2: Patient only had one small incident of pain that came and went over the weekend.  Toe touch now at the lower shin with much improved hip hinge and lumbar flexion.

Manual Therapy:

B hip flexor release from hip flexed to straight to flexion/extension of hip

Exercise Progression:

All fours belly breathing – much better control here, plus I have hinge towards the feet some

Half-kneeling hold-relax hip flexor mobilization -progressed with overhead reaching and verbal cue to keep the ribs down and finish with an exhale

Half-kneeling pallof press – focus on a narrow base of support, carrying over pelvic position from previous exercise.  I am a big fan of putting people into a position to reflexively get what you want from the core.  Or we could cue drawing in the transverse abdominus, but then I would also have to punch myself in the face.

Rear-foot elevated split squat – Bodyweight, with cue to keep his pelvis underneath of him and maintain a somewhat vertical shin.    This will change as he becomes even more dynamic.  SFMA people will probably notice a relative flow through these progressions of the 4X4 matrix.

Last exercise: habanero hot sauce eating competition, instructed patient to not cry when he got in the car with his mom.  He impressed with this one.

Visit 3: Patient returned this afternoon with no pain and is curious how he will feel when he returns to lifting.  Funny he asked, prepare for fitness.

No manual therapy today, toe touch to top of foot.  Started him with 5 on the bike since he just got done sitting all day.

Today we began to develop a dynamic warmup to hopefully create joint positions that are smart to train from.

Lacrosse ball self-myofascial release to adductor longus/complex and deep hip/glutes

Half-kneeling hip flexor hold-relax with overhead reach and pigeon-ish pose with breathing.  I have tried to bite some content from Andreo Spina’s work, and hope to treat myself to some home study content from him as a business expense soon.  Followed by all fours breathing.

Walking lunge with overhead reach.  Enough for now, time to train a bit.

Primary lift is the deadlift.  I ask him to pull a 16 kg kettlebell to see how he moves.  Too much shin angle, bigtime knee valgus, high hips on the pull and lumbar hyperextension to finish.  Pretty standard in many cases.  I point out the positives, and start to pick apart some of the bad with encouragement.

Next we load a barbell with 135lb.  Light weight that is good for technique work.  Teach him to load hips first, knees second.  He starts in an olympic position, so I get him more vertical with the shin and get him setting up closer to the bar.  Teach him to take slack out of the bar and finish with the ribs down.  Minimal pain at the start, no pain after technique improves.

Finished with half-kneeling chop/lifts and the reverse lunges with kettlebell in goblet position to get in some single leg work and work on acceleration with a stable trunk.

No pain at the finish and he’s ready to get after it next week.  I’d like to teach him the swing and get-up (at least to an extended arm position).  

Thanks for the read and as always, leave any comments/ideas to improve!