Six Things I’ve Learned In Six Years of Practice (by Dr. Reiner)

If there is one thing I have come to accept in six years of practice, it’s the more I learn the less (I feel) I know. I believe this is what drives so many of us in the fitness and rehabilitation profession. We are in constant search of the latest and greatest information to improve upon ourselves and ultimately create better athletes, clients, and patients. Reflecting on 2011 made me realize how much material was absorbed this past year. Had I possessed this information fresh out of chiropractic school, there would have been far less headaches and days of frustration. However, learning the hard way often makes us more appreciative of how far we have come. Without further adieu, my list of the top six things I’ve learned over the last six years.

1. It’s not just about you
Sure it’s always nice to think an athlete is back on the field and feeling better than ever because of what “you” did. The fact of the matter is, it’s a team effort. We can’t be experts in every field and with an overwhelming number of therapies, specialists, and philosophies, it’s imperative to create a “team” of like-minded specialists. Our “team” at Fitness Quest 10 consists of chiropractic, physical therapy, massage therapy, acupuncture, nutrition, strength and conditioning, yoga, and Pilates. More often than not one of our athletes will at some point encounter all of us in their quest for athletic perfection. My previous article, “Who’s on your Team“,discusses the importance of surrounding yourself with a group of specialists that communicate well and provide a comprehensive approach to rehabilitation, injury prevention, and athletic performance.

2. Get it right from the start
Top of the line equipment and trendy treatment techniques can make any clinician/therapist feel invincible to any injury that walks through the door. Without proper assessment and a correct working diagnosis, it’s easy to chase pain and treat the symptoms with those cool toys. While chiropractic school provided the basis for standard examination, it’s through courses, seminars, books, and colleagues outside of the chiropractic profession, that I’ve come to understand biomechanics and motor patterning. Understanding movement and analyzing dysfunctional patterns will direct you to the cause of the injury. Bottom line….don’t chase pain. Some of the most influential to my practice include Gray Cook, Dr. Stewart McGill, Shirley Sarmon, Sue Falsone, Greg Rose, Charlie Weingroff, Craig Liebenson, and Mike Reinold.

3. Don’t get caught up in the “black and white” of biomechanics. The nervous system is a bigger beast and creates many shades of gray when treating patients.
Only considering biomechanics when assessing injuries or faulty movement patterns will often leave you short of solving the problem. The nervous system is a far bigger beast to comprehend when motor control issues and compensatory patterns exist. Is it the pain that drives the faulty pattern or the faulty pattern that drives the pain? Studies have shown pain, regardless of its origin, alters motor control.

This same concept applies to the rehabilitation of our stabilizers. Just six years ago in school we learned to “strengthen” weak stabilizers (ie. core and rotator cuff). Current research, however, points to timing as the key factor. Without the nervous system activating our stabilizers first, it doesn’t matter how “strong” we make these muscles. Put down the tubing for your IR/ER shoulder exercises and focus your attention towards patterns that consider timing. Understanding biomechanics is the first step in looking at function, but improving the pattern only comes with careful consideration of the nervous system.

4. Look beyond static posture and alignment
Chiropractic school emphasized posture and alignment with the majority of the assessment occurring in the standing or lying position. While this continues to be a part of my examination, evaluating movement is just as important. The majority of musculoskeletal injuries occur as a result of poor movement quality. For the general population the overall decline in activity, I believe, translates to poor movement competency. As such, the weekend warriors and/or gym goers often present with mechanical neck and lower back pain. Posture and alignment are a start to understanding the problem, but looking at fundamental movement patterns such as gait, running mechanics, and throwing, are essential when working with any patient or athlete.

5. Don’t throw the baby out with the bath water
The health and fitness industry often discount various techniques, exercises, and philosophies if evidence is inconclusive or unfavorable. While I’m a firm believer in testing our hypothesis and seeking out the best information, it’s the combination of clinical experience and evidence based research that should be the driving force behind our programs/treatments. The majority of the assessment, treatment, and training techniques I utilize are evidence led. Notice I didn’t say evidence based. Performing and executing flawless clinical studies and trials is virtually impossible. Brett Contreras wrote an article demonstrating that one could find a study to prove or disprove just about anything. Whether a study supports or refutes the testing hypothesis, taking into account your clinical experience is sometimes more important. Many researchers are limited to working in a lab without stepping foot in a clinic/training facility. As a clinician or strength coach working in the trenches, we see first hand what is effective and what is not. Just because the Journal of whatever discounts your school of thought doesn’t mean you toss the technique or philosophy aside. While research fuels the growth and science of the health and fitness community, always consider your experience and results within your setting. Proving efficacy is often evident in your success. Bottom line…do what works.

6. Without written goals, it is difficult to track your progress and map out where you are headed
It’s that time of year again, time for New Years resolutions and planning for the upcoming year. We all talk about it, but it often becomes a distant memory by mid February. This past year I took the time to write out several goals, both the professional and personal. Creating a list and placing it a high traffic area my house, kept me on track for the year. Let this be the driving force for self-improvement in the important areas of your life. For me, I made it a point to spend at least 10% of my income on continuing education (thank you Diane Vives for the recommendation). Looking back at the number of seminars, courses, classes, workshops, and books I have learned from this past year, has kept me motivated and passionate about my work. Most important, the attention to both personal and professional goals will help maintain the balance between the two and your focus on the things that matter most.

Let this be the most enlightening and productive year you’ve had yet.

About Dr. Reiner
Dr. Jennifer Reiner is the chiropractor for Water and Sports Physical Therapy and Fitness Quest 10 in San Diego, California. She obtained a Bachelor’s of Science Degree in Exercise Science from the University of Florida and went on to pursue a Doctor of Chiropractic degree from Palmer College of Chiropractic West. As a member of the Palmer West Sports Council, Dr. Reiner focused her studies on sports injuries and rehabilitation. She is also a Certified Strength and Conditioning Specialist (CSCS) by the National Strength and Conditioning Association.

She spent five years as the official chiropractor for the University of California San Diego, providing care to a variety of sports including swimming, soccer, volleyball, track and field, tennis, and basketball. Dr. Reiner is certified in Graston Technique as well as Active Release Technique (ART). She also holds certifications in FMS (Functional Movement Screen), SFMA (Selective Functional Movement Assessment), TRX suspension training, and K-laser therapy. Follow her on Twitter –@drjreiner.