Yet on occasions it all ends badly. Of course is it always the fault of the other party(!) even though we soften the blow with comments such as ‘it’s not you it’s me’, or ‘we are moving in a different direction’, or ‘I think it is in your best interest professionally to work in different environments’.  However, you as the supervisor, manager or director of the business may have contributed to the problem. So I present to you the

Seven sure Ways to Mismanage Your Staff

1. Think ‘It’s my way, or no way’. Yes you are clever and have more experience. In fact you are so clever you seek and hire people with skills you might not have in order to grow your business. Then you crunch their enthusiasm and enterprise by forcing them to fit your system. You might as well hire clones of you (which many people inadvertently do) in order to remain the sole source of wisdom in your business.
2. Blame or criticize the other. Criticism is very useful when presented in a safe and structured environment (for example  in a performance review) but only if it is positively presented. In such circumstances the information is received at a rational level.  Negative criticism and/or blame will be received at an emotional level which taints the information before it gets to the frontal lobe for rational analysis. Even more so if the information is received second hand (often known as ‘gossip).
3. Be intolerant or inflexible. Leading a team is not easy, and the hardest part is being aware of what is happening in your own head. Understanding your own barriers to progress is critical and is far more difficult than being a barrier to others. This is even more true if your own emotional baggage (insecurity, anxiety, frustration, fear) is filtering any incoming data.
4. Behave in a hurtful manner. Never acceptable. Be respectful at all times if you want to command respect in return. You may be able to remove the person to whom you were hurtful, but the collateral damage in others who are now aware of your mean streak will remain in the organization.
5. React before you think. Many comments or actions made in the heat of battle are later regretted. Angry emails, derogatory comments or personal attacks are evidence of emotion being the driver rather than discipline. Emotions are a normal part of life but should be filtered through the frontal lobe (not to mention the mission statement, HR policy and the legal department) before being acted on. If you can ‘own the space’ between stimulus and reaction you will be a powerful force for good.
6. Dismiss or oppose the others viewpoint. See #1.
7. Give Up. No matter how good your professional mask and demeanor, staff members will know when you have given up on them. It might be an obvious sign, ‘Miss Brown, can you please document your position description.’ Or it will be a subtle blend of verbal and non verbal signals received at the other end. For example, not being included in office banter, or meetings to which they were previously welcomed, or handing them and empty carton and asking for the office keys to be returned. Giving up often means you haven’t paid attention to the preceding six mismanagement strategies listed above. And once someone realizes you have given up on them, it is a downward spiral that can damage the organization before the final separation occurs.

These seven items are pretty obvious as you read them now while your emotions and ego are in check. Avoiding them in the heat of battle when dealing with situations or pe0ple is indicative of a strong leader. Managing others always begins with managing ourselves, this list might help you identify where to focus your improvements.

Of the many injuries physical therapists see each year, hamstring strains are notorious for being stubborn to heal. They are frustrating for both patient and therapist, as they often reappear many times in one’s sporting life, especially in those sports requiring sprinting, jumping and kicking. Soccer and Australian Football League (AFL) come to my mind when I think of the hamstring injuries I’ve seen in both New York and Australia. Gabbe et al (2006) investigated the predictors of hamstring injury in the AFL – they make up 16% of all muscle injuries in the game. Small et al (2010) found that soccer players can miss up to 3 games per hamstring injury, and make up 40% of the muscular injuries in soccer (Yeung et al, 2009).

Why are hamstrings so difficult to rehabilitate? Sure…muscle imbalance, poor core stability, pelvic torsion, adverse neural tension can all be to blame. But perhaps we have not taken into enough consideration the way the muscle tissue was injured. Hamstring injuries are not homogeneous after all. In a brand-spanking new article Askling et al (2012) investigates the method of hamstring injury and the prognosis following injury.

Askling et al (2012) break down hamstring strain into two types: 1) Stretching injuries and 2) High speed running injuries.

Stretching injuries occur when the hamstring tendon is lengthened beyond its normal elastic/plastic tearing point. This usually occurs when the athlete’s knee and foot are at their highest elevation at the end of the kick – the combination of hip flexion and knee extension. This movement puts the hamstring in a position of extreme stretch, most commonly injuring the semimembranosus tendon at the ischial tuberosity (Askling et al, 2006, 2007). Unfortunately the combination of poor rehabilitation protocols, premature return to the field and the fact the tendons located near the ischial tuberosity have a poor blood supply, lead to this particular injury having a poor prognosis.

This particular injury needs a prolonged rehabilitation period. Passive stretching should be avoided in the first week to avoid further pain and tearing at the proximal attachment. Players, trainers and coaches should be informed that although these injuries do not seem to be as severe as more distal intramuscular hamstring injuries, they take much longer to heal due to the time it takes for remodeling of the tendon to occur (Garrett el al, 1984).

Conversely, high speed running injuries to the hamstring are usually located at the muscle-tendon junction of the biceps femoris. Although these injuries usually result in greater initial pain, bleeding and functional loss, they do not require as long a rehabilitation time as the stretching type of injury. Silder et al (2008) believe the biceps aponeurosis scarring which occurs after the injury, may allow for alternative force transmission paths, and therefore a faster return to activity.

Intramuscular biceps femoris strains usually present with greater VAS pain scores, greater weakness, larger range of motion loss and more tenderness to palpation. A number of tests which measure range of motion, pain and strength can provide a good estimate of the time it may take to rehabilitate this type of hamstring injury (Schnieder-Kolsky et al, 2006).

Although these injuries heal faster than the stretching type of hamstring strain, they still need to be given the respect they deserve. High load exercises and passive stretching should be avoided with this type of injury in the initial stages of rehabilitation (Askling et al, 2012).

Again, players, trainers and coaches need to be made aware of the fact that although this injury may feel better in the initial stages of rehabilitation compared to the stretching type of strain, it is imperative that symptoms are not provoked, so as not to further prolong the rehabilitation time.

Prior to the past couple of years, I used the Sherry and Best (2004) hamstring rehabilitation protocol for my hamstring tears. I now use the below protocol by Heiderscheit et al (2010), which provides a very detailed 3-phase hamstring rehabilitation protocol. The authors note that individual attention needs to be placed on the sets/reps for each patient and adjusted where appropriate.

Any thoughts regarding this new and interesting article by (Askling et al, 2012) are welcomed.

Phase I

1. Protect scar development
2. Minimize atrophy

Protection: Avoid excessive active or passive lengthening of the hamstrings

Ice: 2-3 times/Therapeutic Exercise (performed daily):

1. Stationary bike × 10 min
2. Side step × 10 m, 3 × 1 min, low to moderate intensity, pain-free speed and stride
3. Grapevine × 10 m, 3 × 1 min, low to moderate intensity, pain-free speed and stride
4. Fast feet stepping in place, 2 × 1 min
5. Prone body bridge, 5 × 10 s
6. Side body bridge, 5 × 10 s
7. Supine bent knee bridge, 10 × 5 s
8. Single limb balance progressing from eyes open to closed, 4 × 20s

Criteria for Progression to Next Phase:

1. Normal walking stride without pain
2. Very low speed jog without pain
3. Pain-free isometric contraction against sub-maximal (50-70%) resistance during prone knee flexion (90°) manual strength test

1. Regain pain-free hamstring strength, beginning in mid-range and progressing to a longer hamstring length
2. Develop neuromuscular control of trunk and pelvis with progressive increase in movement speed
3. Protection: Avoid end-range lengthening of hamstrings while hamstring weakness is present
4. Ice: Post-exercise, 10-15 min Therapeutic Exercise (performed 5-7 d/wk):

1. Stationary bike × 10 min
2. Side shuffle × 10 m, 3 × 1 min, moderate to high intensity, pain-free speed and stride
3. Grapevine jog × 10 m, 3 × l min, moderate to high intensity, pain-free speed and stride
4. Boxer shuffle × 10 m, 2 × 1 min, low to moderate intensity, pain-free speed and stride
5. Rotating body bridge, 5 s hold each side, 2 × 10 reps
6. Supine bent knee bridge with walk outs, 3 × 10 reps (
7. Single limb balance windmill touches without weight, 4 × 8 reps per arm each limb Lunge walk with trunk rotation, opposite hand-toe touch and T lift, 2 × 10 steps per limb
8. Single limb balance with forward trunk lean and opposite hip extension, 5 × 10 s per limb

Criteria for Progression to Next Phase:

1. Full strength (5/5) without pain during prone knee flexion (90°) manual strength test
2. Pain-free forward and backward jog, moderate intensity

1. Symptom-free (eg, pain and tightness) during all activities
2. Normal concentric and eccentric hamstring strength through full range of motion and speeds.
3. Improve neuromuscular control of trunk and pelvis
4. Integrate postural control into sport-specific movements

Protection: Avoid full intensity if pain/tightness/stiffness is present

Ice: Post-exercise, 10-15 min, as needed Therapeutic Exercise (performed 4-5 d/wk):

1. Stationary bike × 10 min
2. Side shuffle × 30 m, 3 × 1 min, moderate to high intensity, pain-free speed and stride
3. Grapevine jog × 30 m, 3 × 1 min, moderate to high intensity, pain-free speed and stride
4. Boxer shuffle × 10 m, 2 × 1 min, moderate to high intensity, pain-free speed and stride
5. A and B skips, starting at low knee height and progressively increasing, pain-free
   1. A skip is a hop-step forward movement that alternates from leg to leg and couples with arm opposition (similar to running). During the hop, the opposite knee is lifted in a flexed position and then the knee and hip extend together to make the next step.
   2. B skip is a progression of the A skip, however the opposite knee extends prior to the hip extending re-creating the terminal swing phase of running. The leg is then pulled backward in a pawing type action. The other components remain the same as the A skip.
6. Forward-backward accelerations, 3 × 1 min, start at 5 m, progress to 10 m then 20 m (
7. Rotating body bridge with dumbbells, 5 s hold each side, 2 × 10 reps
8. Supine single limb chair-bridge, 3 × 15 reps, slow to fast speed
9. Single limb balance windmill touches with dumbbells, 4 × 8 reps per arm each leg
10. Lunge walk with trunk rotation, opposite hand dumbbell toe touch and T-lift, 2 × 10 steps per limb
11. Sport-specific drills that incorporate postural control and progressive speed

Criteria for Return to Sport:

1. Full strength without pain
   1. 4 consecutive repetitions of maximum effort manual strength test in each prone knee flexion position (90° and 15°)
   2. Less than 5% bilateral deficit in eccentric hamstrings (30°/s):concentric quadriceps (240°/s) ratio during isokinetic testing
   3. Bilateral symmetry in knee flexion angle of peak isokinetic concentric knee flexion torque at 60°/s
2. Full range of motion with pain
3. Replication of sport specific movements near maximal speed without pain (eg, incremental sprint test for running athletes)

References

Askling, C.M, Malliaropoulos, N & Karlsson, J (2012) High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis, British Journal of Sports Medicine, vol 46(2), pp86-87

Gabbe, B.J, Bennell, K.L, Finch, C.F, Wajswelner, H & Orchard, J.W (2006) Predictors of hamstring injury in the elite level of Australian football, Scandinavian Journal of Medicine and Science in Sports, vol 16, pp7-13

Garrett WE, Jr, Califf JC, Bassett FH., 3rd Histochemical correlates of hamstring injuries. Am J Sports Med. 1984;12:98–103.

Heiderscheit, B.C, Sherry, M.A, Silder, A, Chumanov, E.S & Thelen, D.G (2010) Hamstring strain injuries: recommendations for diagnosis, rehabilitation and injury prevention, Journal of Orthopaedic & Sports Physical Therapy, vol 40(2), pp67-81

Silder A, Heiderscheit BC, Thelen DG, Enright T, Tuite MJ. MR observations of long-term musculotendon remodeling following a hamstring strain injury. Skeletal Radiol. 2008;37:1101–1109.

Small, K, McNaughton, L, Greig, M & Lovell, R (2010) The effects of multidirectional soccer-specific fatigue on markers of hamstring injury risk, Journal of Science & Medicine in Sport, vol 35, pp120-125

Schneider-Kolsky ME, Hoving JL, Warren P, Connell DA. A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med. 2006;34:1008–1015

Sherry M, Best T. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. Journal Of Orthopaedic & Sports Physical Therapy [serial online]. March 2004;34(3):116-125

Yeung, S.S, Suen, A.M.Y & Yeung, E.W (2009) A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor, British Journal of Sports Medicine, vol 43, pp589-594

In these financially pressing times, do you ever wonder whether that gym membership you are paying for makes economic sense? Do ever you look at your credit card statements and feel sick with guilt that you may be paying up to $160 month, but only going to the gym maybe 5-6 x per month, if not at all.

Read the latest article in the examiner to find out more…

Non-specific low back pain (LBP) has been researched and many have speculated correlations between physical activity and disability. Traditionally, it is assumed that patients who have LBP feel more disabled, report more restrictions within their daily life and as a result, are less physically active. It is important to note that disability and physical activity are not synonymous terms. The ICF states disability is an umbrella term that covers 3 aspects of health: body functions and structures, activity limitations, and participation restrictions. Physical activity is defined as the execution of a task or action by an individual. Simply, disability focuses on what people are unable to do, and physical activity focuses on what people are able to do.

Lin et al recently conducted a systematic review and meta-analysis to assess if a relationship exists between physical activity and disability in acute, sub-acute, and chronic non-specific LBP. Inclusion criteria required disability to be assessed by a self-report questionnaire (eg, Roland Morris Disability Questionnaire, Oswestry Disability Index) and physical activity to be assessed utilizing self reports forms (eg, Baecke Physical Activity Questionnaire, International Physical Activity Questionnaire), or movement instruments such as pedometers or accelerometers. The authors grouped patients into three categories: acute, sub-acute, and chronic. The acuity was based upon duration of LBP: acute (< 6 weeks), sub-acute (6 weeks – 3 months), and chronic (> 3 months).

To Finish Reading, Go to www.forwardthinkingpt.com

1. Pain is 100% of the time, an output from the brain. In 1996, Ronald Malzack developed the concept of the neuromatrix. The neuromatrix, in simplistic terms, is all of the mechanisms within the brain, that when activated, produce pain. So when your ankle hurts, the pain is generated by information gathered by the brain. Pain is simply a defense mechanism developed to protect the body.

2. The degree of injury does not always equal the degree of pain. Research has told us that very major injuries may not hurt at all and very minor injuries may hurt alot. The degree of pain you experience is more related to past experiences. For example, if you have sprained your ankle in the past and then you sprained it again, the second sprain will likely hurt more. This is because the brain has learned to protect that ankle following the prior injury and defends it through pain.

3. Despite what MRIs X-Rays and CT Scans show objectively, this may not be the root cause of your pain. While diagnostic imaging may give us excellent views of your internal anatomy, it gives us little information about pain. A study performed on individuals 60 years or older, who had no symptoms of low back pain, found that 36% had a herniated disc, 21% had spinal stenosis and over 90% had a degenerated or bulging disc. What shows up on an image may or may not be related to your symptoms.

4. Psychological variables, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different things and psychological components are one of them. A recent study in the Journal of Pain showed that psychological variables pre-total knee replacement was highly related to long-term pain post-total knee replacement. The treatment of these co-morbities may actually be more effective than surgery.

5. Arthritis does not cause pain. Despite the two being related, not all individuals with arthritis experience pain. Pain from arthritis is often correlated to secondary variables such as inactivity, depression, etc.

For the 6-10, Check out my full article @ forwardthinkingpt