The first thing you always need to consider is movement.  If movement quality is not above a minimum standard, then this is the first problem you need to deal with.

Performance problems come next.  If you move well, go ahead and add some conditioning, strength and speed.

Issues with skill are the final thing to fix (IE, golf swing, throwing technique, running form, etc.)

If you can’t change the movement of the majority of clients you are working with then you are doing something wrong.  You need to have a standard operating procedure as a way to test and re-test their movement patterns.

Programs are carried out the same way, no matter what happens.  Systems have a way of breaking things down and telling us “if this, then than” and “if that, then this”.  Use systems instead of programs to get what you want in your clients training programs.

Gray Cook, PT


Carpal Tunnel Syndrome

The carpal tunnel is formed the wrist bones on the bottom and the transverse carpal ligament over the top. The median nerve runs through the tunnel along with the flexor tendons to the wrist. Pressure within the tunnel can compromise the nerve and lead to carpal tunnel syndrome. The hallmark of carpal tunnel syndrome is numbness in the thumb, index and middle finger. Additional symptoms can include:

The condition is more common in pregnant women, middle age women, and people with jobs that include daily repetitive hand motions. The condition is diagnosed by a physical exam, as well as a nerve conduction study, an electrical study that measures the length of time that it takes for a signal to cross the carpal tunnel.

A delay is indicative of carpal tunnel syndrome. Initial treatment usually consists of conservative physical therapy, contrast baths, nerve-tendon gliding exercises and addressing other potential causes of nerve entrapment (cervical spine, thoracic outlet, pronator teres muscle of the forearm). It’s also important to recognize that these symptoms can also be caused or contributed from problems in the cervical spine, shoulder or elbow and all those regions must be evaluated in order to treat properly.

If the symptoms persist, cortisone injections can be tried. If conservative measures fail, or there is evidence of nerve damage (such as weak thumb muscles or profound numbness), then the carpal tunnel can be released by surgically incising the ligament to give the nerve more room or also done endoscopically.

Carpal Tunnel Syndrome

Thoracic Outlet Syndrome

TOS occurs when the nerves and vascular structures from the neck get compressed as they run through the shoulder into the upper extremity. Tests upon physical exam can usually identify the location of the compression. Many times, there may also be compression in the spine or further down the shoulder, elbow, arm or hand. Symptoms may include numbness, tingling, weakness, pain or blanching of any of the fingers. Conservative management can be very effective in treating TOS without drugs or surgery.

Trigger Finger

Trigger finger, also known as stenosing tenosynovitis is a condition in which one of your fingers or your thumb catches in a bent position. Your finger or thumb may straighten with a snap – like a trigger being pulled and released. If trigger finger is severe, your finger may become locked in a bent position. Often painful, trigger finger is caused by a narrowing of the sheath that surrounds the tendon in the affected finger. People whose work or hobbies require repetitive gripping actions are more susceptible. Trigger finger is also more common in women than in men, and in anyone with diabetes. Treatment of trigger finger varies depending on the severity. Many patients will respond to conservative treatment including functional rehabilitation and Graston technique among others. At Sport and Spine Rehab we strive to do what is in the patient’s best interest and thrive in an environment that requires medical co-management of a patient’s condition.

Trigger Finger