Nicky Kirk, DC, MS

I decided to stop the high performance incubator because I wanted to share the lessons I had learned with my colleagues, and help people reach their goals faster by introducing them to people who have already walked the path.
 
Transcript: "I'll keep this one short. Why did I decide to start the High Performance Incubator? I spent many years traveling around Latin America and the United States and also Europe working with a variety of practitioners from different backgrounds. In fact, I learned so much from, in particular, the strength and conditioning world that I felt it was remiss of me not to try to share some of these lessons with my colleagues. Obviously, I'm a chiropractor, but I consider myself to be more of a performance therapist or an individual who is dedicated to high performance. That being said, I feel like I've spent a lot of years trying to search for my people the right path for me. And part of the High Performance Incubator is allowing people to take a shortcut and to get to where they want to be a little bit faster by exposing good, reputable people to individuals who may have already walked their path."

Weight training to strengthen lower back with lumbar stenosis should focus on controlling the lumbo-pelvic relationship and emphasizing exercises to educate the individual into a more suitable posture. Endurance should be increased by increasing strength and resilience of the lumbar muscles, while making sure not to put yourself into provocative or painful positions.
 
Transcript: "Hey Carter, that's a great question. Weirdly we actually run a lumbar spinal stenosis boot camp through our clinic here. And for those that don't know, lumbar spinal stenosis is a narrowing of the spinal canal where the spinal cord passes through in the lower back area. It can be caused by aging and degeneration or it can be caused by genetic factors such as a smaller canal. And it can be very problematic for individuals and can often lead to surgery if unchecked. So weight training to strengthen the lower back with lumbar stenosis. Number one, educational piece is huge in this. We want to be able to control the lumbopelvic relationship. And what that means is typically in stenotic patients, they do not do well in spinal extension. That's to say when they are leaning back and increasing that lumbar curve. Therefore we emphasize exercises to educate the individual into a more suitable posture which would be bringing the lumbar curve into flexion. So once you've established good lumbar control, in all honesty, then it becomes a question of increasing endurance, which is going to increase the strength and resilience of the lumbar muscles. And then making sure that you're not putting yourself into provocative or painful positions."

Difficult patient cases can be difficult to diagnose and treat, but if you use your training and experience to objectively analyze the available data, you can make a good decision that has a greater likelihood of success. It is also important to be forthright with the patient about the potential outcome and any risks associated with the treatment.
 
Transcript: "So difficult patient case is a very subjective term. So is it difficult in that the patient was a difficult individual to work with, or was it difficult as in the diagnosis was difficult to arrive at? Either way, you have to fall back on your training and your experience. If we are able to remove ourselves from the equation and look at, well, what findings do I have to work with here? Number one, do I have objective measurements that can lead me towards a quality course of action that makes a good outcome likely or not? And when you go through a decision tree like that, it helps you immensely with difficult patient cases in addition to being forthright with the patient, letting them know roughly what the likelihood is of success."

The first step would be to rule out any underlying conditions causing the high permeability by conducting tests. If everything checks out, then we want to establish a baseline of weight and control, and progress from there as with any other physical conditioning program.
 
Transcript: "First thing we want to look at with a suggestion of hypermobility is we want to look at bait and test and quantify to see if actually hypermobility is present or not. And if hypermobility is present we want to establish first of all if there's any underlying cause for that such as Ehlers-Danlos syndrome because that can come along with concomitant issues in other systems in the body. We want to be very cautious about that. So that would be my first protocol is to rule out any potential sequelae from a diagnosis based upon the hypermobility. That being said I think if that's not the case and everything is well then with hypermobility we simply want to make sure that we establish a baseline of weight and control and we progress from there in the same way as we would do with any other individual who's embarking on any type of physical conditioning program."

Athletes need to be strong and well prepared for the demands of their sport, by understanding what type of demands are placed on their body, such as lumbar endurance, coordination of lumbo-pelvic movement, and postural control. These factors should be taken into account when creating effective strategies for training.
 
Transcript: "Athletes need to be strong and they need to be well prepared for the demands of their sport. There are many different types of sports which place many different types of demands on the body. Repetitive strain versus frequency of games or competition versus intensity of training versus phase of the season. So the effective strategies are first of all understanding what type of demands are placed on the spine during the sport and then what levels of intensity ebb and flow during the season. Once you understand that there are certain basic things that you can look at such as the lumbar endurance, the Soroson's test where we effectively ask the individual to support their body weight for a given period of time and there are certain benchmarks. So they would be lying face down and supporting themselves from the pelvis up in an extended position. That would be one example. Another would be coordination of lumbopelvic movement. Do they have good postural control? Those would be some of the key things we would want to look at. And then we would look at how the lumbar spine can expand."

Fabric braces or bracing with a bit more rigidity can be used as support during the rehabilitation process and to protect in the early stages post-injury, but they cannot prevent sprains.
 
Transcript: "The jury is still out on whether or not ankle bracing can prevent sprains. What they can help with is the sense that there is some sort of support or stability and they can often be useful as a bridge back into sport and activity. They can also be used as a supportive aid during the rehabilitation process. However, if I was simply hoping that a fabric brace or even a brace with a little bit more rigor would entirely prevent a sprain, I think that's unlikely because they're not designed with that purpose in mind. They are really orthoses to support during the rehab process or to protect during the early stages post-injury rather than something which you should use long-term to try to decrease the incidence of sprains during sport."