Sunday, January 14, 2018

Why Do Self Myofascial Work

We live in an age where your health is in your hands.  No longer is inadequate information, tools, or ability an excuse.  Relatively speaking, self myofascial care is one of the biggest health returns for your money and high return on investment from a time/money perspective.

Self Myofascial care is when a person uses a tool or object to influence the muscles, nerves, blood vessels, bones, lymphatic system, and fascia.  Fascia is a big deal as it is literally everywhere in your body.  It covers your body, it's embedded into the muscles, it forms "structures" or thickened areas. It has the ability to contract, relax and move.  It can be dehydrated.  When we target an area, we are essentially working all this stuff and this is globally referred to as connective tissue.

A person can experience restrictions in the connective tissue.  This means that areas, such as between muscle bellies, that should have a slight glide or wiggle room, no longer wiggle or move as smoothly as they should.  Over time, this can lay down fibers that further increases the inability to glide smoothly.  This can also mean these areas are less hydrated.  Dehydrated tissue is one mechanism that can be thought to contribute to muscles strains.

Certain areas of the body can also experience trigger points.  Trigger points are areas that are super sensitive when applied pressure too, and can even express pain at sights elsewhere in the body.  For example a trigger point in the glute medius, a hip muscle on your side, can express pain in the lateral calf and even into the lower back.  Trigger points can be active or latent.  Active means you know this hurts, latent means you were unaware that it hurt until it was pressed on.  Trigger points, while controversial, have been studied and shown that when blood was taken from them a much higher (H+) was in them.  It was more acidic.

Restrictions in movement can also start to lead to congestion from a lymphatic system perspective.  Remember, the lymphatic system works on the muscles actively contracting.  If they can't contract as strongly as they are capable of, the lymphatics can be congested in certain areas.  There is some evidence that this creates muscle inhibition.  (It makes us unable to express the strength we should be able to)  Muscle weakness.  

When the body starts having restrictions in how muscles contract or move and trigger points that unconsciously affect how we feel, we will start to move differently.  This compensation pattern may last weeks or years.  But eventually, this too will have it's own restrictions and inadequacies.  How often do we just chalk it up to moving poorly or sore when we wake up or an increase in nagging injuries to just old age.  Perhaps our connective tissue is just in poor shape?

Do you brush your teeth twice per day?  What did you do for your connective tissue today?

WHY DO IT!

1.  Keep from developing or start to break up the restrictions.  This is going to help you move better.  More easily.  Increased Range of Motion!

2.  Stop Trigger Points, but also become aware of latent ones.  This is going to start to get rid of unconscious avoidance of movement or positions.  It can also drop down peoples pain!

3.  Increase lymphatics and blood flow.  This brings more blood flow (more oxygen) to the tissues, but also gets rid of the metabolic waste products.  Win, win.  It can create stronger muscular contractions!  

4.  It can help get rid of the delayed onset muscles soreness that can be present after hard workouts.  Increase recovery!

HOW IT DOES IT!

1.  It increases circulation of blood flow.  Blood flow is the reason tissues can heal.  Sometimes people have surgeries just to get blood flow to an injured area.  This in itself is such a big reason it can not be overstated.

2.  Connective tissue heats up.  Some famous fascia researches state that when the area hits a certain temperature from myofascial work, the area will move better and have better contraction ability.

3.  Tissue tension changes.  The connective tissue can relax for a bit.  Often times when one area of the body relaxes another area adjacent becomes more active or "stronger."  This is called reflex neural inhibition.  Work your quadriceps and often the lateral hips will feel stronger.

JUST DO IT!

At the end of the day regardless of everything you just read, I believe there are two very unscientific reasons why we should do a self care on our connective tissue.  One, it just feels good.  You will get up and feel better.  Two, it's a gateway habit.  Ever hear of the concept gateway drug?  Haha...yea, gateway habit.  When you start to do self care, I believe it bleeds into other areas of your life from exercise to nutrition to self image.  The snowball effect.

Minutes a day at minimal cost can create huge healthy and lifestyle benefits.  As a plug in we created the MOBI to address all the soft tissue needs for a self maintenance program.  It replaces the foam roller, the ball, the stick and every other odd object you have collected to hit different parts of your body.  It's also a nice self defense tool if the zombie apocalypse hits.




2018 should be the year you develop your Self Myofascial Care Program, your body deserves it, and you only get one of them.

Thursday, December 21, 2017

Achillies Tendon Rupture: Post Surgery Week 1-2

On Dec 2 in a Cyclocross race my left achllies tendon ruptured.  On Dec 5th I had surgery to repair it.  I took that week of work off between doctors appointments and surgery and used the guidance of elevatation to help to control swelling.  I went back to work the following Monday and worked a regular schedule with the help of a knee scooter.

The doctor told me it was the worst achillies rupture he had ever repaired.  In his words there must have been a previous tear in there.  Because of the extensive damage he decided to put me in a cast for 12 days instead of the normal 3-5.  Being in a cast wasn't that bad until a week in and the itching started.  Nothing you can do about it.  Those were some sleepless nights.

I got on an air dyne that evening after surgery to help try to get whatever residual anesthesia may be in my system and get some blood flowing.  I used a Marc Pro a minimum of 2-3x a day for 1-2 hours each for the first week.  I continue to do that at least once a day.  Here is a timeline of modalities used and why.

Day 0 surgery.
Introduced air dyne.  10-20 min easy effort.
Marc Pro 3 sets of > 60 minutes
Kept the foot elevated
Wrapped blood flow restriction band (BFR) around upper thigh and did bodyweight leg extensions.
Did Glute ISOmetric holds for time.  Both sides.
Hip Flexion, knee rotation CARS
Side planks with Active Movement



Day 1-3
Pretty much did the exact same protocols.  But did this 3x a day.
I added in bone both with gelatin and 3-5 grams vitamin C in a drink that I slugged down 30-60 min before I rehabbed.  Who knows if this will help, but it can't hurt.
Reverse Hyper without any weight with Slingshot around my knees.  My thought process is that I was getting some type of stimulation into the calf perhaps.
Regular GYM work for what I would do for upper body, lots of extra pulling work.

Day 4-7
Started pushing through the heel of my cast into the air dyne pedals.  This felt good.
Extra seated work at the SkiERG
Light band resisted knee extensions with BFR on upper thigh.
Stopped taking the Ibuprofen they recommended.  I felt like I was controlling inflammation well with exercise and the research seems to say NSAIDS delay tendon healing.
Still taking baby Aspirin morning and night to help prevent any clotting issues.

Day 8-12
Lack of showering under my cast is starting to feel it.  Itching.  Nothing you can do about it.
Kept up all the same work as previous days.
Got the cast off!

My doctor walked in looks at me and states,  "You tore the shit out of it."  But it looks like it's healing well."

I was shocked at how swollen my foot looked.  I thought I had been doing a pretty decent job of elevating and movement when I wasn't working.  Now I'm in whats called a CAM boot now.  Locked in Plantar flexion of 20 degrees for 2 weeks and then 10 degrees for two weeks and then at a month at neutral or 90 degrees.  It just feels awesome to be able to take it off.  I've found that If I put half a deck of cards in my Timberland boots it makes for a secure workout bike riding boot.  I can ride much more aggressively and really drive through the foot with no pain.  Thats big.

Day 14
Holding ISOmetric lunges with the left leg forward for repeated sets of 20-30 seconds.  I can raise up out of it for 2-3 inches with minimal pain.  Going to start doing LOTS of this.

The next few days, I'm going to feel out, band assisted bodyweight box squats, hip thrusts loaded,  Seated calf raises and some alactic/aerobic work like 10/50 work to rest for blocks of time.

There is nothing like skin in the game to start really reading and applying something to your life.  All injuries have reasons.  Do we ever figure them out is another story.  But, I've come to accept that this one is 90 percent my fault and 10 percent shit happens.  This achillies has a history of bothering me.  I would do some eccentric calf
raises for a few months, bring back some jump roping and by fall it would be feeling pretty good again.  Winter comes, I don't do a much of that stuff and I think my tendon, which had a small tear in it apparently already, would get cranky from "spring enthusiasm" and be sore in the summer, start to rehab it, be good by fall.  Cycle starts again.  This year I got more into biking and spent most of my time biking.  After chasing a 1/2 mile time I wanted to beat, it got sore, but instead of rehabbing, I just biked more and avoided it, I believe without the loading, my tendon got weaker.

I didn't do the work.  Tendons need load, not rest.  Things I knew, but didn't apply.

"Knowledge without application is simply knowledge.  Applying knowledge to ones life is wisdom, and that is the ultimate virtue."  Kasi Kaye



Tuesday, December 5, 2017

Achilles Tendon Rupture: Pre Surgery Day 1-3

When it comes to injuries, hindsight is 20/20.  It's easy to look back in time and create the why.  It's also easy to chalk up injuries to bad luck.   As a Strength coach and Chiropractor/therapist I want to know the why's.  I don't believe in bad luck.  There are reasons.  I don't know all of them, but we do our best to learn and move on.  We also have to be careful to not just create reasons because it fits with our need to have answers.

Sunday morning I had a complete rupture of my left achillies tendon.  I somehow saved my bike from a slide out, I must have used my leg as a kickstand and I felt someone run into or kick my calf.  I looked behind me to see who was there, and in that matrix like moment, time slowed, I saw no one, dropped an f bomb and knew.  I knew instantly when I didn't see anyone behind me.  In the seconds that processed through my brain I thought, here comes the next year of my life.


I've had on and off pain in this achillies tendon for over 10 years.  So chances are there are some decent amount of degeneration in the fibers before the rupture.  From a mechanics stand put, this ankle has lacked as much dorsiflexion in it since a pretty bad ankle sprain that limited life for about 6 months as a freshman in college, jumping over a wall and landing on a parking berm.

Take Care of Your Joints.

It would come and go the inflammation around the achillies.  One thing I've neglected is dynamic loading when I was feeling good.  We know you need to use the qualities you want to keep.  Healthy tendons need load, eccentric strength and must go through stretch shortening cycle.  This had started to fade over the years.

Variable Loads Are Needed.

I normally take my HRV every morning, but I had just finished getting over a weird cold that seemed to last 18 days and had gotten out of the habit.  It had left me with good power in terms of strength, but anything over 160 heart rate I was wiped out.  Part of me thinks I was still fighting something, had extra inflammation in my system when this all when caput.

When I got home from the ER, that Sunday reached out to a bunch of friends and got some surgeons names that were recommended.  I was able to see my Doc Monday morning and he stated it was a bit higher then normal.  I said, great more blood flow!  He said yes, but less tendon to work with.  (here's hoping I'm right)

A good friend sent me to the website of Dr. Amol Saxena, one of the leading foot/calf guys in the world.  He performs lots of achillies surgeries on athletes who's livelihood depends on it.  He lays out a great rehab protocol.  Week by week.  Post Op Rehab Achillies

Nutritionally I'm going to do a very high protein, high fat, low carb diet for at least a month.  Essentially eat no junk and try to limit inflammation.  Bought a bunch of high quality bone broth to drink multiple times a day to see if I can maximize connective tissue health.

Have a Plan

ALTIS just posted a nice recap of their Coaching program and one thing that stuck out was this from Matt Jordan.  1.  Know what matters.  2.  Measure what matters.  3.  Change what matters.  Dr. Saxena has seen hundreds through to the return to running and 3 things matter.  1.  Perform 5x25 single leg raises with 15 seconds rest between sets.  2.  Have a post operative limb within 5mm of the good leg.  This is tricky as mine was already 1.5-2 cm smaller from when I had a back injury to the left.  My goal will be to get as close to the size pre surgery.  3.  Have ankle dorsiflexion and plantarflexion of 5 degrees of the good limb.  If access to an AlterG run 85% bodyweight for 10 minutes.

Be Abel to Measure Your Plan

Surgery is in the morning.  Then the fight begins.  It's been humbling to feel and hear all kinds of support from family and friends.  My wife has been amazing.  Funny, after my first thought of oh shit I tore my achillies, my 2nd thought was, Kelly is going to kill me!  lol

Instagram @drjasonross


Wednesday, November 29, 2017

Developing a Template and Momentum for 2018

When you watch a lot of sports you get a sense of the power of momentum.  It's a very weird thing to witness.  One team seemingly has control, but one play later and things can change.  That one play leads to another.  Everyone can feel it.  Players that weren't making plays, start making spectacular plays.  The ball starts bouncing their way.   Momentum is powerful.

"Momentum solves 80% of your problems. "  John Maxwell

This is about building some momentum going into the new year 2018.  People want to think that a new year is a new you.  There hoping that some extra magic happens because they watched a glittery ball drop.  

Instead of starting from scratch, prepare, get it going.  Preparation is the key to getting where you want to go.  Most peoples new year resolutions revolve around being more healthy.  That is hard to define.  So take the time to define it.  Perhaps it means losing 15 pounds.  Getting your blood pressure low enough to get off medications.  Complete a 100 mile bike race.  Do your first 5k.  Walk a 12 minute mile.  Eat 3 servings of vegetables a day.  The list is endless. 
 

Step 1.  Define in very specific details what you want to accomplish.  
This needs to be written down.  Research has shown that what gets written by hand is a much more powerful way of doing things.  Buy a journal/writing pad that can be used daily for a year.  Get a pen with blue ink.  Research says we remember blue ink better then black ink.  (It can't hurt!)

Now, one can have more then one goal, but it's hard to have 3 or 4 specific and different goals.  But, some goals become very similar when you break them down.  I'll have several people tell me they want to get to the gym more, eat better, lose some weight.  At the end of the day, they are all kind of the same goal.  Write a book, lose weight, attend all my kids games, make more money.  These are all very different goals.  So choose wisely.  

Step 2.  Figure out what you are going to give up.  This is the power of negativity.  Example is giving up smoking.  Your not doing anything extra, but your stopping doing something that isn't healthy.  Perhaps it's giving up your happy hour with friends or one night out a week.  Giving up TV, cable.  Giving up buying a treat with your coffee.  Make some time for what your trying to do.  At the very least, by examining your week/day hour by hour, you will be much more conscious on how you are spending your time.  

"How we spend our days, if of course how we spend our lives.  What we do with this hour and that one is what we are doing."  Annie Dillard 

Step 3.  Make a list of all the Micro things it takes to accomplish your goal.  
Take the Micro and make it Macro for awhile.  I call this the consistency beats intensity.  We all know the person that is gung ho for a few weeks and then fades like a shooting star 3 weeks in.  They stuff every possible new habit into the day.  Wake up early, eat a crazy smoothie, hit the gym, run, cook every meal, do yoga, no TV, go to bed early, read that book.  3 weeks later, they are stressed out and burned out.  

Take what you envision to be your ideal day and mold that day into a week.  Instead of cooking every day, pick one dinner out of 7 and cook that one.  Get that one meal down.  What to buy for it, what to keep in your fridge to make it.  Did you cook that one meal one time in the week.  That is a check mark in your journal.  

Instead of hitting the gym everyday.  Get to the gym one time. (Gym is just a word for lifting weights)  Work out for 45 min doing something you enjoy.  Did you do that one time this week.  Check it off in your journal.

Did you floss your teeth one time this week?  Did you elevate your heart rate for 30 min one time this week (aerobic stuff).  Check those boxes off.  Wake up early one day, go to bed early one day.  Check those boxes. 

The idea is to make a checklist of what your vision of a perfect day is.  Then expand your day to a week.  So it's not about burning out day to day, it's about building slow growth over the course of that week.  Get momentum, (there's that word again).  Create consistency with smaller commitments that will most likely bleed into bigger ones.  Also check those boxes, for real.  Are brains are wired to achieve pleasure in marking off things done.  They are victories after all.  

Step 4.  Remove Restraints
Listening to Freakanomics Podcast on Behavior Change and they interviewed Daniel Kahneman.  He had a great idea that he credited to Kurt Lewin, that peoples behavior is driven by two main forces.  Restraining and Driving and our behavior is the equilibrium between these two.  There are two ways of going about influencing behavior.  Get rid of the restraining forces or increase the driving forces.  Increasing the driving forces is a poor choice, getting rid of the restraining forces is the key.  

Instead of trying to figure out how you can eat more vegetables, figure out why you aren't doing it in the first place.  This goes for everything.  At the end of the day, we all have more then enough information.  We need more application.  One by one address the answers that pop up with the question why not.  Remove the restraints to make moving forward easier.

I never have vegetable in my fridge when I get home from work.  (Every Sunday I'll buy vegetables)
I go to make them and they have gone bad.  (Ask the groceries or Google what are the best vegetables that last a full week or how to store vegetables.  
They taste bad.  (two recipes on google with spices that create an enjoyable eating experience)
Clean up is annoying and tiring (aluminum foil on a cookie sheet)

Step 5.  Create Discipline
Look at your week and write down when you are going to do what.  Obviously make sure that it's a real time commitment.  Can't hit the gym at 530 if you routinely get out of work at 545.  No matter what, commit to what you put in writing no matter what you "feel."

Feelings at the end of the day are irrelevant.  I don't feel great, so I'm going to skip the gym today.  I feel tired, so I'm not going to cook tonight.  We have all said that and done that.  How many of us have said I'm still tired I'm going to lay in bed and not show up to work?  My kid is really bothering me today, I don't think I'll take the time and get dinner for him.  Can you see how silly that sounds.  We can keep commitments when they are obvious.  Just eliminate feelings as a choice. This is how discipline is created.  Doing what you said you would do.

"Discipline Equals Freedom"  Jocko Willinck

Get started now, create momentum to hit the ground running in 2018.  Don't wait for the glittery ball to drop.  

Wednesday, November 8, 2017

Patience in 2.5 Unit Increments

There are a lot of quotes on patience.  A quick google search will brings hundreds of memes that extol patience.  We all know we need it, very few of us want to use it, even fewer of us want to be in situations that require it.  I speak from experience.

 We all know it's useful but unless there are concrete actionable steps to take, be patient becomes just another saying.  Want to be successful, early bird gets the worm.  Cool.  Wake up early and then what?  See what I mean, memes and saying look nice on a quote board, but unless a plan is in place, sayings are just poems.

I came across an article about a man learning to use the 2.5 minute rule with his kids.  Every task, partition an extra 2.5 minutes because kids are slow, less dexterous, and some things aren't memorized motor tasks.  Ask them to put their shoes on, extra 2.5 minutes.  We can slip our shoes on literally in a few seconds.  Not so much for young kids.  Tasks like this.  Give yourself and your kids this leeway.

I learned early on that you need to partition extra time when you are taking your kids somewhere.  I learned it so well almost 6 years in with kids, that I'm only late like 3 out of 5 times.  Of those 3 times, I'm sure I was a bit stressed and I'm sure I stressed them as well.

There was no plan.  If you don't have a plan, you ultimately don't succeed often, when you do, it's probably by luck.  Give your self "extra" time is just arbitrary.  2.5 minutes is concrete.

When I first started lifting weights.  The only principle I understood was that if I put more weight on the bar then the last weeks effort, I was getting stronger.  If I kept doing this, I'd get to where I wanted to go.  So I used those small 2.5 pound weights every single time for my last set.  If I beat my last weeks effort, I'd go up 2.5 pounds on each side the following week.  If I didn't I stayed there.

Those 2.5 pound weights got me where I wanted to go.  They also taught patience.  You don't go from squatting 135 pounds to 405 pounds in big increments.  Your body needs time to build up connective tissue, motor unit recruitment, cross sectional muscle development, vascular networks and loads of other physiological adaptations.

One of the things I've noticed with myself is the lack of patience with some of my bigger lifts in the last few years.  I've also noticed lack of progress.  Part of it, is just being content at staying at a certain weight.  Part of it, was just lack of patience.  Wanting to just get
in get a lift in, but not having the patience to commit to slow progress.

With winter coming, patience in 2.5 unit increments is becoming a concrete goal.

"The two most powerful warriors are Patience and Time."  Leo Tolstoy

Monday, October 2, 2017

The MOBI Is A LifeStyle Tool for Better Movement and Recovery

We know that information doesn't lead to change.  Facts are not enough to convince us to do something or change a habit.  Would anyone still smoke if facts were enough?  We all know some very basic health facts, that not all of us do.  Do we all floss?  Do we all eat 3-5 servings of vegetables a day?  Do we all wear a seatbelt?

So if facts don't change our habits, what does?

Charles Duhiggs book the Power of Habit is one of my all time favorites.  In it he outlines a habit loop that consists of 3 parts.  Cue, Routine and Reward.  

1.  Cue.  Some call it the trigger or reminder.  This is usually visual.  I see it, so I'm reminded to do it.
2.  Routine.  Because of the cue, you proceed to do what has been determined to be correct action.
3.  Reward.  Because of the action taken, we usually have a burst of dopamine that reinforces good behavior.  For example, floss tonight and you will feel accomplished.  I took positive steps towards my goal.  


We created the MOBI to be a musculoskeletal tool for your connective tissue.  Part recovery tool, part mobility tool, but 100% lifestyle tool.  What does that mean?

Our goal was to create a visually appealing, aesthetically sound device that feels natural to have around.  It feels good to hold in your hands.  It doesn't look weird to be laying flat on your desk at work.  It travels well regardless if its a backpack, computer bag, yoga mat or gym bag.  

We wanted something that was around.  Visual cues.  I'm an out of sight out of mind type of person.  If I see, I do.  I keep post it's on my computer of things I have to do.  If I see the book I'm reading on the couch, I pick it up and read it.  If my kids knock it under the couch, I tend to almost forget about that book.  The biggest benefit to MOBI in my eye is the greatest asset any athlete can possess,  availability.  If an athlete is not available, they are not helpful to their team.  If something can help you, but you don't have it with you, in the end it's not helpful.   MOBI is designed to be "available."

If your foot has pain with walking, of course you will be reminded about trying to do something for your foot.  But, why wait for pain.  We have been taught at a young age to brush our teeth morning and night, not because they hurt, but because they keep our teeth healthy.  

What did your parents, coaches or health practitioner teach you about the rest of your body.  Do you have a physical practice or routine that helps the muscles, fascia and joints to move and feel better?  

Do you do something daily that helps with how your body recovers or moves?  

I want MOBI to be that tool that becomes your cue.  We have created videos that show routines to help create small 60 second actionable steps to form your own personal movement and recovery routines.  It doesn't matter if you are sitting at your desk, finished a bike ride, starting a session at the gym, or hanging in your living room.  If there is something in your hands, you will use it.  You will have a routine to help areas move and feel better.

It's the small stuff that adds up over a lifetime.  One minute, 10 times a day is 10 minutes a day of being better.  It wouldn't help to brush your teeth once a week for 10 min.  But, one minute, 2x a day can be the difference between healthy teeth and dental nightmares.  The body responds the same way.  Frequency trumps intensity.  

Every time you use your MOBI your brain will elicit the reward to do it again.  Not because the MOBI is magic, (it's just a tool) but because you took a positive action towards better health, recovery and movement.   We know that if we do that daily, over months we will have created a positive habit.  I think spending 5-10 minutes a day working on moving and recovering the musculoskeletal system can be an amazing health habit, that everyone needs.  

We are few weeks out from our Kickstarter goal.  Check out the video of the MOBI in action.  If you know of someone that you think this may help, please share.  MOBI on KICKSTARTER.
Thanks!

DRJASONROSS on Instagram for some MOBI videos, pictures of coffee, kids, bikes, occasional workout ideas, craft beer and more coffee.

Monday, September 18, 2017

Becoming A Performance Therapist

Performance therapy is a term that has become more mainstream in the last decade.  When I was in school, the term Sports Chiropractor was probably more common.  I can only give this article the viewpoint from the lens of a chiropractor as I have not walked the road of other professions even though I interact with them frequently.

I've been an athlete my whole life and because I was a fairly good, I was able to make a National Team in the sport of bobsled.  I had just graduated chiropractic school, so the first people I worked on were high level powerful folks.  In my world, this was the norm.  It took me almost a full year to get used to a more passive mindset in clients when I left to work in the private sector.

I've had the good fortune of working an Olympic Games, traveling the world with some really fast guys and taking part in big meets and events.  I've been able to work with lots of different sports and teams and had some amazing memories from them.

This article isn't about getting to do that.  Some of it was luck and some of it was knowing the right people, and some was the classic right place at the right time.  Sure, if the door opened and you aren't that good, you don't get asked back.  This article is about being good enough to get asked back.

Performance therapy by my definition, is therapy that perpetuates better performance.  It can be on a spectrum.  Hurt on the left.  Increased performance on the right.  Someone will present somewhere between those two points.  While performance therapy can be used to overcome injury, it is by definition treating someone not injured and looking to make that session or that race optimal.  I think the best work is done in a heavy training block and therapy is used to help recover and allow more training volume and better training sessions to happen.  I stress that not injured doesn't mean optimal.  Think of someone that is running well, but the lower back get sore after every sprint session.  Perhaps the big toe doesn't have enough motion to allow full ROM on push off at high speeds so the athlete arches their back to compensate.  Still training well, but not as fast as they could progress and are getting increased lumbar soreness.  

First a few points to remember.  This is my opinion.  Ask someone else and they may disagree on everything I'm about to tell you.  Don't ever get into the mindset that because someone works for someone or some team that they are amazing.  Just like someone driving an expensive car doesn't mean they are rich.  The outline I'm going to talk about is also not the path I took.  Many of the courses and people I've met along the way, weren't around when I was in school or on my graduation.  So in a way, even though I've taken these courses it wasn't my path.  This should tell you there are many paths, but the following path is what I tell kids when they email me asking advice on how to become a performance therapist.

Get a huge base.  You need a big base if your ever going to build a big pyramid.  Your base is what your going to spend most of your time with and it will take up most of your treatment.  All other things become less effective if you don't master the basics.  How many times have we been told, master the basics,  build a solid base, don't skip ahead.  The best course hands down for building this base is the Functional Range Release (FR).  You get very good at finding anatomy and feeling anatomy.  Locating tension and then addressing tension and tone, also differentiating mechanical tension from neural.  (This was one of my biggest mistakes on leaving school) If you develop this base well, you will be able to help a lot of people even if you never went any further with your training.  I plan on taking one every year or so, until I feel like I'm not getting anything out of it.  I'll bleed this one dry.  Get good at knowing what structure you are feeling and if what you are feeling is normal.

Get good at loading the tissue. 
Things get better when we load them.  Things get worse when we load them wrong.  Things don't improve very much or as quick if we don't load them at all.  Become a master of understanding load.  The best course is Functional Range Conditioning.  You may think I'm biased, but it probably worked out this way for a reason.  The FR originators understood that to get great results required load and the conditioning course was born.  This course goes deep into that understanding.  I mean deep.  It made me go back and read histology and cell physiology and truly enjoy it.  I will retake this course in the future.

Get good at Being Part of a Team.
A performance therapist should know about physical training.   Understand strength and conditioning.  You probably won't be the primary coach for that person or athlete, but to understand what exactly is happening during training is extremely important.  The body adapts to training, understand how your therapy can be synergistic to that.  Being able to have a competent conversation with the athlete and coach is so undervalued it's criminal.  If you end up working in a team setting, this may be the difference in being asked back.  Are you competent in being part of the triangle of performance, athlete, coach and therapist.  The best course is being offered by ALTIS, another hands down.  It's the only thing really like it that I know of.  You get to experience the triangle in action.  You can ask a therapist why they pulled an athlete after watching them in their warm up to treat X.  Then see how that treatment changed the movement or drill.  You can watch and learn as treatment, coaching and athletes response feed of each other and determine the daily dose of training.

Get good at Regression and Lateralization.
This is a term I learned from Charlie Weingroff.  Regression is taking an exercise and making it available to that athlete that can't quite do it as prescribed.  They lack hip mobility so you take a deadlift from the floor to a deadlift off blocks, this is an example of a regression.   Lateralization is a side step.  If you don't have dorsiflexion to get into a great squat position, substitute the squat for a trap bar.  Still being able to train a heavy load with out putting the athlete at risk while working on getting them dorsiflexion.  Charlies Training=Rehab series of DVD's are a tremendous resource.

Get good at Energy Systems.
Not understanding the impact that the physiology of the energy systems plays, is one of the biggest mistakes in therapy.  Getting in great aerobic shape can help the healing response and position the athlete to have better tissue quality, less prone to colds and allow more training volume.  Blood flow brings healing, build more ways for that blood to flow!  I'm currently taking Joel Jamieson's Bioforce Conditioning Coach course.  It's very good.  His book is also a tremendous resource.

Get good at Nerve Flossing.
How to address neural tension or nerves that are causing the major course of dysfunction.  Michael Shacklocks Neurodynamics course is amazing.  4 days of of insane amount of information.  Great anatomy tie ins and superb blend of teaching and hands on.  I will retake this course in the future.

Get good at Knowing What You Don't Know.
This category exists to understand when you need help.  For me, this category is stuff I want to get better at, but am currently inefficient in to give guidance at an elite level.  For example, the everyday person, I can give blood work advice on some basic stuff.  Throw in an autoimmune problem, or fluctuating patterns that I'm not confident with, I'm not going to risk their health.  Some of the systemic monitoring like HRV and omega wave and using technology like EMS are one of the pools I'm learning to swim in, but again, I don't feel confident in giving advice.

Get good at Waking Up.
I think this is a small percentage, and to be honest I'm still figuring out where it belongs in the big scheme of things. But I do think it belongs somewhere.  I put the courses fascial manipulation and Reflex Performance Reset in these.  I give RPR the nod, as it's like 1500 dollars cheaper.  I think there is an appropriate time to "wake up" tissue, like post surgery or when body awareness is low.  I currently am using it mostly in the untrained individual.  I'm finding they  have a hard time "feeling" a muscle work/contract.  Even if it is!  The body awareness is so poor that when you do exercises with them, they start biasing into what they can feel.  RPR has allowed them to have better body awareness.

Get good at Competition
I think therapists should compete in something.  I think you should understand what being at a start line, waiting for the whistle to blow, or waiting for the green light is like.  What it feels like to know your ready to compete, to also know what it feels like to know your under prepared.  To fully know the frustration of being hurt.  To know what bonking is.  To know what heat/cold feel like.  To know the highs and lows of training.  To know that most days are just showing up and putting in work and your therapy is a part of that.  Nothing special, just a part of their day.  You don't have to be good, but you have to work at something and put yourself out there.  I think athletes appreciate when they know you may know a little about their world.  It also helps from an esoteric level.  If your at a big meet/event and you can feel the energy and nervousness that is around, it helps you give a more calming, positive presence in your treatment.  If you have never felt the nerves yourself, you may get caught up in the situation and put out nervousness and feed forward that to your athlete.  So join a lifting club, enter a 5k, register for a local cyclocross race and put yourself out there.

Get good at Reading
Every talented therapist I ever met has been a voracious reader.  It's not just therapy books either.  Although you should have some solid anatomy books.  (I like Stecco's stuff)  The bigger the library the more you start to see how things fit together or intertwine and overlap.  I think this helps you start to recognize patterns and process information at a higher rate.  The more that is in your understanding the faster you can start to process information.  In a private clinic that might mean you get to see 3 people in an hour instead of 2.  At the track it may mean you get to solve a potential problem in warm up instead of interrupting the practice.  Figuring stuff out faster is important.  Train your brain to learn and be creative.  Read more and read from a broad spectrum.  Variability is a good thing for joints, heart and your reading.

This is my recommended path when kids email me.  Now I can just send them to this blog post instead of just listing some courses.  Like I said, this was my opinion.  I'm sure others would have other recommendations.  If you are a therapist that works with sports or athletes, what course have you found instrumental in your learning?