My six year old recently requested that his nickname be changed from Trout to Bike.

"Just Bike."

While he still enjoys fishing and playing ball and all that, Bike has found his first love. And I'm good with it. More than good.  Bike is gaining some initial confidence. He's motivated to get after his book-learnin' so he can go ride. He's building body awareness and multi-joint coordination that surely transfers to other playlists.

He's learning his limits too. Bike has a pretty good handle on what he should try and what he'll leave for the Youtube "fail" videos. This isn't due to some kind of stellar genius. I think it comes from the process of risk analysis that forms naturally when little ones know that they are allowed to try things without constantly being hovered over.

The concept of relative risk deserves a revisit. Sure, I worry about Bike getting wrapped up and breaking an elbow or ankle. I understand the tears and misery and other costs of the ER. But what of the risk of him living in fear or rebelling because we failed to let him try, and learn his own lessons? What about the fact that we drive our children everywhere? Like, at great speeds in giant metal(ish) machines? We stare down a far bigger, uglier risk on a daily basis, and say "bring it."

Somehow driving is acceptable, while allowing our kids to bike and play football and lift weights is questioned.

I still think that the biggest risk is couch-TV syndrome. And putting our sons and daughters into a batters box for a showdown with a flighty, uncoordinated, but strong for his age 12-year old on the mound.

Development. Confidence. Performance. Lessons in baseball. Injury rehab.

This whole entry is kind of how I make a living.

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Confident Does Not Equal Competent

[A guest post from Kyle Wagner.]

When you're involved with baseball you invariably run across all types of coaches. Some you seem to like right away and others you'd just rather not have dinner with.

I'm always skeptical of the coach that seems to have ALL the answers- especially those involving the hitters. The one that doesn't hesitate to offer any little bit of advice that he feels is necessary at that moment. At times like that I always remember the old adage by Abraham Lincoln, "better to stay quiet and let people think you're a fool, then open your mouth and remove all doubt."

It isn't that they don't have good intentions - they do. It's that they believe, at least that's what I can only assume, that by being loud and quite confident in their opinion they are a vastly superior coach.

Let me explain why I believe this coach is victim to the "confidence" illusion.

Hitting a baseball requires many skills for sure. But, gameday is not the time for major wholesale swing changes. Gameday is the time to make sure the player is ready to compete against the pitcher. It's not about the stride or the hands too high or the head pulling off the ball. It's about competing in the batters box. Yet, coach after coach seems to offer technical advice to these young kids and if it wasn't so darn devastating it would be comical. Paralysis by Analysis.

Hitting a baseball is a timed event. You need to apply your skill in a given amount of time. It is not golf where you can swing on your own terms. You have a ball moving at you in unpredictable locations. If you want to help your player in the moment you must give him something that will help his quickness to the ball. For the most part, on gameday, these pieces of advice sound like this...

"Turn it loose"

"Free and easy"

"Get a good pitch to hit and hit it hard"

"Don't give up your strength" (In other words - "look fastball!")

These pieces of coaching advice are vague by nature. They are supportive, subtle suggestions to make a hitter more focused and less pre-occupied with unnecessary swing thoughts.

When the ball comes out of the pitcher's hand a hitter needs to react to what he sees. It's this reaction time that separates the great hitters from the good hitters, the good hitters from the average hitters.

The easiest thing a coach can do to improve a players reaction time is to improve a players anticipation strategies. In other words, give him better things to think about if you want to make his swing faster and quicker to the ball. As the ball moves towards home plate the three primary elements that effect how quickly your barrel moves in the direction of the ball are 1) anticipation (Green Light Hitting strategies) 2) swing quickness (mechanical efficiencies) and 3) bat speed. Are you really going to change variables 2 and 3 in 10 minutes? Very, very doubtful. It takes time. A lot of time.

So, the only thing left to impact as a coach is a players anticipation strategies. Give your player's a thought process that makes them quicker to the ball- not cues of doubt that WILL absolutely slow them down. Here are some doubt producing cues for sure.

"Make it be there"

"It's gotta be perfect."

"Don't swing at the high pitch"

"Don't chase 'em out of the zone"

"Watch out for the curveball."

The "competent" coach knows not only what to say but when to say it. And, when to roll their eyes at the "confident" coach.

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Cinnamon Toast Crunch

Is there anything better to "consume" after a workout that Cinnamon Toast Crunch?

[Or insert your favorite sugary/junk cereal.]

I really don't think there is. After years of trying out and studying up on expensive recovery supplements and fooling around with blenders and what not, I can tell you that none of those are any more (or less) effective than Cinnamon Toast Crunch.

I'm resisting the urge to write a parody, like I did here in an attempt to get across the proven effectiveness of chocolate milk.

Some may read this and judge me a dimwit. What about high fructose corn syrup? What about the ratio of protein to carbs and the milk, with it's supposed suboptimal amino acid profile?

What about the fact that after intense exercise, your body benefits greatly from a surge of insulin with some easily digested carbs and protein in store. How about worrying a little more about getting the rest of the week right, eating and drinking mostly non horse-sized portions of unprocessed foods, before ruminating the minutia of post workout recovery formulas.

Others may read this and go around telling people that Cinnamon Toast Crunch is the "secret" to fat loss, muscle gain, and many other great mysteries of the universe. But make no mistake, Cinnamon Toast crunch is primarily good for, above all else, cinnamon sugary goodness. And it happens to fit the bill for a moderate amount of high glycemic carbs and protein.

If you're regularly training hard for the purpose of weight loss, have a bowl of cinnamon toast crunch. Go ahead after a workout, because that's the time when eating a moderate amount of pretty much whatever you want will actually work for you.

If you're training hard for the purpose of gaining size and strength, have two bowls of cinnamon toast crunch and a normal dinner an hour or so later. The common themes here include regular, hard work and Cinnamon Toast Crunch. Hard work, not like the recumbent bike or a stroll through the mall. Hard work, like, there were at least a few points where you felt pretty miserable and would have loved to lay down and create a pool of sweat on the floor.

The timing is important. Total calories count, and you don't want to eat like that all the time, whatever your goals. But it can totally work for you. And since the window of optimal recovery is open for about 30 minutes immediately after exercise, better go get you some

cinnamon and sugar
we're baking up a bunch
baking homemade taste
in the Cinnamon Toast Crunch.

Testimonials. Do you really need to see a series of exaggerated and completely fictitious testimonials?

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This week I'll be speaking to pre-physical therapy students at Messiah College about interpersonal skills in the clinic. I'm certainly not the expert on this, but chose this topic because:

1) It's relevant for all health care providers and especially so for this profession. It applies on a daily basis whether you're a PT or intern or volunteer. I succeed and fail with this stuff every day.

2) It's not another academic fact binge. They're probably getting their fill during all the rest of the time they have to sit and listen to middle aged people talk.

3) Although things may have changed since I was in school, interpersonal skills don't get much coverage, at least not practical, realistic, honest attention.

So for 30 or so hopefully not too boring minutes, it's gonna go a little something like this...

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The American Physical Therapy Association attempts to summarize the essence of physical therapy with a little blurb under the APTA logo. Has anyone seen it?

"The science of healing. The art of caring."

I think it's great. I REALLY like that motto. What therapist (or any health care provider) wouldn’t do well to take it seriously and examine themselves by it? 

How do you feel about "art" and "caring" being put up there with equal status of "science" and "healing?" 

Things may have changed a lot since I was in school almost 10 years ago, but I would bet my gluteals that all of you can guess if it was "caring" or "science" that occupied 99 percent of training. We heard a lot about ethics and codes of conduct, but nobody even tried to teach us how to care. I can understand why it's that way, and I'm not so sure it could be any other way (especially at a state school). 

The assumption, I guess, is that you do care. You want to help people, right? But I can tell you that when you're put in any kind of competitive environment; when you're asked to walk the line between efficiency and quality of care; when you're up against a schedule full of folks with arthritis on a rainy day and everyone is achy, the caring isn't always foremost on your mind. 

Art, really? What professor or clinical expert confesses to art? Are you going to mention your artistic ability during entrance interviews? Maybe you should.

In defense of science

There's no substitute for clinical competence. All else being equal, what person with a miserably sore knee would pass on a top clinician with poor bedside manner in favor of a kind chap who uses the Magic 8 Ball in his clinical decision making? 

There’s a reason why much of our weight is planted on science while art barely gets a toe touch. We believe that PT can help many people function and that it makes sense economically. We believe that our methods are reliable and valid. But believing does not make these things true. After all, therapists have a vested interest in doing a good job, even if their “caring” only concerns themselves.

Art and caring are soft and non empirical. Neuroscientists may track electrical activity in the brain that are vague evidence of some thoughts, but who can calculate caring? You can quantify caring no more than you can see a ground reaction force. Employers and insurance companies don't reimburse you for caring.

The caring of science

Or do they?

The problem with the above scenario is that all else is not equal. The bridge between science and caring is the reality of two whole people. Go ahead over to Medline and search "bedside manner." Notice the number of studies that pop up, and the trouble they have with even defining, much less studying bedside manner in purely humanistic terms. 

Caring isn’t just the spoonful of sugar that makes the medicine go down. It's a vital ingredient in the medicine itself. It’s science that now confirms and helps us understand the complex interaction between the body and mind. Among many mysteries, we now have an inkling to how experience, expectation, stress, and other purely mental “events” have an effect on pain perception and other facets of healing.

So we're learning and practicing in terms of clinical pathways, prediction rules, and confidence intervals. And the patients...nobody cares. Really, nobody cares about how much you know until they know how much you care. In a decade of treating patients, I can tell you that people, whether they want to admit it or not, care far more about how you make them feel as a person and how you satisfy their personal needs than they do about how well written and effective your treatments are. Just watch. You don't need an MRI to see that.

So care, damn it

If healing and caring are a package deal that were never meant to be sold separately, what are some practical suggestions for caring?

1) Stand on evidence, yes. You have to. But stand at the edge, where you can still reach over and wrap both arms around a whole person in need of some caring (the hug may be metaphorical at times).

2) Our caring should have feet. External validity, if you will. Does your life generally validate your work? Do you highlight research journals on weekends and catch yourself analyzing the gait of strangers? Does your physical appearance affirm that you know something about body maintenance and repair? Do you offer your services to your closest friends and your own mom for no other reason than because you think you can help?

3) Maybe you need to seek or create an environment that leaves a little room for art. This may be difficult to do as a student, but again, watch and learn. I'm certainly aware of clinical models that have PTs "treating" four patients every hour, many of those patients going out and telling their friends that rehab doesn't work.

4) Do you care enough to look them in the eye and listen? Part of INTERACTING "in a confident yet respectful  manner" entails your mouth being shut. Wisdom knows how to pull off engaged listening without getting caught up hearing about a sisters sons cat for the third time. I could certainly use some help here. But I can say that if your caring is mostly just about your competitive drive and need to defend your chosen profession and pay the bills, the clients can tell. And sooner or later, so will your "outcomes."

5) It all counts-the type of person you are developing into along the way toward your PT license. Credentialing exams don't test you for caring, by the way. I think that seeing PT as a calling is the only route to this caring. Otherwise, it’s just a bunch of knees and backs and shoulders. I suppose it's possible to get by that way, but it can't be very easy and rewarding. Or fun. 

The logo captures far more than the academics of PT. I’m humbled and challenged.

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