Dr. Keith J. Cronin, DPT, OCS, CSCS, has been a physical therapist for nine years and owns a niche distribution and education company in Denver called Sports and Healthcare Solutions, LLC. He works with innovative clinicians and companies from around the world to offer effective rehabilitative products and strategies that maximize patient outcomes. In 2018, Dr. Cronin will launch Biomechanikits, a distribution platform that combines quality education, great products and competitive pricing. He also serves as a consultant for Dynamic Tape and a CEU instructor/course designer for PTWEBUCATION.com. Dr. Cronin first became aware of HawkGrips about four years ago and soon implemented them into patient treatments. He’s a passionate advocate of combining the instruments with biomechanical taping, and is very enthusiastic about the groundbreaking new water-based emollients HawkHydro and HawkHydro+.
How would you describe your physical therapy background?
I graduated from Belmont University in Tennessee with my doctor of physical therapy (DPT) degree in 2008. Since then, I’ve worked in a variety of different environments that helped prepare me for my current roles. I started in direct patient care and eventually became a manager for about four or five years, which enabled me to see more of the business side. I’ve also done a lot of writing and had more than 100 posts published by MomsTeam.com. In addition, I’ve run four online courses focusing on ACL injury and rehab and have been part of a PBS documentary on concussions.
When were you first introduced to HawkGrips?
About four years ago, because HawkGrips was conducting instrument-assisted courses with one of my previous employers. The first couple times, I honestly thought it was a bunch of malarkey. That was back when I believed all I needed was my brain and hands to fix anybody. But my mind began changing when I started to get cramps and trigger-finger from providing manual treatments.
At that time I was only about 30 years old and thought if I was already starting to hurt at work, it just wasn’t sustainable for a career. So one of my coworkers used ASTYM plastic tools, and I decided to give them a shot. Until then, I was probably overly evidence-based and thought I needed to see all the research instead of just figuring out how to utilize something correctly. So I tried her tools and thought it was an easier way to provide treatment, because it let me pinpoint what I was looking for and allowed for better coverage of large treatment areas.
So then I went to an instrument assisted soft-tissue mobilization (IASTM) course and was pretty impressed by what you could do with metal tools. That actually led me to attend more product-oriented courses in general. My instinct previously had been if a product cost money, I wasn’t interested. But I began to look at it from a different perspective: How will this provide a better experience for my patients and me as a clinician?
So once I started using HawkGrips, I just really liked them better than other tools I had tried, which included Graston and ASTYM. I’d say they’ve cut down the workload for my hands by about 50 percent. I stopped getting trigger finger and having soreness. Most importantly, when I did treatments where I had to put effort into using my hands in a certain spot, they felt fresher and less worn out.
I found that to be a huge benefit. So for anybody out there who is skeptical of tools and why you would spend money on them, the main reason is because they perform the same way every time. As a clinician, just as your hands are your instruments, the tools become an extension of you. So they need to perform consistently and that’s what I’ve found with HawkGrips.
What is your current involvement with HawkGrips as a company?
I helped them in a consulting role for their new water-based emollients, HawkHydro and HawkHydro+. My advice focused on the consistency, tack vs. non-tack, marketing, what rehab clinicians and companies are looking for and why. The greatest benefit of utilizing HawkHydro rather than a traditional emollient is infection control. If you ever speak with someone who manages a JCAHO-accredited [Joint Commission on the Accreditation of Healthcare Organizations] facility, the amount of paperwork just for daily operations is astonishing.
There needs to be a system for everything you do, and traditional emollients can potentially harbor bacteria. In physical therapy, generally we don’t do much that could cause infection control issues with a patient. But when you’re part of a hospital-based provider, you have to meet the same standards as the hospital. So in a JCAHO-accredited facility, there’s a procedure for emollient where you’re supposed to put on gloves, use a tongue depressor to scoop and apply, then throw away the depressor and close the container immediately.
You also have to sign and date a form indicating when the emollient was used, and discard any unused portion within one month after opening the container. So all of this needs to be recorded in a log, plus you have to conduct training seminars with your staff about these procedures and they have to sign off on receiving the training.
It’s all very time-consuming, and to make matters worse if JCAHO conducts an inspection and finds any bacteria in the emollient, you could be in a lot of trouble. So realistically that’s just too much work and effort for the sake of putting something on the end of a tool. HawkHydro changes everything because it’s a closed container. So you don’t have to worry about what goes in it, there’s a twist-top so you never have to touch the tip, and the tip never touches the skin. You squeeze it, the lubricant comes out and you close it, so there’s no possibility of contamination. Now you’ve just removed the need for seven pages of paperwork and three training seminars a year.
What is the benefit of utilizing emollient when providing IASTM treatment?
If you use nothing, the skin will become irritated. The reduced-friction surface created by emollient is what allows a clinician to start feeling the adhesions underneath the skin and soft tissue. That ability becomes enhanced through training and repetition. The general consumer probably wouldn’t be able to detect discrepancies that well. But when you’ve done something 100 times, it’s easier to tell where the problem is.
How can HawkGrips be combined with biomechanical taping and why is that beneficial?
I think biomechanical taping and IASTM with HawkGrips work phenomenally together. So much so that I’ve actually taught several weekend-long courses for large PT groups about the combination treatment. Because anybody who comes into therapy is usually stuck somehow in what we call the pain inflammation cycle. So they feel pain and are just not getting better. Research has concluded that after an orthopedic injury, 85-90 percent of people will recover on their own within three months. So by the time a patient shows up at our door, they’ve generally been having problems for months if not years. As a result, it’s typical to find adhesions, poorly laid tissue, as well as problems with pain, bad movement and poor functional patterns.
So when you put biomechanical taping and HawkGrips together, something very interesting happens. The instruments do a phenomenal job of breaking up soft tissue problems. They can also create mechanical transduction, where you actually push on the skin to cause an immediate change in pain by reducing the information transmitted to the brain that says something abnormal is occurring. You could try it with your hands but the angulated tools get into the tissue better. So that addresses one half of the pain inflammation cycle. The other half is poor movement patterns and abnormal loading. From those two conditions, you get poor neuromuscular firing and tissue breakdown.
Probably the best example is if somebody has tennis elbow that never heals because the tissue just keeps breaking down through constant overload. So you use the instruments to break up adhesions and immediately reduce some of the pain. Then you apply Dynamic Tape, which acts like a bungee cord by reducing the workload through the muscles, and decreases the overall load. If there’s less load going through the tissue, perhaps now it has a chance to heal. When utilizing the two treatments in conjunction, the first two weeks are most critical. Not because the condition will completely heal during that time frame, but it’s when you have the opportunity to gain a patient’s trust because they start to notice improvement.
Another nice thing is when you utilize HawkGrips in the clinic and apply biomechanical taping on a patient to go home with, you’re implementing clinical strategy even when the patient isn’t with you. So if they come back and say they feel better, worse or no different, but the tape is still on and has been used correctly, you now know what to do.
In the past when you asked a patient if they performed their home exercises, they might say yes but you wouldn’t really know if that was true. In this case, with a high-quality tape that’s soft and has a strong recoil, I know how it functions. So if it’s still on when the patient comes back to my clinic, I know it made an impact. That knowledge is extremely important because if you have the right information, you can create the right treatment strategy.
Which conditions do you believe HawkGrips are most effective in treating?
I would say anything in the category of an “opathy” or “osis.” So for example, tennis elbow, Achilles tendinopathy, plantar fasciitis, and chronic rotator cuff pain. I also love it for chronic low back pain. You’ll notice the chronic theme, because as rehab specialists we see those patients the most. People might think sprained ankles or wrists are the common conditions we encounter but that’s not really the case, since many of those injuries tend to heal just fine without professional help. Patients with chronic conditions are far more typical. Utilizing combination techniques with IASTM instruments and tape as part of an overall treatment strategy can address 95 percent of the people who walk through the door, and that’s pretty cool.
How would you characterize your interactions with the HawkGrips staff?
They’ve been fantastic. My original conversations with [HawkGrips President] Frank Osborne and [HawkGrips COO] Sean MacNeal go back a long time. They initially contacted me about how to start setting up educational courses, which was before I began working for Dynamic Tape or established my consulting company. They were nice and straightforward, and I said I’d be happy to help. Since then, we’ve continued working on various projects together, such as combining some of our course materials for different events. They’ve always been extremely helpful to me, opening doors throughout the country, and it’s very rare to work with people like that.
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The human skin is the the largest organ of the integumentary system. It is enriched with dense neurological tissue that permeates the entire body and provides a uniquely accessible means of influencing tone and function of underlying structures. Fascia and muscle generate and transfer kinetic energy in an environment by which functional movement relies on a combination of elastic recoil and eccentric control around a focal, multi-planar axis.
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