Archive for the ‘Sports Medicine’ Category
Ankle Flexibility is Key to Performance
Monday, May 2nd, 2011.jpg)
Research shows that all athletes need at least 20 degrees of dorsiflexion in their ankles to maximize speed and prevent injuries. Most of the time when I tell this to coaches or patients, I get a blank stare back and they ask what in the world “dorsiflexion” is. Simply put, dorsiflexion of the ankle is the motion where you pull your foot back towards your body — the opposite of pointing your toes. This motion is vital for running, cutting, jumping and even proper throwing/pitching mechanics.
Most Americans have very limited dorsiflexion in their ankles, regardless of their age or activity levels. We see just as many tight ankles in our youth athletes (even grade school age!) as we do in sedentary adults. The reason we all tend to have tight ankles is because most people tend to overuse our gastrocnemius (posterior calf) muscles and underuse our glute max muscles as we walk, run and jump.
For a while, we’re able to fool ourselves and maintain performance without using our glute max for power. We just use more calf power. But after a period of time, the gastrocnemius muscle starts to fatigue, develops scar tissue and loses it’s strength because it starts to tighten, reducing our ankle flexibility. Sometimes you’ll notice tenderness or a decrease in speed. At other times, you simply won’t continue to improve your performance – you will plateau or become sloppy and have no idea why.
Pro Stretch Device
For prevention, I always encourage all athletes to make sure they regularly stretch their posterior calf muscles by using a stretching strap, runner’s stretch or using the Pro-Stretch device. In addition, using “The Stick” or the foam roller on the area can also help keep the muscles lose and flexible by working out knots. But don’t stop at stretching…make sure you are actively working on strengthening your glute max muscles through squats, lunges or kick-back exercises. The stronger your glute max, the less you will overuse your gastrocnemius muscles and the looser your ankles will be.
If you try these stretches and exercises and don’t see improvements within a few weeks, it’s very possible that you have been tight so long that you need professional help to get your flexibility back. In our practice, we see good results using Graston Technique, Kinesiotaping and even manipulation of the ankle combined with glute strengthening. Often the patient is able to return to 100% or even reach new levels of performance once they acheive proper flexibility.
How many repetitions does your back have left?
Tuesday, April 19th, 2011
I was recently listening to a webinar by Stuart McGill PhD, a researcher in Canada who has made it his life’s mission to solve the puzzle of low back pain. He was speaking about recent research that has shown that flexion-type exercises such as sit-ups, crunches or ab machines increase lumbar disc degeneration by overloading the delicate structures of the low back.
For the past year, we have eliminated the use of all flexion exercises in our rehab department and also have been encouraging patients not to do sit-ups and ab machines at the gym — especially if they already have low back pain. Sometimes it’s hard to convince patients that there is inherent risk with these exercises. After all, we all have been doing sit-ups since we were in PE class.
Dr. McGill used an example that I think will help patients better understand why flexion exercises increase risk for low back pain. If you wanted to make a break in a wire hanger, what would you do if you didn’t have wire cutters? You would repetitively bend the hanger at the spot that you wanted it to break. After a few dozen bends, you would have two pieces of wire hanger. Mission accomplished.
The lumbar spine (low back) has the same properties as that wire hanger. Every low back has a limited number of “bends” until something breaks. The number of “bends” each back has in its capacity is predetermined by genetics and other injuries that we may have experienced over the years. Since we all need to flex forward to accomplish certain movements and tasks, the best strategy to avoiding low back pain is to limit flexing to when we need to do it — not burning up thousands of repetitions through sit-ups.
So instead of using up your reserve through sit-ups (which are very ineffective ab exercises, by the way), investigate the use of bridging, planks, bird-dogs and other dynamic floor exercises which have been shown to prevent low back pain by stabilizing the spine — avoiding flexion. And as always, if you have questions on how to add this into your home exercise program, please let us know and we’ll be sure to set aside time to assist you!
Easy test for hip strength can predict knee pain risk
Tuesday, April 5th, 2011Knee and thigh pain are some of the most common complaints that we see in our pediatric and adult athletic patients, whether they run track, play softball or compete in triathalons. Many times, patients will come in with a stack of CD’s containing MRIs, x-rays and other testing done on their leg to no avail — they’re still in pain. Since nailing down the exact cause of knee and thigh pain can be tricky (especially if there is nothing showing up on imaging), chiropractic sports physicians and other rehab specialists started testing various hypothesis on how muscle imbalances in the hips and legs might contribute to knee pain.
Proper positioning during the SLST
One of these hypothesis is that weakness in the muscles that abduct the hip (keep the thigh from tilting towards the midline) creates additional pressure on the thigh and knee, creating additional wear and tear along the backside of the patella. To test the strength of these hip muscles, we have the patient stand on one leg and perform a small squat or dip, keeping the torso perpendicular with the ground. If the hip, knee and ankle all stay in one line during the test, the patient’s hip strength is good. If the knee moves towards the midline during the test, the patient’s hip strength is poor. This test is called the Single Leg Squat Test (SLST).
Athough this hypothesis has been working well for doctors in a clinical setting, researchers at the
Failing position during the SLST
Melbourne School of Engineering in Australia wanted to test the reliablity of the SLST for measuring hip strength as well as predicting risk for knee pain. In the February issue of the American Journal of Sports Medicine, their study was published and it confirmed that the SLST was a reliable tool and also can identify those at risk for knee pain. What’s even better about the SLST is that it doesn’t cost anything to perform and can be done by the sports doctor in 60 seconds — much easier than spending thousands of dollars on MRIs and CT scans.
It’s important to see a doctor who is familiar with sports injuries and also is up to date on the latest diagnostic and treatment methods to get you back to your sport as quickly as possible. Although family practice and immediate care physicians are great at detecting fractures and life threatening conditions, they may not be up to date on functional strength tests such as the SLST and possibly miss the true cause of your knee pain.
If you have knee pain or think that you might not pass the SLST, feel free to email me at drerin@ducatchiropractic.com and I would be glad to answer your questions. Remember the longer you compete on an injured or weak area, the longer it will take to get back to 100%!
3 Steps to Prevent Fitness & Sports Injuries
Wednesday, March 9th, 2011This article was originally written to be published in “The Park Bench News” for the Bloomingdale Park District this Summer. As every one is becoming more active with warmer weather around the corner, I thought that all of you might find these tips helpful.
“An ounce of prevention is worth a pound of cure.” Most doctors and patients agree that it is much easier to prevent an injury than to fix it after the damage is done. But when it comes to fitness and sports-related injuries, patients are often confused by the newest training fads and don’t know where to start when it comes to prevention.
As the sports medicine provider for the Bloomingdale Park District, I have been able to identify three easy steps that anyone can take to prevent spinal, shoulder, arm and leg injuries while being active — no matter what your age or where your fitness level is.
1. Make Stretching A Daily Habit
We need flexibility just as much as our cats or dogs do. The problem is that we rarely stretch on a daily basis, unlike Fluffy or Fido. Starting a daily stretching program is vital for injury prevention. Learn how to stretch by watching the videos posted on www.ducatchiropractic.com under “Injury Prevention”.
2. There’s A Reason It’s Called Proper Form
No matter what exercise or sport you’re participating in, it’s important to make sure that you understand how to properly perform the movements involved. Small changes in angle or speed can create dangerous pressures on your muscles and joints. Talk to a personal trainer or ask your coach to help you perfect your form and you’ll prevent injuries while improving your performance.
3. Never Work Through Bad Pain
The motto “No pain, no gain” is only true if the pain you’re experiencing is good muscle soreness that comes from working out. If you notice that your pain is sharp or lasts for more than 24 hrs, you need to rest, stretch and ice the area, not work through the discomfort. Visit a sports physician if the pain persists for more than two weeks or is accompanied with trauma, swelling, numbness or tingling.
Although you can never entirely prevent discomfort while working out or playing sports, following these simple guidelines have been shown to decrease the chance of injuries. Just make these steps a part of your healthy lifestyle and enjoy your activities with fewer interruptions!
Which is more important? Flexibility or Strength?
Tuesday, March 1st, 2011In the field of sports medicine, there are generally two camps of thought: doctors who think a lack of flexibility is the cause of most injuries and doctors who think a lack of strength is the cause of most injuries. Those two groups of doctors influence athletic trainers, personal trainers, coaches and parents to either teach their athletes to be constantly stretching or constantly strengthening. Since these two camps have been entrenched in sports medicine several years, we are now able to see if an emphasis on stretching or strengthening helps prevent athletic injuries. Interestingly enough, athletes in both groups have just about the same number of injuries.
So does that mean that stretching and strengthening are both a waste of time? Although it’s easy to make that argument, new research is now showing that both flexibility and functional strength play a large role not only in injury prevention, but in athlete performance as well. The problem is that many of the measurements that we commonly use on athletes to guage their flexibility and strength are looking at the wrong parameters.
Take for instance the sit-and-reach test. This tool has been used to measure athlete flexibility in sports ranging from baseball to track to basketball. The test itself is flawed. Although we think that we are measuring pure hamstring flexibility (hip flexion), we are really measuring hamstring flexibility coupled with low back flexion. Just look at this picture. See how the low back is rounded? That biases the results and doesn’t tell you anything about your athlete’s true hamstring flexibility.
On the strengthening side, many times we monitor how much our athletes can chest press or squat in the weight training room. What do those movements have to do with your athlete’s pitching technique or running efficiency? Little to nothing. Those strengthening exercises train athletes for gross strength (big, powerful movements), not agility or core strength (small, fine movements that protect from injury and also increase performance).
In response to this new research, there is a new movement in sports medicine called functional strengthening. The keystone of this philosophy is that we need to measure athlete risk by taking them through functional tests that include both flexibility and agility/core strength parameters to determine areas that are tight, tender, weak or deconditioned. Examples of these tests include the squat test (pictured here), and wall angel tests.
If the athlete can pass these tests, their risk of injury is very low and can often continue with a basic strength/conditioning program. If the athlete cannot pass these tests and are pain-free, they can start an individualized training program to loosen restricted areas and increase strength in their weak spots. Often they are released from the individual program within 4-6 weeks and can then continue with a basic strength/conditioning program. If the athlete cannot pass these test and has signs of injury/pain, they need to start rehabilitation ASAP (even if the pain isn’t stopping them from competing) to reverse these tight/weak muscle patterns and prevent a career-ending injury.
We take every patient (athletic or not) through these functional tests so that we can not only help eliminate their pain, but prevent it from returning by treating it from its source. As part of our sports clinic outreach, we also conduct workshops for coaches and athletic trainers on the basic functional tests and how to triage injuries so that they can help their athletes improve performance and return to play. If you have further questions on functional strength testing or would like us to come conduct a workshop for your group, please email drerin@ducatchiropractic.com.