Category Archives: Injury prevention

The Long Femur and Squat Mechanics

The squat is one of the best exercises to improve performance, period. Athletes incorporate the squat into their workout regimen because it increases strength and power of the entire lower extremity and significantly activates the core muscles. Unfortunately, performing the squat improperly can lead to significant injury.
Without getting into too much detail, there are 4 main reasons why a person may not be able to squat with good technique.
 
  1. Poor ankle mobility, primarily dorsiflexion
  2. Poor hip mobility, primarily hip flexion and external rotation
  3. Muscle weakness/muscle imbalance of the lumbo-pelvic-hip complex
  4. Long femur (a high femur to torso length ratio or high femur to short tibia ratio)
 Three of the above can be fixed with corrective exercise. This might shock you but there is no corrective exercise program that will lengthen the torso and shorten your femur (yes, that is sarcasm). Unless you are skilled at removing portions of the femur with a chainsaw you’re not going to fix #4.
Squatting with a long femur can lead to low back injury. In the image here you can see that the individual with the long femur has an increased forward lean. The excessive lean increases load at the low back.
I love the video here. If you move to the 3:40 mark the video shows an individual squatting with long femurs squatting.

It drives me bonkers when a provider (athletic trainer, personal trainer, therapist, etc.,) attempts to correct a client’s squat mechanics by forcing changes in items 1, 2, or 3 when the real problem is the unfixable number 4. Before you waste a client’s running them through a corrective exercise program make sure it is something that can be fixed.
If you have a long femur to short torso ratio you do have options!
  1. Widen the stance
  2. Externally rotate the legs
  3. Raise the heels
 If you continue watching the video (around the 5:30 mark) you will notice how the individual’s squat mechanics are improved by making subtle changes in body positioning.

All of these options change the lever arms and evenly distribute the weight between the low back, knees, and feet. Thus, one joint is not excessively loaded more than the others. You can try adjusting one of the above items or mix and match any three of the above.
 

The Squat: Should Your Knees Travel Past the Toes?

Should the knees migrate past the toes when performing a squat? I posted this question on downloadsocial media, and the immediate response by most was “No!”. I expected this answer from most everyone, from novice to advanced lifters. To you, I happily say, you’re wrong! The debate on proper squat mechanics will never die, but I am going to steal a line from Randy B., an athletic training, and performance enhancement peer, who answered my question: “Absolutely, [the knees] should [go past the toes]. Don’t believe urban legends or follow sports med sacred cows!” I couldn’t have said this any better! Randy is spot on. This urban legend could lead to injury. The purpose of this blog is to shed some light on the debate and provide the rationale for proper squat technique.

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Knee Osteoarthritis and ACL Injury

ACLSix months (+/- a few) is the standard time needed for an athlete to return to competition following anterior cruciate ligament (ACL) surgery. To reach this date, therapy must be thorough and exact. Range of motion, neuromuscular control, or strength deficits that go unaddressed, negatively influence return to play and can also lead to other long-term consequences.

Those who suffer from ACL injuries are at greater risk of developing knee osteoarthritis (OA). Knee OA is a condition whereby the cartilage slowly wears away. This is a painful, life-long health issue that can lead to disability. With proper rehabilitation and adequate strengthening of the quadriceps, OA can be prevented. Sounds simple, but clinicians must also deal with arthrogenic muscle inhibition (AMI).

ASpinal tractMI is a neuromuscular dysfunction that limits the ability to strengthen muscle and is common following ACL surgery. With AMI, neurological signals from the quadriceps muscle to the brain and spinal cord are interrupted or slowed. You can read more about Brain and CNS deficits here.  So the question is, how do you combat AMI to properly strengthen the quad and subsequently prevent knee OA? The answer might be vibration training.

Vibration training employs a low-amplitude, low-frequency mechanical stimulation that exercises musculoskeletal structures. Vibration training provides strength gains without joint loading and stimulates osteoblastic and chondrocyte activity through the mechanisms of  Power Platemechanobiology. Subsequently, bone and joint health are improved.

A recent article by UNC’s EXSS Impact site found that vibration training (local or whole-body) improves quadriceps function by improving central nervous system function. Following vibration training, brain activity was altered in such a way that it became easier for these subjects to activate and use their quadriceps muscles. As such, muscle vibration can be an effective method to improve quadriceps strength and reduce the risk of developing knee OA.

Below is the full article from UNC.

Why did you do this study?

Individuals with anterior cruciate ligament (ACL) injuries are at greater risk of developing osteoarthritis (OA). OA is a considerable burden on the US healthcare system and contributes to physical disability and comorbidities such as obesity and diabetes. The lifetime cost of ACL injury amounts to $7.6 billion annually for patients that undergo reconstruction, $17.7 billion for patients that undergo non-surgical rehabilitation. Quadriceps dysfunction is ubiquitous following ACL injury and reconstruction, and is a major contributor to the development of OA. The quadriceps are responsible for absorbing impact forces during everyday tasks like walking and stair climbing, and also athletic tasks like running and jumping. When the quadriceps fail to act appropriately, their ability to attenuate these forces is reduced, and cartilage within the knee joint experiences greater loading. Subtle increases in joint loading are amplified through repetitive activities like walking, and over time, greater loading contributes to a gradual breakdown of articular cartilage.

Given the implication for future OA development, the restoration of proper quadriceps function is extremely important in rehabilitation. However, quadriceps dysfunction is caused by a neuromuscular phenomenon called arthrogenic muscle inhibition (AM), which presents a substantial limitation to muscle strengthening. Essentially, sensory signals from the knee joint inform the central nervous system – the brain and spinal cord – that the ACL as been injured. In response, our central nervous system responds by inhibiting the quadriceps to prevent further damage of the injured joint. While this mechanism may protect the joint in short term, AMI persists for many years following the initial injury and is thought to contribute to excessive cartilage loading and the development of OA. Therefore, strengthening the quadriceps is important in rehabilitation, but traditional exercises do not address AMI. Novel rehabilitation modalities are needed to combat AMI prior to the implementation of strengthening exercises.

Previous work in our laboratory indicates that muscle vibration provided directly (local muscle vibration – LMV) and indirectly (whole body vibration – WBV) may improve quadriceps function. However, what remains unclear is the mechanism by which these vibratory stimuli actually work to enhance muscle function. Given that AMI involves alterations in central nervous system function, it is imperative to understand how muscle vibration influences characteristics of spinal cord and brain function. Therefore, the purpose of this study was to understand how both WBV and LMV influence characteristics of central nervous system function.

What did you do and what did you find in this study?

Left - Transcranial magnetic stimulation to assess cortical neuron excitability; Right - Whole body vibration platform

We recruited subjects with ACL reconstruction for this study. First, we measured various characteristics of quadriceps function (i.e. strength and activation), and also how the brain and spinal cord contribute to muscle contraction. Following baseline measurements, subjects received an intervention of WBV, LMV, or control (no vibration) treatment. We repeated the same measurements of quadriceps function and central nervous system function following the treatment.

Active motor threshold was used to assess corticomotor excitability. In this case, both WBV and LMV lowered AMT relative to the control condition. This indicates that it becomes easier for the brain to activate the quadriceps following treatment. (* indicates P<0.0083)

We found that both WBV and LMV acutely improved quadriceps function (strength and activation) relative to the control treatment, and that this improvement was likely due to greater cortical neuron excitability. In other words, muscle contraction can either be voluntary (the brain tells the muscle to contract) or involuntary (spinal reflex loops). What we found was that following WBV and LMV, brain activity was altered in such a way that it became easier for these subjects to activate and use their quadriceps muscles.

How do these findings impact the public?

These findings indicate that vibratory stimuli acutely improve quadriceps function, and could be useful in addressing deficits in central nervous system function such as AMI. As such, muscle vibration could be an effective method to improve quadriceps strengthening protocols following ACL injury, and in turn reduce the risk of developing knee OA. Overall, knee OA is a major economic burden on the US healthcare system, and these findings could have important relevance for alleviating healthcare costs and physical disability.

A comprehensive rehabilitation program is vital for an athlete’s return to competitive sport. Failure to normalize range or motion, strength, and neuromuscular control can result in performance loss, reinjury, or long-term disabilities, such as knee OA. Make sure your rehabilitation program is inclusive of all components. Of course, the best cure for ACL surgery is preventing ACL tears all-together. If you want to prevent ACL injury, read about the RIDS Program designed to prevent injury. 

12 Booty Exercises to Improve the Back Side

 The glutes (not counting the core) are the single most important muscle group for athletic performance and injury prevention. 

Booty

I prefer a booty that has a functional purpose.

I am an ass man. Not in a sexual context, but in a functional movement context.  I do not care if you are fat, skinny, or look great in a pair of yoga pants. If your glutes function at an optimal level you will have better athletic performance and prevent injury. Over the years, I have worked with a variety of clients and the glutes are a focus for all of my clients. It does not matter what your current fitness level is; if you want to prevent injury, boost performance, or become more fitter, the butt is key.

Ask any client I have trained, and they will tell you that I will destroy your glutes – in a good way. Over time, I have developed some favorite booty-popping exercises.  In clinical research, there isn’t any published data that truly says these exercises are best. What you have here is based on my clinical experience and what I have found to work best. These exercises are designed to give you optimal gluteal function and they might even make you look good in a pair of jeans.

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10 Reasons – Icing Injuries is Wrong

iceIf you know me, you are aware of my anti-ice stance. The ice debate continues to heat up. As peer-reviewed data continues to pour in, the evidence for the use of ice to treat musculoskeletal injury still lacks. I’ve written about ice many times, but many of my anti-ice articles are science-y and focused around one topic. I wanted to do something different this time. I wanted to keep it short, sweet and comprehensive. So, I bring you 10 reasons why we shouldn’t ice injuries. Continue reading

15 Myths and Facts for Runners

runningRunners are a very particular type of athlete and will try almost anything to run longer, faster, and remain injury free. Unfortunately, there is a lot anecdotal and pseudoscience being pulled from the internet that leads runners astray. In this article I talk about the biggest myths and facts in running.

  1. Static stretching decreases performance.

MYTH: A study done a few years ago demonstrated static stretching reduced power output and performance. Suddenly, performance experts started saying “Static stretching is the worst thing you can do.” This is not true! These people just misinterpreted the facts.  The data stated that performance decreased when the muscle was stretched for 45 seconds or longer… When a stretch was held for 30 seconds or less – as recommended – there was no performance loss.  A recent study published in the Journal of Strength and Conditioning confirmed this (1). This study found that the threshold of continuous static stretching in which muscular power output decreased was 60 seconds. Static stretching for a short-duration (30 seconds) had a negligible influence on performance.

  1. Static stretching can increase tightness.

stretchFACT:  Muscle is made up of two types of fibers, intrafusal and extrafusal.  Inside the intrafusal fibers is a receptor called the muscle spindle. It’s like a spring-loaded sensory detector. It is a protective mechanism that when over stretched sends a signal to the brain and spinal cord telling the muscle to contract and protect itself, thus making the muscle tighter. Some muscle spindles are overly active causing chronic tightness. So, when you stretch a muscle that already has over active muscle spindle, the tightness can increase. I wrote an article about this phenomena, if you want to read more about that.  I understand this can be confusing, but when you read #3 you will see how all of this comes together.

  1. You should foam roll after running.

Foam Roll TFL

MYTH: Foam rolling or self myofascial release is one of the most effective tools to improve motion and prevent muscle injury. Unfortunately, many runners foam roll after a run. It is just as important, or even more important, to foam roll before a run. As I mentioned in #2, muscle spindles create tightness when stretched. Due to the repetitive nature of running, runners are very susceptible to developing hyper-active muscle spindles. Foam rolling or self myofascial release targets the muscle spindle and inhibits it (hence the term release in myofascial release). Foam rolling overloads the muscle spindle and the nervous system and gets it to relax and turn off. This allows the muscle to be stretched without the muscle spindle becoming overprotective. Every client I see is directed to foam roll first, stretch, then exercise.

  1. Icing or an ice bath after a run helps injury and speeds recovery

MYTH: Inflammation is REQUIRED for the body to bring supplies to worked areas, clean up any debris and help rebuild tissue. When we ice that sore knee, aching Achilles, or painful plantar fascia after a run or workout we are delaying our body’s innate ability to repair that tissue. Yes, icing is not all it is cracked up to be. Even the physician who coined the term RICE (Rest, Ice, Compression and Elevation) has said that icing is wrong. I’ve written many articles about this, but the most recent, explains why RICE is no longer accepted as the cure-all.  If you want to recover, cool down with foam rolling and stretching, and have a few days of light exercise or rest.

  1. Drinking extra liquid will prevent heat illness.

MYTH: In general we overhydrate. Tim Noakes, MD, a long-time researcher of water balance and author of “Waterlogged:  The Serious Problem of Overhydration in Endurance Sports,” says we have been misled to believe that we need to drink to stay ’ahead of thirst’.  Hydration prevents dehydration, but it does NOT prevent heat illness. Dehydration and heat illness have very similar symptoms and often we use the two interchangeably, but they are not the same. If someone is suffering from heat illness, giving them water is not the answer, cooling their body temperature is. Giving excessive water to a person suffering from heat illness can cause a serious or fatal event called exercise-associated hyponatremia encephalopathy (EAHE).   Marathoners and distance runners who drink at every aid station or drink excessively before a run put themselves at risk for this condition. Dr. Noakes states we should aim for ingestion rates that never exceed 27 ounces/hr (2). 20140501More about our hyper-hydration nation can be found in this article.

 

  1. Dehydration kills performance.

MYTH: It’s long been held as fact that losing more than 2 percent of bodyweight to dehydration will hurt performance. But several recent studies, as well as anecdotal evidence from the world’s top runners, suggest it’s possible to lose more than 2 percent with little to no detriment to performance. A study in the British Journal of Sports Medicine found that current hydration guidelines are erroneous and that dehydration does not impair performance (3). In this article the authors found weight loss of up to 3 percent did not slow down athletes (cyclists, in this case) or lower their power output.  Finally, in 2012 a study found that Haile Gebreselassie lost a whopping 9.8 percent of his bodyweight during the 2009 Dubai Marathon—and still won, in 2:05:29 (4).

  1. Energy chews prevent bonk or fatigue.

FACT: But don’t be fooled: Energy chews do work to prevent fatigue during long distance running events, but so do raisins!  A study published a few years ago compared raisins vs. energy gummies. There was no difference in performance between the raisin group and the gummy group. In addition, the raisin group showed a lower insulin spike when compared to the gummy group, a win for the raisin. Plus, the raisin group demonstrated higher free fatty acid content in the blood post activity, demonstrating more fat metabolism. So, for the same performance gains, you can gain additional benefits from raisins over energy gummies.

  1. Bananas prevent cramps

MYTH: While bananas are a great source of nutrition and do contain many electrolyte replacing nutrients, they alone do not prevent cramping. Cramping can be caused by a large number of reasons, including over hydration (see above) or poor conditioning. Tim Noakes, MD, in Lore of Running, 4th Edition, suggests muscle cramps are caused by muscle fatigue and that cramping has more to do with not training properly than nutritional or hydration deficits.

  1. Runners need to strength train.

FACT: Running strengthens your muscles, but it only strengthens certain muscle fibers to a certain degree. A total body strength training is imperative for running performance. Strength and stability of the core and shoulder help translate to lower body power and efficiency. If you need a kick to climb a hill faster or sprint to beat an opponent to the line, strength training is imperative. Proper strength training and targeting specific muscles will also prevent injury. John Martinez, the assistant head doctor for the Ironman World Championships says “You can run five days a week and you’ll finish a marathon, but if you want to PR or qualify for Boston you need to have some kind of strength training in there. It’s about improving our performance.” Always add a strength training component to your training program. Running alone is not enough.

  1. Running is the best way to lose weight.

Graphics like this misguide those seeking weight loss.

MYTH: You’re being duped folks! Long duration cardio training does not make you lose more fat or weight. Running in the “fat burning zone” as depicted on a cardio machine does NOT burn more fat. If you want to lose weight, you need to burn calories. What burns calories? Intensity! Higher intensity requires more oxygen demand and thus a greater oxygen debt.  High intensity training has a caloric after burn that lasts for 12-24 hours. Standard steady state running only has a caloric after burn of 1-4 hours. You can burn more calories in a 20 minute high intensity interval training program than you can running for 60 minutes at a steady pace. If you want to lose weight, get off the treadmill!

  1. Minimalist shoes improve running mechanics and prevent injury.

vibram-shoes1MYTH: Will the minimalist running trend ever end? Minimalist shoes do not prevent injury. In fact, those who jump from a normal shoe to a minimalist shoe without proper training or adaptation are at an increased risk for injury. Five separate studies presented at the annual meeting of the American College of Sports Medicine “found no significant benefits, in terms of economy, from switching to minimalist, barefoot-style footwear.” Minimalist shoes also do not magically improve your running mechanics. There are no quality studies that show running in a minimalist shoe improves mechanics. In order to improve mechanics, you need a quality strengthening and flexibility program that encourages appropriate muscles firing. If you want to go the minimalist route, walk first. Adapt to the new style and supplement with a structured training program.

  1. Getting a shoe that matches your arch height will prevent shin splints.

MYTH: Shin splints are not caused by a high or low arch. Many runners with a high or low arch can avoid shin splints. Similarly, runners with a “perfect” arch can develop shin splints. The cause of shin splints is multifactorial and correcting musculoskeletal dysfunction through a structured program prevents shin splints. The article Shin splints 101 demonstrates how to prevent shin splints. A systematic literature, published in the Journal of Sports Physical Therapy found that selecting running shoes based on arch height had little influence on injury risk. (5)

  1. A midfoot strike is best for performance.

MYTH: If you run slower than a 5-minute mile, it may be most efficient to heel strike. A study published in Medicine and Science in Sports and Exercise found that rear-foot strikers are up to 9.3 percent more economical than midfoot strikers (6). Lead author Ana Ogueta-Alday believes the reason for the improved efficiency stems from the increased ground contact time the study observed in rearfoot strikers. More contact time with the ground allows for more force to be applied, while also decreasing the metabolic cost of running. If you’re a heel striker and haven’t been chronically injured, there’s no need to change your ways.

  1. The more mileage you run per week the better your performance.

MYTH: If you want to improve, you need rest, recovery, and varied training. I challenge you to find an elite marathoner who trains only by running. The elite runners have rest and cross-training built into their weekly programs. See the importance of strength training in item #9 above.  Two of the best known experts on running, Jack Daniels and Hal Higdon, provide run training programs. There programs stress the importance of recovery days and strength training days. In fact, Jack Daniels says that when training for long running events, train for time, not mileage. Getting 20+ miles is not the best for all runners and could cause injury.

  1. Preventing injury is a matter of not doing too much too fast.

FACT: There are many things that can cause injury, but one of the biggest determinants of injury is doing too much too fast. A study in the Journal of Sports Physical Therapy evaluated progression of running distance and its relation to injury. The authors found novice runners who progressed their running distance by more than 30% over a 2-week period seem to be more vulnerable to distance-related injuries than runners who increase their running distance by less than 10% (7). Owing to the exploratory nature of the present study, randomized controlled trials are needed to verify these results, and more experimental studies are needed to validate the assumptions. Still, novice runners may be well advised to progress their weekly distances by less than 30% per week over a 2-week period. So stick with the 10% rule.

If you are a runner and look to increase performance or prevent injury, please feel free to contact me for a free consultation.

References:

  1. Pinto, MD, et al. Differential Effects of 30- Vs. 60-Second Static Muscle Stretching on Vertical Jump Performance. December 2014. 28:12. p 3440–3446.
  2. Noakes, T. Waterlogged: The Serious Problem of Overhydration in Endurance Athletes. Human Kinetics. Champaign, IL. 2012.
  3. Wall, BA, et. al. Current hydration guidelines are erroneous: dehydration does not impair exercise performance in the heat. Br J Sports Med. 2013 Sep 20.
  4. Beis, LY, et. al. Drinking behaviors of elite male runners during marathon competition. Clin J Sport Med. 2012 May;22(3):254-61
  5. Knapik JJ, et, al. Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations. J Orthop Sports Phys Ther. 2014 Oct;44(10):805-12.
  6. Ogueta-Alday, A, et. al. Rearfoot striking runners are more economical that midfoot strikers. Med Sci Sports Exerc. 2014; 46(3):580-5.
  7. Nielsen RØ, et. al. Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. J Orthop Sports Phys Ther.2014 Oct;44(10):739-47.

 

 

Future of Medicine

cocaine1In time everything we do to treat injuries, prevent disease, or reverse disease will eventually change. Think of all the things we used to do in medicine. Cocaine was used for toothaches. In the 1600’s, “hydrotherapy” was used to would wash away insanity in mental patients. Jan Baptist van Helmont would literally drown people to death and then resuscitate, believing that water would cleanse and the near drowning would snap people back to reality. In the 1800’s ketchup was used to treat athletes foot. In rehabilitation science, we use a myriad of techniques that we think is proper today, but overtime, the way we treat will drastically change and I believe it will come sooner rather than later.  Continue reading

Season of Running and Injury

Illinois MarathonIn April, the Boston Marathon kicks off yet another season of running. Whether it is 5k or a Marathon, from April to October running enthusiasts have no trouble finding a running event to participate in. Here in my town of Champaign, some 20,000 participate in one of the Illinois Marathon events. With these races comes training and where there is training, you can find injury close by. Continue reading

The Great Toe

When you think of the most common lower body injuries, you think ankle sprains, shin splints, runner’s knee, jumper’s knee, fasciitis, or Achilles tendinitis. When you have these injuries, you treat the injured area. We might be overlooking a little, but big deal.  Dysfunction in the big toe influences every step you take, every lunge, every jump, and every stride of every run. Ultimately, it can be a direct result in many of the aforementioned common lower body injuries. If you have dysfunction (pain, instability, or hypomobility) at the first big toe joint (MTP joint), it could wreak havoc on the entire kinetic chain.

Normal range of motion of the big toe is 40° flexion, 80-90° extension, and 10-20° abduction and adduction. Lack of motion, especially extension, will create compensatory movement at other joints. Common big toe issues such as, hallux valgus (bunion), hallux rigidus, turf toe, sesamoiditis, and gout will limit toe mobility. Below is an image of a client who demonstrates normal range or motion on the right and limited toe extension on the left.

N ROM   Limited ROM

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Icing Injuries: Are We Evidence-Based?

Are you an evidence-based practitioner? Think about it; are you really?

An athletic trainer working a Division 1 women’s volleyball tournament with elite Top-25 teams sent me a text: “You should do a study on the average number of ice bags used by volleyball teams after a match… Entire teams are getting ice on both knees and the hitting shoulder. No post-match mobility work, just pounds of ice. Crazy! Some athletic trainers and strength and conditioning coaches are too ignorant and too lazy to provide proper warm-up and cool-down protocols to address mobility.” This is not shocking to me. I worked with Division I volleyball for several years and I observed this too. This is where I learned ice is overused.  This isn’t just a volleyball thing; this is an all-sport issue. Continue reading

POS: Reduce Pain and Increase Performance

SwingDysfunction of one movement system can lead to a multitude of injuries. Treatment and care for one movement system can prevent our most common ailments. Most potential clients I interview complain of one or more of the following: sacroiliac joint (SIJ) pain and instability, non-specific low back pain (LBP), chronic hamstring strains or tightness, and peri-scapular and thoracic tightness or pain. Whether these complaints are isolated to one body part or involve many, the pain can typically be resolved by treating dysfunction of the Posterior Oblique Subsystem.

 

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RIDS Program: A New Paradigm for ACL Prevention

ACLThe grandeur of the World Cup is upon us. The world’s most popular sport has its chance to shine. As soccer gets its much deserved pedestal, summer camps fill. High school and collegiate soccer athletes become inspired. Training begins and with that begins the season of the ACL. With approximately a quarter-million ACL injuries per year, it is safe to say the injury is common in sport. Though most common in female athletes, ACL injuries happen to anyone anywhere, with soccer, basketball, and gymnastics athletes being at most risk.

While an ACL injury is traumatic in nature, the injury is rarely due to direct trauma. More than 75% of ACL injuries are non-contact in nature (1). Non-contact ACL injuries stem from a complex interaction of anatomical, hormonal and neuromuscular factors. Recent studies suggest that ACL injuries are caused by both neuromuscular fatigue and unanticipated movements commonly found in athletics, such as evasive maneuvers that involve some form of deceleration, change of direction, or landing. The coupling of these movements with modifiable risk factors (see graphic) is what leads to non-contact ACL injury. The good news is that non-contact ACL injury can be prevented by addressing these modifiable risk factors. Continue reading

Butt Battle

A nice booty is not always a good booty.

A nice booty is not always a good booty.

Everyone loves a nice butt. Walking down the street, at the mall, or at the bar, there is bound to be a butt that catches your eye. Like a kitten following a piece of yarn, there is the occasional butt that walks by and causes heads to turn, leaving onlookers with a severe neck strain and mouths agape. Don’t act all innocent and holier than thou, we’ve all done it! Therapists and rehabilitation specialists are no different. In fact they can spend an entire day staring at booty. However, we are not looking to see if “Baby Got Back” or how that plump bump fills a pair of Wranglers, Levis, Seven, or True Religion jeans. We have a reason to look and it is strictly professional; is the little butt working?

For several years now rehabilitation journals have published articles linking a myriad of lower extremity injuries to poor gluteal control. While the glute max – that which makes our heads turn – and the glute minimus are both important, the glute medius is the real problem. We have learned the important role the glute medius has on controlling lower extremity mechanics. Glute medius inhibition precipitates many lower extremity injuries such as ACL tears, Patellofemoral pain, Iliotibial band syndrome, Achilles tendinopathy, plantar fasciitis, MTSS (shin splints), the list goes on. Rehabilitation specialists must pay special attention in strengthening the glute med., but how? What is the best exercise?

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Pelvic Upslip and Rotation: Evaluation and Treatment

Pop quiz: What musculoskeletal issue could result in chronic low back pain, chronic Chronic-back-pain-image muscle strains, lower extremity tendinopathies, periscapular pain and tightness, glenohumeral and shoulder girdle pain, or tension headaches? I am sure you can think of a few possibilities, but few can result in all. Often, when a patient reports to our care with one of the aforementioned we immediately think locally. Unfortunately, the real problem could be pelvic upslip, anterior pelvic innominate, or both. Despite being oft-overlooked, these malalignments are not hard to identify if you know what to look for. Continue reading

3C’s + P Approach to Successful Outcomes

How many times have you racked your head wondering; why is this not getting better? How come they’re still in pain? How do we have all of this evidence and knowledge at our disposal, yet individuals do not respond as anticipated? The science says, for injury ‘Z’ treat with ‘X’ and rehabilitate with ‘Y’, yet when we apply those tools they don’t work? Why are they not getting better? What are you doing wrong? What are they doing wrong? Continue reading