Tag Archives: Injury Prevention

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.

Continue reading

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

A Blog Inspired By and Dedicated to Runners

I have been looking for something to blog. No idea surfaced that said, “Yes, that is a great blog idea.” That was until yesterday’s tragic Boston Marathon bombing. Runners are a rare breed. You cannot keep them down. A runner’s passion for sport, resilience to challenge, and unique characteristic to rise above is unparalleled by any other athlete. I am not a runner. In fact I am the antithesis of a runner. I go in to anaphylactic shock just hearing the word aerobic exercise, but have many friends who are passionate runners. I dedicate this blog to my running friends, competitors of the Boston Marathon, the friends and family of those impacted by yesterday’s events, and runners everywhere from the competitive to non-competitive. I will keep it true to my blog site and remain sports medicine focused. I hope you find the information useful.

Running is one of the most popular recreational sports in the US. Race events can be found in almost every town. My town – Champaign, IL – has 2 events in the next 4 weeks. Some estimates say 20% of the population is runners and 10% of these people participate in race events. The benefits of exercise are well documented. Running has shown to build confidence and character, reduce stress and improve mood. However, the due to their very nature – the unwillingness stop – running does bring about an increased incidence of musculoskeletal injury.

You don’t need to be an astrophysicist to know running injury is secondary to cumulative overload. Running injuries are multifactorial; neuromuscular imbalance, poor arthrokinematics and other things such as age, nutritional status and environment are to blame. From a biomechanical point of view frontal plane knee adduction moments play a significant role in lower extremity injury. Q-angle – a measure of knee alignment – can indicate risk for running injury. An increased Q-angle can be a result of many neuromusculoskeletal inefficiencies from poor muscular hip control to limited ankle dorsiflexion and excessive forefoot pronation.

Running brings about many injuries, but the most common are Patellofemoral Syndrome, Iliotibial Band Syndrome, Medial Tibial Stress Syndrome / Tibial Stress Fracture, Achilles Tendinitis, Plantar Fasciitis, and Sacroiliac Joint Pain. What is interesting is that all of these injuries can be caused by biomechanical breakdown and neuromusculoskeletal inefficiency. The good is the dysfunctional patterns are identifiable, preventable and correctable. Below is a sample 15 minute injury prevention program from a blog I wrote in Sept 2012. Yes, 15 minutes is all you need to prevent many running injuries.

Step 1: Decrease neurological drive to hypertonic tissue – 3 minutes

  • Self-Myofascial Release (foam roll) or Manual Trigger Point Therapy
    • Gastrocnemius/Soleus – 60 seconds
    • Adductors – 60 sec
    • TFL/IT-band – 60 sec

Step 2: Lengthen hypertonic muscle or joint tissue – 3 minutes

  • Static stretch or joint mobilization
    • Gastrocnemius/Soleus Stretch – 1 set @ 30 sec
    • Kneeling Hip Flexor Stretch – 1 set @ 30 sec
    • Adductor stretch – 1 set @ 30 sec
    • Posterior joint mobilizations at the ankle – 90 seconds

Step 3: Increase neurological drive to hypotonic tissue – ~ 6 minutes:

  • Exercise: Isolated Strengthening or positional isometrics
    • Resisted Ankle Dorsiflexion – 2 sets x 15 reps (slow) (2 minutes)
    • Resisted Hip Abduction and External Rotation- 2 sets x 15 reps (slow) (2 minutes)
    • Resisted Hip Extension – 2 sets x 15 reps (slow) (2 minutes)

Step 4: Integrated Dynamic Functional Movement – ~ 3 minutes

  • Box step-up with overhead dumbbell press – 2 sets x 15 reps (slow)

Beyond the correction of movement dysfunction there are alternatives to treat running injuries which are effective and gaining popularity. This table highlights a few.

Prolotherapy This has been around since the late 1800’s, but has since become popular. The basis of prolotherapy is that it expedites healing by increasing fibroblastic activity and collagen repair.
Autologous Blood Blood is the medium that carries tissue repairing materials to injury sites. However, sometimes, blood cannot deliver adequate amounts of material to the injured area. Thus, injections directed right at the injury site deliver tissue repairing material.
PRP Like autologous blood, Platelet Rich Plasma (PRP) is injection of a concentrated mix of tissue repairing blood components, specifically platelets, which facilitate tissue repair healing.
Bone Marrow Aspirate Concentrate Despite the negative press and belief that stem cells are only derived from an unborn fetus, stem cells do come from other sources – such as bone marrow. By taking stem cells from bone marrow and injecting in to damaged areas will facilitate tissue repair.
ESWT Extracorporeal Shock Wave Therapy might best be known as lithotripsy. Lithotripsy is a procedure in which sound waves blast and destroy kidney stones. ESWT is the use of sound waves to destroy calcific tendons and ligaments.

I prefer preventing and rehabilitating injury through correcting neuromuscular inefficiencies and dysfunctional movement. The problem with the above treatments is that they are treatments. If an injury is caused by dysfunctional movement patterns and those patterns are not corrected it is likely the above treatments will simply serve as a Band-Aid because the true problem was not fixed.

If the person(s) responsible for the Boston Marathon bombing were looking to put fear in people, they chose the wrong population to target. Runners are the most stubborn and prideful athletes. No means yes, and yes means do more. If you took a graphical representation of marathon registration numbers from last night through the end of this week I would bet you’d find a spike, rather than a decline. Social media is exploding with a rise of the runner. A quote from a friends Facebook page: “If you’re trying to defeat the human spirit, marathoners are the wrong group to target” –unknown. Other movements like, wear a race shirt tomorrow, donations, and wear yellow and blue (Boston Marathon colors) have already begun. So, thank you runners for inspiring this blog post!

Foot Center of Pressure Reduces Kinetic Chain Dysfunction and Chronic Pain

If you read my blog before you are well aware that I am a big proponent of identifying human movement dysfunction and correcting functional imbalances to reduce chronic pain, such as knee osteoarthritis (OA), patellofemoral pain syndrome (PFPS), and low back disorders such as sacroiliac dysfunction, facet arthropathy, or generalized lumbago.

A few years ago I read about a new neuromuscular technique called AposTherapy.  For those unfamiliar, AposTherapy corrects gait abnormalities by retraining muscles to adopt an optimal gait mechanics. The primary goal of AposTherapy is to correct the foot center of pressure (COP) during gait. This is done by wearing a unique, foot-worn biomechanical device. At the time, I heard good results about the use of AposTherapy, but data was too young to consider valid just yet or share-able, just yet.

Recently, when looking at functional rehabilitation techniques for chronic knee pain I came across an interesting study in the Journal of Biomechanics the evaluates the benefits of AposTherapy, to correct kinetic chain dysfunction responsible for the development of knee OA (1). The results of the study were significant. Following the intervention patients demonstrated significant reduction in knee adduction (valgus) moment (KAM). Several authors have demonstrated KAM to be a primary cause of knee OA, including Miyazaki, who noted KAM correlates with the progression of knee OA (2). In addition, patients who participated in AposTherapy demonstrated increased walking velocity, reduced pain, and improvement of functional living (1).

The foot-worn biomechanical device alters foot COP, allowing for proper kinetic chain alignment neuromuscular efficiency. Clark and Lucett, noted that dysfunction at one joint precipitates altered movement patterns, at adjacent joints, both proximally and distally (3). This is the foundation of AposTherapy. By correcting  foot COP during gait, altered joint mechanics up the kinetic chain are nullified and neuromuscular efficiency is enhanced. Overtime, strength gains occur allowing for optimal gait patterns. Sharma, stressed the role of neuromuscular ineffciency, suggesting that secondary to elevated joint stress with higher impact loads and altered joint mechanics facilitate the pathogenesis of the chronic joint disease (4).

Biomechanical interventions focusing on foot COP, neuromuscular development and agility, enhance functional ability, reduce pain and increase spatiotemporal patterns of gait (1).  Working knowledge of human movement dysfunction and human movement compensation patterns are prudent to health practitioners.  Health practitioners should emphasize and correct human movement dysfunction when treating clients with chronic joint pain such as and certainly not limited to knee OA, PFPS, SI pain, and other  low back disorders like facet arthropathy.  Training to enhance neuromuscular recruitment, force-coupling, as well as the correction of altered length-tension relationships and poor joint arthrokinematics will go far in reduction of pain, prevention of chronic pain, and improved functional outcomes.

What techniques do you implement to train for optimal neuromuscular efficiency?

References:

1. Haim, A, et al. Reduction in knee adduction moment via non-invasive biomechanical training: A longitudinal gait analysis study. J of Biomechanics. 45 (2012) 41–45.

2. Miyazaki, T., Wada, M., Kawahara, H., et al. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Annals of the Rheumatic Diseases.  2002. 61, 617–622.

3. Clark, MA, and Lucett, SC. NASM Essentrials of Corrective Exercise Training. Lippincott, WIlliams and Wilkins. 2010.

4. Sharma, L., Dunlop, D.D., Cahue, S., et al. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Annals of Internal Medicine. 2003. 138, 613–619.

Postactivation Potentiation (PAP)

For years there has been a gap between performance enhancement and injury management. Strength coaches fail to address rehabilitation  and injury prevention during performance training whereas health care practitioners (ATs, PTs, OTs) fail to address performance training during injury management. There are some who continually seek to merge the two disciplines, by utilizing the unique training principles from each side. I am not saying ALL fail to bridge the gap, but it certainly is the majority.  Health care practitioners could be a bit more boundaryless and integrate performance enhancement concepts and protocols into injury management programming. One method we can use is Postactivation Potentiation or (PAP). Continue reading

15 Minute Rehabilitation: It’s Time to Unplug

While working as an athletic trainer I was frustrated and furious with the constant flow of athletes ‘needing’ certain treatment. I was tired of students and support staff hooking athletes up to every biophysical modality in the athletic training room. Why? They had no clue – it felt good to the athlete, it ‘worked’, it was easy, the coach said to – my blood beginning to boil.

It seemed every injury for all athletes was treated by the wonderful benefits of electrical stimulation. After a quick evaluation the injured body part is surrounded by electrodes and covered with a comfy hot or cold pack. For 20 minutes the athlete sat there with a special tingly, prickly feeling that gives those in pain a warm fuzzy feeling. As a health care provider there is nothing easier than slapping on a few electrodes and walking away for 20 minutes; it’s easy and clients love it. I must admit that I have fallen victim to the persuasive effect of e-stim as both an athlete and health care provider. But it was time to unplug. The overuse of modalities coupled with the under usage of manual therapy and rehabilitation was sickening. So what did I do?

I unplugged it all. I took all of the modalities and put them in one room with one table. It was not to be used unless a valid reason existed to do so. Holy s***, did I make some people mad. Instantly, coaches and athletes, became health care experts saying it was needed. But for the fellow athletic trainers – they understood. It made them learn reasons why to use modalities. It also help them look at the treatment of injuries in another way. This method also enhanced their ability to identify and correct common human movement dysfunction than causes pain.

Before I go further and before those in support of  modality usage start throwing data at me, stop. E-Stim (along with the other biophyscial modalities) is a versatile modality, has few contraindications and is a quick easy way to reduce pain in most clients. For this reason e-stim is often the first tool of choice.  The effectiveness and subsequent overuse of e-stim, is secondary to pain relief. A structure called the substantia gelatinosa (SG), lies in the IV Laminae of the dorsal horn in the spinal cord. This structure is where nociceptive (pain) fibers terminate and decisions with regards to how pain should be handled are determined. Also terminating in the SG are A Delta fibers (sensory fibers). E-stim has several modulations, but the most common is for a theory called “Gate Control Theory”. Essentially, electrical impulses from e-stim therapy bombard the SG through the A Delta Sensory fibers and over-ride the nociceptive fibers and ‘turn-off’ pain. The pain relief can last from minutes to several hours.

Unfortunately, all too often, athletic trainers try to control pain rather than fix the problem. Rather than spending 20 minutes turning off pain, why not allocate the time to long-term pain relief and correcting dysfunction? Why not spend 20 minutes correcting a muscle imbalance, which will lead to lifelong change and keep athletes out of your athletic training room? All you are doing is putting a band-aid on a problem, unfortunately you have to keep putting that band-aid on everyday for the entire season. I said it before and will say it again – Athletic Trainers need to transition from triage to rehabilitation and optimizing functional movement. However, I understand the problem: it is a time crunch. Athletic training rooms are vastly understaffed – making it difficult to dedicate 20 minutes of rehabilitation time to one athlete, when 3oo are lined up at the door. So we have a time crunch, but there is a solution…

Almost all injuries we see in the athletic training room are a result of:  altered length tension relationships, altered arthrokinematics, altered neuromuscular recruitment. Collectively, these issues are what makes up human movement dysfunction. You name the injury – tendonitis, ACL tears, PFPS, fasciitis, MTSS, impingement, rotator cuff pathologies, you get the point – can be linked back to human movement dysfunction. The good is that human movement dysfunction is identifiable, preventable and correctable. The better is that the strategies to correct human movement dysfunction can be done in less than 15 minutes per day.

Yes, I said it – you can perform a 15 minute rehabilitation session. I presented on this topic at the NATA District 10 and District 2 conference and even did a few customized workshops. A colleague presented on the topic at the June 2012, NATA conference. Imagine correcting a problem, preventing injury, or rehabilitating an athlete in 15 minutes per day. That would be better than slapping on a pair of electrodes and setting up hi-frequency biphasic sensory-level stimulation. You will fix the problem and reduce pain. How you ask?

As I said above, human movement dysfunction is often composed of three problems, all which are identifiable during human movement assessments. The assessments will indicate where human movement impairments exist. But lets say for example we have a patient with patellar tendonitis, we would likely see functional impairments somewhere along the lower extremity. Below is a sample program I would do in 15 minutes.

Decrease neurological drive to hypertonic tissue – 3 minutes 

Exercise: Self-Myofascial Release or Manual therapy

  • Gastrocnemius/Soleus – 60 seconds
  • Adductors – 60 sec
  • TFL/IT-band – 60 sec

Lengthen hypertonic muscle or joint tissue – 3 minutes

Exercise: Static stretch or joint mobilization

  • Gastrocnemius/Soleus Stretch – 1 set @ 30 sec
  • Kneeling Hip Flexor Stretch – 1 set @ 30 sec
  • Adductor stretch – 1 set @ 30 sec
  • Posterior joint mobilizations at the ankle – 90 seconds

Increase neurological drive to hypotonic tissue – ~ 6 minutes

Exercise: Isolated Strengthening or positional isometrics

  • Resisted Ankle Dorsiflexion – 2 sets x 15 reps (slow) (2 minutes)
  • Resisted Hip Abduction and External Rotation- 2 sets x 15 reps (slow) (2 minutes)
  • Resisted Hip Extension – 2 sets x 15 reps (slow)  (2 minutes)

Integrated Dynamic Functional Motion – ~ 3 minutes

Exercise: Integrated movements

  •  Ball Squats w/Resistance Band Around Knees – 2 sets x 15 reps (slow)

Note this is just a sample program. In the above instance I assumed the client had limited ankle dorsiflexion and muscle imbalance at the hip musculature. The specific human movement impairment will be client and injury dependent. That said, you can follow the same formula and perform rehab in the same amount of time that it takes to perform e-stim. Too often we use the time crunch as an excuse for our failure to perform due diligence as health care practitioner. We have a job – that is to keep athletes healthy. Let’s choose the path that works – not the band-aid.

 

The Dreaded Hamstring Strain

How many times are we going to see an athlete suffer from recurrent hamstring strains? How many times are we going to see delayed recovery from a mild hamstring pull? Unfortunately, it’s going to continue, because some health and wellness specialists (ATCs, PTs, and Strength coaches) are looking in the wrong area. Sometime ago I had a disagreement with the parent of an athlete (the parent also happened to be a chiropractor).

The parent was upset that I was not fixing the hamstring in rehabilitation. He said, ‘She needs flexibility and strengthening of the hamstring! You are not doing that!’ The concerned parent actually complained to my athletic director. Now I have my boss challenging me on my treatment.  Ugh, such is the life of an Athletic Trainer. Thankfully, after conversation, he backed me up.

Now, before I swarmed by an angry mobs of chiropractors trying to beat me with sticks, this is not about chiropractors – this is just one example of the trap that many health care practitioners – Athletic Trainers, PTs, OTs, RKTs, DC, MD, LMTs, etc – fall in to.  Many practitioners are too concerned with ‘the what‘ rather than ‘the how‘ and ‘the why‘.

This particular parent was upset and did not understand why I was not addressing the what. In my defense, I was dedicating some time to fixing the what – using ultrasound, massage, PROM, etc – to facilitate proper tissue healing. However, I knew this would not fix the problem. In this particular instance (and most hamstring injuries) I needed to correct human movement dysfunction (poor neuromuscular recruitment, suboptimal arthrokinematics, and altered length-tension relationships). This will fix the problem and go a long way in prevention of re-injury. Flexibility and strengthening of the hamstring is not needed.

Don’t get me wrong, flexibility is a good thing, but hamstring flexibility is way overrated. Take yoga as an example, yoga is  known for improving flexibility (among other things). In fact, I’ve prescribed yoga to many of my clients. Unfortunately, many yoga poses place the already lengthened hamstrings under further stretch. Hamstring strains are very common in Yoga enthusiasts, especially amateurs. It is so common, it was given a name – Yoga Butt. Yoga butt is essentially a tear of the proximal hamstrings, subsequent to repetitive lengthening of the hamstrings.   There is a reason for this.

Secondary, to pattern overload or prolonged static posturing many individuals suffer from chronic hypertonicity and mechanical shortening of the psoas.  A chronically tight psoas will cause altered reciprocal inhibition of its functional antagonist, the gluteus maximus. With this muscle imbalance an abnormal force coupling occurs yielding poor arthrokinematics in the form of an anterior pelvic tilt. Because of the hamstring’s proximal attachment to the ischial tuberosity an anterior pelvic tilt will cause the hamstring to migrate superiorly and posteriorly, essentially lengthening the muscle. If you recall from your applied kinesiology course, muscles have optimal length tension relationships – a zone where maximal muscle force can be produced. The longer or shorter a muscle is, the less the muscular force can be applied or tolerated.

In addition to this, with the glute inactivity caused by altered reciprocal inhibition. So now a synergistic muscle must help with glutes ability to perform hip extension. Which muscle is going to this? You guessed it – the hamstring.  This is called synergistic dominance – the hamstring (synergist) must dominate the movement of hip extension.

If you recall from above, the hamstrings are working in a lengthened and suboptimal position. Coupled with this it is being asked to do more work. So, when we are applying the greatest amount of muscular tension – eccentric contraction near end ROM (such as sprinting) – the hamstring fails. Commonly it fails near the proximal attachment secondary to a line of pull change.

Why do we see so many hamstring injuries? Because health and wellness professionals are not identifying or intervening to correct human movement dysfunctional patterns.

Why do we see so many recurrent hamstring injuries? Because we are not fixing what needs to be fixed and allowing the hamstring to work inefficiently.

Why are we seeing delayed recovery? Because we are using antiquated rehabilitation techniques. We are focusing on the hamstring when the problem exists elsewhere.

Correcting movement dysfunction and optimizing function will fix the problem. This is so much easier in the long run. Recently there has been a slew of research published discussing the effectiveness of high-intensity eccentric hamstring strengthening on the prevention and rehabilitation of hamstring injuries. Yes, eccentric hamstring exercises work, but why? They work because you are making the hamstring more tolerable and able to function with poor mechanics. Again, this is not fixing the problem. To fix the problem you must address glute weakness and hip flexor tonicity.

The Season Ending ACL

What is happening in the world of sports? Last week sports talk radio was abuzz over significant injuries to Derrick Rose and Iman Shumpert of the NBA. Now we lose yet another sports star – future hall of famer, Mariano Rivera of the New York Yankees – all three stars suffered ACL tears. This rash of injuries has created much debate on the issue. People are asking why? Did the shortened pre-season lead to this rise in injury? Did the condensed schedule lead to the injury? Are these just chance freak injuries? The answer to all is yes. However, each of these injuries could have been prevented.

Many original research studies and systematic literature reviews have shown a significant reduction in ACL injuries following implementation of neuromuscular training. In fact, a systematic literature review was recently published in the Journal of Bone and Joint Surgery (March 2012). This showed that ACL injury prevention programming provides a significant reduction in ACL injury. Many others literature reviews and research papers have also shown the effectiveness of neuromuscular training programs. A shortened pre-season may have led to the increased injury rate, because players were not exposed to the pre-season neuromuscular training. Unfortunately, not all teams apply injury prevention programming as part of the workout routine.

As for the condensed season schedule; a condensed season schedule with limited recovery dates will yield higher incidence of injury. A study published in the American Journal of Sports Medicine (2011) shows that injury rates in a short recovery group demonstrated a significantly greater overall injury rate, practice injury rate, and game injury rate compared to those in the extended recovery group. The injury rates were 6.2 times greater for overall injury, 4.7 times greater for game injury, and 3.3 times greater for practice injury in the short recovery group. That said, these injuries could have been prevented, even if neuromuscular training was not implemented during the pre-season. As the season progresses a gradual decline of neuromuscular efficiency occurs. This leads to the breakdown of mechanics and subsequent injury. ACL injuries can be prevented. Identifying faulty mechanics as the season progresses and then applying corrective techniques to fix those mechanics will go a long way in preventing non-contact ACL injuries.

Improve Your Golf Game and Reduce Injury

Injuries in golf occur as they do during participation in any athletic orientated activity. Research indicates injuries in golf relate to functions of age, skill level, and frequency of play. According to Gosheger et al., over 80% of golf-related injuries are due to overuse (1). The most common injury experienced by professional golfers is low-back dysfunction. Low-back golf injuries can be chronic in nature due to poor swing mechanics, poor conditioning, or overuse. Research has shown that golfers who have low-back pain demonstrate a decrease in range of motion for hip internal rotation on the lead leg, decreased lumbar extension, decreased activation and/or timing of the abdominal obliques, spinal erectors, and knee extensors (2-4). A common low back disorder of golfer’s is sacroiliac joint (SIJ) dysfunction.

When loads are transferred between the trunk and legs, the flat surfaces of the pelvis bones (sacrum and ilium) make the SIJ subject to considerable forces. If SIJ stability is not maintained, loads cannot be transferred efficiently between the trunk and legs, which may result in abnormal loading joint tissue and the development of pain (5). The transverse abdominis and internal oblique muscles play a significant role in resisting shear loads across the SIJ and maintaining stability (5). Proper execution of an abdominal drawing-in maneuver during performance should enhance the stability of the SIJ joint and allow for the most efficient transfer of forces between the trunk and legs.

Exercise is believed to be a vital component in preventing the occurrence of low-back pain and injury. What is unclear, however, is the type of exercises that should be performed as part of a low-back pain prevention and rehabilitation program. Liddle, et al. concluded that strengthening exercises targeting the lumbar spine, lower limbs, and abdominal muscles were the predominant exercises performed in successful exercise programs that decreased pain and improved function (6).  Conversely, Hayden, et al concluded in a systematic review that programs that strengthened the trunk stabilizing muscles were most effective. A separate meta-analysis, (7) indicated that the most effective programs consist of a supervised, individually designed set of stretching and strengthening exercises.

I am in agreement with the observations and recommendations from the scientific literature noted above. The best approach to developing a low-back injury prevention program includes a variety of inhibitory and lengthening exercises aimed at improving flexibility of tight and overactive muscles, isolated strengthening exercises for weak and inhibited muscles, and improving neuromuscular control through integrated exercise is recommended.

Golfer’s with SIJ dysfunction commonly have overactive and underactive muscles. The overactive muscles include the Tensor Fascia Latte, IT Band, Hip adductors and Piriformis. Underactive muscles include the glute medius and minuimus as well as intrinsic core stabilizers (multifidus, transverse abdominus and obliques). Inhibiting and improving flexibility of the overactive muscles followed by strengthening of the underactive muscles will help reduce or prevent low-back pain and could improve your golf swing.

References:

1. Gosheger G, Liem D, Ludwig K, Greshake O, Winkelmann W. Injuries and overuse syndromes in golf. Am J Sports Med. 2003;31(3):438-443.

2. Horton JF, Lindsay DM, Macintosh BR. Abdominal muscle activation of elite male golfers with chronic low back pain. Med Sci Sports Exerc. 2001;33(10):1647-1654.

3. Lindsay D, Horton J. Comparison of spine motion in elite golfers with and without low back pain. J Sports Sci. 2002;20(8):599-605.

4. Vad VB, Bhat AL, Basrai D, Gebeh A, Aspergren DD, Andrews JR. Low back pain in professional golfers: The role of associated hip and low back range-of-motion deficits. Am J Sports Med. 2004;32(2):494-497.

5. Snijders CJ, Ribbers MT, de Bakker HV, Stoeckart R, Stam HJ. EMG recordings of abdominal and back muscles in various standing postures: validation of a biomechanical model on sacroiliac joint stability. J Electromyogr Kinesiol. 1998; 8:205-14.

6.  Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works? Pain. 2004; 107:176-90.

7. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005:CD000335.

Personal Trainers, Are you Bored?

Let’s face it, everyone gets bored with day-in, day-out monotony. Although Personal Trainers have unique clients and face unique challenges everyday – they too can get bored with the gym scene. Some may begin to look for other opportunities. Personal trainers have a profound knowledge of functional anatomy and mechanics. So how can this knowledge be utilized elsewhere? I would like to open your mind to an avenue of exploration that combines, your knowledge of function with ergonomics; a practice I call BioErgonomics.

BioErgonomics comes from Biomechanics (mechanical principles in biological systems) and Ergonomics (Greek for work laws) and means addressing biomechanical dysfunction with ergonomics to prevent and correct work related musculoskeletal disorders. This practice speaks to health and wellness professionals as they are experts at identification of human movement dysfunction. Take a look at these staggering numbers:

  • Currently, corporate wellness is a $1.6 billion dollar industry and is projected to be $5.8 billion by 2015.
  • The insurance information institute says indemnity (time lost from work) rates have doubled over the past 12 years.
  • Over the past 2 years there has been a 69% increase in corporations offering corporate wellness.
  • 65% of companies recognize the value of corporate wellness and state they will increase funding and incentives for employees participating in wellness programs.
  • Avg. cost per permanent disability claim is ~$41,000
  • Musculoskeletal disorders account for 29% of all days lost at work
  • 33% of all injuries are a result of poor ergonomics and biomechanics
  • An employer’s return on investment for corporate fitness programs can be as high as 6 to 1.
  • 42% of large firms will require employees to complete health coaching or a disease management programs
  • 65% of respondents said that for 2011 they’ll increase incentives to take part in corporate fitness programs
  • Insurance companies strongly advocate corporate fitness programs
  • Lower back injuries account for 24% of all injuries and 65% of these are caused by over-exertion and poor mechanics.

These data points prove companies need help. They also prove companies recognize the value in corporate fitness and have already started to incorporate programs within the company. Many have invested big money on staffing in-house ergonomist. Unfortunately ergonomist, do not understand functional human mechanics like health and wellness professionals do. These companies need extra help! Why can’t you be the one to help them?

Many companies have ergonomic consultants or internal safety teams that purchase high-tech gadgets and ergonomically correct workstations to mitigate injury or reduce risk of injury for employees. Unfortunately, this does not fix the issue. As health and wellness professionals, we have the ability to recognize movement dysfunction. By applying the proper exercise techniques we can help employers address these issues and save companies huge money on workers compensation costs and eliminate wasted money spent on expensive equipment.

Market yourself, become entrepreneurial, several job opportunities exist for positions in corporate fitness, these include working for a company, or even better you can create your own position by becoming a consultant.