Tuesday, August 9, 2011

Flexion & the Spine

"To Crunch or not to Crunch: An Evidence Based Examination of Spinal Flexion Exercises, Their Potential Risks, and Their Applicability to Program Design"- Contreras, Schoenfeld JSCR 8-11.

I probably have disagreed with every article these two guys published.  Which is why its important never to throw the baby out with the bath water sort of speak.  I have to admire this work, they really took on some sacred cows regarding spinal flexion exercise in general.  They make a lot of great points...

"The studies in question attempted to mimic the loading patterns of occupational workers by subjecting spinal segments to thousands of continuous bending cycles, which is far beyond what is normally performed in the course of a normal exercise program".

They also note research by Battie & Videman which indicates much of disk injury to be related to genetic factors and not exercise.

They note that many of the en vitro spine studies involve porcine models (which have very different mechanics than the human spine), or human cadaveric spines with most  of the supportive structures removed.

They conclude by saying that based on current research its premature to conclude that the human spine has a limited # of bending cycles...and variety in spinal loading is associated with a lower risk of spinal pathology.  And you want to do a good warm up before doing spinal flexion exercises early in the morning, or after prolonged periods of sitting; or save them for later on in the day.

Great work guys.

Thursday, August 4, 2011

It's whats between the notes that counts!

"Anatomical Structure determines Function, this determines Exercise Selection & Prescription- Richard Lieber

I'll agree with that...but I'll follow that with a quote by anatomist Jaap Van Der Wall...

"typically researchers "dissect what they have in their mind and lose
the continuity of the tissue."  He goes on to say, "Muscle spindles
and GTOs are mostly concentrated in areas of muscular tissue directly
intermediating distal and proximal regular dense collagenous
connective tissue structures. These mechanoreceptors occur often in
muscle/connective tissue transition."

Let's use the hamstring musculature as an example.  We've known for a long time that strains occur NEAR, but not actually AT the musculotendinous junction.  Recent MR imaging has also demonstrated tears at the epimysial boundries between muscles.

The anatomy of the hamstring muscles are complex, and even vary between individuals.  They not only have osseous attachments, but also numerous fascial expansions that attach muscle to bone, AND to other muscles. They are innervated by 2 different nerve branches; the long head of the bicep femoris, semimenbranosus & the semitendinosus by the tibial, the short head by the peroneal.  Some anatomists consider the adductor magnus muscle a 5th hamstring muscle, as it shares a common nerve and thick fascial expansions.

When we attempt to understand the function of the hamstrings, like music, we need to understand what's going on  proximal to distal, but also in between.  Not only in the sagittal plane, but in the frontal, and especially in the transverse.  The plane that a muscle is the most powerful in is not always the most important.  What the opposite side of the body is doing during a particular task; and whether it's setting the hamstrings up for success.  Now we have MR images documenting morphological improvements in an individual muscle from specific exercises.  Yes that's useful in indicating the degree of healing, but not the whole picture:

"Movement is not an isolated event that occurs in one plane of motion.  Rather it is a complex event that involves synergists, stabilizers, neutralizers and antagonists all working together to produce efficient triplanar movement"- Vern Gambetta.

The current trend of prescribing exercise by muscle architecture is subjective, and can be misleading.  Rehab the athlete, not the injury...and let them leave you a little more athletic then when they came in.  And never feel like you have to squeeze any muscle injury or prevention program into a traditional weight room exercise just because its there.

Tuesday, August 2, 2011

Yoga & Rotator Cuff Rehab

Thank you Tracy Fober PT (www.ironmaven.blogspot.com) for the heads up on this article:


This variation of a traditional Yoga posture was found to be more effective than traditional physical therapy in treating rotator cuff tears.  I don't think there is anything magic about the technique.  It is very similar to the wall slides I have described previously in this blog. The concept of shortening lever arms, unloading the shoulder by way of the hand resting on a wall, and changing the limbs orientation to gravity gets the shoulder back into its envelope of function & helps normalize muscle recruitment patterns.  I'll often add lower extremity drivers to the hand motion to enhance the exercise.  I tried linking some of my old posts on the topic but the search command doesn't seem to work very well.

Sorry by the way about my lack of posting, they will probably be scarce for the next few weeks as we get the fall sports rolling here at EHS.

Thursday, July 21, 2011

Haven't missed a tour since high school, but this one will be tough.  Two nights in NY on nights I have soccer games.

Monday, July 18, 2011

Video of Dr. Luigi Stecco performing Fascial Manipulation

For those who want a look at the Fascial Manipulation technique...he doesn't begin actually performing the technique till about 9m into the video.  In FM, you treat AWAY from the injury site, which is a bit different from other myofasical techniques.

Sunday, July 17, 2011

2nd Annual ATSNJ Concussion Summit

Some great points made by Dr. Robert Cantu,
...you will not know the true severity of a concussion until the athlete returns to their baseline.
...concussions are not created equal.  One may be too many, while three may not necessarily prevent an athlete from future competition.
...the football helmet will never be the end all in concussion prevention.
...the most sever concussions involve blows directly to the head.

Neuropsychologist Reuben Echemndia presented research indicating post concussion neurocognitive testing (Impact et al) is beneficial even in the absence of baseline testing.

At the roundtable discussion I asked the possibility, based on the research by Sandra Black and David Viano, of neck strengthening playing a role in concussion prevention.  The consensus was, at least from a theoretical standpoint, yes.  But what kind??

Friday, July 15, 2011

Makes ya go hummmm...

"Motor Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain"- Klykken et al, JAT 6-11.

I'm really impressed at the quality of the research in the Journal of Athletic Training in the last decade or so.  This was a good one.  The researchers took 10 athletes with recently sprained ankles, placed them in a relaxed prone position, then measured the motor neuron pool excitability of the soleus, anterior tib, & peroneus longus.  The soleus was facilitated, the anterior tibialis inhibited, & no difference in the peroneus longus.

The authors go on to explain the reasons for the results.  Included was the possibility the CNS was re-organizing to compensate for the loss of posterior talar glide, ie loss of dorsiflexion in the ankle.  In running & gait, remember the soleus is a knee extensor.  So in this scenario it is helping to limit the degree of knee excursion to control the degree of ankle dorsiflexion at the ankle joint.

A thought:  What if this loss of dorsiflexion is not restored?  Could the facilitated soleus persist? Could the articular complications resulting from an unresolved ankle sprain(s) be a culprit in chronic calf cramping in middle age runners?