EHS baseball '09 pics

"Proper" Firing Patterns?

Muscular activation patterns during active prone hip extension exercises- Journal of Electromyography & Kinesiology Jan. 09.

A popular sports medicine certifying agency uses the prone leg extension test as a method of screening for "gluteus maximus latency". They claim a normal firing pattern goes something like hamstrings, glutes, contralateral erector spinae, ipsilateral. I've yet to see this pattern substantiated in a major scientific journal.

Yeah, I believe there is a plethora of weak butts out there; and all of the dysfunction it causes from ankle sprains to sore backs. I'm just wondering if this test needs to be thrown out. Your 2 cents please.

EHS baseball '09

Make sure you read Vern's post for today, Jan. 26, 2009, "punishment is not coaching". It is amazing how much fun the baseball players are having doing their off season workouts- pulling on rings, tossing sandbags, hopping/jumping. Sweating their asses off & smiling the whole time. I will get some stills.

Joe P. speaking engagement

For those of you in the NJ area, I'm speaking at the Yogi Berra Center in Upper Montclair this Wed. Jan 28. Go to www.yogiberramuseum.org for more info. I'll be applying the kinetic chain concept to rehab & conditioning. Steve Donohue, assistant AT with the NY Yankees is speaking, as well as Paul Reddick, co-author of Tom House's pitching books.

Rehab Session Management

...this is something that is probably not important to the collegiate or clinical ATC. It is not taught in any A.T. college curriculum, that I know of (please tell me if I am wrong). You are all by yourself and you have one classroom period to rehab 5 different athletes with 5 different injuries in various stages of healing. Here's an example of how I get it done. I think if you click on the image you can enlarge it.

GAIN '09 Lineup announced

Apprentorship = Apprenticeship + Mentorship.

What a lineup!! In addition to last year's faculty James Radcliffe & Kelvin Giles have been added.

James is the S&C coach at the University of Oregon, and author of "Functional Training for all Sports".

Kelvin is president of "Movement Dynamics" and is really doing some interesting work on creating an athletic profile as a starting block for athletic development & identifying movement problems.

There will be more info posted on www.gambetta.com in the coming days. If you really want to dive into this stuff join us this June in Florida USA. We're on the go from 6am-ish to 10pm-ish with both formal & informal hands on instruction. In addition, we have our own web forum where I have the opportunity to go deeper into the ideas in this blog, upload video etc.

Smorgys

...learned this workout paradigm from Vern about 10 years ago. It's a great way to design an introductory module to your particular athlete's athletic development program.
-simple to execute & administrate
-reduces the possibility of injury by the nature of it's design
-highly adaptable to ANY sport
-keeps the athlete focused

It involves an UE exercise, a core exercise, a LE exercise, followed by an anerobic exercise. My baseball guys are doing one now. It looks like this:

dumbbell upper cuts-exercise band partner see-saws-rotational R stagger squat-SP jops
dumbbell V press- exercise band partner skiier- rotational L stagger squat-FP jops
dumbbell curl/overhead press-ex.band partner rotations-rotational lunge- TP jops

They do 45 seconds of work, 15 seconds of rest. There are 30 exercises total. Counting the warmup & some static stretching at the end, it takes about 1 1/2 hours to complete. You can increase the difficulty by doing 3 in the right column first, followed by the jops, then the middle column and so on. To minimize the amount of equipment, the team is split up into 3 different groups that start at different points in the workout. In this way, some are using dumbbells, some bands, some bodyweight etc.

Thought Provoking

Kudos to Dr.'s Hurd, Axe, & Mackler from U. Delaware for their article, "Management of the Athlete with Acute ACL-D. in this month's Sports Health.

The authors challenged the notion that ALL ACL deficient knees need to be reconstructed. They designed an algorithm to better predict copers & non-copers.

I work in an inner city environment. Many of my athletes lack sufficient health insurance, and often are referred to charity care when they require surgery. A long waiting period is often involved. I can't tell you how many times an athlete has gone through "prehab" during this period and said to me, "P", you know, my knee feels great! Do I really need this surgery?"

The authors point out recent research into long term outcomes for ACL reconstruction indicating it does not automatically prevent future symptom complaints or degenerative knee arthritis. They got the idea for this study when some of their student-athletes refused to follow proper protocol after "prehab", which was surgical intervention. And most of them did quite well! This prompted a shift in their clinical practice guidelines.

The authors go on to stress the importance of "perturbation training" during rehab. That is, trying to keep still on a tiltboard. I guess you already know my opinion on that. I emailed the authors and asked them what they thought of my alternative- the body moving dynamically over a fixed foot. Dr. Mackler's response was, "The systems challenged are very different physiologically". I'm not sure if that's true, and if it is, if that is a good thing or a bad thing.

Surprise, Surprise

"The Effect of Coracoacromial Ligament Excision and
Acromioplasty on Superior and Anterosuperior Glenohumeral
Stability"- Journal of Arthroscopic Surgery, Jan. 09.

Sometimes having good health insurance is a dangerous thing. I've had orthopedists talk parents into bilateral versions of this on high school age athletes. Remove the coroacromial ligs like tonsils. It's intended to cure impingement syndromes. However, if these researchers are correct, the surgery actually increases anterosuperior translation of the humerus an average of 2.5mm!

Be patient with impingement syndromes. Conservative therapy works just fine, especially when you can get to it as fast as an ATC can. Activity modification, myofascial realease, joint mobes & plenty of modalities works.

Femoral IR Comments

I am really enjoying your discussion on my post-

1. Thanks JH for your comment on the collapsing of the pelvis in the sagittal/frontal planes during the jump. Very likely. The point is the researchers only looked at one plane/one direction/one joint. I think we would all agree that strengthening IR in isolation probably wouldn't do much to prevent ACL injuries in female athletes.

2. Again, you were all on target with looking at the subtalar/midtarsal joints of the LE. KP began by suggesting ankle hypomobility, with JH & ATCREF the opposite. I think you are both correct. As the ankle runs out of sagittal plane motion, it will steal it from the other two planes, usually choosing pronation. This & the planus foot structure will usually (not always) cause hyper IR at the tibia with a chain reaction up to the femur. If the timing of the IR in the femur & the tibia is out of sync, ACL beware.

3. Bonnie, you are on the right track with your idea of a same side arm reach @ shoulder height to block that femoral IR. All you need to to is bring the contralateral arm over with it. JH mentioned it would not be a strategy that he would use, & that is fine. The point is using other drivers to assist the hip in planes/directions it is weak in. Assuring the knee/hip/ankle are all going in sync to protect the ACL. Of course, as the hip gets stronger it will be necessary to train them out of sync so each segment is strong enough to stand alone.

I am aware that there are many commercial programs out there that teach the importance of the hip/knee/ankle staying in a straight line during jumping. I know these programs have been proven to reduce ACL injuries. However, I don't believe this happens out on a soccer field or a basketball court. Can you imagine coming down from a rebound and saying, "would you be a sweet heart and move your foot out of the way so that my LE can stay in sync". I prefer the Gray/Gambetta "lower extremity performance & prevention" video.

Thanks JH for reminding us that all muscles have a triplanar function, including the quads.

Femoral IR?

Gender Differences in Rotation of the Shank During Single-Legged Drop Landing and Its Relation to Rotational Muscle Strength of the Knee-AJSM Jan. '08

This study looked at femoral rotation during a 20cm single leg drop landing. The study showed the female subject's femurs internally rotated faster & further than the male subjects. The authors suggested female athletes strength train the hip external rotators as a method of ACL prevention. I would like your opinion on these questions:

1. What do you think was (or wasn't) going on in the other two planes at the hip?

2. What foot/ankle dysfunctions might exacerbate the effect at the knee joint?

3. Assuming a weak butt is the culprit in the excessive IR, what methods might you use to block that IR in rehab?

Don't Miss This!

This month's Journal of bodywork & movement therapies is free online (full texts). Take a look. There are abstracts from the '07 fascial congress. Great journal.

Skip to the Lou!

In this month's "Journal of Biomechanics" some researchers from U. Colorado set out to study the effects of reduced arm swing in elderly adults by comparing them to young adults. Just for the heck of it, they also had the young adults mimic reduced arm swing. No surprise, it increased metabolic demand at the same rate as in the seniors. Their hypothesis was that the increased energy cost was the lack of stability that went along with the decrease in the arm swing.

The arm swing in running becomes even more important. Ask your athletes to run with their hands folded across their chest & watch them weeble wobble across the floor. The arm swing blocks rotation in all 3 planes and helps create kinetic energy in the fascial system.

I believe skipping is a great way to train this effect-and not only in running. There are skips to warmup & enhance throwing, hitting, even swimming.

Crawling

We just started our first pre-season baseball fitness module today, & it made me think up this post. I use crawling quite a bit in both conditioning & rehab. In fact, my wall slide routines for the injured shoulder are nothing more than modified crawling when you think of it. If you are fortunate enough to attend this year's GAIN meeting in Fla, Steve Myrland will put everyone through his crawl progressions in our AM workout.

A few of my pals are going to be new baby daddys, so I thought I'd post some research on crawling. Here is a quote from Dr. Carla Hannaford, a biologist who specializes in children with learning disabilities:

"We have known for years that children who miss the vitally important crawling stage may exhibit learning difficulties later on. Crawling, a cross lateral movement, activates development of the corpus callosum (the nerve pathways between the two hemispheres of the cerebrum). This gets both sides of the body working together, including the arms, legs, eyes (binocular vision) and the ears (binaural hearing). With equal stimulation, the senses more fully access the environment and both sides of the body can mover in a more integrated way for more efficient action." She recommends the book, "Caution, Save your baby, throw out your equipment" by Laura Sobell.

However, the topic is not without controversy. David Tracer, associate professor of anthropology, health, and behavioral sciences at the University of Colorado at Denver studied indiginous cultures and challenges Dr. Hannaford's theory. Read on:

http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=103153&org=NSF

FMR- L femur in pitcher's follow through

GIRD (glenohumeral IR deficit) is considered a major contributor to GH instability & medial elbow injury in baseball pitchers. The cause is believed to be the tremendous traction placed on the posterior shoulder during the follow through phase. Most of the treatment I've seen to date is directed at the posterior joint capsule itself. We kinetic link enthusiasts insist on looking deeper. What if some other link is not doing it's job & over taxing the shoulder? Like:

1. Stiffness of the contralateral anterior shoulder.

2. Frontal/Transverse T-spine stiffness.

3. Trail leg ABD,IR stiffness.

4. Lead leg cavus foot.

5. Limitation of R cervical rotation (in a R handed pitcher).

Or, what I'm working on here: Limitation of L femoral IR. I've changed the position of the lead foot a little bit by placing it in neutral rotation. My R hand is mobilizing the R ilium into L rotation (as if I were opening a jar lid). My L hand is gently slowing down that L femur from bailing out into external rotation. The authentic drivers I'm using are the athlete's R hand & foot.