Tuesday, March 31, 2009

Scapular taping rationale

The purpose of my taping is to influence scapular position on the thorax, period. Restoring normal length/tension myofascial relationships in the process. In "the lucky 7", I'm correcting anterior rotation with the vertical strip, abduction, int. rotation, & downward rotation with the horizontal. I "tape it as I see it". I'm not attempting to facilitate/inhibit any muscle groups- I don't believe a piece of tape can do that. I know I'm going to hear it from the kinesiotape enthusiasts, & I don't want to seem hard headed, but I'm sorry, there's not enough evidence based practice to support it. From my previous posts you know how I am, if I can't pull out my goniometer or ruler & see something happening with my own eyes, it isn't happening.

Monday, March 30, 2009

More HS injuries

A good article in this month's "Sports Health" mag- "An evidence-based approach to hamstring strain injury: A systematic review of the literature".

1. Hip flexor flexibility appears to be more important than hs flexibility.

2. hamstring strength,quad/hs imbalances assessed isokinetically is conflicting.

3. Yet another article that points to the efficacy of the Sherry/Best functional protocol outlined in JOSPT '04.

Saturday, March 28, 2009

Lucky 7

Oh, did I tell you this kid continues to play? The problem here in NJ is the baseball season is only 8 weeks long. So, if I kept him out of the sport long enough to correct his shoulder dysfunction, the season would be over. With the cooperation of the coach, he's being platooned to reduce his "reps". And, I'm correcting the malposition by taping it (doesn't it look better?!). He plays pain free; no more subluxating shoulder as long as he wears the tape. The strange thing I notice is the tape seems to have a temporary proprioceptive effect lasting hours after it is removed.

By the way Heidi- as long as you clean the skin good with alcohol, then spray it good with tough skin, it will even stay on pretty good in the water!

Wednesday, March 25, 2009

Integrating the Core- SICK R Scapula

Thanks to Jennifer Walle P.T. from CJW Sports Medicine in Virginia for the great question. She asked for an example of my take on the "core". Here is how I integrate into SICK scapula rehab:

We know that two weak muscles responsible for the SICK scapula are the rhomobids & serratus anterior, right? We also know that these muscles are part of the sling that creates the "serape effect". As you recall in a previous post I said placing a weight in the hand of this type of athlete is not a good place to start. Picture the arm as a back hoe, with the scapula as the cab controlling it. If the cab is not stable, the load will cause the cab to tip over, no? So, I have a better idea- my wall slides.

The athlete begins this exercise facing a wall with both hands side by side in front of the Right shoulder. The hands are covered by socks so they slide easier on the wall. Now the athlete takes a right cross step with his left foot. The hands slide across the wall at shoulder height, in the opposite direction of the left foot. The eyes move opposite the hands. The athlete then returns to the start. He controls the amount of weight bearing on the hands by how far away he stands from the wall. This is continued for 30 seconds, 10 sets.

Now the rhomboids & serratus ant. are loaded from the top down by the hands leaning & sliding on the wall. The hands are "buddied up" to minimize the stress on the R glenohumeral joint. It also encourages more motion in the thoracic spine, which is desirable in this condition. The pelvic R rotation loads the int/ext obliques from the bottom up which myofascially is linked to the SA & rhomboids. The head rotation? I'm not sure about that one, it just seems to load the shoulder better.

The prone planks are a little easier to figure out. The athlete is shifting his weight R/L, diagonal R/L, followed by the sponge bob "bring it around town" R/L circumductions. The lever arm is shortened, & all of the abs & hip flexors are integrated.

Of course there's still lots more to address, other muscle groups to integrate, the possibility of some long thoracic nerve neuropraxia et al. Any comments pro or con are always welcomed.

Monday, March 23, 2009

The SICK Scapula

Take a look at the right scapula:
Scapular Malposition
Tender Coracoid Process
Prominent Inferior Angle
Scapular Dyskinesis
Downwardly rotated to boot.
Kibler took a lot of poetic license on the SICK scapula term.
This is our JV catcher, met him for the first time today with complaints of a "popping" R shoulder during throwing/batting. He is anteriorly unstable. He has barely done any throwing, it is the pre-season. A lot of the stuff we see on the high school level are remnants of poorly designed programs of the past. 12 year olds playing on 3 different little league teams. Physical education is 3 hours a week with the personal trainer. Now it is our problem.
High school ATC's, let's make sure the buck stops with us. Let's not send them up to the college or minor leagues with this stuff. The baseball player's back should be ripped by the time you get through with them. The thrower's 10 is fine to milk out post game soreness, but you'll need to be a lot more creative to fix these. To be continued...

Saturday, March 21, 2009

Can I have an ice pack?

Here I am working with an outfielder with pain in the distal bicep & forearm. By way of neurodynamic tension testing I determined that this athlete had a median nerve entrapment in both the lig. of struthers & the pronator teres. I explained to him ice was for sprained ankles & things like that. A few simple neural glide techniques & his symptoms disappeared. Whole process took a few minutes.

Neurodynamic entrapments were documented in cadavers about 15 years ago. In this month's JOSPT nerve gliding was documented for the first time in vivo by some Australian researchers. Frijoles Frios!

May I recommend Butler's "Mobilisation of the nervous system" & "The sensititive nervous system" for your reading pleasure.

Thursday, March 19, 2009

Reactive Abs 2: Throwing & Swimming

Last summer I gave an emample of how we might integrate the abs in with the UE in a functionally consitant manner. I gave an example in which the hips were going out-of-sync with the shoulder, running.
Now we're going hips in sync with the shoulder, a la a right handed thrower. My drivers are the R hand & foot. I'm using a L SLB, RUE posterior @ overhead L120 reach c/ 3lb. powerball; RLE @ knee height L 120 reach c/ 6lb. ankle weight.
I'm using different weights because I want the hips to lag behind the torso just a bit to create a proximal acceleration, even though they are moving in the same direction.

Tuesday, March 17, 2009

Grade 2 Adductor Stain day 8

Exercise Physisiologist Jack Blatherwick questions why fitness qualities such as strength, flexibility, stability etc. need to be worked as separate entities. Good question.
In these two photos one of my athletes is doing rehab for a right adductor strain. Accomplishing all of the above using a jungle gym.
The traditional exercise you would see in a weight room would look something like right side lying with the left foot up on a basket
doing leg raises. Training the adductors to do something
they don't really do in upright function. For example, this athlete
strained his doing straight ahead sprinting.
The remainder of the workout included some double leg agility ladder stuff & some med ball rotations in a stride stance.

Saturday, March 14, 2009

Postural Screening?

I can't emphasise this enough when it comes to this postural screening stuff- asymmetry is the norm. There is no simple algorithm; A+B does not always equal C. A few years back Vern Gambetta was lashed at in his blog when he suggested "pronator distortion syndrome" or "upper crossed syndrome" often disappeared when you moved from the static to dynamic/functional. Even suggesting he could not be a good strength coach without paying $400 bucks for a popular postural course.
Vern humbly dropped it, but he had the research behind him. In 2005 Lewis et.al in the journal of shoulder & elbow surgery came to the same conclusion with regard to shoulder injury in throwers. More recently, that same postural screening program was found to be a poor predictor of running injuries (don't have it handy, will have to dig it up).
Anecdotally, I've even seen the opposite! In other words, an athlete who has good ROM in a particular joint statically, but does not have the mostibility to present it dynamically.

Wednesday, March 11, 2009

Mike Marshall Technique

OK, it's like this. If you throw the "traditional" way, the medial elbow & anterior shoulder structures are stressed & prone to injury. And if these things hurt, naturally switching to a different technique will bring you relief, possibly increase your MPH too because a lack of pain. BUT, if you throw this way long enough, other structures will be stressed. By the way it looks, probably the lateral elbow & posterior shoulder. The Marshall technique has not been used long enough, often enough, & used by enough practitioners to say it is better than the traditional way.
I'm not a big fan of the "my way is the only way- everyone else is ignorant" style. Marshall is not the only pitching guru who is guilty of this. Give me my high school coach, Ray Korn, any day. 1 elbow injury in 27 years, & not a single shoulder as far as I can remember. As soon as an athlete complains about something hurting, he has them do something different with their foot, or how high they lift their knee or something like that and no more pain.
Something to think about: Say your a cave man a few million years ago and you're starving to death and you see a woolly mammoth cross your path & you've got a spear in your hand. What throwing technique would YOUR body choose?

Sunday, March 8, 2009

Selye & BMD

From the 3/08 Orthopaedic Research Society Annual Meeting-
Real simple, the researchers had young women push down on load cell attached to an oscilloscope 15m per session, 3X per week for 15 weeks. They did periodic BMD tests on the carpal bones of the wrist. All subjects increased bone mass at the conclusion. HOWEVER, at 7 weeks, the subjects actually showed a decrease!
Something to keep in mind when we are prescribing exercise. Always remember bone growth always lags behind muscle a little. Always keep the planned performance training model in the back of your mind, and cycle in periods of loading & unloading. Don't let your workouts become a survival of the fittest.

Friday, March 6, 2009

Book Recommendation

Excerpt from, "Recommendations for the diagnosis of low back pain from the American College of Physicians & the American Pain Society":
-"Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with MRI or CT only if they are potential candidates for sugery or epidural steroid injection".
Pretty cool. Even with all this high tech stuff, MD's understand the importance of good postural, static, dynamic, and functional testing. A great text I would recommend to all high school athletic trainers:
"Functional Soft Tissue Evaluation & Treatment by Manual Methods" by Warren Hammer. Dr. Hammer is a chiropractor. They were the first at this manual stuff, and they are still the best.

Wednesday, March 4, 2009

Hip to Elbow?

Justin Duchscherer, pitcher for the Oakland A's, was placed on the disabled list for the 3rd time in his career. The previous 2 were for a R hip torn labrum and some exostosis on the femoral head. This one is for his R elbow. Could there be a connection here?
In my thought process, biomechanical problems that injure the throwing shoulder are the same that injure the elbow. It's just a matter of how the athlete chooses to compensate for their LE issues. The baseball pitcher requires a tremendous amount of extension, I/ER in the hips. They really need to be as strong & flexible as a hurdler in track & field. As the R handed pitcher runs out of R hip extension/external rotation in the acceleration phase, they will often drop the elbow to shorten the lever arm to give it a chance to catch up with the body. Another strategy is to lean the torso away from the ball to steal a little more extension out of the hip by getting it to externally rotate.
The other issue is that Justin is one of those pitchers who throws his 2 seam fast ball almost like a screw ball. This creates a tremendous amount of movement on the ball, but really beats up the radial head/capitulum.

Tuesday, March 3, 2009

The Rossiter System

Despite 6" of snow with a 30 mph wind @20 degrees F, our state meeting went on. Steve Viana, my local compadre from Linden NJ did a great job of putting the exhibitors together. One of them was Richard Rossiter, a Rolfer who has developed his own brand of myofascial release, "The Rossiter System".


I was walking by his booth when he grabbed my ear & explained the technique to me. I explained to him I already did soft tissue work using ART. He immediately said, "AHHH, but your thumbs are sore by the end of the day, admit it!" Ok, I couldn't deny that I work on athletes, and yeah, that has happened. So he explained his method uses the FOOT in lieu of the hand! My response was, "I can't do this stuff- what will people think when they walk into my A.T. room & see me stepping on a kid!"

However, as fate had it I won his book & DVD in the raffle- worth 40 bucks. I thought it was a very nice gesture, so I am giving him a plug. He offers courses throughout the U.S. that you can get NATA CEU's. If anyone else has experience with this technique, let me know. And what the hell, like I do with ART I'll have the protocol manual out while I am doing it so they know I'm not a wacko.