Corrective Exercise for Anterior Innominate

Thanks Jerimiah for getting us started here. You have the right idea, getting out on one leg. However, we need to remember iliosacral motion is relative motion. That is, all the bones of the pelvis are moving in the same direction; but, one is going faster than the other. In this case, the motion is driven from the bottom up, so the L ilium is going faster than the sacrum in a counter clockwise fashion.

What I'm getting at is you have the right idea of going after the core, but we need ground reaction force to get the right chain reaction biomechanics going on in the pelvis.

Jonathon, you & I are thinking along the same lines. Use the same side arm to turn on the abs to keep that ilium from going too deep into the zone. I chose a LLE posterior lunge c/ a LUE posterior @ overhead reach. I realize you chose an anterior lunge. Who is right, me or you? Or are we both right- or both wrong? I will have to consult with Marty Lambert on this one. He is a functional P.T. with a background in osteopathic medicine.

Weekend from hell

Sorry I haven't posted in the last few days. I worked all day Friday, Saturday, then Monday. The worst part was baseball got knocked out of the state tournament. Track was a surprise though, with a good # of athletes moving onto the state champioship meet. I will post as soon as I get caught up here.

L Groin Pain

While others are already on their way to the Jersey Shore for the extended memorial day weekend, I'll be lucky if I get Sunday off. But, here's an interesting one.

One of our basketball players comes stops in complaining of L groin pain. He claims the pain began shortly after a fall onto his L glut while being low bridged during an AAU game. His butt was pretty sore for a few days, but he didn't think anything of it. A few days later, his L groin began to inexplicably hurt. After ruling out L1 involvement, I dug in further.

The fall caused a left anterior innominate that is interfering with his hip flexion. My plan is:

1. Plenty of myofascial release to the L dorsal sacral ligs & glut.

2. MET to correct the innominate.

3. Modalities to treat the muscle irritation.

Any ideas for an exercise program to to keep the correction? Is there such a thing?

And don't say a BRIDGE.

(I'm not being sarcastic here- I'll explain why it's inappropriate in my next post).

Sal Marinello

I'm often asked for personal trainer recommendations, and if you live near the Essex County area of N.J., Sal is a good choice. His facility is the Millburn-Short Hills Athletic Club.

He has an interesting background, starting out with a degree in Urban Studies from Lehigh U. in 1984, then decided to go back & get into the strength & conditioning world. I like Sal because he keeps an ear to the ground by coaching at nearby Chatham high school. He's been in the business for 20 years now. He sells a book on his website about how to develop a profitable personal training business, but the truth is he's done it by ignoring fads & getting people moving.

His website is http://www.healthandfitnessadvice.com/

Reactive Abs Part 3

From the May '09 Journal of Strength & conditioning research. "Ballistic Abdominal Exercises: Muscle Activation Patterns During 3 Activities along the Stability/Mobility Continuum."- an excellent article out of Canada by Dr. Stuart McGill.



I don't want to beat this "proper firing pattern" thing to death, but the evidence based practice on this stuff is slim & none. Don't get me wrong, there's nothing wrong with bridging. If you're working with wrestlers or soldiers who need to get off their backs in a hurry, it would be a good idea to include some in your repertoire. But if you're doing it to improve glut firing patterns, you'll have to do a lot more to convince me.

In this study, Dr. M studied the firing patterns of the abdominal muscles in 3 different activities: tightening your tummy as if you were about to get punched in the gut, doing one of Bruce Lee's famous "1" punch", & pitching a baseball. The firing, resting, & sequencing of the 3 were all different. He concludes by stating, "...we do know that the demands for stiffness, stability, force, & moment production cause different patterns of contraction", & ""muscles must be stiff enough to ensure joint stability but not too stiff to impede movement, in turn, making for a slower/weaker throw or punch".

Remember the glut muscles; like the abs also act in concert with each other, and muscles about the pelvis. Think of the 2 innominates as being the scapulaes of the lower extremity; feeding information back & forth between each other as well as to the UE & LE. You can train a muscle to do anything, it doesn't mean it's the right thing. The proper glut firing patterns that it takes to decelerate a shoulder rotating at 7000 degrees per second is different than the firing patterns it takes Shakira's glutes to shake it on stage is different from the firing patterns of Usain Bolt's glutes running a world record 100 meters.

Someone please give me a better explanation than this. Until then, I'll stick with a good sequential warmup any day. And let the glutes figure it out for themselves.

WRONG

Cool song, cool video.

Berlin era David Bowie + Trent Reznor= New Depeche Mode album.

http://www.youtube.com/watch?v=5bsXOcK9_Cw

Pivot Lunges

Great for LE rehab. They are close chain, and tons of variations you can do.

I'm using them now for an athlete with a grade 3 inversion ankle sprain that disappeared on me for 2 weeks. When he returned that ankle was totally gunked up & ROM dysfunctions in all planes. With plenty of ART, joint mobes, manipulation; and with the help of youth; they are coming along just great. We did pivot lunges today.

I used them to increase his dorsiflexion ROM. Lunging posterior to anterior, then reverse with his non-involved leg. The posterior part of the lunge was not a problem. However, I was careful not to go too deep into the transformational zone on the anterior lunge, and force dorsiflexion he does not yet have. I placed a piece of tape on the floor at approximately mid stride to ensure that.

Then I added in upper extremity drivers to influence the ankle top down. I went with the frontal/transverse planes to complement the bottom up sagittal plane drive.

Baseball Pitch Counts

Kev asked this question I thought would make a good post topic:

"Curious on your thoughts on pitch counts in HS baseball pitchers? This past weekend our kid threw 112pitches in 9 innings of work while the opposing pitcher threw 155 in 6innings of work in the same game.We had a kid who will be drafted this year that could throw about 90-100 pitches/game and be able to turn around and do it again 3 days later. I have another kid now who can throw about 100 pitches and not be ready to go again for a week."


The low 100's at this time of year I would say is right on the money for a high school age pitcher; 155 in the danger zone. Remember, you have to count in warm up throws, bull pen, pitches between innings etc. As far as the differences in your two kids recovery wise, a lot of stuff comes into play. Physical age, training age, physical fitness, height, arm length etc. But, I think the big one that separates recovery time is throwing mechanics. And, I also believe trying to change throwing mechanics at the high school level is just as difficult to change as running mechanics. Those with lousy mechanics will also tend to "over-throw" to get the velocity they need.

Late Season Break Down

The N.J. news papers are full of stories about high school pitchers who are already broken down for the season. The baseball season up here is not even that long. Including the pre season, about 10 weeks if you go to a state championship game.

So I found it odd that I heard this comment from a baseball coach.

They like where they are coaching because of no "athletic trainer interference". He got annoyed when A.T.'s would stick their 2 cents into what they where doing. Let the coach & parents & booster club & what not run the show. There was plenty of money around to fix what was wrong.

I've seen this before; athletes that come out of these types of systems. They are only in their early 20's with surgery scars all over them. The A.T. was only there to slap on ice packs & do ultrasound & E-stim.

An A.T. is not a physical therapist trained in first aid! We need to be interwoven into the team matrix. That being said, there are a lot of egos in this business. Back door diplomacy must be used for the coach to gain confidence in you & let them know you are a partner in their success.

Orthotics?

"Suspected Mechanisms in the Cause of Overuse Running Injuries: A Clinical Review"; Ferber, Hreljac-Sports Health May 09".

This is not the first article asking the question, "What constitutes a normal foot?", & states, "minimal and conflicting experimental evidence supports excessive foot pronation as a contributing factor in the cause of injuries."

The bottom line is be cautious when recommending orthotics for your athletes with MTSS or PFSS. As far as I'm concerned, the majority of the time a customized felt insert works just fine. Things like training progression, work-rest intervals, variety, overall body strength/fitness, pelvic hip mostibility are more important.

Slip-not

Knee Strength Capabilities and Slip Severity; Wyszomierski, Chambers, et al. Journal of Applied Biomechanics- May '09.

This studied the influence of knee strength on recovering from unexpected slips during self paced walking. Knee strength was determined isokinetically, so only ant/post sagittal plane was studied, & non weight bearing. No surprise, young males were stronger & recovered from their slips faster than their female counterparts. May I emphasise again, to a certain extent adolescent male athletes can get away without strength training, female athletes cannot.

In a reverse way, I use slip training as part of my ACL rehab. I buy some cheap carpet runner at Walmart, cut them up into 12" squares, and toss them randomly on a gym floor. The athletes will sprint, skip, hop or jump in 3D patterns onto the carpet & slide.

Another technique I use is to have them walk up & down grass slopes outside the school in the AM when the morning dew is on it.

ART Recert

Rough weekend. After tonight's game ends about 8pm, it's a 4.5 hour drive to upstate NY for my ART recertification. The instructor is Dale Buchberger, a chiropractor/physical therapist. He does a lot of work with the Toronto Bluejays baseball club, and just a brilliant guy. At one time he was right around the corner from me in East Brunswick N.J.; but I know it will be worth the trip.