Thursday, October 29, 2009
"A COMPARISON OF 2 REHABILITATION PROTOCOLS ON STAR EXCURSION BALANCE TEST PERFORMANCE IN SUBJECTS WITH CHRONIC ANKLE INSTABILITY"
He compared a "traditional" ankle rehab program (that focused in on the ankle) with one that focused on the hip & knee. The hip/knee program contained half functional (SLS variations) & half open chain supine (SLR's et al). His conclusion was:
"Proximal joint rehabilitation may be as effective, or more effective
than traditional ankle rehabilitation, for improving dynamic postural
control in subjects with CAI."
Along the same lines, some researchers from Ireland (Coughlan et al) in their study came to the conclusion,
"that a 4-week dynamic lower limb training program resulted in no significant changes in the ankle position or velocity during treadmill walking, jogging, and running. This study raises issues regarding the methods of ankle sprain rehabilitation and the measurement of their effectiveness in improving functional activities. "
Kind of sounds like when I say "rehab the athlete, not the injury", no?
Now I need you opinion. In other research, Dr. Gribble found that CAI subjects had less glute max activity in a same side rotational SLS at the point of maximal excursion than the control group. Any ideas why?
Wednesday, October 28, 2009
Monday, October 26, 2009
Thursday, October 22, 2009
Tuesday, October 20, 2009
"The neutral spine principle, M. Wallden DO".
"The migratory fascia hypothesis, P. Lelean."
From page 351, "being able to dissociate the spine from the hips is a foundational movement skill".
First of all, Dr. Wallden did a great job of articulating his view on the topic. However, I'm still not buying into this. Yes, the neutral spine is something to be desired, but is it something that needs to be taught? Or, is the neutral spine a chain reaction of everything that went before it? On page 358 he gives a chart of pathological findings, and corrective exercises to ameliorate them. The problem is every one of the exercises focuses in on the spine itself.
At GAIN '09 I spent about 3 hours going over 2 case studies of athletes I worked with personally with low back back pain. In both cases, there were upper & lower extremity reasons why the athletes could not maintain a neutral spine. Not one isolated "spine" exercise was performed.
I think the second article I referenced kind of backs me up. The author discovered abnormal fascial folds throughout the pelvis & hips in patients , which produced facial strain patterns , which could contribute to iliolumbar strain patterns. The concept of rather than a weak spine, a spine that is biomechanically fed erroneous neural input.
I'm not sure if there is one size fits all here. I'll continue to rehab it as I see it.
Saturday, October 17, 2009
JH and others who work in the clinic please give us your input of the mind set. If any readers have made the switch over, or switched over & come back to traditional, I would really enjoy your input.
Thursday, October 15, 2009
Tuesday, October 13, 2009
"CLAIM AND COUNTERCLAIM: FOOTWEAR AND FOOT AND ANKLE MECHANICS DURING PHYSICAL ACTIVITY"
RICHARD SMITH, Discipline of Exercise and Sport Science, University of Sydney, Sydney, Australia.
Compared lower leg & foot mechanics during barefoot running to running with so called "neutral" & "dual-density" shoes. Their conclusion was, "The change is not always that which was intended by the shoe maker. The ground/shoe/rearfoot interface with the shank can be the
promoter or recipient of the motion drivers." Across the board there was more ankle motion/less mid-tarsal joint motion with the shoes. In the "stability" shoes, they noted tibial external rotation began much earlier than in barefoot-even while the knee was still flexing at ground contact. What do you think? Can this make one more susceptible to ankle sprains?
Sunday, October 11, 2009
High School ATC's who work with collision sports stay vigilant. Remember we get paid to watch the athletes, not the game. Athletes (some coaches too) think it's macho to ignore head injuries & will hide it from you. Here is an interview from the NY Times with an ex-Gators linebacker. He's only a year older than me yet has paid all his life from injuries 30+ years ago. He talks about how much has changed from those days, but has it really?
Saturday, October 10, 2009
1. It's difficult to overcome heavily developed biceps/pecs/subscapularis without a forceful technique.
2. Even if you un-hook the shoulder pads, you still have the tight jersey to contend with.
3. Considering #2, it's very difficult to get enough ROM to do a Milch.
4. Along with Sarah's comment about the "audience", I've seen practitioners (including orthopedists), fail to reduce, get frustrated & embarrased, and use more & more forceful techniques.
5. The extra 1 minute walk or so to your A.T. table behind the bench is worth it compared to an ambulance ride & ER wait (remember I'm a hs ATC, no team orthopedist!)
6. Finally, in the spirit of this blog, it's only my opinion on what works best for me.
Friday, October 9, 2009
"A Randomized Sham Controlled Trial of a Neurodynamic Technique in the Treatment of Carpal Tunnel Syndrome", Bialosky et al JOSPT 20-09.
NDT reduced temporal summation in this population. I believe these techniques have a place in the recovery/restoration phase of conditioning. It should be noted that the sham NDT also provided a therapeutic effect. This drives the point home that as A.T.'s we shouldn't be afraid to use our hands. Have the technique manual nearby so the athlete understands what you're doing.
I've used NDT in American football brachial plexus (aka "stinger") injuries, hamstring strains, shoulder dislocations, and other injuries that create neural stretching. Any comments Juan?
Thursday, October 8, 2009
Monday, October 5, 2009
Saturday, October 3, 2009
Thursday, October 1, 2009
It is part of the rehab circuit for an athlete with a complete ACL tear. In this athlete's sport the ground is a dangerous place to be and needs to get up and back onto his feet quickly after a fall.