Monday, January 18, 2010

Sports Hernia

Garvey et al- Sportsman hernia: what can we do? Hernia. Jan. 12, 2010

The author's state risk factors as reduced hip range of motion and poor muscle balance around the pelvis, limb length discrepancy and pelvic instability.

I think this is all stuff we as A.T.s can be proactive on. Leg length discrepancies can easily be treated with some 1/8, 1/4" felt in the (full length of the) shoe of the shorter leg. Make sure the athlete can functionally 3D load the hips & abs. You would be surprised, for example, how many athletes cannot perform a decent posterior lunge. Traditionally, pelvic stabilization programs are performed in bridging variations. The problem with this approach is you're using the pelvis as a driver, really not getting the athlete into the proper transformational zones. The ab/groin region must be loaded bottom up/top down to be effective.

I'm really surprised the authors never mentioned femoral torsions as an etiology. I think I'll contact them and see what they think.


JH said...

I've got a semi-hypathetic for you. (based on a true story). I'm not sure if you like hypotheticals so if you don't, simply ignore it. It won't hurt my feelings.

Let's say you've got a pitcher that has arm pain only when he starts to accelerate beyond about 60% of his max speed. he only has pain at in the follow through.

I've gone through my head and cleared the ankle for any deficit that may prevent dorsiflexion. I've also cleared the hip to see if the external rotators of the left hip (right handed pitcher)to see if they are too tight or too weak to decelerate. No sign of scapulr dyskinesis although he can volutarily wing his scaps bilat if he chooses. Strength is good in the shoulder in general. External roation of the humerus is tight.

What else should I be looking for as I feel like I've thought of everything I know to do.


Joe Przytula said...

Jonathon- have you taken a look at my eata 05 presentation on vern`s wesite? Other places to look are trail leg mechanics, si joint dysfunction (common in pitchers!)- hypertonic t spine (all planes), r cervical rotation- the presentation has some good screening stuff.

Jack Martin said...

Off topic but in my knee PT I have doing a lot of work that involves proprioception and I am having difficulty at my advanced age. Can you point me in the direction of things to help me restore (if I ever really had it) my functional balance?
Any help is appreciated.
Thanks. Jack Martin