Phil Donley, the real deal

Just got back from the first day of the ATSNJ symposium in Princeton. Spent 5 hours in a shoulder course with Phil Donley ATC. He starts his shoulder evaluation with a kinetic chain assessment. He spent quite a bit of time on the head & cervical spine's influence on throwing mechanics; how they influence the body & how the body zooms the neck.

He gave us his take on this new emphasis on humeral retroversion & it's effect on the throwing shoulder. If you're not familiar with it, these guys feel GIRD (glenohumeral internal rotation deficit) is not a big deal as long as the total arc of rotation is similar to the non throwing arm. The theory is by pitching for such a long time and from a young age, the humeral bone itself kind of torques itself backward as a way of developing more external rotation. In their mind, the posterior capsule is not tight & working on it's flexibility is a waste of time.

Phil feels that's bull. He says rather than the humerus bone rotating backward, the pre pubescent throwing never allows the bone to develop into it's naturally internally rotated attitude. He disagrees strongly that this is a positive adaptation that allows the athlete to load & throw faster. And, he feels the tight posterior shoulder capsule is a frequent contributor to ulnar collateral ligament injuries to the elbow.

I asked how he felt about pushing of the rubber to gain more throwing speed. He said he didn't have a problem with it as long as the athlete was biomechanically sound. I on the other hand feel this is injurious to the shoulder. Our ex baseball coach, Ray Korn also discouraged it. One elbow injury, one shoulder in 27 years.

Interval Training vs. Slogging

Backs up what Jack Blatherwick has been saying for years.

http://www.washingtonpost.com/wp-dyn/content/article/2010/02/25/AR2010022500030.html

Abbreviations

Don't mean to confuse anyone. It's just that I usually post in between periods & only have a few minutes to get it done- I'm a high school ATC first. Remember this blog is about you guys. Anything you don't understand, fell free to ask!

The hip & MTSS

"Distinct Hip & Rearfoot Kinematics in Female Runners With a History of Tibial Stress Fractures"- Milner et al JOSPT 2-10.

The big rocks uncovered in this study was (at gound contact):
1. Very little difference in knee motion between injured & uninjured subjects.
2. The stress fx subjects demonstrated greater hip adduction.
3. " " subjects demonstrated greater rearfoot eversion.

I found it interesting that the rear foot eversion didn't seem to have an influence on peak motions at the knee; it was also contrary to the author's hypothesis (did it have an influence at the hip???). They do note however, 5 of the subjects had a movement towards knee abduction AFTER initial foot contact, when that lower leg should have been locking up. I'm wondering if this creates the possibility of timing issues- remember the study only looked at peak bone excursion.

The authors go on to say that orthotics to correct rearfoot eversion do not result in changes at the hip. Very cool, they suggest altering running mechanics through gait training as a mode of stress fracture reduction. Now I'm even more excited to sit down with Franz Boche in Fla. at GAIN '10 this June.

OK, of course there is no one-fix-all panacea exercise for stress fx prevention/rehab. But when orthotics are not the answer, how about this exercise for controlling those issues created by excessive rearfoot eversion(RLB, LLE L rotational reach- both c/ a BUE posterior overhead reach)?

Oh yeah- How about a study on the trail leg's mechanics on MTSS?

Physioball Leg Curl

This is one of the rehab exercises suggested in the JOSPT 2-10 hamstring article. I'm not really a fan; but can be persuaded if you come up with a good argument.

Sometimes it's what you DON'T say

Going through the February JOSPT. The issue is dedicated to the hip. Lots of cool stuff on biomechanics & implications for rehab. The editorial that opens up the issue asks, "LE injury- its it just about hip strength?" The author knows like music, sometimes its what in between the notes that really makes the difference. I'm going through the hamstring rehab article right now; which is heavy on rehab based on the location of the lesion. One of the authors is Marc Sherry, who has done some cool research on the topic in the past. One of the claims he makes is that most of the running stains involve the bicep femoris muscle. Do you guys find that to be the case in your athletes?

More Knees & the Brain

http://www.ns.umich.edu/htdocs/releases/story.php?id=7249

GAIN faculty member Steve Myrland initiated a thread on this topic in the GAIN forum.

Vern makes it clear that work capacity is more than just training the individual energy systems.

From page 122 in Vern's "Athletic Development" book: "(general physical preparation is) the capacity to resist fatigue, WHATEVER the source. Fatigue is MORE THAN METABOLIC; in involves the NERVOUS SYSTEM and MENTAL CAPACITY. Resisting fatigue is the refinement of the efficiency and coordination of the cardiovascular, metabolic, and nervous systems."

When you're designing your rehab & prevention programs, always take this into consideration. I'm particularly fond of circuits to accomplish this. They integrate the specific movements you need to work on with a climate of fatigue. Again, if an athlete can go through your protocol with an ipod or texting, you're probably not working neuromuscular. Think global. If the athlete's overweight then integrate that into their routine; if they need more coordination training then add that. Leave them a little more athletic then when they walked in. Like Bruce Lee says, "don't concentrate on one star; you'll miss all the heavenly glory!"

Sorry

Got blasted with 14" of snow last week; 16" yesterday. Been busy shoveling out. I am determined to not buy a snowblower; convinced this is free exercise. Is my back sore. Overtraining for sure.

Is all our supposed digital progress a zero sum gain?

Vern asks this question in his last blog post. Of course it's important for A.T.'s to embrace current technology. But are you getting the most bang for your buck?

In my opinion, it's the 3D computerized cinematography stuff (like Dartfish) that gives us a picture of what the body is doing real time. Allows us to measure which was previously impossible. I don't own this type of equipment, & wouldn't have the time to use it if I did. But, the journals are full of this stuff now & provides us with plenty of practical applications.

IMPACT concussion testing software is another great tool. And I love my SPORTSWARE injury tracking software.

What's your opinion? What technology out there do you feel benefits the high school ATC, & which has led to dead end roads?

Energy Medicine

Thanks everyone for your whirlpool comments. JH brought up an interesting point, heat to make tissues stronger. That's something that comes from the energy medicine proponents. The concept of encouraging the inflammatory process to speed healing. I guess in a round about way IASTM & ART would fit into this category. If you want to get more into the topic, check out James Oschman's "Energy Medicine in Therapeutics & Human Performance".

For the record, I am very skeptical.

Whirlpools

Are there any AT's out there who still use their whirlpools? I haven't used one for about 15 years; have one I use as a slop tank & to fill up coolers. I'll start using it again if you can give me a reason. Pain relief in the acute phase maybe? Elbow sprains? Go ahead, convince me.

Aquatic Rehab the right way

This athlete is performing a same side rotational single leg squat. He's standing on a 6" submersible box to allow more knee flexion. He's beginning at about 40% bodyweight & is at 20% at maximum flexion. I gladly give up a TR for our pool. Unfortunately the way our high school is set up now, not all of our athletes can take advantage of it. But it is my post acute modality of choice for LE injuries when the situation permits. If the athlete cannot do full weight bearing without an antalgic gait, they are in the pool. I know there are functional purists who feel the aquatic environment is gravity confused for land sports, but if I spent a few hours with them I bet I could change their mind. I know there are clinics, high schools, & universities out there who have their own pools-sometimes built in to the TR. Comments?