Thunder Thighs?

Just read an article in Training & Condtioning Mag where a S&C coach mentioned leg training for female athletes. His protocol for women is different than men because of the cultural bias against thick legs for women.

From my experience, functional exercise doesn't do this. It's the traditional bodybuilding isolation machines that hypertrophy the legs. The worst is probably the hip sled/leg press.

The only other exception would be Weight and Power lifters who spend an extrodinary time with very heavy weights doing deep squats.

Glut Medius info

People were asking for an article on the glut medius, here is a post I did about a year and a half ago. Remember my gut opinion is it is silly to attempt to isolate out individual muscles (I should know-I was one of them); all the new neuromuscular research since that post backs me up :

http://joestrainingroom.blogspot.com/search?q=gluteus+medius

Clarification on Hamstring Exercise Explanation

Pete Koeniges asks:
Joe, I like the exercise and understand about neural glide. I don't understand your statement "specific to how the muscle is used in forward running". I think of the hamstrings as a hip extensor in forward running, where foot contact occurs with the foot below the pelvis. In this exercise, the lead foot is obviously ahead of the pelvis. So, in my understanding, it's not specific to how the muscle is used in running."

Thanks for the question Pete- I was not specific enough. In the exercise I'm working on the first "transformational zone" as Gary Gray refers to it. That is, the hamstrings function with the leg out in front of the body. Here the HS's are decelerating hip flexion and actually acting as a knee extensor with the quads. That's when most hamstring strains occur; and the exercise attempts to freeze that moment in time.

Robbing Peter to pay Paul- Redux

A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis, Garg et al; Journal of Shoulder & Elobow Surgery-05 April 2010.

You get the idea here- taking the stress off the extensor mechanism by way of a wrist immobilizer. They compared it to a traditional tennis elbow brace. The researchers found it did work better.

We really don't see this in the high school population, right? But you probably have a load of coaches, teacher, and maintenance guys coming to you with it. Traditionally treatment has focused on the elbow itself with cortisone injections and wrist extension exercises. But close to 100% of the time, anecdotally at least, I find the cause to be the loss of wrist extension. Of course it manifests itself in the 40's- but I believe it begins in school age.

How may of you out there have kids who can't do pushups because it hurts their wrists? They are in their teens and they already have range of motion loss. Athletes coming to you ad nauseum asking you to tape their wrists. I believe prevention should begin at the elementary school level. Forget that cup stacking nonsense. Crawling is a great upper extremity/core strength exercise, great for wrist mobility, and the variations are endless. I continue to use it in rehab.

Of course the brace will alleviate the pain. But it will contribute to the dysfunction that caused it in the first place. I personally prefer the unloading technique I described in my "less is more" post from about a year and a half ago.

Groin Injury Update

Coach Martin's "injured" athlete wins the 800 then comes back to help his team win the 1600 relay in the NJ state sectional championships this past weekend. His team finishes 2nd overall; Elizabeth 14th. I think I will turn this blog over to him.

Groin Strains in Track & Field

Coach Martin asked me for some comments on this topic. First of all we need to define it, since it's sort of non-specific. I take it to mean the area including, but not exclusive to the adductors, sartorius, pectineus, iliopsoas, origin of the rectus, and the lower abs.

Before we even get started, keep a close eye if the pain is right up on the pubic ramus (bottom/front pelvic bone), or in the AIIS (anterior inferior iliac spine). They are frequent sights of stress fractures, especially in females and all athletes in the 14yr. old range. Way more common then you think.

Not too much GOOD research on the groin area. The best functional study of the adductors I have seen is from way back in Partridge Family era 1970! Get out your platform shoes and polyester shirts cause we're goin' retro (Am.J. Phys. Med. 49(4): 223-240, 1970). Researchers Greene & Morris found subjects with enough guts to walk around with fine wire electrodes in their legs. Here's what they found about how the adductors functioned in walking/running:

The left adductor magnus and the right adductor longus exhibited equal activity at left heel strike. The reverse occurred at right heel strike. This would be consistent with the magnus functioning as a hip extensor and the longus functioning as a hip flexor. As subjects walked with their trunks intentionally held in a forward flexed position, the activity of the adductor magnus increased dramatically, while the adductor longus activity appeared to change very little. Walking with an extended trunk increased longus activity and decreased magnus activity. Apparently, the adductor magnus plays a major role in decelerating hip flexion and accelerating hip extension. The opposite would be true for the longus.

The authors then had the subjects walk with a very wide and a very narrow base. Although this appears to be a change in the frontal plane, the authors intended to change the amount of transverse plane motion of the pelvis. Their measurements of pelvic rotation showed that the wide base decreased pelvic rotation and the narrow base accentuated it. With both “tweaks” the pattern of activity (opposite magnus and longus contracting together) remained the same. With the wide base of support there was still significant activation of both muscles. Of great interest is the substantial increase in the “amplitude and duration” of both muscles produced by the increased pelvic rotation caused by the narrow gait. (Thanks for D. Tiberio of GIFT for the commentary).

-What's to be learned from this?
1. The adductors obviously don't adduct the legs in walking or running; gravity gives that to us for free.
2. The adductors don't dig (using 70's terminology) the pelvis wiggling around during running (Jack- here is where the cramping could come in). Strength training is important here.
3. If #2 is true, then it is conceivable that the adductors, rather than being week, may be taking on the butts role is decelerating leg adduction and internal rotation. Again, dormant butt= strength training (functional that is).
4. Getting back to numero dos- remember the pelvis is an interdependent ring. What goes on one side has a direct influence on the other. Remember runners who run in straight lines are subject to what Vlad Janda called "pattern overload". Their bodies may have become adapted to running and movement patterns rigidly grooved.

Now- what the hell to do about it.
-in the short term, reduction in activity and E-stim/sound combo treatments, ice, massage stick, light IASTM if it's available, and MET (muscle energy technique) about the pelvis is valuable to reduce spasm and make the athlete more comfortable.
-The long term muscle spasm can create adaptations in the pelvis like rotations and upslips in the innominate bones of the pelvis. That's fancy wording meaning you can wind up with more groin strains. The MET's work great on this stuff.
-for long term- I believe 3D running should be an integral part of the recovery/restoration process. Backpedaling and backward running, slide steps, carioca; with a variety of arm swings should be included in the cool down process, or included on what Bowerman would call "the easy days".
-for long term- Plenty of 3D lunges, squats, and step ups. Combine them with an overhead reach if you want to do some "integrated isolation" on the groin.

Phew! Talked too much! Good luck this weekend Coach Martin and all coaches! Would love to be there but I've got baseball/softball at Williams Field.

Give me a break Jack

Look coach Martin, stop being so modest.

Like your kid with the groin strain really ran a sub 2 minute 800m split because a kid lent him some tiger balm or something.

Truth is you create competitors, not kids who just run fast.

Don't Worry Be Happy

JH brought up a good question:

"Get this, I sent a patient back to his Dr. because I believe him to have a nerve palsy preventing him from controlling his arm in ER as wellas scap control. GUess what the Dr. said to do? Yep the Dr. wanted me to work on more scap stability. How can I when the person has a nerve palsy?? "

I see what's bugging you about this. The MD probably went to some workshop where everything was caused by scapular dyskinesis. However, it does come down to one of those chicken or the egg things. Did the nerve palsy cause the scapular control/ER issues you speak of, or did these issues cause a hypermobility in the shoulder that created the nerve palsy? Because either way, exercise is the answer; and his diagnosis gives you plenty of leeway to create a sound program. It could be worse; pigeon holing you into specific treatments that frustrate you and the athlete.

Hips in/ Hips out

Thanks to my buddy Lou Argondizza for demonstrating. Lou is an umpire and bartender/papi chulo at Sunsets Restaurant in Belmar, N.J. It's right on the Shark River at the Jersey Shore and gets beautiful sunsets, hence it's name. Ladies stop in and flirt with Lou when you get a chance.

One of my favorite exercises I use in hamstring strain rehab. There is a sagittal plane bias, which places it in the latter phase category.

The athlete begins with the "hips in" part. The athlete stands in a stride stance (affected leg forward) with a 7lb. heavy ball held posterior at overhead; elbows straight. Both feet should be pointed straight ahead. The foot of the trail leg may be permitted to slightly externally rotate.

At that point the athlete pushes his butt to the rear, moving the ball forward toward the lead ankle. The lead foot is dorsiflexed as the COG translates to the rear. The athlete smoothly reverses the motion, pushing the hips forward, returning the ball to the starting position, as the foot plantar flexes back to the floor.

As they become more comfortable with the exercise, I have the athlete internally & externally rotate the lead leg as the hips go back. It's appropriate for both high or low strains.

Besides being specific to how the muscle is used in forward running, the exercise also gets a good sciatic neural glide going. Neural glide is no longer a theory; it's been documented in the professional journals. The sciatic nerve must be conditioned to tolerate the constant lengthening & compression that goes along with the muscle action.

The other issue this exercise addresses is the influence of the contralateral iliopsoas on the affected hamstring. Tightness in the hip flexors may cause the opposite side hamstrings to fire prematurely and contribute to strains.

Great Quote from Carl DeRosa

In the song, "Magic", Bruce Springsteen says, "Trust none of what you hear and less of what you see".

I am a big fan of Carl DeRosa, own all 3 of the books he wrote with Jimmy Porterfield. Feel he has been misinterpreted by the gurus out there. He did a great editorial in this month's JOSPT. He was speaking of manual therapy, but we could easily apply it to what is going on in the rest of athletic therapy, strength & conditioning, and personal training.

"Practitioners and commentators seem to be intent on deliberately obscuring what we are doing, going far as to create individual languages and terminologies to describe the techniques, understandable only to those who may have undergone the secret training. A cynic might ask how different this is from apprenticing with the sorcerer from the middle ages."

http://www.hulu.com/watch/3529/saturday-night-live-theodoric-of-york

Ted Dardzinski is NOT an ATC

Watched CNN's story about Project Walk (www.projectwalk.org) last night on Anderson Cooper. Sanjay Gupta made a statement that "Trainers" do not have a background in rehabilitation and questioned the value of such a program. Ted is NOT certified by the National Athletic Trainer's Association. Apparently he attended the "Egoscue University" (http://www.egoscueuniversity.com/)-not a real university.

Robbing Peter to pay Paul

The Effect of Posterosuperior Rotator Cuff Tears and Biceps Loading on Glenohumeral Translation- Su, Budoff et al/ Arthroscopy May '10.

The long biceps tendon is one of the shoulder's backup systems to control GH instability. Tendinitis is usually a warning that the tendon is becoming a primary stabilizer.

A pretty simple study; they cut fibers of the subscapularis, supraspinatus, and infraspinatus to different degrees and combinations. Then mesured the amount of anterior/superior translation of the humeral head in the glenoid with and without biceps loading. The long head biceps tendon reduced humeral head translation up to 53%!.

Relocating the tendon from the scapula to the humerus is often a surgical treatment that increases shoulder instability; which is a precoursor to rotator cuff tendinitis.

ATSNJ Concussion Summit

August 2, '10; mark the date! Cantu, Jordan, Brolinson- The top brain injury researchers in the world will be there!

Download the brochure at:

https://www.signup4.net/Public/ap.aspx?EID=20101530E

New Link

On the right side of this page in the "my favorite websites" section you'll see a link to:

http://www.atsnj.org/

The Athletic Trainers Society of New Jersey

Since it's inception I've always believed it's been a superior website that was the brainchild of Mike Goldenberg ATC- A guy that has always been on the cutting edge of this stuff.

Great information for athletes, coaches, parents, and fellow athletic trainers. Be sure to take a look at the new concussion section.

Let's put the Neuro back into Neuromuscular

I just read an article on groin injury rehab in a popular journal. The protocol was divided up into warmup, strengthening, sports specific. The warm up got off to a pretty good start- a good combo of different kinds of squats of lunges. However, the remainder was very much muscle tissue focused on hip adduction. Exercises like a seated adduction machine; squats squeezing a ball between the legs.

Most of the exercises in the protocol all seemed to involve a good deal of stabilizing isometric contractions that I'm wondering if they possibly contribute to the neural confusion that causes these injuries in the first place.

Remember the adductors come off the pelvis; and forces coming bottom up from the same side foot, & top down from the opposite leg, torso, and arms also need to be taken into account. It sounds complicated, but it's really not. Trying to piecemeal individual muscles is what makes it seem complicated. Functional science requires the practitioner to think on their feet- the rehab is customized to the athlete and injury.

"The Plan"

Not as grandiose as "the secret", but it goes like this: This is one of our track & field athletes who has a grade 1 strain of his left semimembranosis from this past weekend. He has an important meet coming up today so I came up with a plan of action:

I pulled him out of practice for 4 days and we did his workouts in the pool; primarily done as combinations of deep water sprints. I supplemented this with plenty of soft tissue work. Graston the first 3 days. I used mainly sweeping strokes to reduce muscle spasm. Today before the meet I did ART. It is important to remember ART is not simply a "pin & stretch" technique. If you do it right, you are not going to get anywhere near their full range of motion. Once you take up the myofascial tension, hip & knee extension will limited.

We followed it up with my favorite hamstring stretch. The affected leg is placed on a bench or chair with the toe pulled toward the head. The contralateral foot is on the floor slightly toed out. The torso is forwardly flexed just enough to meet the muscle barrier. At that point, the hip is actively internally/externally rotated as the arms drive in the opposite direction of the foot for about 30 seconds.

Will the plan work? I've effectively used it many times before with lower extremity muscle injuries, but who knows.

What squat to start with?

This is one of our softball players who tripped trying to run out a ground ball. She smashed her knee into the dirt and wound up with a contusion to the anterolateral patella and lateral retinaculum (see the abrasion?). Some pre patella bursa injury too.

Day 3 post injury, I wanted to get her going on some partial range squats. My goal is to get a good muscle pump going to reduce edema and prevent quad atrophy. A traditional squat subconsciously caused her pelvis to translate to the uninvolved limb, as well as the foot of the involved leg to overpronate. Her body attempting to unload the patella & lateral retinaculum.

I successfully switched her over to R stagger squat; you can see everything line up better. What other squat variations could I have chosen?