High Ankle Sprain

I took a snapshot of this because you don't see this too often.  An "isolated" high ankle sprain of the distal anterior tibiofibular joint.  The deltoid, ATF, CF, and PTF ligs, and posterior tibiofibular ligs were spared.  The transverse draw tests were negative for aberrant motion, but were minimally painful.

In this scenario the traditional Mulligan style taping for a positional fault of the distal fibula will give you good results; because it also provides good stabilization to the distal anterior tibiofibular joint.  I'm expecting this athlete to make a fairly quick recovery.

This is the future

Vern spoke at this conference at the UKSEM's invitation.  It's a quick read that will keep your compasses adjusted to true north.  It's not just track, it's going on in other sports also.  We A.T.'s; especially us old schoolers with a physical ed-motor learning background have an edge here.  Get over this blog being called Joe's "training room" and REALLY start defining yourself from other health care professionals.  At 51 I've never been more excited to be an athletic trainer.

http://www.guardian.co.uk/sport/blog/2010/nov/21/athletics-world-records

Goin' retro

I've previously posted on the value of retro training as an important part of the recovery/restoration process, but a recent conversation with fellow GAINer Chris Webb got me thinking.  I did some research into lower back pain in swimmers.  Apparently the stroke doesn't have too much to do with it.  The consensus seems to be the hyperlordosis created by the aquatic environment.  As a result, most of the treatments I've read involve pelvic stability stuff.  Consider a few other things.

The T-Spine:  This section of the spine is susceptible to Fryett's type 3 motion...that is, if one or more joints are locked up in one plane, that dysfunction will also carry over to the other two planes.  Most "movement screens" involve the transverse plane.  In my clinical experience, this is the "go-to" plane.  In other words, this is the plane that has the most range of motion in the T-spine.  So it can trick you. The frontal plane in both directions, and the sagittal plane in the posterior direction are the most affected in T-spine dysfunction.

The T-spine is a trouble maker; the lumbar spine a hit taker.  Since swimming is primarily driven by the hands top down, it might be possible that the T-spine is stealing the motion it doesn't have from the lumbar spine.

Retro-Training:  Janda coined the term "pattern overload", meaning sports that require repetitive motion in one plane in one direction (ie cricket bowling, pitching, swimming, running) may result in muscle & joint imbalances.  Simply doing some training in the opposite direction, or with the opposite hand my be beneficial in ameliorating this.

I'm suggesting two more variations- environment & orientation to gravity.  Using swimming as an example, simply switching from the Australian crawl (yeah, that's right, the Aussies invented the freestyle stroke) to the backstroke is probably not effective.  The reason being the body is essentially weightless.  To produce the retro effect I'm thinking you would need to go dryland/horizontal supine or full weight bearing.  Adding exercises to the athlete's repertoire like jackknifes, pencil rolls, reverse crunches (horizontal); posterior lunge-overhead medball combos, dropstep- overhead exercise band combos (FWB).

Please chime in, even if you think I'm full of it- especially if you think I'm full of it!

Yeah, but who has this kind of time?

"Negative effect of static stretching restored when combined with a sport specific warm-up component"- Taylor et al, Journal of Science & Medicine in Sport '09.

Static stretch, then negate the neural inhibition caused by the static stretch with a dynamic warmup.

Save the static stretching for the recovery/restoration phase; you'll get more out of it.  I know the so called "science" behind the "stretching a cold muscle is better" movement.  They are treating muscle and fascia as it is a plastic or metal, and not the living biologic tissue that is.

Taping for MTSS- The modified Hossler Technique

Learned this technique years ago from Phil Hossler, the great ATC at East Brunswick NJ, USA high school; and took some artistic license with it.  It's important to remember it's not a substitute for a good athletic development program that encourages lower extremity osteogenesis.  But used prudently, it does provide excellent results.

DiveBomb Pushup

This is a sports specific variation of the traditional pushup that places more of an emphasis on the lats.  Its an appropriate exercise for throwers, swimmers, and latter phases of shoulder rehabilitation.  Thanks to Adam Moss for naming it after the famous WW2 P-38 war plane- I am honored.

This 'n that 'n muscle slack

Muscle slack is a term I picked up from Frans Bosch this past summer at GAIN. Quite simply, it means the interval between initial muscle stimulation and contraction is too long. Don't confuse it with Coach Wilt's "amortization" term as it is applied to plyometrics. While Amortization is a proprioceptive term; muscle slack is more of a coordination term. Improper joint angles or posture at any given point in a skill results in a lack, or excessive pre stretch in any one given muscle.

I decided to do a post on it because it seems it is being misapplied on many internet sites. Exercises are singled out because the practitioners feel they contribute to muscle slack and should be avoided. I think the mistake they are making is applying it specifically to straight ahead running on a relatively flat surface. Once you get away from that, you need allot of tools in the toolbox. Please be prudent when applying sports specificity- you could be creating new problems.

So far I've only seen muscle slack applied to sprinting. It also happens in batting, tackling etc. I'll address it later posts.

I love "The Onion"!

Oprah Invites Hundreds Of Lucky Fans To Be Buried With Her In Massive Tomb

You can't afford NOT to have an A.T. on staff!

Potential Savings of a Program to Prevent Ankle Sprain Recurrence:  Economic Evaluation of a Randomized Controlled Trial- Maarten et al, AJSM 11-10.

A great, simple study with a large group of subjects comparing 2 groups of ankle sprain patients.  One with just initial acute intervention, the other with some proprioceptive training added in (common place in the high school setting).  The authors computed the cost of medical care/ lost productivity among the two groups.  The  mean costs per athlete in the intervention group was 81 euros ($112); and in the control group 149euros ($205).  This is the kind of data we should be presenting when we make the case for a full time A.T. on staff in this economy.  Overall it is just plain more cost effective.

Serious Computer Crash

Dropped my laptop on a concrete floor from a 1m height.  The weird thing is the diagostics are showing the hardware to be functioning normal; but the hard drive seems to be corrupted.  So, a clean install which wipes out everything.  I have everything backed up, but will probably take me a week or so to re install all the programs and what not.  I may be away a bit.

BTW- Anyone who wishes to contact me personally may do so through my Linkedin profile.  I think you have to establish a Linkedin account youself first.

The state of the art of Strength and Condtioning

Reading a round table discussion last night from a group of U.S. strength coaches.  Let me summarize  what I learned.

1.  Barbell squats of ANY type are BAD and should NEVER be done.
2.  There is an ANTERIOR and POSTERIOR chain that are separate entities, and need to be trained that way.
3.  The glutes are not activated by ground, gravity, and momentum like the other muscles of the body.  They need plenty of supine sagittal plane bridge work to fire properly.
4. Athletes must be trained on how to properly activate the lower extremity.
5.  Every athlete must static stretch/self myofascial release before every workout.
6.  Glutes and hamstrings MUST be emphasized over the quads.  Machines that isolate the "posterior chain" help.
7.  Use the FMS to evaluate physical competency to do a sport.

One of the things I love about the GAIN network is the diverse background of the group- geographically, culturally, and knowledge base.  While it's the Gambetta method that unites us, we definitely have a wide variety of opinions on how to get from point A to point B.  And understand there are many ways to get to Rome sort of speak.

At least in the U.S., I see a lot of intellectual isolationism going on in this profession.  You could easily be led to believe for instance that,
1.  Tom Myers fascial work from 10 years ago has never been expanded upon.
2.  The efficacy of the FMS has never been studied.
3.  Muscles function independently of modern motor control theory.
4.  Human tissue has the same mechanical properties as plastics and metals.

I know sometimes I come across as just saying things for the sake of being different.  And, I also understand that sports medicine is a discipline that has always been driven by the practitioner first.  But always remember I'm not just some internet guy- I make no money with this blog.  I earn my living being a real life ATC in the biggest high school in NJ.  The time I get to spend with each athlete is limited, and very precious to me.  Everything I do has to give me the "biggest bang for my buck". 

I can't afford to take wrong turns.

Good Question

Kevin Moody asked a good question in response to my "Taking advantage of the topography" post I thought deserved a separate post:

"Just tried some retro & side walking on the treadmill with an incline pitch. Had to slow the speed down for the side walking. Could definitely feel the quads working on the retro walking but wasn't getting much on the side walking. However, I was only experimenting and did not have a lot of time play with it.

Any thoughts?"

That would make sense Kevin.  If you were walking down the hill, the lead (lower) leg would be resisting momentum and abduction.  On the treadmill, there is neither.  In order to get the same effect on  treadmill, I'm thinking you would need to do a tapioca with the affected leg to the rear.  Safety would become an issue; be sure you have a bar to hold onto.  Try it and give me your thoughts.

Meanwhile, I'm stilllllll thinkin'......

This is one of our athletes scoring what would be a 1 on the ankle dorsiflexion PCA test- the toes only 2cm from the wall and the heel already coming off the floor.  It is fortunate she is not a rock & roller back in the 50's because she would never be able to do the famous Chuck Berry duckwalk.  Back then we didn't worry about the knees going past the toes when we squatted.  We were too busy ducking under our desks training for when the Russians would drop the big one on us.

Think I'll keep a Fender Telecaster handy in my AT room and use the duckwalk as a remedial exercise:

"OOOOHHHH Carol don't let him steal your heart away, I'm gonna get that ankle ROM back if it takes me all night and day"

The rest that's best- the shoulder

Subacromial pressures vary with simulated sleep positions: Journal of Shoulder & Elbow Surgery, 10-10; Werner et al..

The researchers studied subacromial pressure in subjects side lying, prone, and supine.  Both the side lying & prone positions place at least one arm in an abducted and/or internally rotated positions for 8 hours at a clip.  Not suprising they increase subacromial pressures greater than the supine posture.  The authors were studying this in the context of the post surgery environment, but I think it's safe to assume the same happens in the throwing athlete recovering from a tough day of practice. 

It's interesting when 2 years ago researchers were studying sleeping posture relationship to kidney stones, the side lying position was again implicated in 88.2% of patients.

But yet the side lying position is often advocated in patients with low back pain, and the back to nature primal enhusiasts.

I don't know, when I sleep I'm flopping all over the place like a fish.  Does anyone know if a sleeping position can be taught?

Veteran's day 2010: Corporal Francisco Jackson

I wish a year could go by without me posting about one of our ex athletes dying in battle.  For many of us these faces are strangers & its easy to forget the U.S. is still very much involved in a war.  I have my own feelings about it, but this blog is not the place for such a discussion.  Francisco was a wrestler of ours.