Friday, December 31, 2010

My last post of the year.

Great comment on Fascia from British Osteopath Leon Chaitow:

"in therapeutic terms, as well as anatomically, there is little logic in trying to consider muscles and
joints as separate structures from fascia, because they are so intimately related. Remove connective tissue from the scene and any muscle left would be a jelly-like structure without form or functional ability, and joints would quite simply fall apart.  We also now know that there exists a tensegrity-like state of structural and functional continuity between all of the body’s hard and soft tissues, with fascia being the ubiquitous elastic- plastic, gluey, component that invests, supports and separates, connects and divides, wraps and gives cohesion, to the rest of the body- the fascial, connective tissue network.

 Any tendency to think of a local dysfunction, as existing in isolation should be discouraged as we try to visualize a complex, interrelated, symbiotically functioning assortment of tissues, comprising skin, muscles, ligaments, tendons and bone, as well as the neural structures, blood and lymph channels, and vessels that bisect and invest these tissues e all given shape, form and functional ability by the fascia."-  JBMT 1-11 (pre-print)

Wednesday, December 29, 2010

As the pelvis goes so goes the rest of the body

"Pelvic Control Of Professional Baseball Pitchers And Its Correlation To Pitching Performance"- McKenzie, ACSM '09 annual meeting.

"Pelvis & Torso Kinematics & Their Relationship to Shoulder Kinematics in High School Baseball Pitchers"- Oliver et al JSCR 12-10.

The first showed pitchers who tilted seven degrees or fewer during their stance transition had lower opponent batting averages (.244 vs. .290) and fewer walks and hits allowed per inning.  Interesting, they did not have fewer injuries.

In the 2nd, the authors found a correlation between torso axial rotation speed and shoulder elevation angle (in other words, shoulder drag) in high school baseball pitchers.

Interesting, both recommended "core" training in the same or subsequent articles or lectures.

Couldn't this same concept of pelvic control be applied to other activities like running & jumping; or low back pain?  The question is, is core training and pelvis stability exercise the answer.  Or, is the unstable pelvis a manifestation of a generalized lack of strength & power in body?  What would their PCA look like?

Sunday, December 26, 2010

Did I pervert the research here?

"Scapular Muscle Recruitment Patterns: Trapezius Muscle Latency with and without Impingement Syndrome- Cools et al, AJSM '03".

Last month I got hammered pretty good on a discussion thread on the GAIN forum on this topic.  The topic had to do with the use of traditional olympic bar pulling movements (shrugs, high pulls et al) in the training of throwing athletes.  I made the point that these types of pulling movements create upper trapezius hypertrophy which can cause impingement syndromes in throwers and swimmers. This is one study, of several, which shows trap shrugging preceding middle/lower trap activity in subjects with impingement syndrome.  Of course one could say this is an adaptive pattern that people with impingement syndrome take on subconsciously to avoid the portion of the arc that is painful. 

My take on the matter is that this muscle firing sequence CREATES impingement syndromes/tendinitis.  I first came up with the idea years ago when I was fortunate enough to take a course with Australia's Lyn Watson, a manual P.T. who specializes in shoulders.  Lyn felt it had to do with the traditional shrug being more levator scapulae dominant than trapezius.  The upper trapezius came more into play when the arms were pushing overhead.

I don't want anyone to be afraid to shrug or pull!  In sports like volleyball, the shrug is an important part of the jumping/striking sequence.  The same could be said for the javelin thrower, where the implement creates a long lever arm that the shoulder must contend with.  But I still think they must be applied prudently in swimmers, baseball players and cricket bowlers. 

These pictures are of one of my favorite thrower/swimmer exercises, the see-saw.  It can be done with the bands attached to a fixed object, or better yet in opposition with a partner.  It creates joint stability/power where you need it the most- where the arms are at the extremes of motion and switching directions.  The "transformational zone" as Gary Gray calls it.  The goal is to get straight arms behind the ears without arching the back.  Many of your atheltes won't be able to do this with moderate resistance.  And if they can't, they're really not getting hip to shoulder.

My point is that it's not only about hip to shoulder; but rather how you get hip to shoulder.  My example has resistance applied with a horizontal vector bias.  The middle/lower traps are integrated quite nicely.  And so are the upper traps, but as opposed to a shrug, through a long lever arm.  As the arms would during swimming and throwing, no?  Think about it a bit, and let me know if I'm on target or just making some wild metaphysical leap with the research.

Tuesday, December 21, 2010

Poor, good for nothing quads

I was just reading Vern's leg circuit post, followed by an article by a noted ACL injury researcher.  The ACL article spoke of girls using a faulty quadricep dominent movement pattern, with the need to "teach them to activate their glutes & hamstrings more.  Interesting, the recent strength coach roundtable I recently mentioned pointed to the same, but in all athletes.  I wonder what running, cutting, and landing mechanics would like if the researchers injected a nerve block into the femoral nerve?  Do these athletes need to be taught to fire their "posterior chain" better, or is this pattern a result of a poor leg strength foundation/progression?

Listen, do yourself a favor and save Vern's post to your hard drive:

Friday, December 17, 2010

Can we have our food now?

At 51 years old I still relax the same way I did as a kid, watching cartoons before I go to bed.  There is a new episode of South Park where one of the parents decides to become a gourmet chef, quits his job as a geologist, and begins preparing his neuvo cuisine in the school cafeteria.  The students are left standing there with their empty trays saying, "can we have our food now?" as the dad becomes totally immersed in his culinary skills and totally forgets he has hundreds of mouths to feed.

I had an email discussion with my buddy Pat Donahue, ATC at U.Illinois @ Chicago.  I was inquiring about a new school of rehab he had experience with, and I asked him how it was working out.  He brought up a very good point- that while its practitioners were claiming outstanding results, it just didn't fit into the A.T. concept.   Very practitioner driven, one-on-one protocols.  In the A.T. environment, our time is very precious to us.  When we tie up our hands with manual techniques we must be sure we are getting the most bang for our buck.  For instance, I do myofascial release.  I choose ART and Graston because I feel they are very effective and extremely time efficient.  However, it appears the Italian School of MF release (Carla Stecco) is really showing an edge.  But it's just too time intensive for the typical A.T. setting.

I feel this philosophy goes well beyond the A.T. room as the health care dollar shrinks.  We don't want to feed our athletes fish sticks and pizza, but we don't want them standing there with empty trays either.

Thursday, December 16, 2010

Good question from Kev...

"Could you define pelvic drop since I am unable to view the article please? Is it in the frontal plane? Would farmer and waiter carries be an appropriate exercise to address the QL and GM in order to encourage stabilization of the pelvis and reduce lumbar shear?"

pelvic drop=non weight bearing pelvis dropping in frontal plane= Trendelenburg sign.

In these subjects, in was occurring in Treadmill walking.
The point I'm getting out of this article, and others like it, is don't piece meal muscles (of course occasionally you need to, but not in this case).  If we look at this issue from that point of individual muscle then we would also have to look at the same side erector spinae, the same side internal oblique, opposite ext. oblique- the list goes on and on.
As far as remedial exercise, Frans has a few that address the issue.
Others I can think of are SLS on the leg opposite the drop, while keeping the non weight bearing illum as high as possible...double time skips doing the same...extended walking/running in other planes & retro sagittal.

However, in my opinion it may be more of a physical competency thing.  Not enough of a lower extremity strength & power base.  Pelvic drop means the body is lollygagging in the force reduction phase, maybe as a protective measure.  Opinions?

Tuesday, December 14, 2010

No Magic Muscles

"The Relationship Between Hip-Abductor Strength and the Magnitude of Pelvic Drop in Patients With Low Back Pain- Kendall et al, JSR 12-10."

Pelvic drop in walking or running is not a good thing. It creates shear at the lumbar spine, is implicated in patellofemoral stress syndrome & medial tibial stress syndrome ("shin splints") et al.

These researchers wanted to know if strengthening the glut medius/minimus would improve the Trendelenburg sign (pelvic drop) during treadmill walking. This type of study has already been done studying floor exercise, but this one used, well, somewhat functional exercises. Interesting that while these two muscles did get stronger, it did not carry over to functional pelvic stability- the same result as the floor based strengthening exercises. But if you are a regular reader of my blog you'll understand why it didn't work. Remember Bosch's definition of strength training, "Coordination Training with resistance" and the outcome is no surprise.

Friday, December 10, 2010

GIRD of the hip?

"Velocity in Professional Baseball Pitchers Passive Ranges of Motion of the Hips and Their Relationship With Pitching Biomechanics and Ball- Robb et al, AJSM 12-`10."

Not me saying that, it's the authors!  Femoroacetabular dysfunction of the lead hip in baseball pitchers; causing loss of ball velocity and shoulder injury.  And, it was the first article that I've seen that suggested a correlation between GIRD and hip dysfunction.  The authors used fluid goniometry to assess passive AB/ADD, IR/ER of both hips (in prone by the way).  Interesting they didn't assess Flex/Ext; it would have been interesting to see how they influenced the previous.  A similar test was done recently by Todd Ellenbecker involving active ROM that didn't show as much of a deviation between R/L hips as passive ROM did.  The authors chose passive because they felt it also measured accessory motion.

Be sure to evaluate lead hip active/passive IR on the whenever you see GIRD of the shoulder and/or elbow injury in throwers. 

This is definately a case of "pattern overload" that could benefit from retro training, like doing some throwing with the opposite arm.

Sunday, December 5, 2010

After Sid Viscious, the Ebonettes

After coming to my neck of the woods we can see why Malcolm Mclaren got bored with the Sex Pistols.  I always liked the Ramones better anyway. 

Just think of the ACL injuries we could prevent Tracy!

High Ankle Sprain-Day 3

Do your athletes still get advice to soak a sprained ankle in a bucket of hot water and epsom salts?
That's what happened here, but we survived it.  If you can exudate the substrate out of the ankle mortise with good acute care and early minimal weight bearing exercise, the injury should look something like this.  Aquatic therapy is particularly useful because of the hydrostatic pressure and weightless environment, so if you have access to a pool use it!  With the tape job described in a previous post, this athlete is already ambulating without an antalgic gait!  Ahhhh youth.

Thursday, December 2, 2010

Functional Training= Purposeful training

This is part of the on ground sequence I used today for my  left "high" ankle sprain re-abilitation program.  Whenever you choose to go to the ground you have to keep in mind you are in a gravity confused environment.  So, the therapist needs to be certain they are getting something from the ground they can't get from upright function.  In this case I'm using contralateral lower extremity drivers to mobilize the affected ankle; because the athlete is not ready for full weight bearing.  I'm doing something that will enhance upright function and prevent soft tissue dysfunction.

Be wary of the mindless application of on ground function- it is rampant.