Grade 2 Adductor Stain day 8

Exercise Physisiologist Jack Blatherwick questions why fitness qualities such as strength, flexibility, stability etc. need to be worked as separate entities. Good question.

In these two photos one of my athletes is doing rehab for a right adductor strain. Accomplishing all of the above using a jungle gym.

The traditional exercise you would see in a weight room would look something like right side lying with the left foot up on a basket

doing leg raises. Training the adductors to do something

they don't really do in upright function. For example, this athlete

strained his doing straight ahead sprinting.

The remainder of the workout included some double leg agility ladder stuff & some med ball rotations in a stride stance.

Postural Screening?

I can't emphasise this enough when it comes to this postural screening stuff- asymmetry is the norm. There is no simple algorithm; A+B does not always equal C. A few years back Vern Gambetta was lashed at in his blog when he suggested "pronator distortion syndrome" or "upper crossed syndrome" often disappeared when you moved from the static to dynamic/functional. Even suggesting he could not be a good strength coach without paying $400 bucks for a popular postural course.

Vern humbly dropped it, but he had the research behind him. In 2005 Lewis et.al in the journal of shoulder & elbow surgery came to the same conclusion with regard to shoulder injury in throwers. More recently, that same postural screening program was found to be a poor predictor of running injuries (don't have it handy, will have to dig it up).

Anecdotally, I've even seen the opposite! In other words, an athlete who has good ROM in a particular joint statically, but does not have the mostibility to present it dynamically.

Mike Marshall Technique

OK, it's like this. If you throw the "traditional" way, the medial elbow & anterior shoulder structures are stressed & prone to injury. And if these things hurt, naturally switching to a different technique will bring you relief, possibly increase your MPH too because a lack of pain. BUT, if you throw this way long enough, other structures will be stressed. By the way it looks, probably the lateral elbow & posterior shoulder. The Marshall technique has not been used long enough, often enough, & used by enough practitioners to say it is better than the traditional way.

I'm not a big fan of the "my way is the only way- everyone else is ignorant" style. Marshall is not the only pitching guru who is guilty of this. Give me my high school coach, Ray Korn, any day. 1 elbow injury in 27 years, & not a single shoulder as far as I can remember. As soon as an athlete complains about something hurting, he has them do something different with their foot, or how high they lift their knee or something like that and no more pain.

Something to think about: Say your a cave man a few million years ago and you're starving to death and you see a woolly mammoth cross your path & you've got a spear in your hand. What throwing technique would YOUR body choose?

Selye & BMD

From the 3/08 Orthopaedic Research Society Annual Meeting-

Real simple, the researchers had young women push down on load cell attached to an oscilloscope 15m per session, 3X per week for 15 weeks. They did periodic BMD tests on the carpal bones of the wrist. All subjects increased bone mass at the conclusion. HOWEVER, at 7 weeks, the subjects actually showed a decrease!

Something to keep in mind when we are prescribing exercise. Always remember bone growth always lags behind muscle a little. Always keep the planned performance training model in the back of your mind, and cycle in periods of loading & unloading. Don't let your workouts become a survival of the fittest.

Book Recommendation

Excerpt from, "Recommendations for the diagnosis of low back pain from the American College of Physicians & the American Pain Society":

-"Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with MRI or CT only if they are potential candidates for sugery or epidural steroid injection".

Pretty cool. Even with all this high tech stuff, MD's understand the importance of good postural, static, dynamic, and functional testing. A great text I would recommend to all high school athletic trainers:

"Functional Soft Tissue Evaluation & Treatment by Manual Methods" by Warren Hammer. Dr. Hammer is a chiropractor. They were the first at this manual stuff, and they are still the best.

Hip to Elbow?

Justin Duchscherer, pitcher for the Oakland A's, was placed on the disabled list for the 3rd time in his career. The previous 2 were for a R hip torn labrum and some exostosis on the femoral head. This one is for his R elbow. Could there be a connection here?

In my thought process, biomechanical problems that injure the throwing shoulder are the same that injure the elbow. It's just a matter of how the athlete chooses to compensate for their LE issues. The baseball pitcher requires a tremendous amount of extension, I/ER in the hips. They really need to be as strong & flexible as a hurdler in track & field. As the R handed pitcher runs out of R hip extension/external rotation in the acceleration phase, they will often drop the elbow to shorten the lever arm to give it a chance to catch up with the body. Another strategy is to lean the torso away from the ball to steal a little more extension out of the hip by getting it to externally rotate.

The other issue is that Justin is one of those pitchers who throws his 2 seam fast ball almost like a screw ball. This creates a tremendous amount of movement on the ball, but really beats up the radial head/capitulum.

The Rossiter System

Despite 6" of snow with a 30 mph wind @20 degrees F, our state meeting went on. Steve Viana, my local compadre from Linden NJ did a great job of putting the exhibitors together. One of them was Richard Rossiter, a Rolfer who has developed his own brand of myofascial release, "The Rossiter System".

www.therossitersystem.com

I was walking by his booth when he grabbed my ear & explained the technique to me. I explained to him I already did soft tissue work using ART. He immediately said, "AHHH, but your thumbs are sore by the end of the day, admit it!" Ok, I couldn't deny that I work on athletes, and yeah, that has happened. So he explained his method uses the FOOT in lieu of the hand! My response was, "I can't do this stuff- what will people think when they walk into my A.T. room & see me stepping on a kid!"

However, as fate had it I won his book & DVD in the raffle- worth 40 bucks. I thought it was a very nice gesture, so I am giving him a plug. He offers courses throughout the U.S. that you can get NATA CEU's. If anyone else has experience with this technique, let me know. And what the hell, like I do with ART I'll have the protocol manual out while I am doing it so they know I'm not a wacko.