Hip Extension ROM

The Thomas Test is the gold standard, but what are you really measuring? In my mind, it's the contralateral leg's influence on the dominant side. That leg popping off the the table may not necessarily be a tight rectus femoris or iliopsoas. A tight opposite side hip capsule, femoral ante/retroversions to name a few will influence the opposite leg. Not that that is a bad thing, it's all useful information.

However, the one I am more comfortable is the osteopathic version. Pretty simple, place the thumb of hand closest to the athlete's head on the PSIS, the other on the distal femur and lift. The first sense of pressure on the thumb is your end range of hip extension. If you see the pelvis rotate or lower back arch, you went way past your end range. Note any sensation of torqing of the femur that may clue you in on a ante/retroversion.

On Ground Function: The Mostibility Shoulder

Sorry I haven't been posting lately; it's not due to a lack of material. It's been raining and most of the time we're cramped like sardines in the field house and it's tough to get a good photo. Lots of cool stuff going on though.

This R handed baseball player injured his left shoulder on the back swing during batting practice in the cold weather a few weeks ago. The result was a non-specific anterior glenohumeral sprain with some "pinching" of the soft tissue in the posterior shoulder. We've got a hip to shoulder force tweak going on here. In the first 2 pics, he's doing a hip hike with the shoulders rotating in sync with the pelvis; hands moving a little faster than the pelvis as to be consistant with up right function.

In the bottom one he's in a pushup position, eyes fixed right, then sliding the left leg under the right, taking the pelvis with it in a scissor type motion.

See what I mean?

Of course I feel like an idiot when I disagree with Donley & Flisk, but I can't help it.

Here's Joe Nathan's pitching mechanics. He is out with a torn UCL. He is one of those "push off the rubber" guys. How can this NOT drag the elbow behind the hips? The problem starts right in the stance phase, look for yourself. The pelvis is already translating forward, and his arm hasn't moved from his side. Now why the elbow & not the GH joint? Look at his belt line in the acceleration phase. Pelvis is tilted posterior in the frontal plane (backward). He MUST drop the elbow to keep from "dunking the clown" sort of speak.

I actually called Flisk on the phone about this, he never called me back. I asked Phil Donley in person & he doesn't have a problem with this as long as the pitcher's body is anatomically sound.

But...how do you stop a runaway train?

A.T. Room Management

Thanks to fellow GAINER Phillip Bizzini for sending me this link from the NY Times on teaching:

http://www.nytimes.com/2010/03/07/magazine/07Teachers-t.html?pagewanted=1&ref=magazine

The article had to do with the recent focus on getting back to "teaching mechanics" sort of speak; independent of subject matter. I couldn't help but apply it to the high school athletic trainer. Obviously being an effective high school ATC a lot more than the A.T.'s technical skills. In the college A.T. room we've got plenty of helping hands in the form of assistant A.T.'s and student A.T.'s. But what do you do with a room full of injured athletes you've got to get out to class on time or onto the athletic field?

#1- Don't let your room become a hangout place. All my tables are portable & you really have to go out of your way to find a place to sit down.

#2- Never tape an ankle when you can brace it. There is not a single study showing taping is superior over bracing. It really frees your hands up for the important stuff not to mention the money you literally toss in the garbarge every day. It is very tough to break the culture of ankle taping, especially if your Pop Warner coaches are taping 12 year olds.

Is this you?

"Service value doesn’t begin until the client gets into it; value is not optimized until the client gets through it; and practice loyalty is diminished if client focus is directed to facilities and equipment rather than you."

This is an exerpt from Bob Wiersma's forthcoming book, "Performance Matters". A lot of times when I go to other schools & mention my blog (and it's ideals) to other ATC's, I usually get something like, "Oh, we don't have that problem, our booster club (or AD) buys us anything we want".

In my mind, if you were someone on the outside that didn't know any better, you would be giving the impression that it's all about the toys. That anyone could step in and take your place. And unfortunately, that's what happens when they ask their superiors for extra compensation. Because most of us aren't in the income generating business, many don't feel the need to stay competitive. The looks I get from other A.T.'s when I tell them I use money out of my own pocket to pay for continuing education! We could all learn from guys like JH who have to compete every day to survive.

Uncle Joe at Read Across America

Thanks to Ms. DaCosta's class at Valley Road School for inviting me in as the "Mystery Reader". Read "Walter the Farting Dog-Banned from the Beach!" Dr. Seuss was probably rolling over in his grave.

More Concussion stuff

Got a chance to hear Dr. Kevin Guskiewicz from U.N.C. speak on the topic of New Research in Athletic Brain Injury. Doing some really cool research. Placed software in football helmets and receiving real time data about the forces coming through the head during contact in games. In some instances it was 150G's! Also troubling was the highest forces were delivered through the top of the head.

Dr. Guskiewicz further validated exercise testing as a diagnostic tool in return to play decisions. It will be positive he says, long after cognitive testing is normal.
My particular protocol is a series of short sprints with very short rest periods; a 5m rest, then a series of longer sprints with short rest periods.

He also spoke of the importance of the cervical muscles in dissipating forces through the helmet. Which brings up a good topic- is there such a thing as a good neck strengthening exercise? Or, is it something that can only be developed by controlled & progressive contact?

Brian's MCL question

Hi Joe I know this is an old post
(http://joestrainingroom.blogspot.com/2009/10/plinth-we-dont-need-no-stinking-plinth.html)
but could you comment on what your response would be from someone who does feel that the pictures are putting early stress on the MCL? Additionally could you comment on bracing in the acute phase of MCL injury in relation to preventing motion beyond 30 degrees extension and or 90 degrees of flexion. Some would suggest that knee position close to full extension early after injury is putting undue stress on the MCL as would some of your pictures. Perhaps an explanation how chain reaction biomechanics actually offloads tissue that have been injured. Personally I don't see anything wrong with what the athlete is doing in the photos and I do some similar movement patterns. Thanks again for such a good blog...!

Brian

Good questions Brian. Actually, this athlete was wearing a functional brace that blocked those very movements. If my memory served me right, the doc removed the stops on the 3rd or 4th day. Happens to be my orthopedist also, very familiar with my stuff.

You & your colleagues are both correct. The healing properties of a particular tissue is one of the factors that will determine what you do & when. That is, what is appropriate for one athlete would be inappropriate for another at any point in time. This particular athlete has a slight genu varum which affected how I sequenced my upper & lower extremity drivers. Perhaps the same drivers on someone else WOULD inappropriately load that MCL. An athlete with a genu valgum would have definitely been a challenge.

Now what you didn't see with this athlete was what he didn't do well- movements on the posterior vector like posterior lunges & backpeddling. That was the last thing we got back & took the most time to do it. He was doing lateral & rotational lunges before he could lunge backward on the injured leg. Go figure. But I couldn't rush it, as it was outside his envelope of function.

Overall though, I'd say MCL ligs heal very well; and I think surgeons feel the same way.

But that is G2's thing, doing your rehab or training right at the functional threshold, which is different for everyone.

Joe P., Author?

On the My Favorite Websites section to the right of my blog page you'll see a link to Momentum Media. They are the publishers of "Training & Conditioning" magazine, among others. There are a lot of free, online articles that are heavy on the practitioner side.

Any way, I'm working with them to produce a series of books on a lot of the topics I discuss in this blog. They will be very affordable, about 20 U.S. dollars a piece. The first one should be available in the early fall. The title is, "Functional Manual Therapy for the Sprained Ankle". Very user friendly with plenty of illustrations. No fancy gadgets- just your hands, ground, gravity, & momentum. For the time being, the books will be available exclusively through the Momentum Media web site.

Don't miss Dr. Kenneth Cieslak at NATA '10!

Ken is a chiropractor & athletic trainer here in northern N.J. He showed me the slides on his presentation at '10 meeting in Philadelphia USA this June. His talk will be on treating the cervical spine by way of regional interdependance. Looks pretty cool.