Gracilis comments

Great job again you guys. Sorry if I come off as a functional exercise freak, but it's important to the high school ATC. If you understand the anatomy & function of a muscle (with the foot on & off the ground) you can inexpensively put together a high tech rehab/conditioning program. In addition, you are preserving function in the gracilis & globally through the entire body. For instance, this athlete, even in the acute phase, was doing cariocas, forward skips, frontal plane double leg mini jumps, throwing - all pain free. I could not have done this if I had generically treated it as your everyday run of the mill hamstring strain.

Moving on, we know the gracilis also influences the pelvis. So, we also need to work top down. What type of core training might provide the gracilis with a better mechanical advantage?

Gracilis strain

One of our baseball players was trying to run out an infield squibbler & came up hobbling. The gracilis is often thought of as a adductor, which is true. But it is the only adductor that crosses the knee joint, which adds knee flexion/internal rotation into the mix. It is often mistaken for a hamstring strain because of it's location to the inside hamstring group. Be sure to differentiate this muscle from the hammies on your evaluation. Rehabilitation is different.

Because of it's origin on the pubis, the gracilis is not a hip extensor. Because of this fact, rehab that involves hip extension is usually tolerated early on. A step up for instance, as long as you begin/end in a narrow stance. So, the step up may be a good early phase way to "tweak out" the gracilis. In other words, it's being minimally recruited in a functionally appropriate manner.

OK, I've "tweaked out" in the sagittal plane. But we know the muscle also decelerates knee/hip abduction in the frontal plane. In the transverse plane, it decelerates knee external rotation. So, how might we functionally tweak out the other 2 planes? On to you guys.

Reductionism

http://www.thetimesonline.com/articles/2009/04/12/sports/top/doc280f2940aa19e13486257595003e125f.txt

What can we learn from this? Certainly not that every high school training room should have a Nintendo Wii. I think the P.T. said it all when she says, "now the patient is excited when they bowl a strike on the Wii, not that they lifted a 3 pound dumbbell." You don't need to tell a suprasinatus or teres minor what to do. Rather, give the body a task that challanges the cuff within the context of their envelope of function.

I just read some dopey article on training the supraspinatus for pitchers. The secret, you see, is only doing the "empty can" exercise to 60 degrees as to not cause subacromial impingement. This gem appeared in a peer reviewed journal. Come on everybody, we can do better than that. The 4 rotator cuff muscles function synergistically to depress the head of the humerus in the glenoid to counteract the elevation effect of the deltoid. THEY ARE NOT PRIMARY MOVERS. Histological studies back that up. I have to dig up a good EMG study done on swimmers a few years back. Motions that you would think would activate one cuff muscle over another did not happen in real life.

Humeral Retrotorsion

Hey Aaron, why do you Aussies always seem to be one step ahead of everyone else?

GIRD in throwers & swimmers has been well documented. Up until the last few years, the consensus was a tightness of the posterior shoulder musculature & joint capsule. As some great research coming out of Australia shows, it's not necessarily the case:

"Sports Participation & Humeral Torsion/Whiteley Ginn et al./JOSPT 4-09.

I realized this occurred in older & professional athletes, but this is the first time (as far as I know), where it's documented in adolescents. The authors say humeral retrotorsion is the norm until about 8 years old. They claim participation in throwing or swimming prior to full skeletal maturity may slow the rate of retrotorsion loss. An interesting finding was in swimmers, the dominant hand side shoulder was more retrotorsioned than the contralateral.

So what does this mean to us down on the hs level? Before making the diagnosis of GIRD, be sure the athletes total arc of rotation is at least equal to the contralateral shoulder. That is, as long as the athlete makes up the active/passive IR they've lost with ER gains, the posterior capsule/musculature may not be hypertonic.

Please Read this article & comment

I just read an article from a very well respected journal by a very well respected pro sports S & C coach. I was very sceptical, to the point I thought the guy was either trying to distract us from his real training program he didn't want published, or someone ghost wrote it for him. After reading this SI article, maybe he was really being genuine, and serious reform is in order.

http://sportsillustrated.cnn.com/2009/writers/ross_tucker/03/18/conditioning/index.html

The neglected hand

One of my favorite comedians of all time, Rodney Dangerfield's signature line was, "I don't get no respect!" The same could be said of the hand. You probably get those brochures for the hand rehab seminars in the mail & you toss them out. From this month's "Archives of Physical Medicine & Rehab"- "Ulnar Nerve Compression Neuropathy at Guyon's Canal Caused by Crutch Walking: Case Report With Ultrasonographic Nerve Imaging Ulnar Nerve Compression Neuropathy at Guyon's Canal Caused by Crutch Walking: Case Report With Ultrasonographic Nerve Imaging".

How often do your American Football lineman come in complaining of wrist pain? Probably all the time, but more than likely you slap some tape on it & send them out. But this type of nerve compression happens, & is re-aggravated by bench pressing ad-nauseum. There are some cool, simple mobilizations for the carpal row & releases for the tunnel ligaments that really feel good on a beat up wrist. I will try to get some up on this blog in August when high school football gets under way again.

Disappointment

I forked over more than 4x the price of my old Rockfit Trainer for the new Firmwave, & I cannot recommend it. As you recall, I purchased the Rockfit many years ago in a closeout sale somewhere. It is a great, cheap sagittal/frontal plane close chain UE/LE exercise device. It even came with this really high quality exercise band that could be attached to incorporate integrated work. I used it so much that I wore out the anti-slip pad on the bottom, which the manufacturer replaced for free.

The firmwave is too small for most athletes, you get the sensation you could fall off the thing. It comes with this crappy workout DVD which went right into the garbage. Don't waste your money.