Annoying

Why do the spray buttons on those Cramer Tougskin cans break off so easy? I can't tell you how many full cans I've waisted when they were accidentally dropped on the floor.

The same thing with Cramer Shark tape cutters. One drop on the floor and the tip breaks off and they are finished.

SM,TA,Pelvic Floor-my turn.

I'm going to let JH's comment answer this one for me:

"Working in an industrial setting we see a lot of back issues. Once pain is controlled we find that they are very strong in the movements they perform daily but very weak in any number of given exercises they do not perform on a daily basis. It is really as simple as giving them a variety of movements that are "new" to the body and the appropriate muscles learn how to respond resulting in a more versatile spine."

YES!!!

If you read the studies on this topic, the subjects are almost entirely involved in repetitive tasks, such as factory workers & cricket batsmen. The same movement patterns are performed sometimes hours at a time. My ART recert classes always begin with a lecture on repetitive stress syndrome, and it's effect on the fascial structures of the body. "Grooving movement patterns" is a popular buzz word in sports and physical therapy today. However, remember Wolf's law from your college AT classes- that is, form follows function. That means you are also molding bone, soft tissue, and the nervous system- for a specific task. There are consequences. Vern Gambetta cautions us not to develop "adapted athletes" over "adaptable" athletes.

There is an interesting topic in Dr. McGill's book regarding an athlete doing a deadlift under a fluoroscope. One vertebral segment appeared to buckle under the stress of the load. What caused an abhorrent movement pattern at one particular level, and no where else? Fatigue from a previous workout? Maybe a sore knee that caused the athlete to push harder with one leg than the other? A rib dysfunction that caused an abnormal rotation? An undiagnosed spondylolysis or pars fracture? The reader is left to wonder. However, we must not jump to the conclusion that a weak multifidus at a specific level, on a specific side, or the TA is the culprit, and the solution is to isolate them with biofeedback.

How can we take JH's clinical work in the industrial setting & apply it to athletics? I think the easiest place to get this started is with recovery/restoration. How about some bat swings from the contralateral side...throwing with the contralateral arm...running backwards, sideways, carioca? If your job requires stooping/lifting to the right, how about standing in a stride stance, alternate over-the-shoulder punches to the left...if you are a cyclist, how about lateral lunges with rotational over-the-shoulder-punches?

There are exceptions. Christina Christie, a P.T. from California, works with women who have bladder control issues resulting from child birth. She describes the pelvic floor as a "trampoline". She points out that beginning the rehab process in the vertical overloads this system. Therefore, her protocols are initiated from the floor. Similar concept as to my idea on wall slides for GH instability.

Magic Muscles?

Effect of Stabilization Training on Multifidus Muscle Cross-sectional Area Among Young Elite Cricketers With Low Back Pain- JOSPT: 2008;38(3):101:108
Julie A. Hides, Warren R. Stanton, Shaun McMahon, Kevin Sims, Carolyn A. Richardson

Free magazines such as Biomechanics & Training & Conditioning Magazine are considered "throw aways". However, they are not that at all. They give you a "reader's digest" version of a variety of interesting topics, then give you references at the end so you can dig in further if you wish. I like them because they give me an indication of which way the wind is blowing, sort of speak.

In one of these journals, a physical therapist interpreted the above article as "It would be wise to evaluate & retrain the multifidus in athletes involved in sports requiring repeated trunk rotation, such as baseball, golf, & hockey."

Me, being the skeptic, says:

1. Even the authors admit there was no control group used in this study.

2. These athletes cardiovascular training consisted of "cycle type ergometers".

3. Resistance Training was described as "Weight Training exercise 3x per week.

4. The authors make the statement, "subjects with LBP who received the intervention commented that their ability to squat with weights was improved after intervention, as they could “feel” where their backs were in space as they added load." This kind of gives you the idea of the type of resistance training that was going on. In addition, "Techniques of squatting and lunging were examined, and subjects were instructed to maintain their lumbar lordosis and thoracic kyphosis throughout the movement." Does this really happen in real life?

5. The authors continuously refer to the proprioceptive role of the multifidus, transversus abdominus, and pelvic floor muscles, but yet choose to train them in a "bodybuilding" type isolation style using ultasound to make sure they are isolating enough.

Ok, I buy into the fact that those 3 muscles atrophy after a localized injury to a spinal structure. Paul Hodges has documented that in vitro & vivo extensively. But allow me to refer to the 2nd edition of Dr. Stuart McGill's "Low Back Disorders". On page 110 he makes the statement, "the reason for the clinical emphasis on the multifidus may well be that the bulk of research has been performed on this muscle." He goes on to mention researchers who have found similar unilateral atrophy in other lumbar muscles. On page 120, he makes another key statement, "conceiving spine stabilizers as intrinsic or extrinsic my offer no benefit for clinical decision making. The relative contribution from every muscle source is dynamically changing depending on it's need to contract for other purposes."

Shirley Sahrmann, in her excellent book "Diagnosis & treatment of movement impairment syndromes" says on page 35, "these patients have motor control problems. The lack of extensive discussion reflects the limited information available, NOT the importance of this factor in movement impairment syndromes." In an article in SPINE in '96, Julie Hides herself suggests "impaired reflexes" being responsible for the failure of the multifidus.

What I'm getting at is, don't these muscles get stimulated the same way others do- that is by ground, gravity, and momentum? If that is true, what could be blocking this?

A preamble to my next series of posts.

In my next few posts, I'll be referring to the work of Hodges, Jull, & Richardson on core training & spine stability. If it sounds like I'm being critical, nothing can be further from the truth. I'm not in same league as these people. The truth is I'm a 49 year old man who watches cartoons at night to help him relax before bed time.

However, this blog is dedicated to the high school A.T.; and the care & prevention of injuries to adolescent athletes. So, I must interpret research and apply it in a manner that suits my setting.

I often work with classified athletes. For example, emotionally disturbed, ADHD, neurologically impaired et al. Yes, they are athletes too, and they have spines that get injured. In addition, I work with the "teenage" population. I know what would happen if I left them alone 5 minutes with one of those pressure gauge bags & an ultrasound unit. They would probably be text messaging their boyfriends, while talking to their friends, with an I Pod in their ear. A few would probably be beating each other over the head with the pressure bags.

I don't pretend to have all the answers, but since this is my blog I get to be selfish & tell you how I approach the issue.

High Tech?

I understand this athlete had a CT scan to his brain 3 weeks prior to his death. As with other sports injuries, we cannot rely on technology alone in addressing brain injury issues in sports. Athletic Training is both an art & a science. However, the more an ATC moves away from high tech (head injuries & other wise), the more we are second guessed (I am by no means saying that this went on in the Montclair case). Yeah, it still happens to me three decades into the game-and I'm sure I'm not the only one. If you would like to anonymously share your "MD coach" stories, feel free to do so. Oh, come on, we all them. I've even had coaches who could read X-rays!

Every athletic trainer's heartbreak

http://www.montclairtimes.com/NC/0/813.html

EHS Coaches Comments...

"Muscles" asked what our coaches do differently-

Good question. I spoke with the coaches about this, and they feel it has to do more with the style of play than conditioning. (I find it interesting that they don't think they do much conditioning. I think that's because a lot of what they do involves the ball). They said the South American/European players are trained to avoid direct confrontation, and it is "instinct" to jump out of the way to avoid a slide tackle or collision. My interpretation of this is it is that it involves both outstanding agility, and an intense knowledge of the game. Like Vern always says, personal training is not coaching.