November, 2009

Overhead Deep Squat and the Golfer

November 19, 2009

carol golfThe overhead deep squat is by far the single most informative test performed on athletes.  For golfers, we utilize this test to help determine the cause of swing faults leading to performance issues including ball distance, swing inconsistencies, swing speed, swing path, swing power, and flight patterns as well as the cause of golf injuries. MyTPI has performed extensive research on various biomechanical tests and how they relate to the golf swing.  They have found several correlations between the two:  Those who can't do a deep squat tend to have loss of posture during the downswing and/or early extension.  Also, if golfers can't maintain the club overhead, they typically will stand up out of their posture during the downswing. Among amateur golfers, a whopping 64% showed early extension and 45% showed loss of shoulder plane, both contributors to loss of posture in the golf swing. What's fascinating is that MyTPI found 54% of PGA tour players place more weight on their right leg during the deep squat compared to 14% of Amateur golfers. This is most likely due to the PGA tour players effectively learning how to load and unload the right hip in the right handed golfer to thrust the pelvis forward into rotation during the kinematic sequence.  (We'll get to Kinematic Sequence in another blog.) Why is the Overhead Deep Squat so informative in our sports medicine clinic?  It can tell us where to put our thumb to release scar tissue, thus improving range of motion and correcting imbalances as well as target the golfers rehabilitation to correct dysfunction and improve swing mechanics.  For instance, having the golfer perform a deep squat allows us to test bilateral (both legs) symmetry of mobility AND stability of the hips, knees, and ankles.  The overhead portion allows us to test the bilateral symmetry of the mobility and stability of the shoulders as well as the thoracic spine, all required in an efficient, and non-injury producing golf swing. This test is not only informative for golfers, we use this test for just about every sport that involves running, jumping, walking, and so on.  Meaning, all land sports including skiing, running, tennis, all ball sports, cycling, etc.   For an example of the squat analysis, visit our sister company, Press Play Analysis.
Our own Mike Rawlins, CPT demonstrating an Overhead Deep Squat on a slide board.

Our own Mike Rawlins, CPT demonstrating an Overhead Deep Squat on a slide board.

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Miracles at Ironman, Kona

November 11, 2009

Chrissie Wellington in T1

Chrissie Wellington in T1

(To see more pictures from the Ironman, click here.) My fourth time working Ironman Championships in Kona, HI and this year proved to be no different than Ironmans past.  Most ART practitioners who work Ironmans have stories to tell:  Every year, the ART team treats last minute injuries occurring the week before the race, flare-ups of chronic injuries, and Ironman winners in for last minute tune-ups. We even treat in the transition tents during the race when someone cramps, spasms, or thinks they are too injured to continue the race.  We treat age groupers, Ironman champions, nuns, eighty year olds, and athletes from all over the world.  As you can imagine, it's quite the experience. This year, I had a few challenges of my own. Fabrice, from central France, finished 2008 Ironman in 97th place overall.  His goal this year was to finish under 60 overall.  However, he walked into our tent unable to lift his left arm past 60 degrees without excruciating pain.  Meaning, there was no way he was going to be able to swim.  To make matters more challenging, the race was in TWO days.  In addition to excruciating pain in his shoulder with minor movements, he was also getting radicular pain, or pain down his arm into his hands.  I did a quick assessment and determined he most likely had tendonitis of his rotator cuff.  No time for an MRI to rule out a tear, I started ART on his shoulder. For those of you who know ART, we need movement of the body part to effectively treat the area.  Since Fabrice could not actively (and sometimes passively) move his shoulder without tearing pain, I had to be very creative and treat within a very limited range of motion.  After the first treatment, Fabrice told me he thinks his Ironman race is over, it won't happen.  I told him to be patient and come back the next day- the day before the race.  Anything can happen. However, I was even grim about his chances to race in two days. Fabrice came back the next day, and as I was treating another athlete, Fabrice walked up to me and said in his french accent shaking his finger with a squint in his eye, "You fixed me." He then showed me FULL range of motion of his left shoulder and stated his shoulder was 90% better.  I reassessed his shoulder and just noticed a little bit of dyskinesis (abnormal movement of his shoulder blade) of his scapula and treated the last 10% of his injury and sent him off running to get ready for the Ironman the next day.  My friend and fellow ART instructor said to me, "You never get tired of this, do you?" Fabrice finished the race, without pain!  Not only did he finish it, he came in 75th overall, quite the feat given that just two days ago, he thought his Ironman race was over. Miracle #2:  Natalie, a patient of mine, like all Ironman athletes, had been methodically training for the big race for months.  This was her first Ironman Championship so she had been coming into the office twice a week and getting weekly massages for months before the race to keep her body and form in tip top shape.  She did everything she could to make sure she was as ready as she could be for the race of her life.  Until a car hit her 3 days before the race in Kona. Every year, athletes get hit by a car while they are biking the course.  Unfortunately, Natalie was struck by a car at the end of her training ride, causing her to hit the ground hard on her right side, bruising her muscles, bones, and skin.  Fortunately, nothing was broken or severely injured, but she did stiffen up quite a bit and that's the last thing you want going into the Ironman.  Natalie came into the tent daily for ART treatment as well as got massages from her long-time massage therapist travelling with her to the Ironman.  Getting hit by a car is nerve racking enough, but hit by a car 3 days before the Ironman Championships is just mentally debilitating.  However, Natalie overcame the effects from the accident and finished at 11:08! Miracle #3:  Rachel was on course to finishing her first Ironman Championships as a top finisher in her age group.  However, 7 weeks before the Ironman, in the peak of training, she broke her foot.  Not able to run for 7 weeks before the race, she was unsure of how she would perform, if she could perform at all.  We had her try running and even at 20 minutes of running, she had some pain in the foot and some tight calves.  She received ART treatment several times before the race on her feet, calves, and back.  Rachel finished the Ironman in 11:43!  Quite the feat given she wasn't able to train for the last 7 weeks. No, you never get tired of these miracles, big and small.  Congrats to all of you Ironman athletes... because completing the Ironman is a miracle in itself.
Jess treating Natalie

Jess treating Natalie

Jess and Fabrice

Jess and Fabrice

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Training hard or overtraining?

November 9, 2009

Yep! Sick as a dog. I’m on the couch, watching “Semi Homemade” with Sandra Lee on the Food Network and writing my first blog. And since I’m unable to torture my patients with ART® these past two days, I’ve decided to talk about slowing down.
It is true, we all need to slow down in our daily and weekly lives to avoid the dreaded cold and flu. When you are out for the count, you are as useless as a dull knife. Attempting to get everything done ASAP can actually hurt you, and can even set you behind. Training is no exception. There is such a thing as overtraining. And overtraining can hurt you. I know we all get excited to run our first marathon or do our first half Ironman or Full Ironman. And many of us are able to do so injury free. However, what you don’t feel during training can haunt you for future races.
I typically see many injuries occur during training for the second marathon, or the second half ironman. One possibility for this is we do not give ourselves ample recovery time. Our bodies have their own odometers and we cannot turn back the miles. If you have not been training consistently and then train for a marathon or half Ironman, you are racking up miles pretty quickly. Sticking with the car analogy, think of an injury springing up on you “out of the blue”. It’s like the wear and tear of a timing belt. You don’t know it’s wearing out until one day it breaks.
My advice? It’s ok to take a week off from training or to have “rest days.” Your body needs to recover. Most repetitive strain injuries occur due to the body’s inability to rebuild tendons in time before the next workout.
Whew… enough of Sandra Lee. GiadaDeLaurentis is on. Gotta learn some mean Italian cooking!
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Weekend Warrior

November 9, 2009

Occasionally, well, not so occasionally- frequently, some of my patients decide to cram in as many "weekend warrior" activities in an amazing 2 week trip as they can. Here's a summary of such an adventure from a dear patient: "In February of this year I went on a 2 week trip to the south island of New Zealand. I went with a company called "Active New Zealand" and boy did they live up to their name! I came home in great shape although in need of some chiropractic and active release therapy treatment. I hiked, biked, kayaked, ran trails, bungee jumped and river boarded! I had never heard of river boarding prior to this trip. They suit you up in a wetsuit, with a helmet and flippers and a boogie board and send you off down the river to run the rapids with 30 other knuckleheads who also have no idea what they are in for. It was the most incredible workout I have had in years! When we were done with that, they dragged us around on a board off the back of a jetski and flung us back and forth (big fun), then sent us down a water slide (30 foot drop) and then off a rope swing in to the river! The bungee jump was off a bridge over a river (over 120 feet). The most beautiful scenery. An even more incredible adrenaline rush. Whew! I knew i should have base jumped off a paraglider but alas there just wasn't enough time!"

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Beijing Bound!

November 9, 2009

Boston was a success for our patients here at Innersport. We had 4 patients running the Boston Marathon and all finished with great times. Congratulations to Mirek Boruta, and Suzanne Franco, Magdalena (Magda) Lewy, Gabor Torak! I'll write more in our next newsletter due in May, however, here's an email I received from Gabor about his experience at the Boston Marathon and the Marathon Olympic Trials for women the day before. He writes: "Steve and I came out of the T (subway) on Sun and right after the motorcycles the first runner was Magda. This was at mile 24 I think. A mile later she was passed by Deena K. Still it was cool to see the transports logo setting the pace. Our run was great too; Steve and I ran together until about mile 19 at which point I decided to slow down (in order to stay alive.) The hills were not bad, but I had to hammer a bit on the last 5 miles to make a sub-3hr pace. Great crowds and weather! Thanks again for all your help! I couldn't have done it without you!! --Gabor" For those of you who have not heard, Magda finished SECOND in the Olympic Trials with a time of 2:30:19. Yes, this means she is going to represent USA at the Beijing Olympics this summer! Congrats to Magda, Gabor, Mirek, and Suzanne!

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THE WALL

November 9, 2009

I’m not talking about “hitting the wall” or “bonking.” I’m talking about OUR wall- Innersport’s wall of very happy faces and active bodies. Those of you who have been treated at Innersport have seen our wall of pictures of patients doing the athletic endeavors they love. Many of you have given us a picture, too. However, there are some of you who have not- and we’d like to change that.

The wall reminds us of our patients’ accomplishments and the hard work they put in to an event or to stay healthy and active. It inspires us to work hard so our patients can train hard. The wall encourages us to be happy, proud, and committed. It promotes great conversations with patients as well as healthy banter between practitioners. The wall is unique and it makes us happy.

I know for many of you the last time you had your picture on a doctor’s wall was at your childhood dentist’s office. Well, there’s nothing wrong with being a kid again. There’s nothing wrong with being proud of yourself for accomplishing an athletic task whether it’s kayaking on vacation or qualifying for the Olympics. We want your picture- and a picture of you doing something that makes you happy!

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The Bench Press: Big Pecs, Bummed Shoulders

November 9, 2009

The bench press is one of the best ways to grow big muscles in the chest so it’s no wonder why so many gym-goers routinely use it in their exercise repertoire. However, the bench press is becoming more and more blamed for ruining weight lifters’ shoulders. I’d like to shed some light on the biomechanics of bench press injuries. The Bench: The bench itself can cause shoulder injuries by restricting the normal motion of the shoulder blades (scapulae). In turn, the shoulder joint (glenohumeral joint) will have to move excessively to compensate for the restricted movement of the scapulae. I often tell my patients that most athletes’ bodies will figure out how to get from point A to point B with obstacles in the way. Unfortunately, they don’t realize that they are using the wrong muscles or joints to compensate and thus, they get injured. The bench can prevent the shoulder blades from going back flat against the rib cage and towards the spine. If this happens, the shoulder blades are now rounded forward, but in order to lower the weight all the way down to the chest, the “ball” must move while it is not centered in the socket. (The shoulder blades house the “socket” in which the ball must sit centered on.) This can be very dangerous for the shoulder joint itself and the external rotation rotator cuff muscles that attach to it as the external rotators will become tight and the internal rotator cuff muscle (Subscapularis) will become weak. This causes the “ball” to move forward and up causing injury and pain. This is true for those who have pain doing a bench press, but no pain performing a push-up. For those of you who have pain doing both, you may have already injured the shoulder joint or the tissues surrounding or attaching to the shoulder. The Bar: As the weight lifter pushes up, the forearm, wrist and elbow joints move into supination to allow the shoulder to stay in neutral or slight external rotation, which is safer for the shoulder joint. However, the bar restricts supination of the forearm, and thus causes some internal rotation of the shoulder joint possibly leading to impingement. Ideally, to overcome this biomechanical problem, the weight lifter can use free weights, which allow normal movement of the elbows and wrists and shoulders during a press. Still want to Bench Press? Follow these suggestions to reduce the risk of injuries. 1. Place a pool noodle about 10 cm or less in diameter along the bench. Then lay on the noodle so the noodle is along your spine and your shoulder blades can roam freely. A half foam roller will do, but do not use a full foam roller unless you are on the floor. 2. Tie red tubing around each end of the bar and then have your spotter pull on the center of the tube away from your head at bar height so as to make a “V” with the tubing. The point of the “V” will be at the spotter’s hand and the opening of the V will be at the bar. As you lower and lift the bar, your internal rotator muscle (Subscapularis) has to activate. 3. As you lower the weight and the elbows lower past the bar, make sure your chest opens up via the shoulder blades moving towards your spine. Once the shoulder blades stop moving, then do not lower the elbows any more. 4. When pushing up, focus on allowing the shoulder blades rounding around your rib cage (away from the spine) WITHOUT hiking up your shoulders to your ears or rounding or flexing the back. This is very important, as you will feel like you are punching your arms towards the ceiling, which activates the Serratus Anterior muscle. The Serratus Anterior muscle has a large influence on Scapular Stabilization, which is necessary to decrease the risk of injury. Adapted from Sports Injury Bulletin, Issue No. 80.
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Need to Recover Faster? You may want to try this…

November 9, 2009

Ever have a multi day event where you had to get back to your hotel room and try every recovery trick you can think of to avoid the "exercise hangover" the next morning? One research study found that Contrast Water Therapy resulted in a smaller reduction in- and faster restoration of- strength and power, compared with rest. Here's the protocol they used. They immersed the lower part of the body alternately for 60 seconds in cold water at 46-50 F degrees followed by 120 seconds in hot water at 104-107 F degrees for a total of 15 minutes. How does this work? The idea is that contrast baths alternately expand the blood vessels and then quickly constrict the blood vessels which will create a pumping action, pumping out edema. This is just one study. More needs to be done, but the bottom line is we are all very different. Different physiology, different body composition, etc. So, you may be able to use this technique as a guideline and tweak the numbers a bit to find what works best for you. You may need to adjust both the temperature and/or immersion time. I found this study valuable since I've already blogged about overtraining. Hopefully more and more athletes are realizing that recovery should be a part of training. The effect of contrast water therapy on symptoms of delayed onset muscle soreness. Journal of Strength and Conditioning 2007: 21 (3) 697-702
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To Stretch or not to Stretch

November 9, 2009

That is the BIG question. It's hard to find the right answer since research has opened up a whole new can of worms. Certain types of stretching (dynamic/static) seem to be appropriate at certain times (pre/post training), for certain reasons (injury prevention/recovery). What we know: Types of stretching (abbreviated list): Dynamic, Ballistic, Static, PNF, AIS. Reasoning behind stretching: Injury Prevention Injury Recovery Increase Flexibility Increase Performance Reduce Pain So, how do you know what to do when? Based on research and clinical experience, here's a very brief synopsis. I have only chosen 2 main forms of stretching. Dynamic Stretching: Use dynamic stretching before your workout. Dynamic Stretching gets your muscles ready for activity and is usually sport specific. It's also another way to "warm-up". Dynamic stretching involves repetitive movements to the end ranges of motion. For example: leg swings forwards and backwards for 30 seconds to "work" the hip flexors and extensors to gear up for running. Static Stretching: Use static stretching after you workout and at any time during the day ONLY when you are warm (after showers, a brief walk, etc.) Static stretching is recommended to increase flexibility and aid in injury rehabilitation (only when closely monitored by a sports practitioner). If doing static stretching to increase flexibility, it is advised to only stretch those areas that are tight and joints that are hypomobile (decreased range of motion.) Also, to have permanent results, one must stretch a particular muscle for more than 30 seconds 4-5 times a day. Results will plateau at around 6-7 weeks of consistent stretching. Static stretching involves lengthening a muscle for an extended period of time. An example is bending down to touch your toes for 30 seconds. When NOT to stretch: Static stretching before a workout has been shown to decrease explosive performance. A prolonged stretch on a tendon can initiate a reflex mechanism to inhibit the muscle you are stretching. Therefore, static stretching before an event which requires explosiveness or power is not recommended. However, dynamic stretching has been shown to increase performance as it is hypothesized that dynamic stretching helps to coordinate sport specific movements. What we still don't know: More research is needed to determine if stretching prevents injuries. The current research is contradictory, probably because there are so many variables. In addition, research is contradictory in stretching for pain as well. Pain can be caused by just DOMS (delayed onset muscle soreness) or an inflammatory response to an injury. Research has shown that stretching DOES NOT reduce DOMS. Stretching for pain may be beneficial if the injury or pain has been caused by restricted range of moiton. However, stretching for pain, if done incorrectly or inappropriately, can actually cause more inflammation and injury and should be prescribed by a sports practitioner. In summary, obviously more research is needed to specifically test WHICH stretching protocol is appropriate WHEN and for WHAT purpose. However, we have a good idea that dynamic stretching is appropriate for pre activity and static stretching is more appropriate for post activity.
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I have a confession to make…

November 9, 2009

Somebody stop me, please! I have a new addiction-habit-obsession. I don't know why it took me so long, but I just can't stop obsessing over bikes and bike parts. I'm on Ebay, Craigslist, and other various websites looking to build the perfect bike with the best deals. I don't know if it's about the treasure hunt or my competitive nature to outbid, but I haven't been able to put the laptop down. Once upon a time, I used to shake my head when patients told me all about their bike collection and which bike had which component and is made of which metal, etc. Now I'm admitting I am that bike freak. I want to talk bikes all day. It's so bad that my new addiction is taking away time from my old addiction, which was actually riding a bike. I need help before I turn into a snobby bike owner. If you know of a support group, please feel free to email me. I'd prefer a support group that meets on a ride, preferably hilly, but not long 10-15% grades, maybe long 8% grades. Happy riding.
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