December, 2009

Injury Prevention: Free lecture series

December 28, 2009

ath-sem-series

Climbers: Saturday, Jan 9 at noon Snow sports: Wednesday, Jan 20 at 7:30 P.M. Runners: Thursday, Jan 28 at 7:30 P.M.

Show up and meet other like-minded athletes, try out my targeted exercises for your sport, and learn something new about training healthfully. Refreshments will be served, and individual questions will be answered!

Maximize your fun this winter!

Have you ever had low back pain, knee problems, shoulder tweaks, ITB syndrome, Achilles tendonitis or a thigh strain?

Or do you just want to find out how to avoid these injuries?

Learn THE TOP sports-specific core and strength

exercises to tackle your arms, back, butt and knees!

Clinic led by Johanna Lelke, DC, ART (Former Div. I collegiate runner; climber; skier & boarder; yoga teacher) Where: Innersport 1250 Addison St., Suite 102 Berkeley, CA 94702 If you're new to the office, enter the main double doors near Addison St, adjacent to the park. Please use the call box if main doors are locked. Follow the first hallway, on the right at the end. Contact: Dr. Johanna 510.883.1126 Email: DrLelke@innersport.com
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Golf Corner: Casting, Scooping, or Early Release and Golfer’s Elbow

December 15, 2009

Elbow Injury: Golfer’s Elbow, or medial epicondylitis, is a common ailment among amateur golfers.  The pain is felt on or around the bony prominence of the inside part of the elbow, near your “funny bone”.  The injury occurs when the muscles that attach to the this area become overloaded due to excessive repetitive forces, weakened muscles, inflexibility, and poor mechanics of the joint.  The tendon, therefore, cannot keep up with the demand of transferring forces and becomes inflamed.  If the golfer does not rest the elbow, he/she could develop what is called tendinosis which refers to the degeneration of the tendon attaching to the medial epicondyle.
Medial Epicondyle of the Elbow

Medial Epicondyle of the Elbow

Swing Faults: One common swing fault, casting/early release or scooping, can cause golfer’s elbow.  Titleist Performance Institute found that 55.9% of amateur golfers early released or scooped.  Casting or early release is referred to the premature release of the wrist angle during the downswing and through impact.  This is similar to the motion of casting a fishing pole (underhand, of course.)  Scooping refers to the golfer “scooping” up the ball to get loft by having the hands behind the club head at impact.  These swing faults can cause the club face to loft, creating loss of power and high loft ball patterns.  In order to gain more distance, the golfer may attempt to swing harder and faster to gain more distance.  This can cause excessive use of the wrist flexors attaching to the medial epicondyle and thus, golfer’s elbow.
Example of Early Release

Example of Early Release

Causes: As I’ve said before, there are many causes to swing faults such as poor technique and poor club fit in addition to poor mechanics and human movement.  I will focus on the physical causes.
  • A number of lower body altered biomechanics can cause Casting or Scooping such as: Poor hip mobility, poor core strength or stability, poor ankle mobility, and poor pelvic control all can cause the body to initiate the swing sequence with the upper body.
  • Poor grip and forearm strength can cause a golfer to use the forearm muscles beyond their capabilities.  This will cause the tendons attaching to the medial elbow to eventually breakdown over time.
  • Poor wrist flexibility can force the golfer to early release since the wrist just cannot get into the proper position during the downswing.
Video analysis is key to determining swing faults causing injury where as a proper golf biomechanical assessment is necessary to diagnose the physical limitations, restricitions, or imbalances causing the swing faults.
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Golf Corner: Reverse Spine Angle and Low Back Pain

December 15, 2009

One of the more common swing faults I find when videotaping golfers is the “Reverse Spine Angle”. The Titleist Performance Institute found that 38.5% of amateur golfers have a reverse spine angle.  In the case of a right-handed golfer, the Titleist Performance Institute defines a reverse spine angle as  “any excessive upper body backward bend or excessive left lateral upper body bend during the backswing.”
Reverse spine angle compared to correct spine angle.

Reverse spine angle compared to correct spine angle.

Lumbar region

Lumbar region

Unfortunately, a reverse spine angle can set up a golfer for lower right back pain (for a right handed golfer) for two reasons:  First, if a golfer has a reverse spine angle, his/her upper body will tend to dominate the swing since the lower body is not in position to initiate the downswing.  The upper body initiation and domination will cause the body to switch from bending slightly to the left to rapidly crunching down on the right instead of the pelvis moving into rotation.  This rapid acceleration of the spine crashing down on the right low back can cause repetitive jamming of the lower lumbar/sacral joints and over time cause inflammation and arthritic changes. Secondly, this swing fault can also cause the abdominal muscles (known to protect and stabilize the spine) to become inhibited and thus the low back vertebrae are left in a vulnerable position.
Muscles of the trunk.

Muscles of the trunk.

Causes: Since I am not a golf pro, but a specialist in human movement, I will describe the most common physical causes of a reverse spine angle.  Please understand there are habit, technique, and golf club fit issues that can cause a reverse swing fault. The most common physical causes are as follows:
  • Poor pelvic and shoulder dissociation.  The ability for your thoracic spine to rotate over your pelvis and on the spinal axis is needed to avoid side or backward bending during the backswing.  This can be due to a restricted spinal mobility or Latissimus Dorsi muscle.  Typically people with poor spinal or Latissimus Dorsi mobility cannot separate their shoulders from their pelvis.
  • Poor right internal hip rotation (in the right handed golfer.)  If the golfer cannot rotate the pelvis posteriorly on the right around the right leg, he/she will then be forced into a lateral sway, which will in turn, cause a reverse spine angle.
  • Poor core strength, spinal stability or pelvic stability.  If the golfer cannot stabilize their spine by using their spinal stabilizers, abdominal muscles, or glutes, the spine may end up being forced out of a proper spinal angle during the backswing due to excessive extraspinal forces dominating rotation beyond the core’s ability to stabilize.  The stronger the core, the more efficient golf swing because the spinal angle line can stay in the correct position while the shoulders rotate around it.  You lose your spine angle, your body is in an inefficient position to make a successful swing.
We use a variety of biomechanical tests to determine the cause of the swing fault, followed by prescribed exercises, soft tissue, and chiropractic treatments to correct the physical causes of a reverse spine angle.  Please feel free to email Dr. Jess at drjess@innersport.com to learn more about swing faults, physical causes, and treatments or about any other golf injury related matter.  Golf_Swing_Animation by Persian Poet Gal
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Choosing the Right Frame Material by Patrick Brady

December 15, 2009

Craig Alexander's Triathlon Bike- winner of 2008 and 2009 Ironman Championships I met Patrick Brady in Italy as one of our guides on a bike vacation from Florence to Rome.  I quickly learned that Patrick is a knowledgeable cyclist and writer.  You can find great articles of his at Red Kite Prayer.  If you like cycling, you'll love his articles.  I asked him to do a piece on choosing a bike frame for my clients who would like to buy a new bike, but do not know where to start.  Enjoy!

Choosing the Right Frame Material

By Patrick Brady

When shopping for a new bicycle, you have to make a few firm choices. Naturally, you have to choose a category of bike. No one but you can decide if your idea of fun is competing in a triathlon, riding a century or going for a mountain bike ride. The more specialized the bike you purchase, the more limited its use will be (time trial bikes are no fun off road), but the more it will excel in its particular discipline, so choose carefully. Your next big choice is your budget. No one can tell you what to spend, but your likely satisfaction can be gauged by matching your spending to your frequency of use. In broad strokes, it’s good to consider spending $500 to $1000 for every day of the week you plan to ride your bike. If you plan to ride at least two days a week you’ll get a good experience from a $1000 bike and a very satisfying experience from a $2000 bike. Okay, so once you’ve made those two all-important decisions you can move on to a much less important but much more easily debatable choice: What frame material is best? Debating the merits of each frame material can seem a bit like debating who the best Bond was. Sean Connery? Manly, but a bit misogynistic. Roger Moore? Dapper; too dapper? Daniel Craig? Badass, but distant. Where were we? Generally speaking, bike frames are made from four different materials: steel, aluminum, titanium or carbon fiber. Some frames combine two of these in hybrid forms (usually carbon fiber with one of the other two). Strong Points So what are the relative merits and weaknesses of each material? Carbon fiber is the material of the day. It is lighter than a pickpocket’s hand, eats energy-zapping vibration and is as fragile as a man’s ego. Titanium is fairly lightweight (though not generally as light as carbon fiber) is more durable than the Terminator, and is guaranteed to be more expensive than a weekend getaway. Aluminum is the one material that offers great stiffness and low weight for those on a budget; its only drawback is that its ride can be as harsh as a shot of cheap tequila. Steel frames can be rolling-sculpture beautiful or inexpensive; either way they offer luxury sedan comfort. What material you choose will be driven to some degree by the style of bike you wish to purchase, so I’ll take you through this by bike, not by material. Road bikes In selecting a road bike you have more latitude to choose than in any other category. The very lightest, stiffest, most sophisticated—and most expensive—road bikes are being made from carbon fiber. Think Mercedes Benz. From sports car to grand touring sedan you can find whatever you want in carbon fiber, except for custom dimensions. Titanium, with its exotic satin sheen, is light and can be made to custom specs but isn’t the stiffest material out there, ounce for ounce; be prepared to open your wallet like it’s a garage door. Aluminum balances low weight, great stiffness and affordable cost with the confidence of a team of Chinese acrobats. Steel is your chance to put beauty ahead of all other concerns; that said, this old-school material is the ’68 Mustang of the bunch: It lacks today’s sophistication, but it’s gorgeous, easy to customize and will outlast Lady Gaga’s career. What you pay will be directly proportional to its customization and beauty. Triathlon bikes With tri bikes your choice is significantly easier. Because aerodynamics are as crucial to a tri bike as the moon is to a vampire, the vast majority of all tri bikes are made from either carbon fiber or aluminum. Carbon fiber is clearly the best choice for a tri bike. The frame and fork designs using carbon fiber can be vastly more aerodynamic than even aluminum designs can be. Below about $2500 you will see very few tri bikes made from carbon fiber; aluminum may be your only choice in that price range. Mountain bikes Your big choice here begins with the style of mountain bike you wish to ride. Do you want a hardtail or full suspension? If you plan to stick to cross country style riding, the best, lightest bikes are made from carbon fiber. Those on a budget can find relatively lightweight offerings made from aluminum. Consider steel or titanium if you plan to keep the bike until your retirement party. For full suspension rigs, your choice is easy … mostly because there aren’t many. The vast majority of all full suspension mountain bikes feature aluminum frames. The exception to this are lightweight rigs destined for cross country racing. Hybrids and town bikes If cycling isn’t an important part of your life, but you still want to go for the occasional ride and maybe run local errands on two wheels rather than four, aluminum is a terrific choice. An aluminum frame can cut a pound from the frame weight of the average hybrid or town bike.
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Reduce Stride Length to Prevent Tibial Stress Fractures

December 7, 2009

A recent research article in the Medicine & Science in Sports & Exercise, December 2009 studied the effects of increased stride length and the incidence of tibial stress fractures in runners. The authors of "Effects of Stride Length and Running Mileage on a Probabilistic Stress Fracture Model" found that by reducing stride length by 3%-6% decreased the probability of stress fracture. Increasing the running mileage increased the probability of stress fracture by 4%-6%. They also concluded that if a runner decreases their stride length by 10%, he or she can run an additional 2 miles/day and maintain the same probability of stress fracture. It is very important to understand the difference between stride length and stride angle as we do not advise runners to reduce their stride angle.  Stride length is the distance from initial contact of one foot to the subsequent contact of the same foot.  There are stride calculators on the web to determine your stride length such as http://www.tech4o.com/stridecalc.html. Stride angle measures the greatest angle your legs create during the running stride.
An example of stride angle

An example of stride angle

We would like to see the stride angle increase without the stride length increasing as we do not want the runner to land too far out in front of her body.
Example of overstriding

Heel strike far in front of body

To increase stride angle, we would do ART (Active Release Techniques) to the hip flexor group and hamstring group as well as other related structures inhibiting range of motion as well as prescribe various stretches and exercises.  To reduce over striding, we work on technique and running drills.  To receive a video analysis of your stride angle and running gait, please email drjess@innersport.com.
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