A Hip Solution to Low Back Pain

Welcome to the new Physical Therapy world. Gone are (or should be) the days of the ultrasound, hot pack, and nice massage. No longer do we treat only the location of pain. Each patient who fell through the cracks after their e-stim machine turned off begged for something more, and the time has certainly come.

Say hello to your new Physical Therapist. Your new therapist doesn’t bother dusting the ultrasound machine as he or she is too busy examining movement. One hour of pain free walking after short term treatments is not enough. Your new Physical Therapist is asking why the pain always comes back after one has sat for too long. A manipulation is only magical if the pain doesn’t return after repeated bending. Physical Therapists don’t simply stop at the area of pain, they move on to determine why that area of pain is under so much stress during seemingly simple movements.

Shooting numbness down your leg while sitting? Piercing pain at your low back with only minutes of walking? Could it be that the answer to your problem is not a laser to damaged areas of your spine? Could it be that the reason the pain occurs while you are sitting is due to tight hip musculature? What if stretching the hip flexors could relieve the pain associated with the osteoarthritis found on the x-ray? Some colleagues of mine have recently explores the relationship between hip stiffness and low back pain here.

In a nutshell, every movement is comprised from multiple parts of the body. Even sitting, the most common position for todays common man is quite complex. Sitting in a low seat requires up to 110 degrees of hip flexion. Ideally, the pelvis will not tilt posteriorly, and the low back will not round into flexion. Unfortunately, most people don’t have 110 degrees of hip flexion. Sitting without hip mobility can result in excessive tensile stress to the low back, and therefore cause that aching low back pain after prolonged sitting.

You can have soft tissue done, a manipulation, or even surgery if you can find the right (or wrong!) surgeon. But, when you go back to sitting without the hip flexibility the pain will return.

It works both ways. Some individuals have tight hip flexors and therefore lack full hip extension while walking. This results in excessive extension at the spine, and/or a compensatory rotation at the pelvis resulting in unneeded torque at the spine.

Once again, any treatment at the spine is missing the cause of the dysfunction.

The Physical Therapy world is changing. You can now see your physical therapist without a Physician prescription in most states. More and more therapists are screening movements and looking for this type of hip dysfunction well before the low back pain even starts. Find yourself a great local therapist and determine the cause of the pain today. Check http://www.optimalmovementpt.com for more information.

What are your favorite hip mobility exercises? Stay tuned for the next blog to learn the best mobility exercises for the hip.

TRX Corrective Exercises for Pitchers

You don’t run to get in shape, you get in shape so that you can run. Simply running every day will not improve your running ability. Cross training, improving muscle imbalances through corrective exercises, and strength training are all required in order to improve performance with running, and minimize the risk of overuse injuries.

You can take the same concept with any activity which requires repetitive motion, especially pitching. Simply throwing every day as hard as you can will only decrease performance and increase the likelihood of injury. There is a certain amount of core strength, rotator cuff stability, hip flexibility, and lower quarter stability that is required to optimize the movement of an overhead athlete. When an athlete has reached a certain level of strength and flexibility, I encourage using a TRX suspension strap to train these elements of pitching. My favorite TRX exercises for pitchers are listed below, but with a disclaimer: as healthcare professionals, we cannot simply prescribe exercises without a thorough examination of the athlete. These exercises should only be performed after an assessment and under the instruction of your healthcare specialist.

1) TRX Side Lunge

The stride phase of the pitch may be the most important phase of pitching. The stride length of a professional pitcher is approximately the length of the pitchers height, and the shoulder has to move towards end range of external rotation. Needless to say, in order to maintain proper mechanics the pitcher requires a certain amount of trunk control. Therefore, the TRX side lunge becomes a great exercise to work on adductor length of the stance leg (ensuring increased stride length) and trunk control during this motion.

2. TRX W Deltoid Fly

This exercise is named for the large deltoid muscle which assists with the abduction of the shoulder, but I like to use it to work the external rotators of the shoulder. This is also important for the stride phase of pitching, and requires a certain amount of instruction without the TRX before it can be done appropriately. After a pitcher learns appropriate joint centration of the glen0-humeral joint (to be discussed in a future blog) he can begin to train the rotator cuff to maintain the stability of the joint during pure external rotation. Again, all of this is being done while maintaining trunk control.

3. TRX T-Deltoid Fly

The cocking phase of the pitch requires scapula adduction and full external rotation of the gleno-humeral joint. At this phase of throwing, the middle trapezius operates at approximately 50% Maximal Voluntary Isometric Contraction (MVIC) and the Infraspinatus works at 74% MVIC. This exercise places works on these muscles to place the scapula and glen-humeral joint in the appropriate position for this phase of throwing.

4. TRX Lunge

 

Of particular note, at this time all exercises have focused on  phases of pitching before the ball is released (showing the emphasis I place on the early phases of pitching). The most important component of the pitch after the ball is released is the follow through. Flexing through the hip and trunk can attenuate the force developed in prior phases from the shoulder. The TRX lunge can work on strengthening the gluteals and hinging from the hip to assist with this phase of throwing.

This form of training requires appropriate flexibility, strength, and supervision, but it can greatly improve your pitching mechanics. If you live in the Redlands area, a great spot for TRX training is at The Energy Lab. Check them out for their TRX classes and all fitness goals.

For rehabilitation, movement screenings, and to work towards your fitness goals, check out OMPT and email me at alan@optimalmovementpt.com

 

http://www.optimalmovementpt.com

World Physical Therapy Day!!!

World Physical Therapy Day is September 8, 2014!!!

World Physical Therapy Day is a day to recognize the profession and all the benefits a Physical Therapist provides to the community. Are you currently participating in therapy? Have you had therapy in the past? How has therapy helped you? How could therapy help you?

For most individuals who have participated in therapy they are aware of the importance of the Physical Therapist as well as the role a therapist can provide in improving movement and function. For those of you who are not aware, the benefit therapy can provide is different for every individual. Every person you encounter has their own concerns and fears. My profession gives me the time to really understand and empathize with concerns and fears, which opens a window into making a real change on the individual level.

Whether it’s running that extra mile, picking up a grandson, getting up the stairs at night, or simply making it through the work day, Physical Therapists help individuals meet their specific goals. A Physical Therapist is a specialist on movement and can help optimize performance, return from an injury, and prevent future injuries from occurring. Imagine the health benefits of having a Physical Therapist who knows you. Think about it, most individuals have their own personal Physician and Dentist. Why not having your own Physical Therapist who can screen and educate on proper movements to maintain optimal health.

Optimal Movement Physical Therapy provides these benefits to many resident in the Redlands area. If you need someone on your team, we would be happy to listen to your concerns. Check out our website here. If you would like to learn more about World PT day, check out the World Confederation for Physical Therapy website.

In celebration of World PT Day we’re holding a contest! If your life has been significantly impacted by a Physical Therapist, let us know in the comments for a chance to win a $25 gift certificate to one of our favorite stores that encourages movement – REI! Follow us on Facebook, Instagram and Twitter for additional entries! Please leave individual comments letting us know where you’re following us! Giveaway ends Monday, September 15th at noon PST. Winner will be chosen by random draw and will be posted Monday evening!

Disclaimer: we are not affiliated with REI in any way. We just really like them and what they stand for!

http://www.OptimalMovementPT.com

A winner has been chosen for World PT Day contest. Thomas has been selected via the website random.org. Please email me at alan@optimalmovementpt.com.

Screening and Preventing ACL Injuries

This may be my favorite time of the year. Fall in Redlands is beautiful, and we finally move away from the heat of Summer into to crisp air of Fall. Cyclists and runners no longer have to get their workouts in early to beat the heat, and we get to look forward to playoff baseball. The aspect of Fall which I enjoy the most is the return of Football and Soccer. These sports showcase some incredible athletes performing at a high intensity level during nearly every play. The unfortunate side effect of this level of play is a multitude of anterior cruciate ligament (ACL) tears. So far in the NFL preseason alone (3 weeks of games) there have been 16 ACL tears: the most notable being Sam Bradford’s second tear. The average lost wage per NFL player who has suffered an ACL injury is 1.6 million dollars!

So what if some professional football players have had an injury? After all it should be expected for athletes in a heavy contact sport, especially in a league with the biggest and fastest athletes in the world, right? Well, are you aware that there are approximately 300,000 ACL injuries per year? Further, according to the Sports Surgery Clinic (SSC) in Dublin, 70% of ACL injuries occur during non contact injuries. Per the last stat from the SSC, female athletes are up to 8 times more likely to have an ACL injury than their male counterparts. This coupled with an average soccer player making approximately 726 cutting maneuvers in a game results in women’s soccer being the sport in which an ACL injury is most likely to occur.

70% of injuries occur without contact. This means that a tear occurs because of a biomechanical stress an athlete places on their ACL during cutting and/or running. Wouldn’t it be nice if we could screen for and prevent such a horrible injury from occurring?

The truth is, we can.

1) We know the population that typically has a non contact ACL injury. It will happen to young female athletes between the ages of 15 and 20. Every year, one in ten female collegiate athletes will have an ACL injury. Further, soccer and football athletes are most likely to have the injury given the demands they place on their knee.

2) We know the mechanism of injury. The injury occurs during periods of cutting or changing directions. Typically the knee is slightly bent, and there is a large valgus force placed on the knee.

Since we know these two facts, we can effectively screen for these injuries. We simply have to analyze the movements of the at risk population. With video analysis, we can determine if an athlete places a high amount of valgus stress at the knee during cutting and jumping drills. With a simple quick screen, athletes who are at a risk for an ACL injury can be identified.

So then what? A study performed by Mandelbaum et al in 2005 showed that athletes invoked in a Prevent injury and Enhance Performance program (PEP) were approximately 80% less likely to have an ACL injury. This program is made up of exercises focusing on flexibility and proximal hip stability.

So, a short screen of athletes, followed by prescription of individualized strengthening exercises can prevent 80% of the 300,000 ACL injuries that occur each year.

One more blurb on ACL injuries. A shift in the rehabilitation after an injury has been occurring of late. No longer are physical therapists following a set protocol. Instead, rehab is being progressed based on biomechanical testing. Biomechanical testing is now being done to clear athletes to return to sport in order to prevent the 12% chance of a re-injury. Given that we are screening athletes who have had an ACL injury before they return to sport, doesn’t it make sense that we begin using biomechanical testing to avoid injuries in the first place?

At Optimal Movement Physical Therapy, we focus on screening and preventing injuries. The video analysis and screening for ACL injuries, as well as ACL rehabilitation and return to sport are all services provided. Call us today to schedule your free consultation at 909-335-7402!

http://www.optimalmovementpt.com

Pitching Biomechanics

There are 39 major league pitchers who have had or are scheduled to have Tommy John elbow reconstruction this year. THIRTY NINE! This includes some big name pitchers (and therefore big money pitchers) including Matt Harvey, Jose Fernandez, Matt Moore, and Patrick Corbin to name a few. The combined salary of these four players is over 2.5 million dollars in 2014 alone. The high amount of elbow injuries has become MLB’s “number one research priority” at this time. There have been several hypotheses regarding pitchers being overworked, pitchers focusing only on one sport starting in their youth and losing out on cross training, to even a varying amount of humeral torsion leading to a higher likelihood of elbow injury.

But what about their movement?

Not all pitchers throw the same. They all have varying amounts of biomechanics, some of which place excessive loads on the elbow.

Determining differences in pitching biomechanics becomes quite obvious when looking at the late cocking phase of throwing. At this phase of throwing and pitching, a pitcher should have maximum external rotation of the throwing arm. 

Take a look at Roger Clemens in the late cocking phase of throwing. His shoulder is at maximum external rotation and he is prepared to move into the acceleration phase of the pitch. Note: Clemens had a long career without much history of shoulder or elbow trouble.

 

Take it a step further and look at Greg Maddux at this phase of throwing. Another long career without a history of injury. His shoulder is also in external rotation when his lead foot makes contact with the ground.

Let’s compare the shoulder position of Maddux and Clemens with the shoulder position of some pitchers with a history of Tommy John. First, Mark Prior. Prior was an up an coming pitcher who along with Kerry Wood was meant to bring the Cubs back to the World Series. His career was shortened due to injury.

You can see that Prior actually has his shoulder in full internal rotation just before his foot hits the ground (showing the ball to the first baseman rather than second or third base).

Adam Wainright is another pitcher with a history of Tommy John. Just like Prior, you can see the internal rotation of his shoulder in late cocking.

Both of these pitchers are very talented, but their pitching biomechanics set them up for injury. Essentially, the legs are moving through the mechanics faster than their shoulder is, creating the need for the shoulder to “catch up” to their legs. The reason for pitching like Prior and Wainright is that the delay between the lower quarter and upper quarter creates more torque at the shoulder. More torque results in a higher velocity pitch as well as more break on the pitch. However, more torque on the shoulder can also lead to more shearing stress at the shoulder and tensile stretch at the elbow.

If trying to eliminate elbow injuries in pitchers, pitch count, appropriate rest, flexibility, and strength are all vital components. After all, Maddux and Clemens had to work at maintaining their long healthy careers. That being said, the biomechanics of the pitcher should also be taken into consideration.