Common Cycling Injuries and How to Prevent Them

In order to maximize efficiency and minimize injury risk, cyclists have to optimize both machines at play, the two machines being the bike, and the cyclist.

Battling between the bike fitting and poor biomechanics of a cyclist is a recipe for pain and poor efficiency. The following is a list of common cycling injuries as well as the biomechanical flaws that may be causing them. Fixing the flaws with corrective exercises is only half the battle, as a poor fitted bike will contribute to these injuries as well.

1. Low Back Pain

Number one, and probably the most common is low back pain. Just because you are sitting while riding, doesn’t mean you can relax and sit in a slumped posture. A slumped posture places excessive tensile force on the muscles in the low back, and asking those muscles to work extra hard for several miles usually results in some amount of discomfort. The main motion to look out for is a pelvis that is posteriorly tilted like this athlete in the picture below.

Posterior pelvic tilt results in excessive flexion at the low back.

The posterior pelvic tilt is typically caused by decreased hip flexion, a motion often limited by tight hamstrings. Further, decreased abdominal strength can result in this slouched forward position. Have your therapist assess your hamstring length and your abdominal strength to determine if these may be the cause of the low back pain you are experiencing.

2. Hip Impingement

When the head of the femur pinches with the acetabulum of the pelvis a pain in the anterior aspect of the groin may occur. This pinching tends to occur when an individual places their hip into more flexion, adduction, and internal rotation than their hips actually have motion for. It can also occur due to weak, or inactive gluteal and abdominal muscles as their role is to rotate the pelvis posteriorly. Riding with your knee more medial than your hip can result in impingement at the hip, pain in the anterior aspect of your thigh, and definitely decreased efficiency while riding.

The excessive adduction and internal rotation can result in impingement at the femoral-acetabular joint.

3. Patello-femoral (Knee) Pain

The movement causes of anterior knee pain is very similar to the movement caused of hip impingement. The adduction and internal rotation of the femur causes impingement at the hip, as well as compression of the patella and femur at the anterior knee. The picture below shows how a simple step down test can identify this movement pattern, which suggests poor gluteal recruitment and / or strength.

The excessive genu values during a step down may result in excessive compression at the patella-femoral joint.

4. Achilles Tendonitis

Posterior ankle pain while riding is often due to excessive plantar flexion of the ankle at the bottom of the power stroke. If you are pedaling with your toe pointed down at the bottom of the stroke, you are likely overusing your posterior ankle muscles which attach to the achilles. This overuse can lead to tendonitis. Reasons why this occurs can be a poor bike fitting where the seat may be too high, but it can also occur as a result of poor activation of more proximal musculature such as the gluteals and quadriceps.

Ankle Plantar Flexion at bottom of power stroke.

5. Neck Pain

The amount of mid back curvature while cycling certainly can lead to higher stress at the cervical spine or neck as you keep your head up to see what is ahead of you. Excessive curvature (known as excessive thoracic kyphosis) will lead to an even greater stress at the cervical spine. As the picture below shows, the excessive kyphosis is often a result of limited hip flexion. This means that solving your neck pain while riding often means improving your hip ROM through stretching and improving abdominal control.

Excessive kyphosis at the thoracic spine can result in excessive compression at the cervical spine while cycling.

The first step to eliminating pain and improving efficiency on the bike is to diagnose the problem. Often times a bike fit and a movement assessment will identify the cause of the dysfunction. Our next blog post will focus on movement assessments and exercises you can start doing to treat the dysfunction and keep you riding.

In the meantime, check out www.optimalmovementpt.com for more cycling, movement, and corrective exercise ideas, or click here to schedule your movement assessment at Optimal Movement.

How Can Physical Therapy Help with Shoulder Pain?

Shoulder impingement, rotator cuff tear, biceps tendonitis, shoulder bursitis? A variety of diagnoses associated with the shoulder share several characteristics, the most significant being a sharp pain preventing dressing, reaching, driving, and / or sleeping. How can a good physical therapist help treat a rotator cuff that is partially torn?

If you’ve been keeping up on previous posts from Optimal Movement Physical Therapy you’ll know that Physical Therapy is not focusing on repairing damaged tissue, rather the focus is on identifying the reason the tissue became damaged in the first place. Once the faulty movement is identified, it can be corrected, and once it is corrected the pain can be alleviated. After all, many studies have shown that individuals can have a tear with no pain at all. Even further, the amount of pain that one has is not proportional to the size of the tear.

Well if the tear is not causing the pain, then what is causing the pain?

Take a look at the following video to better understand faulty mechanics.

Ideally, we want the humerus and the shoulder blade to move together in order to optimize the sub-acromial space. In this video, you can see the scapula does not move as the humerus moves which results in pinching of the structures within the subacromial space.

This poor movement results in impingement of the bursa, biceps, and part of the rotator cuff. Therefore this movement pattern can be the underlying cause of impingement, rotator cuff tear, bursitis, biceps tendonitis, just to name a few.

The sub-acromial space is a small tunnel where several structures pass through. With optimal biomechanics none of these structures become impinged. When the space is smaller because of poor posture, muscle imbalances, and / or faulty movement, the structures can become irritated and painful. Evidence of poor posture and muscle imbalance can be identified by a physical therapist examining your posture and movements. The area of focus for the therapist is the scapula, as the resting position and movement of the scapula is what determines the size of the space. When we are looking at your scapula we are determining whether the resting position is downwardly rotated, anteriorly tilted, and / or depressed as all of these positions will cause impingement.

An anterior tilt of the scapula is one where the inferior border is more prominent than the superior border.

Downward Rotation of the Scapula is one where the inferior angle is more medial than the superior angle of the scapula.

In the examples above, the scapula is starting in a poor position. This poor starting position results in a higher likelihood of impingement because the scapula will have difficulty getting full upward rotation. The scapula is in fact starting behind the starting line.

All hope is not lost. The scapula and it’s resting position, as well as how it moves can be retrained. Typically the muscles which are not “pulling their weight” include the mid and lower trapezius as well as the serrates anterior. At Optimal Movement Physical Therapy, we are looking for faulty scapula movements, testing for weakness at these muscles, and prescribing corrective exercises to eliminate the faulty mechanics.

The 5 best local races for 2015

If you are the runner or cyclist in your family, chances are you will be unwrapping some new gear this holiday season and getting ready to shed some of the calories you’ve either intentionally or unintentionally put on during the holidays. Whether you are a competitive  veteran chomping at the bit to toe the line, or you are planing a training regimen for your first big race, one of the most exciting parts of doing a race is picking which one you’ll enjoy this year. The following is a list of some great local running races for you to gear up for, or to utilize as part of a training program for a bigger race.

1. Run through Redlands – March 8th 2015. 5K, 10K, 1/2M. This is a great run through some historic settings of Redlands. Prepare for some hill work as this run ascends from downtown through prospect park up to sunset before traversing back to the Redlands Bowl.

2. Highland Y Run – January 25 2015. 5K, 10K, and 1/2M. One of the best times to run in the Inland Empire is the winter while there are snow capped mountains and blooming citrus trees. All proceeds from this race go towards scholarships at the YMCA.

3. Citrus Heritage Run – January 10 2015. 5K and 1/2M. Ok, so maybe you should have already finished your training for this one. But if you are a seasoned runner, why not start the new year with an early run. This run is put on by a great local running group with proceeds benefiting local student athletes.

4. Redlands Chamber Night Light Run – December 27th 2014. 5K. The good news about this run, is not many people actually run it, rather they enjoy the show and move along a gradual pace. This run is in its 2nd year and the focus is have a good time while enjoying the lights around downtown Redlands. Look out for the Optimal Movement Physical Therapy Team this year!!!

5. Los Angeles Marathon – March 15, 2015. Marathon. If this race isn’t on your bucket list, it should be. It’s what most of the members of local run groups are training for and it is the best local marathon. The race course was changed several years ago to now incorporate a Dodger Stadium beginning and a Santa Monica finish (the one good thing Frank McCourt did for LA).

What local races are you looking forward to this year? Add your favorites in the comment section and let me know if I missed one. Remember to train safe and listen to your bodies rather than focus on a mileage goal. Also remember, you don’t run to be fit, you have to be fit to run. Let us know if you need our help with returning from an injury or optimizing your training plan to avoid an injury. Visit our website and get in touch with any running related questions you may have.

www.optimalmovementpt.com

How can Physical Therapy help with my Low Back Pain?

This post continues the discussion on how we as physical therapists can best treat our patients’ ailments. Check out the previous post regarding treatment and communication of a patient with knee pain here.

“Well, the reason for your low back pain is that you have degenerative disc disease.”

or,

“You have a slipped disc at L4/L5 which is compressing a nerve.”

or,

“the arthritis in your back is equivalent to a 90 year old.”

Pretty scary huh? How can physical therapy help with diagnoses like these? Can physical therapy remove the arthritis found on imaging?

No it cannot. But perhaps there are more important questions to ask. I would assume that the more meaningful question(s) may be; Can physical therapy eliminate the low back pain I experience when I am walking my kids to school. Can physical therapy allow me to lift items from the floor, and therefore allow me to perform my household duties? Can physical therapy eliminate the discomfort I experience while sitting for prolonged periods at work, and therefore allow me to be more productive? Can physical therapy eliminate the discomfort I have while I play recreational sports so that I can get back to playing basketball?

The answer to these questions is yes. But, look at the disconnect that many patients experience. Originally, they seek out a healthcare professional with a complaint during some type of meaningful activity. Rather than receiving an answer or a long term intervention, the original complaint gets warped into a diagnosis of “degenerative disc disease”, “arthritis”, or “stenosis”. Could it be that what’s causing the discomfort is not the diagnosis, but rather faulty movement?

Why do we rely on imaging to dictate the cause of our discomforts? Look at this research article performed on individuals without low back pain. This study utilized MRI images on individuals without low back pain. Only 36 percent of individuals without low back pain had “normal” findings. 52 percent had a disc bulge, and 27 percent had a disc protrusion. This, once again, begs the question, could it be that what’s causing the discomfort is not the diagnosis, but rather faulty movement?

This is actually great news for individuals suffering from low back pain. Nobody can treat  a diagnosis of stenosis or arthritis. But a movement expert can assess and implement a program to help individuals who have pain with specific activities. Treatment begins with identifying faulty movement, understanding the reasons for the poor movement, and specific corrective exercises to eliminate the poor mechanics.

For example, take a look at this diagram;

No diagnosis is causing this discomfort. Poor movement places a high amount of stress on the joint, the disc, the muscles, everything. Change the movement, change the pain. 

That being said, sometimes the desired activity requires more strength and flexibility than an individual has.

This individual likely does not have the core strength to lift appropriately given this quick movement screen. In order to lift appropriately, she may require a strengthening regimen. Every body is different and requires an individualized assessment and program prescription.  In order to get here, push your diagnosis to the side and begin identification of movements which may cause the discomfort.

Optimal Movement Physical Therapy is dedicated to helping individuals identify and treat their movement faults. Visit our website or e-mail us at alan@optimalmovementpt.com so that we may help answer any questions.

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

Analogies and Pain

What type of client is the most difficult to treat successfully? I think the answer is universal among healthcare professionals. The patient who is suffering from chronic pain can certainly be the most challenging. I know that this is the type of patient I had the most difficulty with when I was fresh out of school. But, through the teachings of more experienced mentors and the research from Lorimer Moseley, David Butler and other folks at Bodies in Mind, I have learned an abundance of strategies to help these folks.

The single most powerful piece of information is knowing that chronic pain can stem in large part from emotions. One emotion that can cause a pain experience is fear. Fear of the unknown, for example “Why do I have this pain?” can be enough to cause a pain stimuli. Thus you can see how a vicious cycle of pain can develop.

It should therefore be no surprise that the focus of treatment for individuals suffering from chronic pain is education. I am of course simplifying the treatment of a complex condition, but, without education on the condition, all following treatments will be useless. Understanding your pain and why you have it is the first gate on a pathway to improved function and pain relief.

Easier said than done. For some individuals, the education on their condition is short and simple. Typically these are clients with an acute condition, who likely already understood the condition. I propose, that these individuals will likely improve with or without skilled intervention. These individuals are simply guided through the healing process to make sure they don’t fall into the world of misunderstanding.

For other individuals, the education is not so easy. Some individuals have had pain for years seemingly for no reason or cause. Some individuals have spent hours, days, weeks, months, and years perseverating on the pain trying to figure out why or what the cause is. Some individuals have seen doctors, chiropractors, trainers, therapists, acupuncturists, and body healers seeking answers. These individuals may have a more challenging time understanding their pain.

Lorimer Moseley, a chronic pain expert performing research out of Australia has suggested stories to portray key concepts of pain to individuals. I highly recommend checking out his ted talk, reading “Explain Pain” and “Painful Yarns”. I also recommend all therapists learn to explain pain to help with patients understanding.

I use Analogies. Analogies bridge the gap between something new and complex with the more familiar. The following are my favorite analogies I use to help patients understand the cause of their pain, and therefore decrease the fear associated with their pain, thus interrupting the pain/fear cycle.

1. Treating a sensitive nerve is like treating allergies. When pain has become chronic in nature, there is usually at least some amount of neurogenic source to the pain. Nerve pain can be difficult to understand. It behaves differently from every other source of pain. You don’t treat it with rest (rather you treat it by moving), the pain can be local but it can also radiate, and it can cause a vast array of symptoms. Treating it can be even more confusing as the idea is to actually cause some amount of stimuli through movement, even if that stimulus is an increase in symptoms. In order to help a client understand why they want to move it until their symptoms flare up, I use this analogy with the following education; When an allergist treats a person for an allergy, they actually expose the person to the allergen with the expectation that a small allergic reaction ensues. The client then comes back after a few days and is exposed to a larger amount of the allergen. Over time, the body becomes less sensitive to the allergen and are no longer allergic to the small amounts they may be exposed to in the environment. A nerve can be quite sensitive and cause pain much in the same was the body can be quite sensitive to an allergy, therefore making the treatment quite similar.

2. An entrapped nerve is like a person receiving an indefinite bear hug. After some education on nerves, a common question is; “why is my nerve causing so much pain?” The analogy here, especially after finding an entrapment spot, is that nerves get compressed from nearby structures. Much like how a person feels when they get a bear hug, the nerve actually is deprived from oxygen and can begin a pain stimulus.

3. Working with a nerve is much like working with an irritable co-worker. When working with an irritable co-worker, they may be quite angry at the beginning of the day. Throughout the day (if you want to maintain a relationship) you continually peek your head in and the anger and yelling slowly dissipates as the co-worker has been able to cool off. When treating a nerve, movement exercises can be quite painful at first. As the nerve gets less sensitive, the movement will be less painful and you will be able to perform tasks for longer durations before pain starts.

4.The bodies alignment is like a huge skyscraper, any point of instability can effect the whole thing. This is generally the education given when ones posture is playing a large role in their pain. At times, pointing at posture can seem like a scapegoat to a client, but pointing out that skyscrapers have to be strong at the base and in the middle in order to support the whole structure can be quite beneficial. This is an especially important analogy when the source of pain is caused by weakness or instability at a location seemingly far away (think abdominal stability for clients with chronic neck pain).

5. Muscles work together like a sports team has to work together to be successful. If a player on a team does all the work while the other players sit back and watch, then that team is not going to be winning much at all. In fact, eventually, the hard working player is going to get tired and irritated. This is quite similar to persons suffering from overuse injuries. An upper trap strain can occur in large part because the synergist muscles (middle and lower trap) are not pulling their weight. This is a great analogy to help patients understand the importance of strengthening synergist muscles.

At the end of the day, clients who understand their pain and understand their role and power in the rehab of their pain are the ones who improve. Empower one by providing some insight and answers. For some individuals this may take time, which is why, as healthcare providers we need to give individuals the time they need. More on that in another post…

If you’re interested in any of the information on this subject I have provided links to several readings used for this blog; Explain Pain, Painful Yarns, and Sensitive Nervous System.

Low Back Pain Paradigm Shift

Ten years ago, if you had low back pain and saw a Physical Therapist, you would most likely be prescribed “core strengthening” exercises. In fact, even today, you will most likely be given some exercises for the muscle group which provides stability at the low back. It’s not a bad idea, it works and there is a lot of research to support this paradigm. It’s become so commonplace that the argument is no longer whether you should train the abdominals, but more on how you should strengthen this muscle group. Brace or hollow? Sit-up or plank? There is multitude of articles and blogs on which exercises are best for persons with low back pain, and professionals often prescribe them without a second thought.

But, what happens when getting stronger doesn’t work? What are we missing?

The truth is, nobody has a “strong” core. It’s something we all have to work on. That’s why we can get away with prescribing it to everyone, because it always tests weak. Sure, some people have a stronger core than others, but in relation to the stiffness of the hip or shoulder, the trunk is often less stiff. Further, some people with a strong core still have back pain. So, again, what do we do when simply getting stronger doesn’t work?

That’s when it’s time to look at the movement. Look at the person’s function. Which movements are they required to do? What are their preferred movement patterns? Are they using the strength they already have?

Case in point: This client complained of low back pain and sciatica for the past 6 months. We began looking at abdominal strength as part of our objective exam only to find that she had great strength. When pointing this out to her, she noted that she is quite active. She hikes, does yoga, runs, stand up paddle boards, does pull-ups and planks. How could she have back pain?

Standing posture with measurements showing mild swayback posture.

The examination did not show many treatable impairments. When a client has a fairly clean strength and mobility examination, we get to move on to function. This client is very active, but the activity she does the most is holding her one year old son who weighs nearly twenty pounds. So, it’s time to check out her function.

Increased swayback posture when standing with twenty pound load (aka her son).

As you can see, the standing posture changes dramatically. The shoulders are no longer lined up with the hip, but they have shifted posteriorly. This client has shifted into extension when she holds her child. This excessive extension is just enough stress through her low back to cause some discomfort.

So, if she has enough strength, then, what is the treatment?

There is no exercise that will magically cure this shift. The only exercise or treatment for her is awareness. After a few small corrections, we are able to prescribe her only “exercise”.

Improved standing posture with 20 pound weight.

No rehab exercises needed. In fact, she is already doing more than I ask most patients to do anyways. She just needs to use what she already has and contract her abdominals while holding her son. She has all the moving parts to perform this movement optimally, and her rehab sessions have been cut from several to one.

This client is a great example of a client with low back pain who will not respond to abdominal exercises. The paradigm has shifted. It’s time to look at function. It’s time to look at movement. At Optimal Movement Physical Therapy, we assess, diagnose, and treat movement.

www.optimalmovementpt.com

Rebecca is the owner of be. Her mission is to inspire and educate people to live healthier and happier lives by spreading knowledge about the importance of nourishing their bodies with the best food. Check out her site at http://www.benourishedbehealthy.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.