Tuesday, August 2, 2016

Core Stability Exercise

Everyone knows that it is important to train core muscles. However, people tend to misunderstand when it comes to how to train those muscles. Understanding the importance of core is important, but you need to train it the right way also. To me, injury prevention and performance enhancement training is based on the idea that every joint and body segment should have enough motion but should not have too much motion in isolation and during movement. Some parts of the body are supposed to move and some are not supposed to move a lot. When a part of the body that is not supposed to have a lot motion moves too much, it can lead to an injury or decreased performance. And the core is one of those that should NOT have too much motion. So, when doing a core exercise, you should really focus on keeping your pelvis and lumbar spine stable instead of focusing on how much and how fast you can move your arms and legs, or trunk, or how much weight you can lift.

Here is an example......

This exercise looks simple but not easy for a lot of athletes to do it right. Starting from laying on a physio ball (top picture), you try t extend one knee (bottom picture) WITHOUT losing balance, dropping a hip or hips, keeping pelvis squared to the floor, and maintaining neutral spine position. Like I said, this exercise is NOT about how fast you can move your leg, but how stable you can keep your pelvis and spine and whole body. 

Thursday, July 21, 2016

Postural Stability and Control

Postural stability and control is an important factor when it comes to injury prevention and performance enhancement. Athletes will have to be able to stabilize, control, and maintain it. The better they are able to do it, the less risks of injury they will have and the better they will be able to perform no matter what the tasks and skills are. This is a main reason that a gymnast falls off from the beam, a figure skater doesn't land a triple jump, a soccer player hurts her knee, etc. To have a good postural stability, athletes will have to have enough strength, musce balance, proprioception, and they also need to be able to recruit muscles when they need to at a right timing. They will also have to have endurance to maintain it for a prolonged period of time. There are a lot different ways to achieve this and also depending on what their deficits may be, training methods will vary. But this is one of my favorite exercises to have an athlete do.

You stand on BOSU ball or something that challenges you to balance on and get in a squat position, holing a stretch exercise band attached to a wall at your shoulder height. Then, you extend the arms out as you maintain the good squat position without letting the BOSU ball tilt. Bring the arms back in towards your body and repeat. Also, keep in mind to maintain the neutral pelvic position.

Sounds easy?! Give it a try and find out!

Tuesday, March 22, 2016

Tennis Serve vs Baseball Pitching

Tennis players and baseball players especially pitchers are called "overhead" athletes because of the way they throw the ball and serve. Tommy John surgery in baseball pitchers is one of the most talked about injury in all sports right next to concussion these days. However, we do not hear anything in tennis players. There are a lot of similarities between baseball pitching and tennis serve, and they both suffer similar shoulder injuries. But why don't tennis players suffer Tommy John injury?! Everyone that watches or plays baseball has heard of "pitch count", however, we don't hear about "serve count" Let's take a look at how many pitches a starting pitcher throws in a month. They usually get 5-6 starts a month and they pitch around 100 pitches per start. So that's roughly 500-600 pitches per month discounting bullpen sessions they do between starts. Tennis players' serve count varies depending on how many matches they win in a tournament. After looking at 250 Grand Slam matches from 2014-2016, male tennis players served 140-150 times a match on average. Those players that advanced to the round of 16 played 4 matches in about a week. So that is 560-600 serves in a shorter period of time. A baseball is heavier than a tennis ball. Tennis players use a tennis racket. 
       One thing that stands out to me is that during baseball pitching pitchers shoulder is rotating at around 5-7000 degrees per second. On the other hand, tennis players shoulder are rotating at a lot slower speed (4-5000 degrees per second). The faster you move the shoulder, the more stress you are placing on the shoulder and elbow. Also, tennis players can use a tennis racket to serve harder than baseball pitchers can throw a baseball. 
       There is no study that explains why baseball pitchers suffer more Tommy John injury than tennis players. So we can  only speculate, but shoulder rotation speed may have something to do with it. Also, tennis players seem to suffer more wrist injuries than baseball pitchers. Tommy John injury is more common in athletes such as javelin throwers than tennis players. And studies suggested that softball pitchers suffer similar shoulder injuries to those suffered by baseball pitchers even though softball pitchers pitch underhand.......

Thursday, March 3, 2016

Preventing Injuries

An injury is something that many athletes are forced to deal with at any level of play whether it is at junior level, high school level, college level, or professional level. Some injuries are more serious than others. But if you have to deal with pain every time you practice or if you have to miss practices and competitions, it is not fun. In many cases, an injury is caused by multiple factors; some you can control (intrinsic) the others you can't(extrinsic). As long as you want to play sports competitively and achieve your goals in the sport, you should be involved in some form of injury prevention program because it is the first step toward success.
      Everyone talks about "core" these days and does some type of core exercises to become a better athlete. But why is it and how is it important?! "Core" is pelvis and lumbar spine (and sacrum). And muscles that are attached to them are called "core muscles". Some parts of the body are designed to move and the others are not. Pelvis, sacrum, and lumbar spine are those areas that should have minimal movements, which means that you should be able to control their movement and stabilize them, which requires muscles  functions. There is a study done on baseball pitchers to see how the amount of pelvis motion affects their performance (ERA, WHIP, etc). And they found that the pitchers that had 7 degrees or more tilt of pelvis during the measurement pitched worse than those that had less than 7. Another study suggested that tennis players with low back pain had more movement of pelvis in a sagittal plane than those who did not have low back pain. Of course, core stability alone will not prevent injury or enhance performance, however, core stability is a huge factor in those two areas. 
       Any athletes that are involved in competitive sports should implement injury prevention program and core strength/stability/endurance/proprioceptive exercises should be included in it. 

Monday, November 2, 2015

Single Leg Squat Test

A lot of athletes use single leg squat as an exercise and strength training. However, oftentimes, we see them do it wrong... knowing what the right form is is one thing and being able to do it right is another. We use single leg squat as a test to identify what the athlete is doing, being able to do or unable to do, what the athlete may need to work on, whether the athlete may be at a risk of injury, etc. We take a video of an athlete doing a single leg squat from the front and the side and put in on slow motion motion analysis app to assess it. 

This is how this figure skater stood on single leg. Other than her toes/foot pointing out slightly she was comfortably standing with a good balance. Then, I asked her slowly squat down and come back up... then this is what happened (shown in the picture below). 

She was having hard time balancing on her leg. Her knee collapsed. Her knee was going over her toes. It was really challenging for her.   
Figure skaters spend a lot of time on ice on single leg. If this is what happens when they jump and land etc, not only will this keep them from performing well but also will lead to increased risk of injury. And if they have trouble performing single leg squat on the ground slowly, they would have much harder time doing this on ice. But the question is.... why is this happening?! It could be from a lot of different reasons and from combination of multiple contributing factors. Some of the most common contributing factors are hip muscle weakness, arch is collapsing, poor muscle strength and balance, etc. A rehabilitation specialist should be able to identify why this is happening in each athlete and fix it. Each case is different and there are additional tests we can do to find out why this faulty maneuver is happening. Or maybe this is what she or he is used to doing.
From performance and injury risk standpoint, this is a huge disadvantage because 1) figure skaters have to be able to jump without using their ankle while skating on ice 2) they have to absorb an impact that is 6-7 times of their body weight without using their ankle on one leg. And in most cases, this is something that needs to be fixed during off ice training.

Saturday, July 25, 2015

Kinesio Tape

Kinesio tape  has been around for a while now and is getting more popular these days as  it is getting more exposure on TV and social media etc. I have ignored it for a while because there is no scientific explanation to why and how it works. However, there have been a lot of research studies that support that it works and getting more difficult to ignore. According to the past studies, it may reduce pain, increase range of motion, increase strength, reduce swelling and ecchymosis (bruise), etc. What we do not know yet is its physiological effects on the body (if there is any...). Could it just be psychological?! Possibly.. But let's say you get injured or aggravated your old injury in the middle of tournament or competition and need to get through it.... if using kinesio tape helps with pain etc, why not use it. But at the same time, you do not want to keep masking the symptom using kinesio tape or NSAIDs instead of taking care of what caused the pain or injury. Kinesio taping could be useful in certain cases. Here is an example of kineio tape applied for wrist flexor tendonitis at medial elbow. 

Tuesday, July 14, 2015

Movement Impairment (1)

Have you had any pain and saw the doctor but were told that there was anything wrong?! Have you had pain that gets better with rest but comes back as soon as you start using the body part?! There is probably nothing more frustrating as an athlete than having pain that keeps you from training and competing but no one can figure out what is really going on. It is a lot easier to understand why you are having pain when you see what is damaged on a film such whether it is broken bone or torn ligament. However, there may be a lot more to "pain" than pain caused by injuries diagnosed by the doctor. Let's say there is a female figure skater with chronic lower pack pain. Her back is fine as long as she keeps her training  short, however, her pain increases as her training intensity and length increase. Her doctor took an x-ray and MRI of her back but did not see anything wrong with her back structurally. So she was told that she was fine and keep training as pain permits. So in her case, is she really fine?! Or is there something wrong that did not show up on the films?! The fact that she has pain that keeps her from training is not "fine". There must be something wrong. But what is wrong with her that even her doctor could not find?! First of all, lower back is where she is having pain and may not necessarily be where a cause of pain is. Then, where is her pain coming from?! This is something we, rehabilitation specialists, can or should be able to find and fix so she will be pain free. We examine things such as flexibility, muscle strength, range of motion, core stability, feet, posture, etc etc etc to name a few. One of the things we look at is how  her body is moving or the way  she moves her body. And what movement(s) she is having trouble with, having pain with, is not doing right, etc. And what movements she has no pain with. Having strong muscles and strength and good range of motion is one thing. But how she is using  those in a system during movements is another story. Every body movement happens in a system, which means that each part of the body/segments have to work in sync to optimize the movement and to prevent stress from being placed on the body. The human body is very well balanced withing asymmetries that we have. Our body is not completely symmetrical but well balanced. So, if a part of the balance system fails, this can be a problem. Doing a certain movement wrong a few times are not likely to cause pain right away, but if that happens over a long period of time, this can be a problem. There are a lot of things that may have caused her lower back pain. But just because the pain is not diagnosed or there is no structural damage, this does not mean there is nothing wrong. Bottom line is... pain is a sign that there is something wrong and it is very important to figure out what is really causing the pain and fix the contributing factors. Otherwise, it will keep coming back.