Box Jump Mechanics after ACLR: after a month of training

We discussed an example of poor box jump mechanics after ACLR. It is shown in many studies that poor jump mechanics is a risk factor for an injury. But it can be fixed through training. 

The picture on the left is taken earlier. She was jumping with her knees almost touching. She also landed on the box with the same knee positions. The picture on the right was taken after about a month and a half after. She is still going through rehabilitation but her jump mechanics is a lot better. She also is not standing straight up like she was on the left picture. She still leans towards her non-surgical side when she jumps, which needs to be fixed.

Box Jump Mechanics after Knee Surgery

There are a lot of research studies done on jump mechanics. It can tell us a lot of different things. Jumping with wrong mechanics is a risk factor for an injury, not ideal for performance, may indicative of insufficient muscle strength, etc. The athlete may be compensating, not feeling comfortable jumping, or scared. 

       There are so many things that we look at when evaluating jump mechanics. We look at it from the front. We look at it from the side. We look at how much the knees and hips are bent when they land. We look at where the feet re pointing, etc. One thing that we evaluate when looking at the athlete from the front is where their knees are when they take off and when they land. The pictures below are showing a basketball players jumping to a box. Her knees are almost touching each other when she takes off. 

 Also, we can tell that she is leaning towards her right leg which is her healthy knee. She is rehabing from a knee surgery and has good quads and hamstrings strength and training her hip muscles as well as balance, squatting mechanics, etc. So, why is not jumping the right way?! She may not be able to use her muscles, or she is so used to jumping this way for a long time, or there are other  potential factors that her jump mechanics is not the way it should be. Whatever the reason  may be, as a rehab professional, we need to find out why and fix this because we know, from the past literature, this is not a good sign and this may predispose her to another injury in the future.

Generalized Joint Laxity and Injury

There are so many research studies that investigated relationship between loose jointed athletes and injury. Some say there is a link and the others say no. We did a research on it too using female volleyball players and found athletes with a history of injury such as ankle sprain were loose jointed. You can read our published article here.

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. 

 

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!

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.......

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.