Knee Balance Exercise

We all know that balance is an important factor for athletic performance and injury prevention. Balance exercises are done usually on a foot on the ground or uneven surface to make it harder. Or you can add a ball toss to make it more challenging. Also, you can do a balance exercise on your knee instead of your foot. It is hard to put your knee down on a hard surface so try doing it on a balance pad or BOSU ball, etc. It challenges more of your hip muscles and postural stability than regular balance exercise on a foot. Pictures below show the knee balance exercise. This is another way to train your hip and core stability and proprioception. Again, balance is an important factor when it comes to performance enhancement and injury prevention!

Left knee balance with his left foot and right leg in the air.

Knee balance with ball toss.

Core Stability and Respiration

Core stability is a crucial part of athletic performance and injury prevention during athletic activities. Importance of core muscles are well documented and known. However, less is known about how it may be affected by respiration. Abdominal muscles such as transverse abdominis and internal/external abdomini create the wall of the trunk, and the pelvic floor muscles create the bottom part of the core. The top part of it is the diaphragm. The diaphragm is also important in respiration. In fact, the abdominal muscles and diaphragm work in sync for respiration and core stability. In inhalation, the diaphragm contracts concentrically and the abdominal muscles contract eccentrically. In exhalation, they work in reverse. And the roles of these muscles get challenged with arm and leg movements and with respiration. It is known that a role of diaphragm in core stability decreases as it is challenged by increased demand for respiration. For example, during running, the diaphragm will work more for respiration and less for core stability than it does when at rest. What this may mean is that, during activities that increase respiration rate, the abdominal muscles may work non-optimally because they will have to help with respiration if the diaphragm cannot work optimally, leading to poor core stability. Performance of core muscles are also affected by other factors. Excessive lumbar extension will lengthen abdominal muscles putting them in non-optimal muscle length. Interestingly, the diaphragm also attaches to lumber spine from 1-3 level and excessive lumber spine extension may also affect performance of the diaphragm. Thus, it may be very important to take this into account when it comes to core stability.   

Pitch Velocity and Elbow Injury in Baseball

Shoulder and elbow injuries are very common in baseball players especially in pitchers. It is hard to watch baseball news on TV without hearing the word "Tommy John surgery" these days. Even before this Major League Baseball season starts, there are already quite a few pitchers that are going to miss this season from Tommy John surgery. Tommy John surgery is a reconstructive surgery for a torn ulnar collateral ligament in the elbow. We have discussed this and its rehabilitation in our previous posts. And it seems like a more popular topic in baseball news lately because of its frequency and names of the players involved in this. There is an interesting article published a few years ago done on high school baseball pitchers and it found out that there was a positive correlation between pitch velocity and stress placed on the elbow. The faster the pitch velocity was, the more stress placed on the medial side of the elbow where UCL is, according to this study. So does this mean that pitchers that throw faster pitches will be more prone to elbow injury such as UCL sprain?! We do not know. But this may be something that we cannot ignore....  

What is Meniscus Tear?!

Sports news world is busy with the news of the basketball player having a meniscus repair surgery. But what is meniscus?! Meniscus is a fibrocartilage that exists in the knee. Its roles are to absorb shocks and to make the knee joint more stable by deepening the concave part of the joint (tibia). There are 2 menisci in the knee; one located laterally and the other located medially. Medial meniscus is more commonly injured. Degenerative meniscus injury is common as people age. But it also happens in sports especially in sports that involve a lot of cutting, changing directions, and twisting such as soccer and basketball. It also happens with anterior cruciate ligament injury. Depending on where the injury is and how severe it is, it can be repaired. The center of meniscus does not have sufficient blood supply and does not heal well. The outside of it, on the other hand, is more vascularized and has more chance to heal. Meniscus repair seems to do better in younger athletes and in those who are having an ACL reconstructive surgery at the same time. Older knees have less chance of successful meniscus repair surgery. Athletes with meniscus tear may complain of dull aches and pain, sharp pain with motion, swelling, loss of motion, loss of function, joint line tenderness, etc. It may cause clicking sounds and it may feel like knee is locking up. The picture below is an arthroscopic view of torn meniscus. Whether a torn meniscus can be repaired depends on the location of the injury and the severity of it. Also, the age is a factor. If it is shaved off, it usually takes about 4 to 10 weeks to rehab. It is repaired it will take a lot longer. Rehabilitation of repaired meniscus usually involves non-weight bearing for 4-6 weeks and start partial weight-bearing and rehab may take as long as 4-6 months.

 



Lateral Posterior Hip Muscle Exercise for Baseball Pitchers

It is well known the importance of hip muscles, especially gluteal muscles and external rotators. They play an important role in not only stabilizing the hips but also the knees and lower legs. Every baseball pitcher has to be on one foot during stride phase of the pitching motion. If he is not able to maintain the stability of his lower leg, hip, and trunk, he will not be able to effectively transmit a ground reaction force through trunk, upper body, and to his arm and to the ball. Doing hip exercise on a table is a good way to start but he will need to train the muscles in standing as well. Here is one easy way to work on his hip muscle strength.

 

This is an isometric hip muscle (gluteal) strengthening exercise. He is pushing the physio ball into the wall with his left knee while trying to maintain his upright posture with his right leg. With this exercise, he should be able to maintain the upright posture without moving any part of the body. This works on his bilateral hip muscles, especially gluteus medius. If he brings his left knee up to the level of his hips, he now is working on his external rotators of his left hip as well as his right gluteus medius. Also he needs to use his core muscles to stabilize his pelvis.

Modified Sleeper Stretch

Major league baseball season is already half way through and summer baseball league is in a full swing for college and high school baseball players. We have already talked about how important it is to prevent injuries rather than treating injuries that have already happened. For baseball players especially pitchers, it is important to maintain sufficient shoulder range of motion(ROM) to prevent injuries. A loss of internal rotation and total arch of motion compared to the non-throwing arm of more than 5 degrees may put pitchers in increased risk of injury according to past studies. Several stretching techniques to increase or maintain shoulder internal rotation ROM have been described. One way to stretch is sleeper stretch. However, for high school and little league baseball level, there may not be a table available to lay on and do sleeper stretch. So, here is another way to do sleeper stretch. Instead of laying down on a table, a wall can be used to do the same stretching(pictures). Also, horizontal adduction(cross arm) stretching is an effective way to regain or maintain internal rotation motion. Stretching the shoulder on a daily basis especially after pitching is an important part of injury prevention for baseball pitchers.

Modified sleeper stretch (start)

Modified sleeper stretch (end)

Knee: In a Triangle Relationship?!

Knee injuries are very common among athletes. There are many different types of injuries that can happen to the knee joint. Common injuries include Osgood-Schlatter disease, Larsen-Johansson disease, ACL tear, meniscus tear, runner's knee, OCD, etc. But why knee injuries are so common?! When I explain to athletes, coaches, and parents, I usually use this analogy "because the knee is in a triangle relationship with the hip and ankle". The knee joint is between the hip and ankle. The hip is important because the posterolateral muscles of the hip controls the knee motion in athletic movements such as jumping, cutting, etc. Past studies have shown that poor control of the knee in those movements may put athletes in more risk of injuries such as ACL tear. Also, it has shown that weak hip muscles are related to lower extremity injuries. The ankle/foot is also important because whatever ankle and foot do will affect what the rest of the body does. If they do not function well, it will affect your balance ability, your ability to absorb ground reaction force, and where the knee goes. Tight Achilles and calf muscles will affect how you do things such as squat. The mid-foot needs some stability. Low and high arch will affect the rest of your lower leg. Foot and ankle are very complex and there are a lot of things that can go wrong. Thus, if you want to keep the knee healthy, you will need the ankle/foot and hip to function in ways they are supposed to. But if you can keep the hips and ankles/feet happy, the knees will be more than likely happy (injury free).