Filed under: Athletes, Athletic Trainers, Coaches, Uncategorized | Tags: hip, hip anatomy, hip girdle, hip pain, innominate bone, labral tear, pelvic girdle, pelvis
There are a lot of injuries that can affect the hip joint and surrounding musculature. There are two common injuries in athletics that affect the structural integrity of the pelvis: hip rotations and labral tears. The pelvis is made up of three joints: sacroiliac, pubic symphysis, and the acetabulofemoral joint There are two innominate bones (right and left)(Hip Anatomy Image 1,Image 2 ) that are fused together by the sacrum that form the pelvic girdle. Hip rotations most commonly involve the innominate bone on each side being rotated either anteriorly or posteriorly (forwards or backwards). All types of variations of rotations are found for different reasons. This most commonly occurs in athletic positions that are one side dominant such as kickers, swimmers (pushing off the wall), divers, pitchers, and high jumpers. These positions force the entire hip girdle to function independently from side to side, leading to muscular imbalances. Muscular imbalances indicate that some muscle groups become tight and others become weak. The tight musculature takes over and pulls an innominate bone forward or backwards causing a unilateral rotation. Rotations that are not fixed can cause misalignment throughout the entire kinetic chain which causes pain due to increased pressure on joints. Over time, some joints can become inflamed and disrupted. The joints most prone to this inflammation are the sacroiliac joint, pubic symphysis and vertebral joints in the lumbar spine. A thorough evaluation is needed when treating patients with a hip rotation. Athletes are more prone to hip rotations due to their specific position in the sport they play, however rotations can also be caused by genetic factors. Realignment is achieved by balancing out the hip musculature so that the muscles can function in a manner that allows full range of motion and strength without compromising the integrity of the surrounding joints.
Labral tears (Image) are also very common in athletics. The labrum serves as a lining in the hip socket (acetabulum) that provides stability and cushioning for the hip joint. A labral tear often results in repetitive movements that cause degeneration and breakdown of the labrum. The most common symptoms are a catching or clicking sensation in the hip joint and anterior hip pain (pain in the front of your hip). An exercise program that maximizes hip range of motion and strength is normally initiated first as a means of conservative treatment. Surgery is typically selected if conservative treatment does not relieve symptoms over time.
Common exercises your therapist may prescribe for these injuries to rehabilitate or decrease symptoms:
For those with Hip Labral Pathologies:
- Running in a pool with a buoyancy belt
- Core stability exercises: Pelvic tilts and bridges
- 4 way hip strengthening: (SLR x4)
- Single leg balance
For those with Hip Rotations:
- Isometric exercises: Quad and Hamstring
- Dynamic exercises: lunges, RDL’s, Single Leg Squats
- Stability exercises: Quadriped with alternate raised arm and leg, donkey kicks
Labral Tear Links
http://ptjournal.apta.org/content/86/1/110.full
http://advancedortho.net/diseases/hiplabraltears.php
Hip Rotations Information
http://www.oefentherapie.be/archief/beenlengteverschil.pdf
http://w3.palmer.edu/robert.cooperstein/publications/tcc/pelvic%20torsion%20tcc.pdf
Filed under: Athletes, Athletic Trainers, Coaches, Uncategorized | Tags: #bighits, athletic trainers, CNN, concussion, Dr. Gupta
A couple of quick links on concussions and the conversation that Dr. Gupta generated last night with the premiere of his documentary “Big Hits, Broken Dreams”. Very well done in our opinion. Dr. Gupta did a great job advocating for athletes, parents, and athletic trainers.
http://thechart.blogs.cnn.com/2012/01/26/gupta-on-where-big-hits-broken-dreams-began/
http://www.cnn.com/video/#/video/bestoftv/2012/01/27/ac-gupta-sports-concussions.cnn
What do you think of the conversation thus far and what is your opinion?
Filed under: Athletes, Athletic Trainers, Coaches, Uncategorized | Tags: college of sports medicine, fluid intake, hydration, re-hydration, sports drinks, water
Staying hydrated is one of the most important things to consider during exercise. Proper fluid intake is essential for maximal performance and safety. The more intense the activity, the more important it is to drink not only enough fluids but the “right kind” of fluids. Common causes of dehydration are excessive sweating, failure to replace lost fluids lost during exercise, exercising in dry/hot weather and inadequate fluid intake. Finding the right amount of fluids to drink depends upon a variety of factors including the length and intensity of exercise. Two simple methods one can use to determine adequate hydration levels during activity are to check urine output and the color. Generally speaking, a large amount of light-colored urine means that you are hydrated; small amounts of dark-colored urine can mean that you are dehydrated. The other way for telling if you are adequately hydrated is weighing yourself before and after exercise. It is unlikely that weight loss during the work out will be from more than water weight loss. Long term weight loss happens over time and the number will not dramatically change after working out. You should try to drink enough to replace the weight loss so that you are making sure you are rehydrating properly
To find the correct balance of fluids for exercise, the American College Of Sports Medicine suggests that “individuals should develop customized fluid replacement programs that prevent excessive (greater than 2 percent body weight reductions from baseline body weight) dehydration. The routine measurement of pre and post-exercise body weights is useful for determining sweat rates and customized fluid replacement programs.” According to the Institute of Medicine, the need for carbohydrate and electrolytes replacement during exercise depends on exercise intensity, duration, weather and differences in sweat rates. They write, “Fluid replacement beverages might contain ~20–30 meqILj1 sodium (chloride as the anion), ~2–5 meqILj1 potassium and ~5–10% carbohydrate.” Sodium and potassium are to help replace sweat electrolyte losses, and sodium also helps to stimulate thirst. Carbohydrate provides energy for exercise over 60-90 minutes. This can also be provided through energy gels, bars, and other foods.
What about sports drinks? Sports drinks can be helpful to some athletes and can be detrimental to others by upsetting the gastrointestinal system during exercise. Sports drinks can be beneficial if used more after activity as a refueling than used during activity as a “quick” fluid replacement. It is said that sports drinks can be good for athletes exercising at a higher intensity activity (60 min or more). Fluids supplying 60 to 100 calories per 8 ounces helps to supply the needed calories required for continuous performance.
Recommendations for pre-exercise hydration is mostly related to intensity of the activity being performed. Two to three hours before exercise, drink about 15-20 fl. oz. and drink 8-10 oz. 10-15 min before exercise. A good hydration goal during exercise is 8-10 oz. every 10-15 min. If exercising longer than an hour and a half, try to drink a sports drinks every 15-30 min to rehydrate and replenish some of the calories and electrolytes being lost during longer exercises. Post exercise, weigh yourself and drink 20-24 oz. of water for every pound lost. It is ok to consume sports drinks after exercise to replenish glycogen stores but should be done within two hours after exercise for greatest effect.
General Guide:
http://www.webmd.com/fitness-exercise/features/drink-up-sports-fitness
Contrasting views on hydration:
http://sportsmedicine.about.com/od/hydrationandfluid/a/060704.htm
http://sportsmedicine.about.com/cs/hydration/a/022504.htm
Link from Gatorade Sports Science Institute on Gatorade and water and the benefits.
http://www.gssiweb.com/tackleheat/pdf/vswater.pdf
Filed under: Athletes, Athletic Trainers, Coaches, Uncategorized | Tags: meniscus, meniscus surgery, meniscus tear, most common knee injuries
One of the most common knee injuries facing active people are traumas to the meniscus, which is often collectively called “torn cartilage”. The meniscus is a piece of cartilage that helps to support and absorb impact to the bones of the patella-femoral joint and it serves to help provide a near friction-less surface that allows uninhibited motion to occur at the knee.
The location of the injury and the type of tear to the meniscus plays the largest role in the return to activity, both with surgical and non surgical cases. Most tears that occur on the outer edge of the meniscus have a relatively sufficient blood supply and may heal on their own. However the further the tear is from the outside blood vessels, the less probably that it will heal on its own. Depending on the type of tear (visual examples of the types of tears can be found here) people can have varying degrees of pain. The pain may be present with all activity or only with certain movements. The general rule is that if it is affecting your quality of life and has not resolved on its own in a reasonable amount of time, surgery may be your best option.
Typically with surgery, small holes are made on the outside of the knee to allow small scopes and instruments to pass into the joint from the outside. The doctor will visualize the meniscus and make their judgment from there. Sometimes the best plan is to debride (remove) the part that is torn. Sometimes sutures (stitches) are placed in the meniscus, sewing it back together. And in the most significant cases, holes are drilled through the meniscus and into the bone, bringing new blood to the area to help it heal itself. While most meniscus surgeries are rather painless and allow you to return to full activity in just a few weeks, procedures requiring drilling can take longer to heal and cause more pain after the surgery.
The initial rehab goals after surgery are to decrease pain and inflammation and to increase range of motion. This is a balance, because increasing your range of motion too soon will cause an increase in pain and inflammation. Your certified athletic trainer or physical therapist will use evidence based practice when rehabilitating you post injury and will progress you through several benchmarks before allowing you to return to full activity. Once cleared by your surgeon, you will be allowed to return to all activities that you enjoyed prior to surgery with no restrictions as long as you’re are functionally able. Most people do great with this surgery and will have many more years of activity ahead of them!
Websites of interest:
http://orthoinfo.aaos.org/topic.cfm?topic=a00358
http://www.medicinenet.com/torn_meniscus/article.htm
Filed under: Athletes, Athletic Trainers, Coaches, Uncategorized | Tags: athletes, caffeine, energy drinks
Really good article discussing the use of energy drinks from the USA Today. It gives great information about the amount of caffeine in various beverages and the risks/rewards of taking them. HIGHLY recommend taking a few minutes to read and educate yourselves.
http://www.usatoday.com/sports/story/2011-12-01/young-athletes-and-energy-drinks-a-bad-mix/51556148/1
Filed under: Athletes, Athletic Trainers, Coaches, Uncategorized | Tags: lower leg muscles, tibial stress syndrome
Medial Tibial Stress Syndrome (MTSS) is often referred to as shin splints which is a catch all term for pain in the distal one half to one third of the shin, localized along the inside(medial) border of the tibia. MTSS is an overuse syndrome that is often the result of repetitive running or jumping. In fact it is accounted for 10 to 15 percent of all running injuries, and up to 60 percent of all conditions that cause pain in athlete’s legs. Not everyone who likes to run or jump is at risk for this injury. There are certain risk factors that make one more prone to developing MTSS. The risk factors that are more controllable include: weakness of lower leg muscles, shoes that provide little support or cushioning, inadequate calcium intake, increased muscular strength of the plantar flexors, and training errors such as training on hard, uneven, or inclined surfaces and overtraining. Risk factors that are a little less controllable but still manageable include: malalignment problems such as a varus foot, tight heel cord, hypermobile pronated foot, or a forefoot supination, and previous injury to the structures involved.
Some studies indicate that the rate of pronation and the timing of pronation are more significant risk factors than pronation alone. If pronation is excessive or occurs too quickly or at the wrong time then greater tensile loads will be placed on the muscle-tendon units that assist in controlling this complex tri-planar movement. Pronation occurs in order to get the forefoot in contact with the ground for push off. Sprinters may present with similar symptoms but with a different cause, that being overuse of the plantar flexors secondary to being on their toes during their event. Anatomic evidence suggests that the soleus and the flexor digitorum longus are the two muscles involved, posterior tibialis has been ruled out because it does not have any medial tibial attachments.
There are several suggested treatments and prevention plans available, however they do not work for everyone and none of them are guaranteed. Treatment plans include: increase strength (especially eccentric) in soleus muscle, control overpronation by use of orthotics and exercises, promote adequate shock absorption via insoles, new shoes, maintenance of proper foot biomechanics, and work with coaches to commit at least one day per week for a pool work out or some other type of non-weight bearing cardio exercise to allow tibial unloading and for proper bone remodeling response. Shoes for a pronated runner should not exceed 500 miles, and should be specifically designed to prevent the arch in the foot from falling too much and/or too quickly. Ideally athletes should not return to full play until there is minimal to no pain upon palpation, all causes of excessive pronation have been addressed with an orthotic and proper shoe wear, there is sufficient gastrocnemius-soleus musculature flexibility, and when the athlete has completed the gradual running progression and a sport-specific functional progression without an increase in symptoms. MTSS can lead to a tibial stress fracture if symptoms continue to worsen without treatment. As with all injuries, it is important to communicate effectively with your athletic trainer and team physician about the severity and timing of symptoms.
Suggested exercises for pronation correction:
Lying on Back
- Curl the toes downward, and hold while pulling the foot upward and inward
- With legs straight and together, try to touch the soles of the feet together
Sitting on Chair
- With left knee crossed over right, move left foot in a half-circle downward, inward, and upward, and then relax. (do not turn the foot outward.) Repeat with the right foot
- With the knees apart, place the soles of the fee together and hold while bringing the knees together
- Place a towel on the floor. With the feet parallel and approximately 6 inches apart, grip the towel with the toes, and pull inward (in adduction) with both feet, bunching the towel between the feet
- With a small ball (~1 ¼ to 1 ½ inches in diameter) cut in half and placed under anterior arch of the foot, grip the toes downward over the ball
Standing
- With the feet straight ahead or slightly out-toeing, roll weight to the outer borders of the feet by pulling upward under the arches.
Walking
- Walk along a straight line on the floor, pointing the toes straight ahead and transferring weight from the heel along the outer border of the foot to the toes.
Kendall, F. P., McCreary, E. K., Povance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function with posture and pain. (5 ed., p. 446). Baltimore: Lippincott williams & Wilkins.
Prentice, W. E. (2004). rehabilitation techniques for sports medicine and athletic training. (4 ed., pp. 597-598). New York: McGraw-Hill.
Craig, D. I. (2008). Medial tibial stress syndrome: Evidence-based prevention. 43(3), 316-318.
Beck, B. R., & Osternig, L. R. (1994). Medial tibial stress syndrome. the location of muscles in the leg in relation to symptoms. 76, 1057-1061.
For many of you out there this time of year calls for new beginnings. Aspirations to get better grades and be a better person in the year 2012 are popular New Year’s resolutions for many, but annually the most sought after resolution is to finally get into shape. Walk into any gym today and take notice of what seems to be a large marathon of treadmills in use. Unfortunately some do not have the pleasure of having access to a treadmill and must brave the coming winter conditions of running outside. Unlike running on a nice seventy degree breezy day, running during the months of January and February in northern locales can pose some possible health concerns.
Low temperatures alone can pose some problems, but when such temperatures are further accentuated by wind, the chill factor becomes critical. Take a runner who is traveling at a pace of 10 mph directly into a wind of 5 mph, this results in a chill factor equal to a 15 mph headwind.
Very important to the runner is the issue of dampness or wetness. Air itself can be relatively comfortable at 50 degrees, but water at 50 degrees is intolerable. With a cold temperature, wind, and wetness added to the formula a runner is at a much higher risk for hypothermia.
A very common condition for runners who take on the cold conditions is frost nip. This condition normally involves the ears, nose, cheeks, chin, fingers, and toes. The before mentioned conditions predispose the runner to this condition. At first the affected area will present as very firm and cold painless area that may peel or blister over the next 24 hours. Sustained pressure with the hand (not rubbing) and blowing hot breath on the area is a quick and easy initial treatment.
There are a few considerations to take before heading out into the cold for a run. First and foremost any runner needs to be dressed properly. Many different brands such as Nike, Adidas, and Underarmour have developed fabrics that are both waterproof and windproof but still allow the passage of heat and sweat evaporation. If breathing the cold winter air seems distressful a ski mask can be used to somewhat warm the air.
Just with running in a hot environment, proper hydration still applies to the runner in a cold environment. When dehydration occurs blood volume decreases which means less fluid is available for warming the tissues.
With this guidelines, we hope all of you runners out there may finally make this the year that you follow through with your New Year’s resolution, and if not just remember there is always next year….unless the Mayans are right.
Prentice, William E. Arnheim’s Principle of athletic training. 13. New York: McGraw-Hill, 2009. 184-186. Print.
Hawley, Kristen. “Cold Weather Running Tips.” Fitsugar. n.d. n. page. Web. 5 Jan. 2012. <http://www.fitsugar.com/Cold-Weather-Running-Tips-12643714>.
