Injury Prevention for the Low Back

January 21, 2014 by Leave a Comment

Injury prevention is important, especially for something as essential as back health. Look at these great exercises
by Christopher McGrath for the lower back and then come visit us at San Diego Sports Physical Therapy for more great exercises! 619-756-7500

Given the prevalence of low-back pain, it is important for fitness professionals to be prepared with preventative strategies to support their clients’ low-back health. While movement deficiencies and dysfunction at any part of the body can lead to compensatory movements that may affect the low back, special consideration can be taken with regards to the core/lumbar region, as well as the functionality of the hips and thoracic spine. Strategies that are designed to stabilize and strengthen the core, while also increasing mobility through the hips and thoracic spine, can minimize excessive stresses to the low back, and enhance overall functionality and performance.

Disclaimer: Low-pack pain can be the result of many different issues (muscular strains, arthritis, herniated discs, stress, etc.). Therefore, it is important to seek appropriate diagnosis and clearance for your client before administering any type of exercise program, especially those designed to improve back health. The principles and exercise examples in this article are designed for preventative purposes—NOT as treatment of low-back pain.
A Quick Guide to Setting Priorities

When addressing strategies for low-back injury prevention, here are some basic principles to follow:

1. Core Stability vs. Core Strength

It is commonly suggested that a strong core will protect the low back. While this is true, it is not as simple as performing a series of planks and crunches. In fact, core stability and core strength can be viewed as mutually exclusive concepts. You can have good core stability without strength and visa versa. Core stability is more about timing or sequencing of the deeper core stabilizers activating at the onset of movement to provide segmental stability of the spine, while core strength is more about fitness and is typically associated with higher intensity and volume (i.e., traditional planks and crunches). Stabilization and strength complement one another; however, deficiencies in stabilization and timing can lead to inefficient strength and place an at-risk back at even greater risk, despite high levels of fitness.

For better core stability and timing, focus on exercises that promote stabilization through relatively low intensity movements. For example:

-With palms down, place fingertips under the lumbar and/or pelvis (it’s not necessary to use your whole hand).
-Assume a neutral arch in the lumbar spine and slowly lift one foot a few inches off of the floor (larger movements can disrupt the focus).
-Place the foot back on the floor and repeat with the other leg. Start by always keeping one foot on the floor.
-Primary Focus: As you perform the marching motion, maintain even weight on both hands by preventing weight shifting from hand to hand. Pay attention to left/right difference and spend extra time developing control of the side that appears weaker.

2. Reflexive Core Strength

During everyday and athletic activities, the core must respond to changing and sometimes unpredictable environments. Therefore, isometric exercises without reactive challenges can limit the core’s ability to be functional. Creating exercises that require the core to respond to shifting resistance can be a great way to teach the core how to stabilize and stay in control during dynamic movements.

Modified Plank With Alternating Knee Extension

-Assume a modified plank position. Always have at least one knee on the floor.
-Slowly extend one knee to full extension (with toes still on the floor) for two to three seconds and return to the starting position.
-Repeat with the other leg.
-Perform a series of alternating reps. Start with lower numbers to ensure control (e.g., three to five alternating reps, short rest, reset, perform again).
-Primary focus: Maintain a perfect plank while knees shift. Resisting the body’s desire to shift/rotate will improve reflexive stability and build for a stronger plank. This deceptively challenging exercise is appropriate for everyone, and serves as a great micro-progression for those that find modified planks too easy and full planks too difficult.

3. T-spine Mobility

Thoracic mobility is important, especially in regards to rotation. If the thoracic spine is restricted, the lower back will likely assume a higher percentage of rotation, leaving it vulnerable to torque related injuries. Aim for symmetrical rotation of the thoracic region.

Active Rotation

-Begin by lying on one side, with the top leg in a 90/90 position (90 degrees at hip and 90 degrees at knee); rest the top leg on an object roughly 6- to 10-inches high (foam roller, medicine ball, etc.)
-With the top hand holding the bottom set of ribs, take a deep breath and exhale while pulling upper body into rotation. Keep the top knee on the object.
-Hold for two to four seconds, return to the starting position and repeat.
-Perform with methodical movements, using slow, deep breathing to guide tempo. Complete six to 12 reps, according to how you feel. Range of motion should increase with each rep to some degree.
-Note left and right differences. If one side is tighter, spend more time on the tighter side.

4. Rotation Control

Once an acceptable range of thoracic rotation is established (or if a client already possesses appropriate or even excessive thoracic mobility), controlling the range is the next priority.

-Lie on back in a figure 4 position, with the right ankle on the left knee.
-Place the right arm on the floor even with, or slightly above, the shoulder.
-Anchor the right scapulae to the floor and do not let it pull away from the floor. This enhances scapular stability.
-Rest the left elbow on the floor and use it as an assistor if rotation cannot be controlled without the help. Otherwise, keep the elbow off of the floor.
-Slowly rotate the lower body (right heel lowering to the left), making light contact with the right foot to the floor. Return to the starting position while maintain contact with the right scapula at all times.
-Repeat on other side. Pay attention to left/right differences. Spend more time on the weaker or tighter side.

5. Hip Mobility

Ensuring adequate levels of flexibility and control through hip flexion, extension, internal and external rotation can help prevent unwanted movements of the pelvis and low back. In addition to traditional hip flexor and glute stretches, also focus on external rotators.

Hip Mobility of the External Rotators – Standing Figure 4 Hip Stretch

-Left leg instructions: Place left leg on a table approximately mid-thigh height with the femur perpendicular to the pelvis and the knee at approximately 90 degrees.
-Support the left leg with a roller, ball or towel under the knee.
-The pelvis must be parallel to the table (do not rotate the pelvis open or away from the table).
-The stretch should be felt deep in the hip (external rotators).
-Maintain a tall posture. With hands crossed over the shoulders, slowly exhale and rotate the torso to the left (towards the stretching leg); return to the starting position.
-Perform enough repetitions that hold the stretch for at least 45 seconds (six to 10 slow reps with pauses in between should be sufficient).
-Repeat on the other side. Pay attention to left/right differences, and spend more time on the tighter side as needed.

6. Hip Rotation/Integration

This exercise integrates a pressing motion with hip internal rotation and core stabilization.

-With a band or cable to the right side of the body, start with a wide, athletic stance.
-With the handle placed in front of the right chest/shoulder region and the right elbow pointing directly toward the weight/anchor, perform a single-arm press across the body.
-Keep the left leg, knee and foot pointing forward, so that the pelvis rotates over the left femur. Resist the foot turning or the leg bowing out.
-Pivoting the right foot (back foot) will result in greater rotation into the left hip.
-Return to the starting position and perform preferred number of repetitions (fitness reps/sets may apply).

One of the best strategies for remaining injury free is to not get injured in the first place. Once the injury cycle has started, however, incidence of future injury increases dramatically. Taking unnecessary risks can lead to a lifetime of recurring, frustrating issues. By prioritizing prevention strategies through proper preparatory work, sensible progression strategies, and knowing how to listen and react to warning signs (in other words, don’t “push through it”), can keep your clients exercising for a lifetime without hassle.

Chris McGrath, M.S., is the founder of Movement First, a New York City-based, health and fitness education, consulting and training organization. With more than 20 years of fitness and coaching experience, McGrath specializes in a variety of training modalities including sports performance, injury prevention, post-rehabilitation and lifestyle/wellness coaching. McGrath is a Senior Fitness Consultant to the American Council on Exercise and has established himself as an international fitness expert.

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5 Reasons You’re Late — and How to Avoid Them

January 14, 2014 by Leave a Comment

Laura Marie Meyers from POPSugar Fitness shares with us how to avoid being late!

Punctuality is a crucial part of professionalism and making positive first impressions. While we’ve heard some ridiculous excuses for being late, tardiness is usually caused by something more mundane. If you regularly find yourself racing the clock, take a step back and assess what’s causing you to run behind.

Alarm problems. Either it didn’t go off, you set it for the wrong time, or you slept right through it — whatever the case, turn around your alarm troubles by spending some extra time planning your sleep schedule. Make sure you’re getting seven to eight hours of shut-eye each night and guarantee a smooth morning by setting two or three alarms.

Struggle to get out of bed in the morning?
Place your alarm on the other side of the room so that you’re forced to get up to turn it off.

Getting ready gets chaotic. Where’s your purse? Your keys? Did you leave that shirt at the dry cleaner? These stressful moments are easily avoidable. Prep for your morning the night before and make a list of everything you need to grab before heading out the door. And be honest with yourself — if it takes you 15 minutes to do your hair, don’t allot five.

A friend calls or an email pops up. Don’t let random interruptions distract you for too long. If your phone rings, answer it and talk to your friend for a minute or so, then ask to call her later and get back on track. If you receive an email that requires an immediate reply, take care of it as quickly as you can and then close your phone to keep from checking Facebook, Twitter,

Instagram, etc.
The Internet steals your attention. It’s tempting to look at your phone, your computer, or your iPad every five minutes, but avoid the unnecessary glances when you’re on a schedule. Save the status updates for when you arrive at your destination and leave the mindless web browsing for later on.

You miss the bus. If you approach the corner just as your bus pulls away, try not to panic. If you let yourself get flustered, you’ll only make it harder to solve the problem. Instead, take stock of your options: Could you call a cab? Take another route? Call a friend? Ideally, you’ll get in the habit of taking an earlier bus so that you have plenty of time to wait and hop on the next one.

Still late to . . . pretty much everything? Maybe you’ve been working too hard and need some downtime. Check out these alternative treatments to uplifting yourself.

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Myths and Misconceptions: Muscle Soreness

January 9, 2014 by Leave a Comment

Is it good to be sore after workouts? Check out this ACE Fit article to see if you may be over-doing it. Then come see us at San Diego Sports Physical Therapy for some great rehabilitation exercises to get you back on track. 619-756-7500

There is a common misconception that muscle soreness through exercise is inevitable and necessary to see results. For many, soreness acts as an indicator of a great workout. But this is a shortsighted view of exercise benefits and can have detrimental effects in the long run.

To clarify, this is not about the minor muscle stiffness that can be felt the day after a workout. This is about excessive soreness—the kind of soreness that lasts for a few days, has you avoiding stairs and dreading everyday activities such as putting on pants, getting in and out of a car, and even sneezing. Some people actually strive to experience this. And while a little soreness is safe and may motivate even the most sensitive among us, when it crosses the line toward debilitating movement, your body is telling you that you went too far.

The Science
In short, all muscle soreness is a result of microscopic tears that take place through workouts, followed by swelling as part of the repair and rebuilding process. This may sound like a violent way to treat your body, but it is a necessary process to stimulate changes that improve strength and fitness. But how much is enough? To answer this accurately, lets look at the available research and remove any anecdotal biases from the equation.

Cause and Effect
Many people argue in favor of soreness because they have experienced positive results and associate soreness with the results. But soreness does not necessarily equate with a cause and effect for the improvements. In fact, there is no scientific evidence that proves soreness gets better results. While there is a lack of research in this specific area, there is no shortage of research indicating that progressive challenges are responsible for improving fitness. The question then becomes, can we progress effectively without soreness? And the answer is a resounding YES.

Consider world-class athletes. No athlete, after falling short in competition, has ever said, “I should have trained to be more sore.” Yes, athletes do sometimes experience sore muscles from training. But it is neither the purpose nor the target of their training. In fact, workouts are often modified for athletes if they are experiencing excessive soreness. The measuring stick used to track success for an athlete has nothing to do with the level of soreness derived from day-to-day training and everything to do with the longer-term outcome of their training program and competition goals. In fact, too much soreness will negatively impact training and competition.

Overload
To improve fitness, it is true that an “overload” is required. This means you need to apply a challenge that is greater than what your body is accustomed to. However, this “overload” can be applied aggressively or it can be applied gradually. Many assume the more aggressively you overload, the faster you will see results. But the body is more complex than that and pain is its way of telling us to slow down with the overload.

Law of Diminishing Returns
Most improvements follow a basic premise of “the more you put in, the more you’ll get out.” However, there is a tipping point that suggests a certain level of extra work does not yield any additional benefits. In short, it means you are working overtime and not getting paid for it. This can be illustrated through the concept of exercise dosage. Much like medical prescriptions, too high of a dose does not provide additional benefits nor increase the speed of benefits. Additionally, repeated “overdosing” can invite negative consequences. Extreme soreness is often just that—an “overdose” to the body.

Why it is Important to Avoid Muscle Soreness?
The Hot Iron syndrome…
Most kids only need to touch a hot iron once. If you simply don’t like to feel pain, soreness is more likely to be a deterrent to exercise, not a motivator. In fact, it may be a subconscious reason it is so difficult to start up or get back to that first workout after a layoff.

Fitness should make everyday life easier, not harder…
Extreme soreness naturally alters choices for activity outside of workouts. If your weekly leg workout leaves you feeling sore for three days, and you choose escalators over stairs, it defeats the functional purpose of being more fit.

Tighten up those muscles…
This phrase, which is often used to describe a positive outcome, may literally mean “tighten” in this case. Consistent states of soreness can easily reduce range of motion and lead to permanent changes to your movement patterns.

Overtraining and overuse injuries…
Overtraining and overuse injuries take time to develop. Unfortunately, by the time they are noticed, you are too deep to reverse the process quickly. Aiming for and achieving soreness week in and week out is inviting either or both.

Distraction from more important goals of exercise…
Exercise and fitness success needs to have a far more sophisticated evaluation tool than the level of soreness. By aiming for soreness in the short term, we may be ignoring the true measurements of success for exercise, such as fitness, strength, functionality and longevity, among others.

How to Avoid Muscle Soreness and Still Achieve Great Results
Avoiding soreness is not the same as avoiding high intensities. High intensities and maximum effort can be reached through sensible and progressive overloading strategies. You just don’t want to start there. Gradual progressions are very effective and are a far more reasonable and comfortable way to improve fitness and reduce short- and long-term risks. This can be accomplished by understanding your current levels of fitness and strength, and applying small and frequent increases in intensities and volume according to where you are now—not the level you someday hope to reach.

Remember, fitness is built. It is not injected. Build it wisely…

By Christopher McGrath

Chris McGrath, M.S., is the founder of Movement First, a New York City-based, health and fitness education, consulting and training organization. With more than 20 years of fitness and coaching experience, McGrath specializes in a variety of training modalities including sports performance, injury prevention, post-rehabilitation and lifestyle/wellness coaching. McGrath is a Senior Fitness Consultant to the American Council on Exercise and has established himself as an international fitness expert.

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The Yoga Injury Debate

January 7, 2014 by Leave a Comment

If you do yoga, do you experience any injuries? Come see us at San Diego Sports Physical Therapy to get back on track,

To yoga or not to yoga seems to be a common question for individuals. The debate is heating up in both trade and consumer publications, each explaining various relevant perceptions. The controversial topic has had the yoga community and advocates in upheaval about the negative perceptions that some have about yoga.

Although yoga has many advanced “acrobatic-like” qualities, classes offered in most health-club settings do not promote or practice advanced postures. In addition, yoga, like any other form of exercise or athletic pursuit, can pose a risk of injury. Awareness, acceptance and proper training are the keys to preventing injury.

What Causes Yoga Injury?

Injuries occur for a wide variety of reasons; in some cases, the cause may be unknown. Injuries may occur on the point of action, while other ailments creep up over time, with no explainable cause as to why the pain or injury occurred.

Some individuals argue that specific yoga poses cause injury due to a joint’s vulnerability in the pose, while others believe advanced postures are the primary cause of injuries.

While there is no single cause of yoga injuries, here are some common reasons why they often occur:

-Pushing beyond one’s physical capabilities to more advanced postures
-Forcing the body to stretch beyond one’s flexibility level
-Not being mentally prepared, or stable, for advanced postures
-Striving for perfection in poses

The Flexibility Spectrum

The occasional yoga participant potentially faces the greatest risk of injury due to a restricted range of motion in the joints. When there is a lack of mobility, other joints may try to compensate, which may result in overstraining, overuse or injury.

On the other hand, many yoga instructors may have experienced injuries due to having a highly flexible body. Having muscles that are too lax or flexible may make the individual more likely to overstretch the ligaments and tendons.

Ideally, one should be located near the center of the flexibility.

Personal Flexibility Awareness

Every body is gifted with a natural ability. Just as athletes are “born” with genetic gifts that, along with considerable training, enable them to excel in their sports, some individuals are naturally more flexible than others. In addition, some individuals who have practiced yoga, gymnastics or dancing from a young age are flexible and strong enough to perform advanced postures in their adult years.

Individuals who start a yoga practice after the age of 30 may or may not progress to advanced postures. It can sometimes take years to get the mind and/or body in an advanced state. Progressing yoga poses is similar to progressing traditional exercises, requiring one to build a solid foundation before moving toward the advanced state.

Wanting to look and perform like others in class, however, can increase the risk of moving beyond one’s current flexibility.

Acceptance of One’s Ability

Mass marketing yoga advertisements show yogis effortlessly performing beautiful postures. This makes us strive to or become curious about how to perform these poses. Generally, this is the point where we force ourselves to move, bend or stretch beyond our capability.

In yoga, this is called the ego—the driving force that wants to shine and succeed, or the voice that tells us we are not good or strong enough. Yoga instructors and attendees need to step off their mat and analyze their abilities and embrace their strengths. Acceptance is what keeps us satisfied in our practice and trusting ourselves on when to progress a given posture.

For example, a person may have a lack in spinal extension, which can make back-bending postures challenging, especially advanced spinal extension movements. However, this person may have exceptional wrist and forearm strength to perform beautiful inversions. This does not mean she has to avoid backbends; rather, she must understand and accept her limits and capabilities without forcing the spine into a foreign position.

What Comes First—the Fear or the Posture?

When progressing to advanced postures, many yoga instructors promote overcoming physical fear through advanced postures. For example, if someone has had wrist issues and a fear of re-injuring that joint or a fear of falling, one can perform a handstand (with or without wall support) to overcome the fear. Although this notion is successful for some, it poses another question of whether or not an advanced posture should be the driving force to overcome fear.

In yoga, as in many other sports, one must truly train the mind and be confident in one’s ability before progressing to advanced states. A baseball pitcher or tennis player must be mentally sound and visualize that perfect pitch or serve. If an athlete doubts his or her abilities, the majority of the time that pitch or serve will be unsuccessful or erratic. The same concept applies in yoga.

When performing a handstand, if one thinks, “I can’t do this. I don’t want to fall. I’m scared,” he or she is not mentally prepared yet. When the mind flutters, the physical body may weaken or fall, which can result in strain or injury.

Final Thoughts

Though some individuals have been seriously injured in yoga, it is best for practitioners to instruct various levels of yoga poses when working with the general population. Many yoga poses are not appropriate for everyone and instructors should understand which higher-risk asanas should be modified.

Neither the student nor the instructor should fear yoga. Education and awareness are essential for those who want to perform to perfection or advanced postures. Many students have that driving force to push forward, but it is through clear communication that we can educate them about the potential risks.

With various body types and mixed-level classes, the requirements are higher for instructors to know the anatomy and potential risks of each pose. When in doubt, teach the basic and common poses, such as Warriors, downward facing dog and balance poses.

References

American Academy of Orthopaedic Surgeons (AAOS) (2012). Yoga Injury Prevention.

Kerr, Z. et al. (2010). Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007.The American Journal of Sports Medicine, 38, 765- 771.

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Why Your Muscles Shake During a Hard Workout

December 31, 2013 by Leave a Comment

If you think you may be straining yourself during a workout, take a look at this article by Jay Cardiello. Then come see us at San Diego Sports Physical Therapy to get your work outs under control.

Pushing yourself during a workout is never a bad thing, and going so hard that your muscles start to shake is certainly a sign that you’re at your max—but your body may also be trying to tell you something. While many people pass this off as a simple sign that they’re out of shape and a majority of my fitness colleagues would agree that this trembling is not a great cause for concern, it could also lead to injury if you’re not careful to use proper form.

Let’s explore why your muscles may quiver during a barre class, Pilates, strength workout, or other type of exercise—and what to do about it.

1. Inadequate sleep. If you are heading into a cardio or strength training session feeling lethargic or lacking a good night’s rest, you will probably experience tremors at some point in your routine. [Tweet this fact!] The body continues to grow and heal when you get the proper amount of sleep. Disrupting this can cause your muscles to stay in a catabolic-like state. If you’ve been skimping on sleep, I recommend you skip the gym and stay in bed (if you work out in the morning) or head to bed (if you’re a p.m. exerciser).

2. Going to extremes. With fitness crazes like CrossFit and endurance events like Tough Mudder becoming the staple in mainstream fitness, people are really pushing themselves to the extremes these days. However, take caution and implement mandatory rest days into your fitness routine. Check out my last blog for the proper way to rest so you can keep up a sustainable workout routine and stop the shakes.

3. Too new, too much, too soon. If you try a new fitness class or jump into a new routine, at some point during your workouts you may feel your body start to wobble because working different muscles than you’re used to may be too much, too soon. While it may not be a cause for great alarm, it’s probably best to lighten up. You could place stress on other parts of your body in order to compensate for weaker muscles, which may cause injury. For example, if it’s your first time performing burpees, by the fourth or fifth one your legs may start to shake. Instead of resting, you decide to continue but with bad form, which can strain your lower back. Bad idea.

4. Dehydration. Your workout can be one of the best indicators of whether or not you are hydrated. When your body is low on water, your muscles and connective tissues have difficulty performing what they are meant to do, as improper hydration can cause an imbalance of your electrolytes, which are involved in muscle contraction. [Tweet this fact!] I recommend drinking half of your body weight in ounces daily. Remember, if you’re thirsty, you’re dehydrated.

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Elbow Injuries in Throwing Sports

December 26, 2013 by Leave a Comment

If you have elbow injuries, then take a look at this article by Sam Hutchison NASM-CPT, CES, PES. Take care of your body when you play sports! Questions? Come see us at San Diego Sports Physical Therapy.

“In today’s highly competitive sports environment, elbow injuries are prevalent for overhead throwing athletes (i.e., baseball and football) at all levels of playing. Although this may be as mild as a sore elbow, it can further degrade into a more serious elbow injury such as a ruptured elbow ligament; in particular the ulnar collateral ligament (UCL).” Ruptures to the UCL have been seen in 1 in 9 major league baseball pitchers since 2001 and requires reconstructive surgery popularly known as Tommy John surgery (1). Tommy John surgery does offer an 85% success rate, but a daunting 12-18 month recovery process follows the surgery, which can be difficult for any athlete eager to get back into action (1, 2). As a fitness professional, it is important to understand the basic mechanisms and signs of elbow injuries and refer to a licensed physician for diagnosis and treatment if an injury is ever suspected.

Mechanism of Injuries

Throwing technique for each throwing sport differs slightly, but throwing mechanics are typically broken down into six phases (3):

Wind up: Initial movement beginning when elevating the leg contralateral (opposite) of the throwing arm allowing for greater momentum. The center of gravity and stability is kept on the stance leg.
Early cocking: The elevated leg strides forward and the throwing arm moves into the throwing position allowing for a transfer of force from the upper extremity to the lower extremity.
Late cocking: Both feet have contact on the ground and the shoulder begins to externally rotate and the elbow flexes. A greater degree of shoulder external rotation enables the athlete to take advantage of the myostatic (stretch) reflex and subsequently results in greater power and ball velocity.
Acceleration: The ball is released after the shoulder undergoes rapid internal rotation and the elbow extends.
Deceleration: The shoulder undergoes maximal internal rotation after the ball is released.
Follow through: The body continues to move forward until arm motion has stopped.
When throwing, the elbow undergoes extension and the distal (furthest away portion) of the elbow joint angulates outward (known as elbow valgus). Elbow injuries typically occur during the late cocking and acceleration phase when the UCL is unable to counteract the extreme valgus and elbow extension created (1,4). Typically the UCL alone is unable to counteract the extreme forces placed on it by throwing. The muscles involved with shoulder internal rotation and forearm pronation are responsible to help counteract these forces and stabilize the elbow. If these muscles become too fatigued or there is a preexisting shoulder injury, an excessive amount of force is placed on the UCL, thus increasing the risk of injury (5, 6).

Risk Factors

Elbows injuries can occur through both chronic and acute trauma however, they typically occur through overuse. A survey looking at 95 youth baseball pitchers (50 with elbow surgery, 45 without elbow surgery) indicated that players who underwent elbow surgery had pitched more months throughout the year, games per year, innings per game, pitches per game and pitches at a higher speed (7). It was also indicated that these injured pitchers had used more aggressive post game recovery protocol such as icing and medicating with anti-inflammatory medication (5).

Along with overuse, another risk factor for elbow injury identified through research is range of motion deficits. A study conducted amongst baseball players with and without a history of elbow, shoulder and spinal injuries measured their passive range of motion (6). Each subject underwent a battery of assessments measuring the range of motion in their throwing arm for elbow flexion, elbow extension, shoulder internal rotation, shoulder external rotation and forearm pronation and supination. Results indicated injured players exhibited decreased internal rotation of the shoulder while exhibiting no significant difference in elbow and forearm range of motion (6).

What We’ve Learned

While the advancement in treatment measures has been shown to be effective at rehabilitating elbow injuries, it isn’t a magic bullet. A well devised exercise program to help prevent such injuries will always be the most viable option for keeping athletes healthy at any level. Fitness professionals should strive to assess their client’s joint range of motion through the use of various assessments and provide a pragmatic exercise program to address any potential muscle imbalances throughout the kinetic chain. It is important not to completely hone in on just the elbow but instead the entire human kinetic chain (wrist, shoulder, spine/core, lower extremities) etc.) to build a strong and balanced athlete to withstand the rigors of any sport.

A comprehensive corrective exercise strategy following NASM’s Corrective Exercise Continuum includes:

Inhibitory techniques (i.e., self-myofascial release) to decrease tightness and alleviate trigger points found in overactive muscles.
Lengthening (i.e., static and neuromuscular stretching) techniques to restore optimal range of motion of overactive (tight) muscles.
Isolated strengthening exercises to improve neuromuscular activation of underactive muscles through a controlled range of motion.
Integrated (total-body) exercises to integrate the entire kinetic chain through multijoint, compound movements.
Figure 1 provides an example a corrective exercise strategy for the elbow. Please refer to NASM’s Corrective Exercise Specialist (CES) course for a comprehensive list of movement assessments and corrective exercise strategies for the elbow.

References

1. Langer P, Fadale P, M Hulstyn. Evolution of the treatment options of ulnar collateral ligament injuries of the elbow. Br J Sport Med. 2006; 40:499-506.

2. Wilk KE, Reinold MM, Andrews JR. Rehabilitation of the thrower’s elbow. Clin Sports Med. 2004; 23: 765-801.

3. Seroyer ST, Nho SJ, Bach BR, Bush-Joseph CA, Nicholson GP, Romeo AA. The Kinetic Chain in Overhand Pitching. Sports Health. 2010; 2(2):135-146.

4. Cain EL, Dugas JR, Wolf RS, Andrews JR. Elbow Injuries in Throwing Athletes. Am J Sport Med. 2003; 31(4): 621-635.

5. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers. Am J Sport Med. 2006; 34(6):905-912.

6. Dines JS, Frank JB, Akerman M, Yocum LA. Glenohumeral Internal Rotation Deficits in Baseball Players With Ulnar Collateral Ligament Insufficiency. Am J Sport Med. 2009; 37(3): 566-570.

7. Bernas GA, Thiele RA, Kinnaman KA, Hughes RE, Miller BS, Carpenter JE. Defining Safe Rehabilitation for Ulnar Collateral Ligament Reconstruction of the Elbow. Am J Sport Med. 2009;37(12) 2392-2400.

– See more at: http://blog.nasm.org/cex/elbow-injuries-throwing-sports/#sthash.YCDLpBmm.dpuf

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Pilates Primer

December 19, 2013 by Leave a Comment

Have you tried pilates? It may be just the thing for you when you need a break!

Are you wondering what all the fuss over Pilates is about? Used traditionally by dancers for deep-body conditioning and injury rehabilitation, Pilates (pronounced Pi-lah-teez) is an 80-year-old exercise technique first developed by German immigrant Joseph Pilates. Only in the past decade has it migrated from its long-held position at the fringes of traditional fitness methods such as aerobics and weight training. Hollywood has been a key factor in turning the spotlight on Pilates, as numerous models and actresses pay homage to Pilates for their beautifully toned, fit bodies.

Focusing on the Core

The abdominal, hip and back muscles are often collectively referred to as the body’s core. Pilates exercises are designed to strengthen this core by developing pelvic stability and abdominal control. In addition, the exercises improve flexibility and joint mobility and build strength.

How can one exercise technique claim to do so much? The Reformer, a wooden contraption with various cables, pulleys, springs and sliding boards attached, lies at the foundation of Pilates. Primarily using one’s own body weight as resistance, participants are put through a series of progressive, range-of-motion exercises. Despite the appearance of this and several other equally unusual-looking devices, Pilates exercises are very low impact. Instructors, who typically work one-on-one or with small groups of two or three participants, offer reminders to engage the abdominals, the back, the upper legs and buttocks to stabilize the body’s core. Exercise sessions are designed according to individual flexibility and strength limitations.

Pilates exercises are not limited to specialized machines, however. In fact, many gyms across the country now offer Pilates mat-based classes that feature exercises that also stress the stabilization and strengthening of the back and abdominal muscles.

Connecting With Pilates

The mind/body connection associated with yoga and meditation also plays an integral part in Pilates. Unlike exercise techniques that emphasize numerous repetitions in a single direction, Pilates exercises are performed with very few, but extremely precise, repetitions in several planes of motion.

What will all this focus and stabilization get you? Well, according to its adherents, Pilates can help you develop long, strong muscles, a flat stomach and a strong back, and improve posture. Of course, these changes are dependent upon other lifestyle factors, such as a well-balanced diet and regular aerobic exercise. (Though some may claim that Pilates is all you need to develop stamina and endurance as well, an additional cardiovascular component is advisable.)

An initial Pilates session typically includes a body assessment, which allows the instructor to pinpoint strength and flexibility weak spots. This is also the time to become familiar with Pilates’ unique breathing patterns, which don’t always follow the exhale-on-exertion pattern of traditional exercise. Sessions typically run 60 minutes, at a cost of $50 or more for private sessions, and $10 to $30 for group sessions. If you’re more comfortable exercising at home, there are numerous Pilates and Pilates-type videos currently available.

Several home versions of the Reformer also are currently available on the market. Whether you work out at a studio or on your living room floor, Pilates is an excellent way to challenge your muscles, improve flexibility and incorporate the mind/body element into one effective exercise session.

Additional Resources

American Council on Exercise—Pilates Mat Training by Shirley Archer: www.acefitness.org/acestore/p-290-pilates-mat-training.aspx
WebMD Video—Yoga Pilates Studies: www.webmd.com/video/yoga-pilates-studies

Selecting a Pilates Instructor

Finding a fitness instructor who is a good match for your goals and personality can be challenging. The Pilates Method Alliance suggests asking the following questions of any instructor with whom you are considering working.

Was the instructor trained through a comprehensive training program?
Did that training program require a written and practical test, lecture, observation, practice and apprentice hours?
How many total hours were spent in the training program? (The Pilates Method is a knowledge-based method of exercise and training. Time spent in certification training produces qualified teachers.)
Does the instructor have any other movement-related teaching experience?
How long has the instructor been teaching Pilates?
What is the instructor or studio’s philosophy and specialty? Are they able to handle special needs, injuries and rehabilitation?
Does the instructor or studio teach the full repertoire of Pilates on all types of apparatus?

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Reducing Workplace Stress

December 17, 2013 by Leave a Comment

Times can be tough and stressful, especially during the holiday season. Things pile up, but don’t fret! Here are some ways to manage your stress at work from ACE Fitness.

Do you have a demanding boss or difficult co-workers? Stacks of work to get done and not enough time? Everyone encounters job stress sooner or later — but that doesn’t make it easier. There are many aspects of your work environment that you have no control over — but you can take action to manage stress so that work doesn’t take a toll on your well-being.

Stress Matters

Workplace stress has been linked to serious health problems — including heart attack. Your body releases greater amounts of the hormone cortisol in response to stress — stimulating an increased appetite for high-fat, high-sugar foods, and increasing fat storage in the abdomen. A study of workers coping with corporate restructuring and layoffs revealed that chronic job stress led to weight gain. Not surprisingly, consumption of high-fat, high-calorie vending machine snacks went way up during the most stressful periods. Research also shows that intense job stress is an independent risk factor for high blood pressure at work, home, and even while sleeping.

Work Mindfully

Mindfulness is a way of zeroing in on the here and now instead of ruminating over the past, mulling over the future, or doing several things at once. Give your full attention to the task at hand, whether it’s a call, a meeting, or a project. Scrolling through your messages while on a phone conference may feel productive — but in the long run, multitasking will only add to your stress and drain your energy.

Be Nice

Get to know your co-workers by asking about their weekends, inviting their opinions, and eating lunch together. Collegial co-worker relationships make the workplace more pleasant for everyone —and studies even show that a positive outlook is contagious. Offer genuine compliments. Smile frequently — it’ll boost your mood and encourage those around you to lighten up.

Communicate Well

Miscommunication is the root of many workplace conflicts. Clarify details and expectations for every job task. Check for understanding if you’re the one dishing out assignments.

Annoying co-workers are best dealt with immediately and directly — or the behavior may get worse. If your co-worker distracts you with loud, lengthy personal calls, talk with her privately instead of just getting frustrated. If it continues, speak with your manager.

Shake It Off

You can let yourself get wound up and upset about things that happen at work — or you can respond differently. Instead of stewing about a project that was dumped on you, could you view it as an opportunity to showcase your skills, talent, and teamwork — or speak with your supervisor? Instead of letting one grumpy customer get you down, can you focus on the 50 grateful customers you helped today? Take a few full, deep breaths to clear your mind and proceed down a more positive path.

Practice Smart Self-Care

Regular exercise and good nutrition — along with time for fun and relaxation —boosts your ability to cope with stress. And when you’re well-rested, stressors are more manageable. Consider taking a walk at break time, or meeting a friend for lunch. Learn relaxation breathing and stretching exercises to do at your desk. Choose high-energy, nutritious foods for meals and snacks. Cultivate a healthy sense of humor; look for the laughable moments in everyday life at work.

Get Help

If your best efforts don’t reduce your stress and talking with your manager doesn’t help, seek advice from your human resources department or employee relations representative. Some employers offer employee assistance programs (EAP) that provide confidential, 24/7 phone consultation with professional counselors for personal matters and workplace issues. If your employer offers this benefit, don’t hesitate to use it.

Make a Change

Life is too short to spend it in a toxic workplace — and living with chronic stress isn’t a long-term solution. No job is stress-free, but if your current job isn’t a good match for your interests, talents, and goals, create a plan to move on. Paint a realistic picture of your dream job by talking with others in your desired line of work before you make the leap.

Additional Resources

The American Institute of Stress Job Stress Self-Test

UCLA Mindful Awareness Research Center Mindful Meditations

University of Pittsburgh Medical Center -Stress Coping: Relaxation Techniques

References:

Clays, Els Leynen, Francoise De Bacquer, Dirk Kornitzer, Marcel Kittel, France Karasek, Robert PhD; De Backer, Guy, High job strain and ambulatory blood pressure in middle-aged men and women from the Belgian job stress study, JOEM April 2007, Vol. 49, Issue 4, pp.360-367. Abstract.http://journals.lww.com/joem/Abstract/2007/04000/High_Job_Strain_and_Ambulatory_Blood_Pressure_in.5.aspx

Fowler J, Christaki, J, Dynamic spread of happiness in al arge social network, BMJ 2008; 337(2338), posted 12/16/2008, retrieved May 18, 2008 from: http://www.medscape.com/viewarticle/584834

Maglione-Garves, C, Kravitz, L, Schneider, S, Cortisol connection: tips on managing stress and weight, retrieved May 18, 2010 from: http://www.unm.edu/~lkravitz/Article%20folder/stresscortisol.html

Nauert, R, Workplace stress linked to obesity, retrieved on May 18, 2010 from: http://psychcentral.com/news/2010/03/25/workplace-stress-linked-to-obesity/12382.html

Fernandez, I, Su, H, Winter, P, Liang, H, Association of workplace chronic and acute stressors with employee weight status: data from worksites in turmoil, JOEM, Jan 2010, v.52, Issue 1S, pp. S34-S41.Abstract. http://journals.lww.com/joem/Abstract/2010/01001/Association_of_Workplace_Chronic_and_Acute.7.aspx

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How can fitness professionals encourage seniors to strength train?

December 12, 2013 by Leave a Comment

With increasing age, your body’s ability to absorb calcium decreases, which unfortunately causes an increased risk for osteoporosis. Strength training can help counter bone degradation! Come see us at San Diego Sports Physical Therapy for your strength and rehabilitation needs! 619-756-7500

Frame strength training as solving a problem.
Identify why the senior needs more strength. In the examples above, Dan doesn’t want to give up golf – it’s an important part of his life. For Jan, the fitness professional will want to probe further; studies have shown seniors may not be swayed by health problems alone. Does she want to travel? Baby-sit her grandchildren? Linking enjoyable life activities to getting stronger provides the motivation to overcome fear and inertia.

Measure progress in “real life” ways.
Continually go back to the senior’s goals and every day activities. Is it easier to bring in the groceries? Are they navigating stairs better? How’s the golf or tennis game? The best part of working with seniors is the rapid gains they make to improve the quality of their lives. They’ll share them with you gleefully!
Strength Program Design Tips for Seniors

Keep it simple.
Design strength training programs with just a few exercises for major muscle groups. Explain the exercises fully and why the senior is performing them. For example, explain that a seated row will strengthen their upper back muscles (rhomboids) which will improve their posture and have the added benefit of improving their appearance!

Strength Program Design Tips for Seniors
Take it slow.
Have the senior perform all exercises slowly. Watch their form and make corrections gently and politely (“please and thank you” are appreciated). Give positive feedback for keeping correct form. Use the same exercises for several sessions so your clients understand them well and get a sense of mastery and control.

Keep strength training to 10 – 30 minutes.
Many seniors have fears of being in pain and getting exhausted. You can relieve those fears by explaining to the senior that strength training is not painful but requires focus and precision to get results. Therefore, they’ll be performing the exercises for 20 -30 minutes – and they can stop at any time if they feel pain. Develop balance, flexibility and cardiovascular exercises if you need to provide an hour session.

The fitness professional’s main goal when working with seniors is to build trust. Trust is extremely important to seniors. They want an expert on making them stronger as well as someone who cares about them and their goals. Celebrate their progress, even small victories, and you’ll have a friend for life. Share your experiences or insights from training seniors in the comments below.

Betsy LaMond is an ACSM Certified Personal Trainer and owner of BoomerFit Cape Cod, Fitness Center for Boomers and Seniors located at 947 Main St, Route 6A, Yarmouthport, MA, BoomerFitCapeCod.com. She teaches Mature Adult Fitness at Cape Cod Community College and provides fitness presentations on boomer and senior fitness to senior organizations.

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Shoulder Pain Prevention

December 10, 2013 by Leave a Comment

If you experience shoulder pain, here may be why it’s happening. Then come see us at San Diego Sports Physical Therapy for rehabilitation and improvement!
By Brian Sutton MS, MA, PES, CES, NASM-CPT

Is shoulder pain stopping you from, playing your favorite sport or achieving your personal fitness goals? Chances are, if you are experiencing shoulder discomfort or pain, you’ll have to alter your lifestyle to accommodate this dysfunction. Shoulder pain can occur in a multitude of ways and is prevalent in 21% of the general population (1,2) with 40% of that population having injuries persisting for at least one year (3). The treatment measures of shoulder pain can accumulate to an estimated annual cost of $39 billion (4).

Shoulder injuries have many different mechanisms or pathologies ranging from acute trauma to chronic overuse injuries. Acute trauma typically comes from a direct force, such as falling directly on the shoulder, or from an indirect force, such as landing on an outstretched hand. Either of these mechanisms may result in fractures of the humerus, clavicle, scapulae and glenoid fossa, or dislocations and tears of the capsular ligaments or labrum. However, the most commonly seen injuries in athletes or the active population stem from overuse syndromes.

Overuse Injuries

Overuse injuries (aka cumulative trauma disorders) are any type of muscular or joint injury caused by repetitive stress that surpasses the body’s natural repair processes (i.e., tendonitis, stress fractures). Overuse injuries of the shoulder are common among athletes who consistently perform overhead movement patterns (i.e., baseball pitchers, swimmers, tennis players) and individuals who repeatedly work with their arms raised (i.e., painters, construction workers) (5-9). Among the overuse injuries, shoulder impingement is the most prevalent diagnosis accounting for 40-65% of reported shoulder pain (10).

Common symptoms of shoulder overuse injuries include (11):

Minor pain during activity and at rest
Pain observed at the top or front of the shoulder during overhead activity (i.e., overhead presses) or during chest activities (i.e., incline bench press)
Tenderness on the lateral aspect (outside) of the shoulder
Loss of strength and range of motion (ROM)
Pain during throwing motions
Poor Posture
In addition to overuse injuries, individuals who exhibit poor static posture of the upper body are at risk for shoulder dysfunction. A common postural distortion of the upper body identified by Janda is the Upper Crossed Syndrome (UCS) and is characterized by protracted shoulders and a forward head (12). UCS generally involves tightness (overactivity) within the anterior chest region (pectoralis major/minor), latissumus dorsi, and cervical extensors (sternocleidomastoid, levator scapulae, scalenes), coupled with lengthening and weakening (underactivity) of the mid-and-upper back muscles (mid/lower trapezius, serratus anterior, rotator cuff) and deep cervical flexors. Individuals who sit for extended periods working on a computer may be at risk for developing upper body dysfunction and poor posture if certain precautions are not made such as taking frequent breaks and working at an ergonomically sound work station (13).

Exercise Selection
Similar to overuse and poor static posture, improper exercise selection can also contribute to shoulder dysfunction. For example, if a baseball pitcher tries to increase velocity of his pitches by only strengthening the superficial muscles of the shoulder (prime movers) that produce internal rotation (pectoralis major, latissimus dorsi) more than the stabilizers/external rotators of the shoulder (infraspinatus, supraspinatus, teres minor), these stabilizers become reciprocally inhibited (underactive) and fail to stabilize the glenohumeral joint during the throwing motion. Without adequate stability the athlete may develop a subacromial impingement, leading to subacromial bursitis, rotator cuff tendonitis, and possible tears of the external rotators (14).

Another example of poor exercise selection involves the over reliance on uniplanar, isolated resistance training exercises. Athletes and fitness enthusiasts oftentimes place too much emphasis on uniplanar exercises strictly focusing of concentric force production (e.g., presses and pulls) while neglecting total-body movements that integrate the entire kinetic chain (lower body, core, upper body) in multiple planes of motion (sagittal, frontal, transverse). Everyday activity occurs in all three planes of motion (front-to-back, side-to-side, and rotational) and only training in one plane (predominately the sagittal plane) will not effectively improve the individual’s ability to move in a coordinated fashion in the frontal and transverse planes. This form of program design may lead to muscle imbalance and faulty movement patterns increasing the individual’s risk of injury and/or joint dysfunction.

Using these two examples, fitness professionals should design exercise programs from an integrated (all-inclusive) perspective. An integrated exercise program encompasses both uniplanar and multiplanar movements; single, compound and total-body exercises; and adequately targets on all muscle groups (prime movers and stabilizers).

Shoulder Injury Prevention Strategies
If a client presents pain or dysfunction the fitness professional should never attempt to diagnose the problem but rather refer his or her client to a qualified medical professional. However, utilizing various movement screens, fitness professionals should assess their clients to identify potential muscles imbalances (muscle weakness and muscle tightness) and faulty movement patterns and subsequently implement a corrective exercise strategy to proactively address these concerns. For a list of comprehensive movement screens and corrective strategies for the shoulder complex see NASM’s Corrective Exercise Specialist.

Following a comprehensive fitness assessment (including a battery of movement screens), fitness professionals should implement a corrective exercise program that is individualized for their client:

Step 1: Inhibitory techniques (self-myofascial release) should be used to decrease tension and effects of latent trigger points of the overactive muscles surrounding the shoulder complex.
Step 2: Static stretching should be performed for a minimum of 30 seconds on identified overactive muscles to help facilitate optimal joint ROM and muscle extensibility.
Step 3: Isolated strengthening exercises should be used to facilitate the underactive muscles of the scapulae. Auditory and tactile feedback while performing these exercises can also help develop neuromuscular activation with proper kinetic chain positioning and control.
Step 4: Lastly, exercises are progressed by incorporating activities that integrate the entire kinetic chain (multijoint, compound movements). During these exercises clients should be instructed to maintain scapular retraction, depression, and posterior tilting while limiting winging by keeping the scapula on the costal surface. Refer to Figure 1 for an example shoulder corrective exercise program.
shoulder prevention

References:

1. Bongers PM. The cost of shoulder pain at work. BMJ. 2001;322(7278):64-65.
2. Urwin M, Symmons D, Allison T, Busby H, Roxby M, Simmons A, Williams G. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis.1998;57(11):649-655.
3. Van der Heijden G. Shoulder Disorders: A state of the art review. Baillieres Best Pract Res Clin Rheumatol.1999;13(2):287-309.
4. Johnson M, Crosley K, O’Neil M, Al Zakwani I. Estimates of direct health care expenditures among individuals with shoulder dysfunction in the United States. J Orthop Sports Phys Ther. 2005;35(1):A4-PL8.
5. Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. The recognition and treatment of superior labral (slap) lesions in the overhead athlete. Int J Sports Phys Ther. 2013 Oct;8(5):579-600.
6. Reinold MM, Curtis AS. Microinstability of the shoulder in the overhead athlete. Int J Sports Phys Ther. 2013 Oct;8(5):601-16.
7. Reinold MM, Gill TJ, Wilk KE, Andrews JR. Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment. Sports Health. 2010 Mar;2(2):101-15.
8. Reinold MM, Gill TJ. Current concepts in the evaluation and treatment of the shoulder in overhead-throwing athletes, part 1: physical characteristics and clinical examination. Sports Health. 2010 Jan;2(1):39-50.
9. Stenlund B, Lindbeck L, Karlsson D. Significance of house painters’ work techniques on shoulder muscle strain during overhead work. Ergonomics. 2002 May 15;45(6):455-68.
10. van der Windt DA, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract.1996;46(410):519-523.
11. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00032. Accessed November 12, 2013.
12. Janda V. Muscles and Motor Control in Cervicogenic Disorders. In: Grant R, ed. Physical Therapy of the Cervical and Thoracic Spine. St. Louis, MO: Churchill Livingstone; 2002:182–99.
13. Cho CY, Hwang YS, Cherng RJ. Musculoskeletal symptoms and associated risk factors among office workers with high workload computer use. J Manipulative Physiol Ther. 2012 Sep;35(7):534-40.
14. Cowderoy GA, Lisle DA, O’Connell PT. Overuse and impingement syndromes of the shoulder in the athlete. Magn Reson Imaging Clin N Am. 2009 Nov;17(4):577-93.

– See more at: http://blog.nasm.org/cex/shoulder-pain-prevention/#sthash.mPXeZhdS.dpuf

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