ACL Injury Prevention 101

ACL injuries (anterior cruciate ligament) have been an epidemic in sports but even more so in women’s athletics.  Females are 3-4x more likely to tear their ACL than men.  A few of the main reasons are:

– poor mobility/flexibility
– insufficient strength levels
– improper jumping and cutting mechanics

ACL Injuries

Poor Landing Mechanics!

At our ACL Injury Prevention clinic you will learn the fundamentals of strength training, flexibilty, speed and agility, and jump training to become a better athlete while also decreasing the risk of devasting ACL injuries.  See our recent blog posts for more information on ACL injuries and examples of how we teach landing mechanics.

Athletes will work in small groups with our expert staff addressing each of these problem areas. They will also learn drills and exercises that can be done at home or within school training programs to continue to develop athletically.

Come ready to work and learn!

Cost is $10 per athlete

Who:  Middle and High School Female Athletes

Where:  Elite Physical Therapy and Sports Performance – 4177 Village Park Dr. Suite B Traverse City (next to Wuerfel Park)

When – February 11th 10am – noon

What to bring:  athletic attire, water bottle, and your energy!





Space is limited to 24 athletes so sign up today!

Bonus:  we’ll be offering a free movement screening session to attendees who would like to participate.  Screening consists of the Functional Movement Screen (FMS), Y Balance test, plus jump and hop testing.  Exercise programs are then individually developed based on these test results.  Those interested can schedule their free screening by calling us at 231 421-5805.

ACL Injuries and Prevention – Jump Training Part 3

Here is video #3 in our series on box jumps and how we use them here at Elite Physical Therapy and Sports Performance to decrease the risk of ACL injuries and also to improve jumping performance.

Don’t forget this Wednesday Dec. 28th – the Northern Pride Sports Academy is running a basketball clinic for 6th – 8th grade girls at Kingsley High School from 2pm – 6pm.  We will be taking athletes through our jump training progressions, injury prevention techniques, as well as what the athletes can be doing at home to continue to get better.

Here is the link to sign up:  http://www.northernpridesportsacademy.com/december-28th-clinic.html

Stay tuned as we’re planning on hosting an ACL injury prevention clinic at Elite PT in February.  I’ll have dates and times coming soon.

Joe

joe@elitepttc.com

231 421-5805

ACL Injuries and Prevention – Jump Training Part II

Last week I talked about some of the main causes of ACL injuries and why they occur at a rate of 3-4x more often in female athletes.  You can find that article along with our first jump training video here:

This week I’m posting the second video in a series of three showing how we begin jump training to a box.  This type of training can be used for ACL injury prevention and to enhance sports performance.  It’s also what we do post-surgically to get the athlete used to jumping again and landing safely.

The great thing about box jumps is that the forces on the knee are quite low because you are not coming all the way back down to the floor.  It’s also much easier because of this for the athlete to work on proper landing technique.

Before I get to the video though I thought I’d post a picture of what you don’t want your athletes knees to look like.

ACL Injuries

a.k.a. valgus collapse of the knee

Check out the video below for more:

Looks fairly simple but let me assure you it can be quite challenging for many athletes – boys included.  Learning to jump and land correctly has been proven to help prevent ACL injuries and it must also be a huge focus of any post-surgical ACL rehabilitation program.

If you have any questions feel free to contact me Joe@elitepttc.com or 231 421-5805.  We also do injury prevention and return to sport testing which does include a number of jump/hop tests.  If you’d like to know where you stand in relationship to other athletes in your sport we can definitely set that up for you.

ACL Injuries and Prevention

ACL injuries (anterior cruciate ligament) have been an epidemic in sports but even more so in women’s athletics.  Females are 3-4x more likely to tear their ACL than men.  There are several proposed theories on why this is so but for the purposes of this article and what we address here at Elite Physical Therapy we will discuss the following:

  • Poor movement quality
  • Strength deficits
  • Landing mechanics

I’ll go more in depth in subsequent articles but for now here are the basics:

Poor movement quality

There are just certain joints in our bodies that need to be very mobile in order to get us through our daily activities and especially sporting activities like running, jumping, and cutting.  Don’t get me wrong – all of our joints need to move through their full range of motion for us to be efficient movers.  Some just need to be emphasized a bit more because of their tendency to become stiff while other areas of our body need a bit more stability/motor control.  Check out the picture below to get an idea of how this works – it’s called the Joint – by – Joint theory.

Alternating sequence of mobility - stability through the entire body

Alternating sequence of mobility – stability through the entire body

It’s a very simplified way of looking at things but it does often work out this way.  The knee joint needs to have a great deal of stability in all directions to prevent injury.  If the ankle and hip joints above and below are moving well then the knee joint will more likely stay within it’s accepted range of motion during athletic movements.  If the ankle and/or hip are stiff then the knee may just have to go outside of it’s normal boundries to land from a jump or decelerate while cutting.  This is where things can go south in a hurry!

Strength deficits

There is plenty of research out there in the medical and physical therapy journals showing that strength deficits can lead to knee injuries, and in particular ACL tears. Years ago the main concern was the ration of strength between the quadriceps and hamstrings, which if it was below a certain level it could inhibit an athletes ability to decelerate correctly leading to injury.

Lately the focus has been more on the hips and muscles of the ‘core’ and how weakness or lack of control in those areas can contribute to injury.  I’ll get more into the ‘how’ and ‘why’ in another article but it is a reality that needs to be addressed.

At Elite Physical Therapy, we know that a comprehensive strength program must be implemented to assist in the prevention of ACL injuries.  Quality movement is critical for effective strength training as well.  Being able to combine these qualities is what we do best, and definitely one of my favorite things to talk about so more to come for sure!

Landing mechanics

It is also well documented that female athletes land and cut differently than the male athletes.  Women tend to land stiffer and higher than the men who typically land in deeper hip and knee flexion angles.  Stiffer and higher landings are more dangerous as far as the knee joint is concerned.

Strength and movement quality again play a large role in this.  Some athletes can’t even get into a good position to perform complex athletic movements.  Big problem!

Many don’t have the strength to get into the proper positions.  Another big problem.

As the athletic activities get faster, more complex, impose higher forces, etc it becomes more and more challenging to perform them using good technique.  Fortunately all of these qualities can be addressed through physical therapy and proper training techniques.

Check out the video below showing how we start teaching athletes to jump correctly using box jumps.  The nice thing about landing on a box is that you don’t really have to come all the way back down.  Much less strain on the knees and an easy way to work on jumping and landing technique.

I’ll be posted a new video every few days showing more of the progressions we use.  We will also be hosting some ACL prevention clinics in the near future so if you’d like to learn more and get some hands on assistance than please contact us.

Here is what we have coming up:

December 28th from 2 pm – 6 pm at Kingsley High School with the Northern Pride Sports Academy.  6th – 8th grade girls basketball skills camp.  We will be teaching a session on jumping progressions to improve athletic performance and reduce injury risk.

In February (date to be determined) we will be hosting an ACL Injury Prevention clinic here at Elite Physical Therapy and Sports Performance.  Topics will include mobility training, strength training, and jump training progressions. More on that to come as we continue to line up speakers and instructors.

For more information you can contact us at 231 421-5805.

Joe Heiler PT

Back Pain and Sciatica – Part 2

Last month I posted a case study showing how we treat back pain and associated ‘sciatica’ like symptoms here at Elite Physical Therapy in Traverse City.  You can find that article here:  http://www.elitepttc.com/back-pain-and-sciatica-physical-therapy-treatments/

This month’s case study is a little different in that the presentation and location of the pain were quite different but it still comes down to playing detective to determine where the patient’s symptoms are really coming from.  Before we get started here, I’m re-posting the picture of the dermatomes of the body (basically the sensory distribution of the nerves from the spine) so be sure to check that out.  Pretty cool how we were created for sure!Dermatomes

Case Study #2

The patient in this case presented to our clinic with pain shooting into the front of his hip and groin as well as down the front and side of his thigh.  He also reported minor back pain but it was nothing compared to the pain in his leg.  The patient reported having this pain on and off over the past couple years especially when exercising but recently it was much more constant and severe.  In the past he had been diagnosed with IT Band syndrome (pain laterally in the hip and thigh might make you think that), and more recently with a hip flexor strain (could also make sense now that he was having more pain into the front of the hip and groin).

Exam

  • minimal tenderness to the ‘hip flexor’ muscles anteriorly, slight weakness with manual muscle testing but no pain (probably not a hip flexor strain).
  • moderate tenderness and active trigger points in the lateral hip musculature that referred pain down the lateral thigh to the knee (could be part of IT Band syndrome).
  • springing of the lumbar vertebrae at L2 and L3 reproduced the typical symptoms  he felt into his anterior hip/groin as well as lateral thigh (Bingo!)

Treatment

Dry needling was performed at the levels of L2 and L3 along with electric stimulation for 10 minutes, and followed up with Graston Technique (GT) to decrease tone and improve mobility of the superficial fascia and muscles of the mid and lower back.

A couple exercises were given to maintain, and hopefully even improve, the mobility gained through the spine and hips as a result of the dry needling and GT.

Results

The patient reported a significant decrease in the anterior hip and groin symptoms as well as a moderate improvement in lateral hip and thigh symptoms.

During the second treatment session I decided to treat the muscles of the lateral hip as well since they also referred pain into the lateral thigh.  This was done with by dry needling + e-stim just like we had done in the low back.

By the third treatment session a few days later the patient was reporting a significant reduction in lateral hip and thigh symptoms as well.

Final Thoughts

It took a few more treatments to completely resolve this patient’s symptoms but it’s nice to see an immediate decrease in symptoms to know that you are treating the right areas.  With a thorough evaluation process it wasn’t hard to figure out that the patient’s symptoms were primarily coming from his spine which was quite a different diagnosis than what was previously thought.

A little detective work plus effective treatment tools like dry needling and Graston Technique can make a huge difference in patient outcomes.  If you have similar types of symptoms or pain that just doesn’t ever seem to get better then give us a call!  If you have any questions feel free to email me:  joe@elitepttc.com

Back Pain and Sciatica – Physical Therapy Treatments

This month I figured I’d post on a couple case studies related to back pain and sciatica, and how we evaluate and treat cases like this at Elite Physical Therapy.  We’ve had a lot of great success with these folks so thought I’d share a couple examples.

Back pain, and associated leg pain, can be difficult to treat but we like a challenge!  Playing detective can be fun if you know what to look for.  Check out the pictures below that show the paths the spinal nerves take throughout the body.  Leg pain (or what many people like to call ‘sciatica’) can follow a number of paths down the leg and sometimes that can be a dead give away to identify exactly where the pain is coming from.

dermatomes

***The letter and numbers above correspond to a particular spinal nerve, i.e. L4 means lumbar spinal nerve #4 ***

There are other ways to narrow down the location of the problem as well:

  • the muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve #4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So here’s a great example of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Pretty simple exercises that are beyond the scope of this article but lots of bang for your buck when they only take 5 minutes 2-3 x per day.

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Final Thoughts

Sometimes it just works that well but I certainly won’t make that guarantee in every case!  Back pain and ‘sciatica’ cases can be quite complex but knowing how to put together all the puzzle pieces definitely helps.

That’s probably enough to wrap your head around for this time.  Next month I’ll post another case study but with a different symptom presentation.  In the meantime if you have any questions just shoot me an email:  joe@elitepttc.com or call 231 421-5805.

Occlusion Cuff

Blood Flow Restriction Training

Blood Flow Restriction training, aka BFR, has actually been around for awhile now but its finally starting to make its way into professional and collegiate sports as well as physical therapy.  Johnny Owens has been the driving force behind BFR in the U.S. after successfully using this technology with veterans recovering from devastating combat injuries.  Since that time he’s been training numerous professional sports teams in the use of blood flow restriction training including the Detroit Lions and Detroit Red Wings.

What the heck is it?

BFR training utilizes a tourniquet-like device which is placed proximally on a limb to limit arterial inflow to the limb while blocking venous outflow.

I should add a word of warning sooner rather than later.  There are commercial devices out there used by trained professionals for this type of training.  Do not make your own tourniquet and try this at home!

Benefits

I’m going to go a bit scientific on you here but just for a moment:

  • Training loads used are only 20-35% of 1 rep max, and often times are just body weight.  The same effects with weight lifting alone must be at least 70 – 85%.  Translation:  same results with less load = happier joints.
  • Higher release of growth hormone, insulin-like growth factor, and other substances known to speed tissue repair and create a positive environment for muscle hypertrophy.
  • Increased recruitment of Type II (fast-twitch) muscle fibers even with sub maximal loads
  • Increased muscle protein synthesis through the inhibition of catabolic substances.
  • Cell swelling : shift in fluid balance into the muscle cell creating a protective response to adapt and grow

Check out the chart below from Dr. Mario Novo at the LiftersClinic.com

LiftersClinic.com

Pretty cool stuff isn’t it?  Even with all the science thrown in.

How do you use it?

We work it into our rehab and training sessions closer to the end of the workout.  The build up of lactic acid will reproduce the ‘muscle burn’ sensation pretty quick causing a good amount of muscle fatigue with only body weight activities.  Body weight squats are usually a great place to start.  They are performed for 30 reps:15 reps:15reps:15 reps with 30 seconds between each set.  These will be the toughest body weight squats you’ve ever done!

The number of exercises performed and time training with blood flow restriction is gradually increased.  So far we’ve seen a rapid increase in tolerance to exercise among our athletes allowing them to do more and more work with BFR.  The results have been excellent too with quicker gains in muscle hypertrophy and strength.  If you notice the last column in the chart above – time to adaptation.  Within 2 weeks we are beginning to see positive changes compared to the traditional higher intensity training.

It might sound like I’m down playing the effects of higher intensity training regimens but I’m not at all.  There are tremendous benefits to lifting heavy and creating a great base level of strength.  BFR just offers a great way to increase training volume and intensity while decreasing load.  Over time the heavy weights will wear down your body – ask any collegiate or NFL football player – but this allows for a certain amount of unloading to happen and still reap all the benefits.

I know you want to try it!

Blood flow restriction training is safe when used with the right person at the right time and monitored appropriately.  It is also a pretty intense workout so definitely not for the faint of heart.

We are currently using BFR with athletes and patients post-knee injury, hamstring injuries, shoulder injuries, ankle sprains, and more.  Athletes that come in strictly to train have been having great success with it as well.  If you’ve struggled to make progress as a patient or hit a plateau in your training this would definitely be worth asking about.  We have a number of unique techniques to promote tissue healing and strength/power gains, and this is just one reason we have been setting ourselves apart from the competition!

Occlusion Cuff Shoulder

If you’re really into the science behind blood flow restriction training and would like to learn more, you can check out the two podcasts with Eoin Cremen (creator of the OcclusionCuff) on SportsRehabExpert.com

Questions?  Joe@eliteptt.com or give me a call at 231 421-5805

Dry Needling for Hip and Knee Pain

At Elite Physical Therapy and Sports Performance we strive to find new and innovative ways to treat pain and get you moving again.  Dry needling has been one on my go-to treatments for the past 3 years now, and the method I’m going to show you today works wonders for hip and knee pain.

The Vastus Lateralis (VL) is one of the four muscles that make up your quadricep and is the most lateral.  Trigger points in this muscle will often refer pain to the lateral knee.  Check out the photo below of the VL and corresponding trigger point referral patterns.

Vastus Lateralis Trigger Points

Even without active trigger points, the VL is often in a state of high tone which can significantly limit hip mobility in certain directions.  With it’s attachment all along the IT band, it can also create greater stress on the knee joint through that IT band.

In the video you’ll see the limitations in our patients hip adduction (her knee should hit the table when I try to lower the leg across midline).  Her right hip does this easily.  This is a fairly standard PT test, known as the Ober test in most circles.  In the video you’ll see how dramatically dry needling the Vastus Lateralis with a few minutes of muscle stimulation can change her hip mobility.

Just a quick note on the video.  This was originally created for my SportsRehabExpert.com website which is read by other PT’s, Athletic Trainers, Chiropractors, etc.  Sorry for all the medical talk but you’ll get the idea with the huge change in range of motion following the dry needling treatment.

Here are some of the common diagnoses you’ll hear from your doctor that will respond well to dry needling:

  • IT Band Syndrome
  • Runner’s Knee (distal IT band syndrome)
  • Patello-Femoral Pain Syndrome/Patellar Mal-Tracking
  • Hip Bursitis

There are many other ‘diagnoses’ that can benefit from improved hip mobility but those above are what we would see most frequently.  For those that are needle-phobic, we can get similar results using Graston Technique and other manual therapy techniques, it’s just often not quite as dramatic.

There are also a number of specialized motor control and strengthening exercises that need to be used following this treatment to maintain this new mobility.  Just because she can move her hip now on the table doesn’t necessarily mean its going to move that well when she is standing, walking, or running.  Strength must also be established in that new range.

Hope that was helpful to see plus you get a bit of a glimpse at what we do here at Elite Physical Therapy and Sports Performance.

Big thanks to our Athletic Trainer, Lydia Case, for being our ‘patient’!

Advanced Kettlebell Carries

We love kettlebell carries here at Elite Physical Therapy and Sports Performance as they have numerous benefits to our patients and athletes including:

  • improved shoulder girdle and trunk stability
  • increased grip strength
  • improved core control and strength

My current PT student, Mitch Babcock, has brought some new ideas to the table to make our carries even more challenging as far as the stability demands go so thought I’d share those with you.

Check out the videos here:  http://www.sportsrehabexpert.com/public/1181.cfm?sd=2

Bio

Mitch Babcock Kettlebell CarriesMitch Babcock SPT is a final year Doctor of Physical Therapy candidate from the University of Michigan — Flint. Mitch received his Bachelor’s Degree from Saginaw Valley State University in Mitch BabcockExercise Science and pursued his passion for movement and exercise to the graduate level. Mitch is certified in the Selective Functional Movement Assessment (SFMA) and the Functional Movement Screen (FMS), as well as a RockTape FMT Level II professional. He has also spent time with clinical rotations in a manual-based orthopedic clinic in mid-Michigan, a sports clinic in Charlotte, NC, and an outpatient neurological rehabilitation clinic in mid-Michigan. With a passion for full human optimization, Mitch is ready to help you get moving, get out of pain, and get back in the game.

Multi-Planar Single Leg Deadlift

The single leg deadlift is a staple exercise here at Elite Physical Therapy and can improve hip mobility, core and hip motor control, and also challenge balance.  Adding movement into other planes can also add value to an already excellent exercise.

Originally published on SportsRehabExpert.com by Greg Schaible
This is a great way to start exploring movement and introducing variability of motion once your typical single leg deadlift has been mastered. Start including these variations to develop better body awareness. It also can effectively be used as part of an athletes warmup.

  • Keep a soft knee and stay long through the torso
  • Torso should be in parallel with the ground

This doesn’t take the place of a progressive loading program with your standard single leg deadlift. Don’t forget the benefits that a progressive resistance program can have on tissue remodeling.

BIO

Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a Student Athlete. As an athlete he competed in both Indoor anGreg Schaibled Outdoor Track & Field where he earned honors as a 5x Division II All-American and a 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. In addition to his rehabilitation services, Greg has a passion for youth sports specific training. Follow On Track PT Performance on Facebook.