Kinetic Health - Calgary

Exercise Rehab For Ankle Sprains

2012-01-26T22:47:00.007-07:00

When prescribing ankle exercises, we must take into consideration the multiple structures that are involved in performing and coordinating ankle motion. To attain a full resolution from an inversion sprain, we must be sure to consider multiple muscles and complex fascial layers, all of which work together across numerous joints.

To do this, we must be sure to address three essential components: strength, flexibility, and proprioception.

Strengthening the Ankle

Strengthening exercises are essential! Manual therapy, by itself, will not fully prevent an injury from returning without the addition of strengthening exercises. This is because the type and quality of tissue remodeling that occurs after an injury is dependant on the type of forces that are applied to that tissue. When appropriate strengthening exercises are applied, the collagen remodels to withstand the stresses that are placed upon it. The possibility of re-injury is very high without appropriate strength training.

Strengthening exercises for an inversion sprain can be subdivided into several categories depending on the stage of the injury. The following subcategories describe stages from non-weight-bearing to full-weight-bearing. Note: These are examples of possible recommendations, but actual exercise recommendations will vary from case to case.

1. Active Range Of Motion (AROM) – Non-weight bearing exercises

a. Four basic foot motions – Perform the following four basic motions: plantar flexion, dorsi flexion, inversion, and eversion. Perform these foot motions slowly, holding the end range of each position for 5-10 seconds. Repeat the action several times.

b. Alphabet exercise – Use your foot to draw the letters of the alphabet in the air, allowing your ankles to rotate with each motion

2. Isometric strengthening of the ankle – Isometric exercises are performed in static positions (unlike dynamic exercises which are performed through a range of motion).

a. The Isometric Four – In this exercise, you need to resist each basic motion (plantar flexion, dorsi flexion, inversion, and eversion) of the ankle. For example:

· Start with your ankle in neutral position, with your foot braced against a wall or table.

· Then, without allowing your foot or ankle to move, try to perform each of the four basic actions. This causes all the muscles involved in the action to contract.

· Hold this contraction for 5-10 seconds and relax for about 10 seconds.

· Repeat this process for 4-8 repetitions, slowly increasing the number of repetitions.

· Repeat this routine for each of the four basic actions.

3. Resisted Strengthening of the Ankle – using Theraband or Tubing

a. Four-Way Resisted Tubing – In this series of exercises, we recommend using a theraband or tubing as you perform each of the four basic ankle motions. For example, with the inversion action:

· Attach a theraband around your ankle and attach the other end to a table or door.

· Against resistance, roll your foot inward (invert your ankle) and hold for 3 to 5 seconds.

· Repeat for 10 to 15 repetitions, increasing the number of sets from 1 set/day to 4 sets/day as you increase your ankle strength.

· Repeat this routine for each of the four basic ankle actions.

4. Partial Weight Bearing Ankle Exercise

a. Shifting Your Weight – In this exercise, lean against a counter or table, and try shifting some of your weight onto the injured leg. Start with just a few seconds of weight, and then increase this time, as the ankle permits. Repeat this exercise about 10 times. Be careful not to do too much, too soon.

5. Full Weight Bearing Ankle Exercises

Once the injured ankle is able to bear the full weight of your body, there are many exercises that will help to further strengthen the ankle. One of my favorites is the Eccentric Calf Raise.

Eccentric Calf Raises - One Legged
(Actually…these are calf drops, not raises)

In this exercise, the rising up portion is not that important. The key lies in the slow lowering of the body, as this builds strength without causing further injury to the body.

· Stand on the edge of step or curb, heels hanging over the edge of the step, and rise up on both legs in a classic calf raise.

· Now, using only one leg, slowly drop down to the starting position for a count of three

· Do 5 to 15 repetitions in each set. Start with two sets and gradually increase to 4 sets as your ankle strength increases.

· Allow your ankle to build up its strength slowly. Do not increase your repetitions and sets until you can complete each repetition with perfect form, and without pain.

Once you are able to properly perform full weight bearing exercises, you should consider beginning a routine that exercises your full body. These exercises should activate the knee, hip, and core.

Restoring Flexibility to the Ankle

It is extremely important to stretch after experiencing an ankle injury of any kind. During the recovery phase, your body forms and lays down collagen to repair the injured area from two days, and up to 6 weeks after, the injury occurs.

If you suffer from an inversion sprain, and perform thecorrect stretching exercises, then you can ensure that the majority of the collagen that is being laid down, is being laid in the same direction as the tissue which is being repaired.This makes the repaired tissue stronger and more capable of performing its function in the future. However, if you do not stretch the injured area, the new collagen will be laid down in more random patterns, leading to the development of weaker tissue (scar tissue) that is easily re-injured

Here are some of the areas for which we recommend stretching exercises when our patients are recovering from an ankle injury:

• Calf muscle (gastrocnnemius and soleus) - Stretch the calf muscle as it often becomes very tight after an ankle sprain, as these structures try to protect the injured joint.

• Peroneal muscles – Stretch the peroneals (along the sides of your calf) as these muscles are often injured along with the ligaments in the ankles.

• Iliotibial Band – Yes, these tissues are in your upper leg, but there are direct fascial connections from the peroneal muscles into the IT band. A injury to the peroneal muscle may cause compensation injuries up into the IT Band. So be sure to perform stretches to release the IT Band.

• Gluteal muscles – Since the IT band is formed from the deltoid complex (gluteus maximus, gluteus medius, and tensor fascia latae, problems in the IT band willaffect hip function. So it is important to release the muscles of the gluteals with stretches and foam rollers.

Proprioceptive Training

Whenever an inversion sprain occurs, the injury is usually not restricted to just the ligaments, tendons, muscle fibers, and fascial fibers. Often, the embedded neurological structures within these soft-tissue structures are also damaged. These neurological structures (golgi tendon organs, muscle spindles, and joint receptors) perform an essential role in positional control. Any damage to these structures can have the effect of decreasing stability, which can lead to chronic ankle problems.

Fortunately this damage can be repaired with exercise protocols that involve balance and proprioception. Some of the proprioceptive exercises we use with our patients at the clinic are:

• One-legged Stand

This is a good initial exercise to try, with a slow progression into partial single leg squats. Do all of this exercise within a pain free range-of-motion.

• Wobble board training

Slowly increase the difficulty of wobble board exercises from the two-legged balance exercises, into a single-leg exercise that combines full-body motions. Once you are ready, you can even try the single-legged version with your eyes closed. Note: The eyes-closed version should only be attempted after you are fully recovered and you are ready to work on increasing athletic performance.

· Upside Down Bosu Ball

The Bosu Ball is a great device for dynamically stretching and strengthening the ankle. Try this Side-to-Side Peroneal Stretch.

§ Turn the Bosu Ball upside down, balance on the flat surface, with your feet about shoulder-width apart.

§ Shift your weight to the right side so that the right edge of the Bosu Ball almost touches the ground. Then immediately shift your weight to the left side so the left edge of the Bosu ball almost touches the ground. Continue to shift from side-to-side. As you do this exercise, you should feel a stretch in the muscles along the lower outside of your leg (peroneals).

§ After a few minutes of performing this action your lower extremity muscles should start to feel fatigued.

§ Once you become comfortable with balancing the side-to-side actions, you can start integrating arm actions into this exercise. As you shift your lower extremity to the right side, swing both your arms to the left. When you shift your weight to the left side, swing your arms to the right. This simulates a downhill skiing (cross crawl) type of action that integrates all the muscles of your body.

Sport Specific

If you are involved in a particular sport, take the time to create a balance/proprioceptive exercise that matches your specific sport. For example:

· If you are a soccer player who is rehabilitating a sprained ankle, you may want to try one-legged stand on the injured ankle, while kicking a soccer ball with the other foot. To increase the level of difficulty, try standing on a balance pad with the injured leg, and then kick the ball with the other.

· If you are a dancer suffering from an inversion sprain, try moving through your basic dance positions while on a wobble board or balance pad.

· If you are a basketball player, try standing on a wobble board with the injured leg and practice throwing hoops.

Be creative with your individual sport. Use wobble boards, balance pads, half-foam rollers, or bosu balls to rehabilitate the damage to your nervous system that is caused by an inversion sprain.

This information is derived from our Release Your Kinetic Chain Exercise Series. If you would like to more information or to purchase our books please go towww.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go towww.kinetichealth.ca.

Bottom line - inversion sprains are a common, yet complex, injury. This injury can involve multiple structures across numerous joints, and may even extend a considerable distance up the body. To correctly rehabilitate the injury, you must use an approach that takes into consideration musculoskeletal connections, the nervous system, and appropriate tissue remodeling.

Ankle Sprains - Ligaments And More

2012-01-25T13:35:00.019-07:00

An ankle sprain refers to the tearing of the ligaments of the ankle and account for approximately 40% of all athletic injuries. 85% of ankle sprains occur on the outside (lateral side) of the ankle and are known as an inversion sprain. This is the type of injury that most runners experience when they sprain their ankles. Medial ankle sprains (along the inside of the ankle) occur less frequently and are usually caused by fractures or other traumatic events.

So, why is an inversion sprain so common? You can put it down to our lopsided anatomy! The bone on the lower outside of the ankle (the lateral malleolus - distal fibula) extends further down than the bone on the inside of the ankle (medial malleolus – fibula). This difference gives the inside of the ankle (medial side) more stability than the outside of the ankle (lateral side).

At a symptomatic level, most ankle sprains appear to resolve completely without rehabilitation. In reality, ankle sprains that have not been rehabilitated correctly are usually susceptible to further injury.

Anatomy of an Ankle Sprain

The outside (lateral side) of the ankle achieves its stability from a three-ligament complex. These three ligaments are the:

• Anterior Talofibular ligament (ATFL)

• Calcaneofibular ligament (CFL)

• Posterior Talofibular ligament (PTFL)

In an inversion sprain, the Anterior Talofibular ligament (ATFL) is the most commonly injured. Ligaments in the ankle are named according to the bones to which they connect. In this case, the Anterior Talofibular ligament connects to the talus bone of the ankle as well as to a long bone of the lower leg - the fibula. The function of the ATFL is to prevent forward (anterior) displacement of the ankle (the talus).

In a severe ankle sprain another ligament called the calcaneofibular ligament (CFL) may also be damaged. This ligament connects your heel bone (calcaneous) with the fibula. This is a stronger ligament than the ATFL, and is not damaged as easily.

Both the ATFL and the CFL are usually damaged in motions where the foot is both pointed down (plantar flexed) and rolled out (inverted). Considerable instability in the ankle can occur when both these ligaments are injured.

The posterior talofibular ligament (PTFL) is not injured very often, except when there is a complete dislocation of the ankle (talus). The PTFL is the strongest ligament in the lateral complex.

Another sprain injury that is becoming more prevalent is called a “High Ankle Sprain” (syndesmotic ligament complex). In this injury, the ligament and connective tissue between your shin bones (tibia and fibula) are torn. This is a serious injury that may require surgery to resolve.

Not Just Ligaments

An ankle sprain may also result in damage to other structures. You may also experience damage to connective tissue, tendons, muscles further up the ankle, and even to the bones (possible fractures). This is why, with a severe ankle sprain, it is important to see a medical professional who can determine exactly which structures have been injured, and then provide treatment recommendations.

Treatment of Ankle Sprain

There are a number of things you can do to treat ankle injuries.

Just After The Injury

Immediately after spraining your ankle, it is important to do everything you can to reduce the swelling in the ankle. The faster you can implement treatment, the faster you will recover. An ankle sprain injury that is addressed quickly will often resolve in short period of time. If the injury is ignored, the ankle sprain could be prolonged for extensive periods of time.

So, immediately after the injury, while still in the acute stage - use RICE - rest, ice, compress, and elevate!

• R = Rest: During this stage, it may be necessary to take all weight off of the injured ankle. In such cases, crutches are commonly used. In my opinion, it is important to quickly return to weight-bearing as soon as possible to improve healing. I have found that reintroduction of weight-bearing stresses tends to decrease recovery time. When should you do this? As soon as possible, but not too soon! Rest is also essential.

• I = ICE : See our Blog about icing. Ice for at least 20 to 30, minutes 4 to 5 times per day to reduce swelling.

• C = Compression: Compression (with an ACE wrap) reduces both swelling and bleeding. With a Grade 3 sprain, wear a brace at all times until you are able to bear weight on your ankle.

• E = Elevation: Elevating the injured area acts to reduce swelling and bleeding.

Once you have used “RICE”, it is very important to introduce motion into the ankle as soon as possible. Depending on the degree of injury, the patient could be asked to perform gentle ankle circles, or if able to do so, write the alphabet with their feet. Light calf stretching and using a stationary bicycle may also be beneficial.

If you are going to use medication (NASID’s) to reduce inflammation, be sure not to use them for more than seven days. Using anti-inflammatory medications for long periods of time inhibits tissue remodeling. See our Blog about Recommendations to Reduce Inflammation without Medication.

Manual Therapy for an Ankle Sprain

Manual therapy can make a huge difference in the recovery and prevention of an ankle sprain. By manual therapy, I am referring to techniques such as Active Release, Graston Technique, Massage Therapy, Fascial Manipulation, Manual Manipulation, and other manual procedures. In my opinion, these procedures are essential in the rehabilitation of an ankle sprain since they all act to break down and prevent scar tissue formation.

Manual therapy also speeds healing by increasing blood supply, oxygen, essential nutrients, and displace waste products that accumulate after an injury. This is especially important in treating ligaments because they generally have a very poor blood supply to begin with.

It is Important to Treat More Than Just the Ligaments

Earlier, I mentioned that there might be damage to several types of structures after an ankle sprain, especially the connective tissue, tendons, muscles, and nerves. The following is list of structures that are often injured in a lateral ankle sprain (inversion sprain).

Ligaments

• Anterior talofibular ligament (ATFL) – Most common injured structure.

• Calcaneofibular ligament (CFL) – Second most commonly injured structure.

• Posterior talofibular ligament (PTFL)

Tendons

• Peroneal tendon

o With an inversion sprain, it is common for the tendons of the peroneal muscles to be injured. It also common for the peroneal tendon to move out of its normal position (subluxate) during the recovery stage of an ankle sprain.

Muscles

• Peroneus brevis muscle – Longitudinal tears of the peroneus brevis are commonly associated with lateral ankle sprains.

• Peroneus longus muscle – These muscles often show a different activation pattern when there is ankle instability. This is often due to restrictions that have formed in the muscle. These restrictions, if not removed, could make a person more susceptible to future injuries.

Both muscles, evert the foot at the tarsal joint, and plantarflex the foot at the ankle.

Retinaculum

• Peroneal retinaculum -

o During a lateral ankle sprain, the foot rolls inwards with considerable force. This forceful action can tear the peroneal retinaculum. This retinaculum is a band of connective tissue that keeps the peroneal tendons in place. When a tear in the retinaculum occurs, patients will notice a snapping sensation in the lateral ankle. Conservative treatment is 4 to 6 weeks in a short leg cast. However, a severe tear of the retinaculum is not a candidate for standard manual therapy and may require corrective surgery.

Nerves

• Superficial peroneal nerve - This nerve is atrisk for traction injury during a lateral ankle sprain (inversion sprain).

Treating Iliotibial Band Syndrome

2012-01-23T12:52:00.010-07:00

The first thing practitioners must do in treating Iliotibial Band Syndrome (ITBS) is to take a complete history and perform a biomechanical analysis. The biomechanical analysis evaluates the patients gait and movement patterns for alteration in any normal movement. This will give the practitioner an initial hypothesis as to which structures are involved.

Then the practitioner will need to examine these areas (hands-on palpation) to confirm that there is a restriction or alteration of the tissue. The practitioner will feel an alteration in normal tissue consistency, it could feel ropy, rigid, thickened and there will often be a lack of tissue glide between adjacent structures. Once the area to be treated has been identified, manual therapy can begin. There are several forms of therapy that can achieve good results in addressing myofascial adhesions (Active Release,Graston Technique, Massage Therapy, and Fascial Manipulation).

Fascia and ITB Syndrome

When we evaluate a case of ITBS, we must also take into consideration all the fascial connections to the structures that are involved in performing and coordinating ankle, knee, and hip motion.

In the case of ITBS, some of the fascial connections we should consider are in the Lateral Line(see Anatomy Trains by Thomas Meyers).

The following is a short synopsis of the lateral line. I have also included a link to the Anatomy Trains dissection video about the Lateral Line – Thomas Meyers Lateral line Video.

Lateral Line

· Beginning at the foot with the peroneal muscles, fascial interconnections travel up the outer leg to just below the knee (fibular head). This fascia then connects directly into the lower IT band into the deltoid complex (gluteus maximus,gluteus medius, and tensor fascia latae).

· The fascia then connects to the pelvis (iliac crest), which connects into the abdominal muscles (internal and external obliques), and then into the quadratus lumborum which connects into the ribs and the spine.

· The fascia then travels up between the ribs (intercostals muscles) and continues up the body to connect into the fascia of the neck (SCM, splenicus cervicis, andscalenes).

Once you see these videos, you will find it very hard to dispute the importance of these fascial connections.

Bottom Line: You can try treating ITBS with all the right techniques (ART, Graston, Massage etc.) and find that you still have not resolved a chronic ITBS problem if you do not consider, and treat, the fascial interconnections.

The key is to any therapy is to address any structure affecting movement patterns in the kinetic chain.

What ever the form of treatment it must be specific and based upon the individual requirements of each person. Treatment should not be a cookbook approach. Practitioners need to find the specific tissues that are restricted or thickened and physically work them back to their normal consistency.

Exercise is Essential

Often getting professional help in the way of manual therapy is essential to get a complete resolution of ITBS, but just as important is exercise. Without the right exercise program the probability of this condition returning is very high.

There are three important areas which must be addressed when prescribing exercise routines for ITBS, strength, flexibility, and balance.

Why strengthening exercises are essential:

Every time you injure yourself, your body lays down new tissue to repair itself. The new tissue is initially very fragile, thin, and easily torn or re-injured. Strength or weight training places stress upon these new tissues, causing them to go through a process of remodeling. In this process, the new tissue literally converts from one type of collagen to a different type which is up to 10 times thicker and 10 times stronger. However, this collagen conversion only occurs when you apply continued stress upon the tissue as you do in weight- and strength–training exercises.

Exercise example: Because the iliotibial band is formed from the deltoid complex, having strong balanced hips is essential for a full resolution of ITBS. One of my favorite exercises to increase hip strength is the Bulgarian Split Squat.

Why Flexibility exercises are essential:

During the regenerative or repair phase of an injury, your body creates and lays down collagen to repair the injured area. When the injured person performs the correct stretching exercises, the majority of new tissue will be laid down in the same direction as the tissue that is being repaired - thereby allowing this tissue to properly perform its function.

Exercise example: We suggest that patients combine stretching with self myofascial release (foam rollers). The following is an example of an ITB stretch, and a foam roller video you will find very useful.

Why balance exercises are essential:

Proprioceptive or balance training is a fundamental requirement that should not be ignored in Rehabilitation Therapy. Your ability to balance depends on feedback from your auditory, visual, proprioceptive (sense of body position), and vestibular systems (relating to the sense of equilibrium). All of these systems must be trained to achieve optimal results. As with all injuries your nervous system is often affected. Training these systems, ensures a greater chance of a complete recovery.

Hamstring Injuries - Myofascial Considerations

2012-01-23T12:40:00.008-07:00

Fascia is everywhere, weaving through, and interconnecting every component of our body.

Muscle fibers originate from, and insert into, fascial fibers. These fascial fibers, in turn, insert into multiple regions of the bone, and even into adjacent muscles. These additional points of contact and control provide the muscle with the ability to generate force in multiple directions.

Only certain sections of the muscle contract when performing an action. Force is not generated from just the origin and insertion points, but also through the numerous fascial connections.

Muscles work together as functional units that coordinate their actions across multiple joints. Depending on the degree of motion required, and amount of force that is needed, each muscle will contract only specific areas of the muscle, rather than the entire muscle. These very specific motions are largely coordinated by the neurological receptors embedded in the fascia, and not by the brain.

Fascia is full of two types of neurological receptors -mechanoreceptors and proprioceptors. A mechanoreceptor is a sensory receptor that responds to mechanical pressure or distortion. A proprioceptor is a sensor that provides the brain with information about joint angle, muscle length, and tension.

Motion is coordinated by the feedback of the neurological receptors in the fascia when tension is transferred from one area to the next. (Previously these receptors were only thought to be located within just the muscles).

Fascial Lines and a Hamstring Injury

When we evaluate a hamstring injury, we must also take into consideration all the fascial connections to the structures that are involved in performing and coordinating motion. It is important to look at the big picture, and take into consideration that multiple muscles, working across multiple joints (all of which are interconnected by fascia) are all required to coordinate these motions.

In the case of a hamstring injury, the fascial connections we should consider are in theSuperficial Back Line (see Anatomy Trains by Thomas Meyers). The following is a short synopsis of the posterior line. I have also included a link to the Anatomy Trains dissection video about the posterior line – Thomas Meyers Superficial Back Line Video.

Superficial Back Line

Beginning at the bottom of the foot with the plantar fascia. This fascia passes over the heel bone (c alcaneus) and inserts into the Achilles tendon.
The Achilles tendon is formed by the calf muscles (Gastrocnemius and Soleus). There are direct fascial connections into the hamstrings.
There are fascial connections directly into the sacrotuberous ligament, which runs into the sacral fascia.
Connections from the sacral fascia run directly into the back muscles (erector spinae) from the low back (lumbar spine) up through the mid back (thoracic spine) into the neck (splenius and semispinalis capitus).
Fascial connections then continue up the neck to the fascia on the skull (nucal line). This continues along the scalp fascia to the forehead just above the eyes.

Once you see these videos, you will find it very hard to dispute the importance of these fascial connections.

Bottom Line: You can try treating a hamstring injury with all the right techniques (ART,Graston, Massage etc.) and find that you still have not resolved a chronic problem you need to consider, and treat, the fascial interconnections

Functional Hamstring Exercises

2012-01-23T10:06:00.007-07:00

It is very important that the hamstrings are trained in same manner that they function during real life activities. The hamstrings work in synergy with multiple muscles and do not act as a singular isolated muscle. For example, to mimic hamstring muscle function during running the hamstrings need to be training in both open and closed kinetic chain movements. Closed chain exercise will mimic the stance phase of running, and open chain exercises can mimic the swing phase of running (eccentric actions).

Closed kinetic chain exercises – These are exercises where, in the case of the lower extremity, the foot is in constant contact with the ground. Examples would be: Lunges, squats, dead lifts, power cleans. These exercises focus on the co-contraction of multiple groups of muscles at the same time. They also involve multiple joints at the same time: those being the ankles, knees and hips.

Open kinetic chain exercises – These are exercises where the leg/foot is free to move and is not in contact with a surface. These exercises are usually non-weight bearing.

Numerous researchers recommend that your hamstrings should be 60 to 80% as strong as your quadriceps.

Strengthening Your Hamstrings

Strengthening your hamstrings is an essential component in reaching a full recovery from an injury. These are only a few of the strengthening exercises we recommend to our patients.

Romanian Dead Lift - This is a great closed kinetic chain exercise for training the hamstrings in eccentric contraction. Starting with low loads, for rehabilitation training, then building up to higher levels for athletic training.

· Stand straight with your lumbar spine in slight extension, with a barbell or dumbbells in your hands. Feet should be shoulder width apart, legs are straight, but not hyper extended.

· Flex forward from the hips moving the barbell or dumbbells down the front of your legs. Do not bend your knees all motion needs to come from the hips.

· As you lean forward, the hamstrings will lengthen, placing them under considerable eccentric load.

· Continue to lower the weight until you can no longer hold your back in the extension position. This will probably be when the weight is at the middle of your shins.

Single Leg Dead Lift – This is a similar exercise to the Romanian dead lift but is performed one leg at a time holding a dumbbell with both hands.

· The same procedure is used except that the back leg can be raised off of the ground for balance

B – Skip Drill

This is a common running drill that is great for strengthening the hamstrings (pawback). Follow this link to view a video on how to perform B-Skips. When doing this exercise, emphasis should be placed on pawing and driving the hip through. (Youtube Video of B-Skip Drill).

Stretching Your Hamstrings

Stretching after a hamstring injury is extremely important. Initially, stretching may have to be done passively within a pain free range of motion. To get a better idea of why stretching is so important, consider this. During the first two days to six weeks after an injury, collagen is formed and laid down to repair the injured area. If an injured person is performing the correct stretching exercises, the majority of the collagen will be laid down in the same direction as the tissue being repaired. This makes the repaired tissue stronger and more capable of performing its function. If the individual is not stretching, the tissue will be laid down in more random patterns, leading to the development of weaker tissue that is easily re-injured (scar tissue).

A word of caution, be careful not to be too aggressive with stretches after an injury. Do not stretch past the point of mild discomfort, doing so may delay healing and cause further injury.

Psoas Stretch

The psoas is a very important muscle to stretch if you have had a hamstring injury or wish to prevent one from occurring. There is an antagonistic relationship between the psoas muscle and your gluteal muscles. Essentially when the psoas become short and contracted it turns off your glute muscles. Your glutesand your hamstrings are your primary hip extensors. Therefore when your glutes get turned off, more of the load is placed on your hamstrings which then become susceptible to injury.

There are several ways that you can stretch out the psoas with either static or dynamic stretches.

Psoas Stretch: Core performance video on dynamic psoas stretch

Note: that after the psoas muscle is stretched out the gluteal muscles should be worked to regain activation of the muscle. This will help to take stress off of the hamstring.

Balance and Proprioceptive Training

Whenever a sprain/strain injury occurs it is not just the ligament, tendon, or muscle fibers that are damaged. Often, the embedded neurological structures within these soft-tissue structures are also damaged. These neurological structures (golgi tendon organs, muscle spindles, and joint receptors) are essential for postural control.

Both Golgi Tendon Organs and Muscle Spindle Cells are sensory neurons(proprioceptors). Sensory neurons monitor muscle and tendon motion (contraction and stretching) and relay this information back to your brain. This creates a feedback loop system that allows your body to discern its position and postural orientation. Joint receptors are located in joint capsules and respond to deep pressure and to other stimuli such as stress or change in position. They are also part of your body’s neurological feedback loop system.

What appears to be just a simple hamstring tear often involves some damage to several neurological structures. The good news is that the nervous system is very good at repairing itself given the right type of exercises.

That is why every patient that comes to us for a hamstring tear is also given exercises that involve balance training. Balance training helps to repair neurological damage, substantially decreasing the chance of re-injury

For more information, go to www.releaseyourbody.com. If you would like information about our clinic please see www.drabelson.com.

References

Boyle M. FunctionaL Training for Sports. Human Kinetics 2003. ISBN 073604681X.

CooperDL, Fair J. Trainer’s corner: hamstring strains. Phys Sports Med1978; 8: 104.

Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM. Hamstring Muscle Strain Recurrence and Strength Performance Disorders. Am J Sports Med 2002; 30(2) : 199-203.

Garett W. The management of muscle strain injuries: An early return versus the risk of Recurrence. Clin J Sport Medicine 2002 12;3-5

Heiser T, Weber j, Sullivan G et al prophylaxis & management of hamstring muscle injuries in intercollegiate football players. Am J sports med 12 : 368-370, 1984

Jonhagen S, Nemeth G, Eriksson E. Hamstring Injuries in Sprinters: The Role of Concentric and Eccentric Hamstring Muscle Strength and Flexibility. Am J Sports Med 1994; 22(2): 262-266.

SafranMR, Seaber AV, Garrett WE Jr. Warm-up and muscular injury prevention: an update. Sports Med1989; 8: 239–249

SlocumDB, James SL. Biomechanics of running. JAMA1968; 205: 721–728.

Activating Your Hips

2012-01-22T21:51:00.003-07:00

A great deal of your core stability actually comes from your hips... an essential part of your kinetic chain and certainly not the part of your body that most of us would associate with dysfunctions and problems in your extremities (neck, shoulders, arms, hands, legs, feet, etc.).

Your hips also act as shock absorbers when you walk, run, or perform any action involving your legs. When your hip capsules and the muscles surrounding them move easily and freely, your body is able to store and release the force/energy generated when your feet strike the ground.

In contrast, a lack of hip motion (due to restrictions in either the hip capsule or the hip muscles) will often cause excessive force to be directed into the lower back and knees. This lack of force dissipation results in your body making compensations from your lower back into your neck and shoulders and can cause a series of chronic injuries.

This type of compensation is often seen in golfers who suffer from chronic shoulder injuries due to a lack of hip motion. Every time the golfer swings, he or she has to over-compensate for their restricted hip with excessive rotation of their shoulders. This usually results in neck, shoulder, and sometimes even jaw pain! Sound familiar?

Another major problem that occurs in conjunction with hip restriction is osteoarthritis. Restrictions in your hip prevent proper dissipation of force. Ideally this energy is stored and released with normal leg motion. However if, due to restrictions, the head of your femur (leg bone) is jamming directly into your pelvis (socket joint), you will see excessive wear and tear of the hip joint. This eventually leads to osteoarthritis, and in some cases, to a preventable hip replacement.

Basically if your hips are restricted, your body will compensate for this lack of motion by creating excessive motion in other parts of your body. Stress in your low back (due to lack of hip motion) causes compensations all the way back up to your shoulders and your neck.

The key point is that hip restrictions are often a contributing factor for many injuries which are distant from that area.

Shaping Your Glutes

2012-01-21T18:13:00.014-07:00

One of my patients the other day asked me what she could do to target her glute muscles. I told her that the best strategy was to do an overall full body workout. But I also gave her a specific exercises that works reallly well to strengthen and shape the glutes. This exercise is called the "One Leg Split Squat or Bulgarian Split Squat".

Click this line to play the video...

One Leg Split Squat or Bulgarian Split Squat

The one leg split squat or Bulgarian split squat is an excellent exercise for activating the glutes (external hip rotators). Besides shaping the glutes this is a key exercise in rehabing back, hip, knee, ankle and even foot injuries.

Working within your Aerobic and Anaerobic Zones

2012-01-20T12:58:00.005-07:00

Your warm-up, like all initial aerobic activity, needs to be performed within your aerobic zone. This is the range within which you want your heart to operate while you are performing your aerobic exercise. Think of your aerobic zone as the base which you must first establish for rehabilitation, and also for moving into the higher levels of performance in your chosen activity.

Calculating your aerobic zone - Use the following formula to calculate your aerobic zone

1. Subtract your age from the number 220.

For example, if I am 40 years old, then 220 - 40 = 180

2. Obtain the low end of your aerobic range by multiplying the result of step 1 by 0.6.

In our example: 180 * 0.6 = 108 3.

3. Obtain the high end of your aerobic range by multiplying the result of step 1 by 0.7.

In our example: 180 * 0.7 = 126

This is your aerobic heart rate zone within which you need to work to develop your aerobic capacity. It is the zone which will best speed your recovery from an injury. If you work above this zone you run the risk of injury. If you work below this zone, you will not achieve the maximum benefits provided by your aerobic warm-up.

Calculating your anaerobic zone - Calculate the ideal heart-rate for your anaerobic zone by using the following procedure:

1. Subtract your age from the number 220.

For example, if I am 40 years old, then 220 - 40 = 180.

2. Obtain the low end of your anaerobic range by multiplying the result of step 1 by 0.8.

In our example: 180 * 0.8 = 144

3. Obtain the high end of your anaerobic range by multiplying the result of step 1 by 0.85.

In our example: 180 * 0.85 = 153

This is your anaerobic heart rate zone within which you need to work to develop your anaerobic capacity. It is the zone which will best assist in increasing muscle mass, speed healing, and increase immunity to disease.

Interval Training and Anaerobic Zones

Interval training is the classic method for increasing your anaerobic zone. There are many books, references, and sports specialists who can help coach you through this process.

Find a good program that works for you and keep the following tips in mind as you start interval training:

Before doing any type of interval training, always warm up for at least 10 to 15 minutes within your easy or low aerobic zone.
Train within your anaerobic range for a maximum of 3 minutes.
Then return to your 0.6 to 0.7 (aerobic) level for five to seven minutes.Your heart rate should return to this 60%- 70% range when you are doing your aerobic training. If it does not, consider this to be an indication that you need to spend more time developing your aerobic capacity.

Note: I highly recommend purchasing a heart rate monitor if you are going to work on increasing your aerobic capacity. They are well worth the investment.

This information is derived from our Release Your Kinetic Chain Exercise Series - Shoulder To Hand. If you would like to more information or to purchase our books please go towww.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go towww.kinetichealth.ca.

Focus on Core - Front-to-Side Bridge

2012-01-19T11:05:00.001-07:00

This exercise is excellent for strengthening your core and improving your neuromuscular responses. The key is to keep your core braced throughout this routine by bracing your rib cage to your pelvis. Do not allow your core to bend as you roll from one shoulder to the next. The Front-to-Side Bridge is an exercise that combines the movement patterns of both the front and side bridge, and acts to stabilize the shoulder, core, and lower extremity.

Click on the image to view instruction on how to perform this exercise…

Release Medial Epicondyle on Foam Roller

2012-01-18T00:40:00.005-07:00

Many golfers suffer from Golfers Elbow, caused by tightness in the medial aspect of the elbow. This myofascial release of the medial epicondyle will help you to avoid this syndrome. For best effect, accompany this exercise with the other forearm and elbow foam roller exercises in our shoulder to hand book.

Click on image for instructions on how to perform exercise...

Benefits of Cardiovascular Exercises

2012-01-16T11:10:00.002-07:00

Cardiovascular or aerobic exercises provide huge benefits to your circulatory, respiratory, and immune systems. Aerobic exercises play a key role in speeding healing, increasing performance, preventing degenerative conditions, and even preventing numerous types of cancer.

Weight-bearing exercises such as running and walking strengthen not only your muscles, but also your skeletal system, and help to decrease the risk of osteoporosis and other age–related diseases.

Aerobic or cardiovascular exercise is all about increasing your aerobic capacity, improving circulatory function, and increasing energy production. Aerobic exercise does this by increasing the density of capillaries in your muscles and by increasing the level of mitochondrial function in your cells. When you have more capillaries, your cells are able to obtain more nutrients for repair and work, and are able to get rid of waste by-products much more rapidly.

Your mitochondria are the principal energy producers in your cells. Mitochondria convert nutrients into ATP (adenosine triphosphate), a readily–metabolized form of energy used by all living cells. The more energy you have, the easier it is for your body to heal itself and power all the tasks you must perform each day.

Aerobic exercises also promote the loss of excess fat and increases your metabolic rate. In addition, aerobic exercises increase the sensitivity of your cells to insulin, and help your body to better regulate its sugar levels. This is very important for all of us to keep in mind since over 7% of our population now suffers from diabetes; and with increasing rates of obesity, more people are at risk than ever before.

Anaerobic exercise (exercising with reduced blood oxygen levels) is also very important for performance or athletic training. Just like weight training, anaerobic training also promotes the production of Human Growth Hormone (HGH). Research has shown that short intense bursts of anaerobic activity produces high levels of lactic acid. In a high–lactic acid environment, your body increases production of HGH. This means that when we combine anaerobic activity with weight training, we can substantially increase our HGH levels. Bottom line: we will be stronger, leaner, fitter, and healthier.

You should include at least half an hour to forty-five minutes of walking and running in your daily exercise regime. If your schedule is too busy for daily walking, then try to ensure that you walk or run vigorously at least three to four times a week.

Russian Twist with Medicine Ball

2012-01-15T01:55:00.006-07:00

Great exercise to help you perform actions that require stabilization of your upper extremity on your torso, such as a golf swing. This exercise really works and strengthens the rectus abdominis, external and internal oblique abdominal muscles, and the transversus abdominis.

Click on the image for instruction on how to perform this exercise.

This information is derived from our Release Your Kinetic Chain Exercise Series - Shoulder to Hand. If you would like to more information or to purchase our books please go towww.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go towww.kinetichealth.ca.

Aerobic Warm-Ups and Injury Resolution

2012-01-13T13:29:00.007-07:00

It may sound a little strange when we tell you to “warm up” your entire body, especially when you feel that your pain is localized in one area like your jaw, neck, or shoulder, and you just want to get started on resolving that particular issue.

But this initial aerobic workout (lasting for 10 to 20 minutes) is one of the first things you should do before you ever begin working on your injured or restricted areas, and definitely before you begin any exercise routine.

Improving Cellular Function with Aerobic Exercises

Aerobic exercise is the fastest way to increase the strength and function of your cardiovascular system. By increasing the density of capillaries, you are able to get more nutrients into your muscular tissue, thereby helping them to heal and perform better.

The increased density of capillaries means that you are better able to eliminate the waste by-products of healing and metabolism from your cells, again allowing them to perform more efficiently.

Aerobic exercise also increases the function of mitochondria in your cells. This increased mitochondrial function immediately boosts your body’s ability to generate power and energy since your mitochondria are the principal energy generators for your cells.

Mitochondria convert existing nutrients into ATP (adenosine triphosphate), a form of energy that is readily usable by all the cells in your body. Your body uses this energy to perform all of its functions – from healing existing injuries, to eliminating waste, to powering your muscles when you walk, talk, or perform any action.

As we age, or when we injure ourselves, our ability to produce ATP decreases. Exercise is one of the few factors that will naturally increase ATP production to give you increased energy.

Aerobic Warm-Ups how they helped resolve my injury!

I have had a personal experience that showed me the importance of cardiovascular warm-ups as they relate to recovering from an injury.

I am speaking about an injury for which most people would never perform an aerobic workout. A few years ago I suffered from a severe case of Bell’s Palsy (weakness of the nerve that innervates and controls the muscles for facial expression) on one-half of the face.

Bell’s Palsy left me with the muscles of one-half of my face paralyzed and expressionless. I was told it would take 3 to 6 months before normal nerve function would be restored!

I was unwilling to live with this condition for that long and immediately researched means for reducing this time frame. One of the first things I did after getting Bell’s Palsy was to get on my road bike/wind trainer for at least 20 to 30 minutes each day. I followed this up with TMJ massage and a variety of jaw, neck, and shoulder exercises.

To everyone’s amazement, I recovered fully, with complete neuromuscular control of the muscles in my face, within about a month. I am convinced that my daily aerobic exercise is one of the major reasons I got over this condition in about a third of the normal time. The aerobic exercises I did every day resulted in increased circulatory function and improved mitochondrial activity (energy production)!

So take the time to do your aerobic warm-up before doing rehabilitative exercise programs...you will be amazed at the difference it makes in your healing, recovery, power, and strength development!

So What is a Good Warm-up?

A good warm-up should include all the large muscles of your body and include movements that increase your heart rate and breathing. This is a good opportunity to listen to your body, and recognize any injury, tight spots, or restrictions that you may have to accommodate during your exercise routine.

Go for a brisk 10–to–20 minute walk. Make sure you move your shoulders and swing your arms. Good upper extremity motion takes the stress off your back and helps you to store and release energy from your core. Don’t walk at a slow pace, this will not achieve the desired results and is actually quite hard on your back compared to brisk walking.
Jog, or run for 10 to 20 minutes. If you are not a runner, start with a brisk walk interspersed with a few short jogs. If you are a runner, make sure you maintain a good upright posture with good shoulder movement, and make sure you land on the middle of your feet. No toe or heel running as this deactivates your gluteals and causes a lot of other problems. Treadmills are fine but do not increase your elevation too much.
Swim for 20 minutes. If you are doing the front crawl, make sure you breathe from both sides. You don’t want your warm- up to create neuromuscular imbalances because you breathe from just one side of your body.
Use an elliptical or ski machine for 10 to 20 minutes. Both are good for reinforcing a cross-crawling pattern, which helps establish good neuromuscular control, as well as for warming up all the big muscles of your body.
Ride a stationary bike for 10 to 20 minutes. This option is not my first choice due to the lack of motion in the upper extremity. In terms of bike types, I prefer the use of upright bikes much more since you can maintain better posture, especially if you have a history of back pain.
Hula-hoop for 5 to 10 minutes. Most people may not think of this as an aerobic exercise, but it is! The hula-hoop is not only a lot of fun, but it is also a great way to learn how to properly brace your core – a key concept in core stability.

Massaging Trigger Points in Your Hand or Feet

2012-01-10T22:23:00.005-07:00

Trigger points are tender points in your muscles where you will find palpable nodules in tight muscle fibres. These are areas where blood flow has decreased, lactic acid has built up, and muscles have tightened up to form “knots” or “nodules” of tissue.

There are two types of trigger points - Active and Latent. When you compress an Active Trigger Point, it will refer pain to other areas of your body. Compression of a Latent Trigger Point will only cause pain at the point of compression, but will not refer pain. Trigger point massage focuses upon releasing the tightness in these hyper-irritable sports.

Use of a golf ball to apply pressure upon the trigger point to release the restrictions.

Apply Trigger Point Therapy

Roll the golf ball in firm, circular motions across the area for 10 to 20 seconds.

When you find an area that is particularly tender, use the golf ball and work this area for an additional 20 to 30 seconds until you feel a softening of the trigger point.

Monitor the level of pain on a scale of 1 to 10 (where 10 is excruciating pain). Do not exceed a level seven pain.
Ask yourself, “Would I be willing to do this again tomorrow?” If not, you are pressing too hard, so back off on the pressure.
Don’t be aggressive with your therapy.
Be consistent with your therapy. Perform the trigger point therapy
several times a day.

Click on the image for an example of how to perform this type of protocol.

TMJ/Jaw Exercise - Clicking Your Tongue

2012-01-09T20:43:00.008-07:00

A common issue with jaw and TMJ problems is the movement of the jaw and tongue away from their normal neutral, resting position.

The tongue-clicking exercise (funny as it sounds) helps to return your jaw back into its resting position and restores normal nasal and diaphragmatic breathing. Once you are able to establish this alignment, you should continue to keep your tongue in this neutral position (tongue positioned against your hard palate) as you go about your daily living activities.

Click on the image to view exercise instructions...

This information is derived from our Release Your Kinetic Chain Exercise Series - Jaw to Shoulder. If you would like to more information or to purchase our books please go towww.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go towww.kinetichealth.ca.

Athletic or Performance Training

2012-01-09T13:38:00.007-07:00

Athletic performance training is all about speed, power, and strength, which in turn are based on the development of superb neuromuscular control. Great neuromuscular control (the training of your nervous system to perform a task) is what defines the world’s best athletes – not strength or muscle size. There are some similarities (as well as some huge differences) in the objectives of rehabilitative exercise and athletic or performance training. In both, the development of neuromuscular control remains critical.

Athletic or Performance training has greater risks than rehabilitation training. Athletic training often involves riding the fence between overloading the body (to increase strength and power) and reaching the point of tissue failure (injury). With Performance training, there is always a greater chance of injury.

Athletic or Performance training differs from rehabilitative training in its:

Increased risk of injury.
Need to work through muscle pain.
Need to increase resistance to the point of overloading the muscles.
Requiring speed training.
Development of the anaerobic system.

Principle 1: Athletic Development is Not the Same as Body-Building!

Exercise programs that focus only on increasing muscle size serve to meet body-building objectives of increasing size and definition and have very little to do with improved athletic performance or improved body function.

Athletic Performance training typically focuses upon developing your speed, power, and strength. To achieve this goal, you must establish good muscle endurance, good motor control, and superb neuromuscular responses. This is very different from body-building which focuses primarily on increasing the size and bulk of your muscles.

Exercise programs that focus only on increasing muscle size by isolating specific muscles (weight training with machines) often result in muscular imbalances, soft tissue injuries, and an overall decrease in performance. This is one of the reasons we do not recommend the use of exercise machines (other than cable machines) in any of our routines.

Look for athletic training programs that integrate elements of strength, endurance, speed, and power. These are the ones that will be most helpful in increasing your performance.

Principle2:GoodTissueQuality = Good Performance

In sports performance, the quality of your soft tissue is a key element that cannot be ignored. When you improve the quality of your tissue (no restrictions, adhesions, or tightness) then you will reap the rewards of faster recovery, increased speed, improved range of motion, more strength, reduced injuries, and improved performance.

Your muscles are like rubber bands. When there are no knots (restrictions) in them you can easily store and release your energy. This directly translates into improved performance. This is why soft tissue techniques such as Active Release Techniques have helped take Olympic athletes to gold medal status. These types of techniques improve the overall quality of your soft tissues.

Bottom line: When you ignore the quality and state of your soft tissues, then you are taking the path of diminished performance! So, if you have restrictions and tight spots that are not resolved by exercising, then take the time to work these restrictions out by using our myofascial techniques (foam rollers, tennis balls, self-massage) or see a skilled soft tissue practitioner for help in restoring your soft tissue quality.

Principle3:Some Muscle Pain is Okay

With performance training, it is often necessary to work through your muscle pain.

I am often asked the question, “How do I know the difference between acceptable muscle pain and injury pain?”

Muscle pain from exercising will usually diminish with time, but pain from an injury will not. I tell my patients that they should never work an area if they feel constant pain even when they are not exercising.

Pain from an injury is usually quite distinctive with sharp, stabbing sensations – or much more intense than normal muscle pain. It is also common to have injury- related pain increase with physical activity.

If you are injured, you need to return to a rehabilitative approach in your exercise program (for the affected structure). Working through injury-related pain is a sure way of continuing the injury or creating even more severe problems. See our blog on rehabilitative training.

Principle 4: Develop Your Aerobic Zone Before Working on Your Anaerobic Zone

Anaerobic training (where your tissues are working with reduced oxygen levels) is an essential aspect of performance training. However, as we mentioned earlier, you must first establish a good aerobic base before you can even consider beginning your anaerobic training.

Athletes who fail to train their aerobic base to a sufficient level before embarking on anaerobic training (intervals) can find themselves dealing with soft tissue injuries, diminished energy, slow healing, and even decreased performance levels.

The anaerobic or lactate system is very different from your aerobic system since it only operates for 5 seconds to about 2 minutes. This anaerobic system is very efficient at producing power, but it also produces a considerable amount of waste by- products.

Do not start anaerobic training until you have established and maintained your aerobic base for several months. Once you start anaerobic training, your Lactate Threshold is established as you move back and forth between your aerobic and anaerobic systems. Your goal is to increase your anaerobic capacity (Lactate Threshold) since this will allow you to train for longer periods of time (within your aerobic zone), at faster speeds, and with greater intensity. A higher Lactate Threshold will also allow you to recover faster.

Medicine Ball Wood Chop

2012-01-08T18:52:00.009-07:00

This dynamic exercise simulates the action involved in chopping wood. It develops core strength, improves speed and reaction time, and increases your neuromuscular control. This is a great exercise for improving your golf swing.

Click on image to view specifics of this exercise...

Having TMJ problems, try this exercise...

2012-01-07T21:23:00.009-07:00

Activate Masseter Trigger Points

The masseter muscle is responsible for the stabilization of the TMJ. This self-massage technique works on specific acupuncture points, and is very effective for reducing tension in the masseter muscles, increasing range of motion, and helping to eliminate trigger points in the tissues. Besides treating TMJ, this technique is also used in Traditional Chinese Medicine to relieve jaw spasms, reduce toothaches, facial pain, and treat Bell’s Palsy.

Click on the image to perform this exercise...

This information is derived from our Release Your Kinetic Chain Exercise Series - Jaw to Shoulder. If you would like to more information or to purchase our books please go to www.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

Your Shoulder’s Kinetic Chain

2012-01-06T13:35:00.009-07:00

Your shoulder’s kinetic chain is made up of a complex series of related structures (links) which connect your shoulders to your neck, arms, core, hips, and lower extremities. These connections include muscles, ligaments, tendons, and connective tissues.

Your shoulder is a truly amazing piece of engineering. When functioning correctly, force and energy are easily transferred from your hips and lower extremity, through your core, and into your shoulders.

But, as remarkable as these interconnections are, they can also be the root cause of many chronic dysfunctions. That is why our exercise routines focus on key areas of power transference with a focus on whole-body stability.

As we discussed earlier, your body’s kinetic chain can be viewed as a synergistic chain of links. When one part of the link goes down, the whole chain loses function.

To understand this principle as it relates to your shoulder, let us consider one of these links — the Latissimus Dorsi muscle.

Normally, the latissimus dorsi functions to extend your arm, adduct your arm (bringing your arm towards the centre of your body), and internally rotate your arm at the shoulder joint.
The latissimus dorsi originates at the crest of your pelvis (iliac crest), connects to the spinous processes of the thoracic vertebrae (T7 to T12), and inserts into your upper arm (intertubercular groove of the humerus) as part of the shoulder complex.

Because of the latissimus dorsi’s numerous attachment sites, any restriction in this muscle has the potential to cause problems from the hips right up to the shoulder. Restrictions anywhere along this path can result in reduced shoulder function. Yes, we recognize that it is strange to imagine that a restriction in your hip is contributing to all those shoulder problems, but it occurs quite often. Once you understand these kinetic chain inter-relationships, it becomes obvious why exercise and treatment recommendations need to focus on much more than strengthening or stretching isolated muscle groups in just the shoulder joint.

This information is derived from our Release Your Kinetic Chain Exercise Series. If you would like to more information or to purchase our books please go to www.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

Rehabilitation vs. Athletic Training

2012-01-05T11:35:00.005-07:00

Exercise protocols and training methods should be quite different when you are rehabilitating an injury to bring your body up to a functional level of performance vs. when you are striving to improve athletic performance on an already well-trained body. After all, the goals and capabilities are quite different between the two.

Unfortunately, most standard exercise programs do not differentiate between the two goals, and tend to use the same exercise routines for both uses.

The objective of rehabilitative exercises are to help you resolve injuries in specific areas of your body, and to prepare your body for the more difficult performance-based workouts. This is a step-by-step, methodical process, that requires patience and time on your side. Moving too fast, with an unprepared body, into athletic training is a sure recipe for injury and disaster.

Let’s take a few minutes to understand the difference between these two types of programs - Rehabilitative and Athletic Training.

Rehabilitative Exercise Routines

Rehabilitation programs (unlike athletic programs) focus upon returning your body to a state of full function without further injuring yourself in the process. Our primary objective with our rehabilitation programs is resolve your injury, to increase muscular endurance and refine your neurological motor control.

Only after you have completely rehabilitated an injury, and restored good muscle endurance and motor control (neurological control) should you consider applying athletic performance strategies to your training.

Rehabilitation training is not just for resolving existing injuries, it is also a critical preliminary step for preparing your body to accept and benefit from advanced conditioning and performance training. If you have not been physically active for a period of time, it is essential that you start with the “Beginner” sections of this book. As you work your way through the exercise levels, you will be tuning and preparing your body for more advanced performance- based exercises.

Rehabilitation requires patience and time! Remember, your body needs time to heal your injuries. Many people, in their enthusiasm to reach their goal, make their injuries worse by not giving their body sufficient time to heal. So take the time to properly prepare your body for athletic level training.

The following rules are a few fundamental principles that you should keep in mind as you work through all rehabilitative routines:

Principle1: All Pain...No Gain!

Rehabilitation (unlike athletic training) requires that you perform your exercises within a completely pain-free zone, essentially a zone of safety.

Exercising in a manner that causes pain creates abnormal neuromuscular patterns that may lead to further injury. Conventional rehabilitation strategies commonly do not succeed because they do not address the underlying neuromuscular problems. They are often designed to make you work through your pain (as in work- hardening programs). This only causes you to create or reinforce the abnormal motor responses which continue to keep you in pain.

In addition, if you work through pain caused by tissue damage you run the risk of central sensitization. This is a nervous system process which causes you to become more sensitive to pain. The only way to break this pattern is to perform your exercises in a pain-free zone. We commonly have patients come to our clinic who have exercised through their pain for years! They are always amazed at how, by exercising in a pain-free zone, we were able to help them break their pain- cycle in just a few short weeks.

If you truly want to rehabilitate your injuries you must work within a pain-free zone. This is quite different from training to improve your performance training in which you may have to endure some degree of muscle pain (not injury pain) to improve strength and endurance.

Bottom line, never work through injury pain. If you have an injury, and the exercise hurts during certain motions, or if you feel pain when resting, then limit the range-of-motion of the exercise to lie within your pain-free range. In addition, avoid the exercises that cause you pain until your body is ready for them. What works will vary from person to person so listen to your body and adjust the routines accordingly.

Principle 2: Develop your Power

Power (within your body) is about the production and transfer of force through your entire body. Power is also a function of how well you can recruit your nervous system to control muscular action. The more efficient your nervous system, the more power you will have. The more power you have, the easier it is to perform your activities and exercises without injury.

Power is not the same as strength, power is about maximum efficiency without effort. (Strength requires at lot of effort and energy.) The more power you have, the less energy you need to expend to perform a task, which equates to more energy to heal and grow your body.

Power generation is also directly related to the quality of your soft- tissues (muscles, nerves, tendons, etc.). The quality of your soft- tissues determines how well you can store and release energy.

Think of your soft-tissues as being alike to cords of elastic rubber (or perhaps a telephone cord). Just like a rubber cord you can stretch (storing energy) in your tissues and contract (releasing energy). In a healthy state, your muscles contract and release instantaneously, storing and releasing energy with changes in body motion.

So what happens when your rubber cord gets knots tied in it? The cord’s ability to store and release energy is immediately diminished. The same thing happens to your soft-tissues when you build up restrictions and adhesions (from the micro-tears caused by repetitive motion), or scar tissue from injuries. These adhesions and scar tissues are analogous to knots in the cords. Just as the cords ability to store and release energy was diminished by knots, so is our bodies ability to store and release energy diminished by these restrictions. Think of these adhesions restrictions as energy leaks that rob your body of much needed energy for healing.

You will have problems with storing and releasing your own energy if your body is full of tight areas and ropy fibrous restrictions. This is why foam rollers, Massage Therapy, Active Release Techniques, Fascial Manipulation, Graston, and dozens of other soft-tissue techniques are so valuable for helping in your healing process. All these procedures act to improve the quality of your soft-tissue by releasing or removing the soft-tissue restrictions between your tissue layers.

Bottom line, you may need to invest in some soft-tissue care to get rid of these restrictions...they are sapping your energy, causing injuries, and aging you prematurely. Consider getting treatment for these areas, this is an investment that will pay countless positive dividends for the rest of your life.

Principle 3: Build your Aerobic Base

Yes, rehabilitative care does require you to build a good aerobic base. Your cardiovascular system is responsible for transporting oxygen and nutrients to all your cells, and for carrying away toxins and waste products. These are essential processes for any kind of recovery from injuries, and even more essential if you plan to take up athletic endeavors.

This information is derived from our Release Your Kinetic Chain Exercise Series. If you would like to more information or to purchase our books please go to www.releaseyourbody.com . If you would like information about our clinic please go to www.kinetichealth.ca.

Stabilizing the lower extremity

2011-10-19T13:39:00.003-06:00

A large percentage of the runners/triathletes I see have weak glutes that do not stabilize the lower extremity. The One Leg/Bulgarian Split Squat can really help these individuals to get back on track. I also notice that they often have tight hip flexors which makes the problem even worse by turning off the glutes neurologically.

Neurological Impact of the Neck’s Kinetic Chain

2011-08-08T13:33:00.004-06:00

Whenever an injury occurs in your neck (such as a sprain/strain), it damages not only the ligaments, tendons, and muscle fibres, but also their embedded neurological structures (Golgi tendon organs, muscle spindles, and joint receptors). These neurological structures play an essential role in postural control. Any damage to these structures can affect overall spinal stability, and lead to chronic back problems.

In order to get a better understanding of the importance of these neck muscles and their role in controlling body posture and gait, let us consider the suboccipital muscles (located at the base of your skull).

The suboccipital muscles (rectus capitis major and minor, superior and inferior obliques) are extremely important since they contain very high concentrations of muscle spindle fibres. Muscle spindles are the part of your nervous system that provide postural information to the central nervous system. Damage to these structures can result in gait disturbances and ataxia (an inability to coordinate voluntary muscle movements).

When we compare the density of muscle spindles that pass through or occupy the suboccipital area, to that of other muscles in the spine, it becomes obvious just how much this area affects whole body function.

Take a minute to review the density of muscle spindles per gram of muscle tissue:

Inferior Oblique (Upper Neck) - 242
Superior Oblique (Upper Neck) 190
Rectus Capitis Posterior Major (Upper Neck 98
Rectus Capitis Posterior Minor (Upper Neck) 98
Longus Colli (Front of Neck) 48.6
Multifidus (Deep back muscle 24.3
Lateral Pterygoid (Jaw muscle 20.3
Opponens Pollicis (Hand Muscle) 17.3
Trapezius(Shoulder muscle) 2.2
Latissimus Dorsi (Large back muscle 1.4

The higher the density of muscle spindles/gm of muscle tissue, the greater the involvement of this area in maintaining whole- body postural control.

Given this, you can see that the inferior oblique muscle (located at the base of your skull) contains 242 spindles/gm of muscle tissue, while the very large latissimus dorsi (large back muscle) only contains 1.4 spindles/gm of muscle tissue.

Even though the inferior oblique is located at the base of your skull, due to the density of muscle spindles in this area, a restriction in this muscle can affect far distant structures; from your neck through to your lower back.

The key point is that any exercise program or treatment protocol must address and resolve issues within all the structures making up your neck’s kinetic chain. This is required in order to deal with the consequences of restrictions which impact the neck’s physical kinetic chain and cascade into your neurological control mechanisms.

For more information, go to www.releaseyourbody.com. If you would like information about our clinic please go to www.kinetichealth.ca.

Interesting Facts About Dancers

2011-05-09T23:44:00.007-06:00

“Ballet ranks with football as the most demanding of all physical activities and sports”. (Photo Alvin Ailey)

Since 1978 – 3000 articles have been published on dance injuries.
Between 75-97 % annual incidence of injury reported among professional dancers.
80% of dancer have a major injury during their carrier.
93% of dance teachers become teachers because of injury. These injuries often go untreated (often due to financial constraints)
65% of injuries dance are overuse 35% are acute or traumatic injuries Byhring 2002.
Only 2% of dance injuries need surgery – 98% can be treated with conservative therapy (Physiotherapy, Chiropractic, Active Release, Graston).
The average dancer does 200 one leg landing jumps per class – These jumps can produce a force equivalent to 12 times the dancers body weight.
There are two common four letter swear words in dance “ Food” and “Rest”.

A high level of fatigue is common in most dancers – Many of the injuries that occur, happen during times of increased fatigue. There are three main deleterious effects of fatigue, that are very well documented: decrease proprioception, impaired balance, decrease joint stability – Altered muscle recruitment patterns

Burnout is very common in dancers, which causes: decreased strength, decreased coordination, decreased cognitive function, decreased immune function
Burn out often comes from prolonged stress – dancers are often perfectionists (unrealistic standards, self critical, full of self doubt, often have perfectionist parents).

Stress usually manifest is three stages ( Dr. Hans Selye’s “General Adaptation Syndrome).

Stage One

Increase heart/respiration rate (increased blood pressure)
Stomach problems (blood flow is being moves from GI tract to Skeletal muscles).
Increased muscles tension (decreased flexibility, coordination, muscle pain common, headaches).
Decreased cognitive function

Stage Two

Level of fatigue increases (affects mental attitude – avoidance strategies common, avoidance of tasks etc, increased procrastination).
Overall lack of motivation
Insomnia common (associated weight gain – increased stress hormones, alteration in eating patterns)

Stage Three

Depression
Chronic fatigue (mental and/or physical)
Increase in health problems
Avoidance of all activities

Prevention of burnout in dancers requires several key aspects:

Balancing activity with rest
Periodization training (Professional dancers do not do what other athletic disciplines do, they often dance at same level throughout the year).
Sleep
Good dietary habits – Dancers are known for the three nutritional C’s – Coffee, Cigarettes, and Candy

For more information, go to www.releaseyourbody.com. If you would like information about our clinic please go to www.kinetichealth.ca.

Running and Arm Motion

2011-05-03T11:22:00.005-06:00

In a normal stride, arm swing plays a very important role since it counterbalances body rotation, regulates cadence (steps per minute), increases forward motion, and provides some lift for the runner.

The backward-swing motion of a runner's arm helps to increase forward motion. It does this by counter-balancing the support and push-off actions of the leg that is currently in contact with the ground. In contrast, the forward-arm-swing acts both as a rest period in preparation for the backward motion and as a counterbalancing action for the airborne leg that is in the recovery phase. Without these counter-balancing functions, your body would have very little rotational stability.

Though minimal compared to leg action, the runner's arm motion also propels the runner's body upward providing a certain amount of lift. You will often see many runners trying to compensate for weakness in their lower extremity by increasing their arm motion.

Ideally the runner's arms should be able to swing freely at the side of their body in a relaxed, straight motion. The runners arms should swing the same distance back as forward, much like a clock pendulum moving in a straight line with no lateral deviations. The correct execution of this action has a considerable positive effect on maintaining a constant horizontal velocity.

Even minor restrictions in a runner's shoulders results in wasted energy, decreased performance, and possibly injury. In many cases, an appropriately designed exercise program can eliminate these problems.

For chronic restrictions, a few sessions of Active Release, Graston will help you to increase your performance. Give us a call at 403-241-3772 to book an appointment to help improve your running performance.

For more information, go to www.releaseyourbody.com. If you would like information about our clinic please go to www.kinetichealth.ca.

Treating and Preventing Meniscus Injuries - Part 5

2011-03-20T16:26:00.004-06:00

Exercise

If the injury is not severe enough to warrant surgery therapy can usually begin almost immediately. If surgery is warranted, exercises can usually begin within a short period of time [depending on your surgeon’s advice].

Initially, patients with meniscus injury tend to do better with non-weight-bearing activities that do not cause compression. Especially in cases of more severe injury it is important to progress to weight-bearing functional activities.

If you’ve had a posterior meniscus injury you should keep your knees ranges of motion limited while performing exercise. This will help to ensure that further injury does not take place. It is also important to avoid any rotational movements of the knee, especially in weight-bearing positions.

In cases of surgery it may be necessary to avoid any type of flexion exercise for up to two months. Exercises that include twisting activities or squats may need to be avoided for up to 3 to 6 months. Depending upon the degree of injury it may also be necessary to limit athletic activity for 4 to 6 months after surgery.

The following exercise recommendations are only general in nature for individuals who do not need surgery, or have been cleared by their surgeon to perform these exercises.

Initial Phase of Exercise

The objectives during this phase are to decrease swelling [RICE], prevent further injury [bracing may be necessary], prevent muscle atrophy and maintain overall strength. During this initial phase which is can be several weeks depending on the degree of injury, four weeks if post operative, further injury must be prevented. During this stage appropriate exercises would include:

Isometric exercises for the Quadriceps (especially the VMO)
Range of motion exercises [passive and active if appropriate]
Stationary cycling - single leg cycling only using the uninjured leg

Intermediate stage of exercise (Patient can now flex and extend knee)

The objective of this stage is to return to full weight bearing on the injured leg and to increase muscular endurance. It is important to combine soft tissue mobilization with exercise to avoid scar tissue formation. During this stage appropriate exercises would include opened chain kinetic exercises such as:

Limited open chain resisted tubing exercises of the ankles knee and hip.
Stationary cycling with no or only minimal tension.
One leg stands - in this exercise you alternate standing on one leg for approximately 20 to 30 seconds, shifting your weight back and forth. This can only be done if you are able to tolerate weight-bearing.
An upper extremity weight training program
Deep water running program
Stretches should include the: Quadriceps, hamstrings, hip rotators, iliotibial band, and calf muscles.

As the patient progresses Open Kinetic and Closed Kinetic Chain resisted exercises can be used.

Advanced stage of exercise (Patient now has full range of motion)

Begin running at 50 to 60% of effort.
Step ups, onto box.
Jumping and hopping exercises. These exercises must be performed completely pain-free.
Eventually exercises should simulate activities performed by the sport or activity the individual wishes to return to,
Balance and stability training on a gym ball can be used at this stage.

Conclusion:

In many cases meniscus injuries can be prevented. Active Release Techniques has been proven to be a viable option in removing meniscus entrapment’s before the actual tear occurs. Once an actual injury has occurred manual therapy and exercise should be implemented as soon as possible. Therapy must always consider key kinetic chain relationships to prevent an ongoing cycle of injuries. In addition to therapy exercise is essential without the correct rehabilitative strategy the probability of ongoing injury is almost 100%.

If you would like information about our clinic please go to www.kinetichealth.ca.

Treating and Preventing Meniscus Injuries - Part 4

2011-02-13T17:49:00.010-07:00

OK… I am finally back at my meniscus blog…delays due to having a blast dancing at the Calgary Salsa Congress. The next Calgary Salsa Congress is April 2012 - and if you are in town…then be sure to go to this. The workshops and performances from around the world are amazing. But now, to the matter at hand…your meniscus injury.

What to do when a meniscus injury has occurred?

You should seek medical attention immediately if you show indications of a meniscus tear as it is extremely important to determine the severity of the injury. The severity of your injury will determine the type of strategy that must be implemented to rehabilitate your meniscus tear. It is important to stop all further activities that may cause further damage to the knee until you have completed this assessment.

Upon initial onset of the meniscus injury – RICE IT!

No matter what the severity of the injury is, at the initial onset of a meniscus tear, follow the RICE (rest, ice, compression, and elevation ) procedure.

Rest - Avoid putting excess stress on the knee. If necessary, use crutches, and a neoprene brace that keeps the knee locked in extension.
Ice – Apply ice to the knee for 20-30 minutes, every 2-3 hours, until the swelling is reduced.
Compression - An elastic tensor bandage on your knee may also help to reduce swelling and can be used in conjunction with the ice.
Elevation - Elevating your knee helps to reduce swelling. Place your knee on a blanket or pillow.

REST

Depending on the severity of the injury it may be necessary to rest your knee completely for several weeks in order to fully recover. Keeping the injured knee in a locked position, in full extension, will take about 50% of the compressive load off the knee.

Initially, you should avoid any activities that involve flexion of the knee. The act of flexing your knee creates tension in the popliteus and semimembranosus muscles. These structures connect into the meniscus, resulting on increased stress in this area.

Resting the injured leg does NOT mean avoiding all physical activity. Exercising your lower extremity on the non-injured leg will help to maintain overall muscle mass. By exercising the opposite leg, there will be some neurological crossover, which helps keep the muscles on the injured side from atrophying. Electrical stimulation, such as inferential current, can also aid in preventing muscle atrophy of the injured leg, and do so without additional stress on the meniscus.

Manual Therapy

Once you have the go-ahead from your physician, you should start manual therapy and exercise as soon as possible. Waiting too long to start treatment will only prolong a meniscus injury.

There was an interesting study that was done in 1988 by Timm about the effectiveness of combining rehabilitative exercises with arthroscopic knee surgery. Those patients who received no rehabilitative exercises showed a zero success rate in recovery (did not recover). Those individuals who received a comprehensive rehabilitation program showed a 92% success rate. This study was conducted on over 5000 subjects.

Manual therapy can help to prevent what is referred to as a flexion or extension contracture. This refers to the inability of the knee to fully straighten or bend due to pain, stiffness, and adhesion formation. A flexion contracture is the most common type of contracture. If an individual is not able to properly straighten their knee, then they will have difficulty in increasing strength or developing stability in the knee.

Types of Therapy

There several forms of therapy that can help to speed the healing process, with the most effective being Active Release Techniques, Graston Technique, massage therapy, fascial manipulation, and joint mobilization. During each stage of recovery from the injury, the patient can greatly benefit from these procedures to maintain active range-of-motion and speed the healing process.

Active Release Techniques

Active Release is a great way to speed the healing process, as well as prevent meniscus injuries (by removing adhesions and impingements in the area). Active Release treatments often involve removal or release of numerous soft-tissue restrictions above, below, or in direct contact with the meniscus. For example, as we mentioned in our earlier blog, the popliteal muscle and the semimembranosis muscle both attach to the meniscus. Active Release Techniques can remove restrictions in these structures, thereby improving meniscus function.

You can locate practitioners trained in Active Release Techniques at www.activerelease.com. When checking over qualifications, make sure you select a practitioner who is certified in working with lower extremity protocols. Of course, if you are in Calgary, Alberta - please come see us at Kinetic Health.

Graston Techniques

Graston Techniques uses specially designed stainless steel instruments to specifically detect and remove soft-tissue fibrosis caused by chronic inflammation. This technique was originally developed to be used on athletes.

With menisci injuries, Graston Technique (GT) proves quite beneficial since:

GT increases the rate and amount of blood flow to the injured area. Since the menisus generally have decreased blood flow, any increase in circulatory function is helpful in the healing process.
GT re-initiates the healing process in many areas where fibrotic scar tissue has formed. It does this by increasing cellular activity in the injured region, especially that of fibroblasts and mast cells.

You can find trained practitioners in Graston at www.grastontechnique.com and at our clinic in Calgary – Kinetic Health.

Registered Massage Therapy

Massage therapy can be very beneficial when treating a meniscus injury. Massage therapy helps to preventing flexion and extension contractures of the knee. In addition massage therapy can be an effective approach for managing pain.

Make sure you look for therapists that are educated and trained to accurately assess and treat meniscus injuries. It is important to remember that not all massage therapist receive the same level of training. Check the credentials of the selected massage therapist. Some massage therapists may also have received additional training in Active Release Techniques and will combine this treatment with their standard massage techniques.

Treating Menisci Injuries – see the next installment of this blog for more information about how you can treat menisci injuries with exercise. For more information about other types of knee injuries, visit the following sites:

For more information about our clinic in Calgary, Alberta - please visit www.kinetichealth.ca.