Getting Fit While You Hit

by Nick Strutz, Personal Trainer

This month, we've invited LSF personal trainer Nick Strutz to be our guest blogger.

A couple of years into my career as a personal trainer, I felt the need to expand my arsenal of tools to help my clients along their fitness journeys. I wanted something that was powerful and efficient in delivering results, as well as something that was dynamic and fun enough to make exercise something my clients could look forward to. That’s where boxing came in.

Boxing can be one of the most well-rounded approaches to getting into the best shape possible. Who doesn’t want to burn fat, increase cardiovascular endurance, target both upper and lower body muscles, improve coordination, release stress, and have fun all at the same time? Studies consistently show that, when done right, adding boxing to a fitness routine can decrease visceral fat, improve cardiac output or VO2 max, and lower one’s resting heart rate (1). In addition, boxing has been shown to be an effective treatment for the symptoms of Parkinson’s Disease. In one study, 83% of participants with Parkinson’s showed improvements in gait, balance, and overall quality of life (2).

It helps to do a little homework before jumping in. I wanted to make sure I didn’t hurt myself while learning the ropes and getting comfortable with boxing, and certainly didn’t want any of my clients to suffer injury, either. Here are a few helpful tips I’ve picked up along the way to make sure boxing is done as safely as possible:

• Those dealing with any injury or chronic condition, especially in the wrist, elbow, shoulder, or neck should exercise caution in trying boxing.
• As with strength training, circuits, or cardio, at least a light warm-up is helpful in preventing injury.
• Before getting the gloves on, it is important to wrap the hands. Wraps can either be attached quickly with a Velcro sleeve, or the old-fashioned way with long ribbon-like wraps. This provides cushion and stability to the small joints in the knuckles and wrists and helps absorb the impact of punches.
• When throwing a punch, be sure to keep the abdominal muscles engaged and the glute muscles active when necessary.
• Before the punch lands, whether on a speed bag, heavy bag, or your trainer’s focus mitts, you will want to clench your fists to provide additional stability to the wrist.
• When getting your head out of the way of a swipe as a defensive maneuver, be sure to step back with your back foot as opposed to arching your low back (bending at the low back to get out of the way).

Whether you want to blow off steam after a tough work day, learn self-defense, or incinerate body fat, there is something for everyone in boxing. When you feel ready to take your fitness to the next level, give it a try!


References
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234943/ 
2. https://academic.oup.com/ptj/article/91/1/132/2735142

Additional resources:
Halbert, C. (2003). The Ultimate Boxer: Understanding the Sport and Skills of Boxing. Impact Seminars, Inc.

Getting Into a Pickle(ball)

by Sally Fansler, PT

Move over, tennis and golf – here comes pickleball! A new favorite pastime among Baby Boomers, this sport combines elements of badminton, tennis and ping-pong. In recent years, it has become popular with older adults because of the smaller court, lower net, and slower ball speed. The rules are fairly straightforward and easy to learn, so pickleball easily becomes a fun social activity. It can be played indoors or out, in singles or doubles.

Over the past decade, however, the pickleball craze is taking hold at all age levels. Teenagers often play it in their physical education classes, and it is showing up as an intramural sport on college campuses. According to the USA Pickleball Association (USAPA), the sport has seen a 650% increase in numbers over the past six years. On-site pickleball courts are now being built not only at many retirement communities, but also as part of community park districts. The equipment – wooden paddles and plastic, whiffle-type balls – is also affordable, making it accessible to be enjoyed by a wide range of people.

Here is the pickleball rule overview:

• The serve must be underhand and below the waist—and it must be made at least one foot behind the baseline, struck diagonally crosscourt.  Only one serve attempt is allowed.
• Only the team serving the ball is able to score points, which take place when the opposite side fails to return the ball or commits other faults, such as hitting the ball out of bounds. 
• When the ball is served, the receiving team must let it bounce before returning, and then the serving team must let it bounce before returning, thus two bounces.
• After the ball has bounced once in each team’s court, both teams may either volley the ball (hit the ball before it bounces) or play it off a bounce (ground stroke).
• The two-bounce rule eliminates the serve and volley advantage and extends rallies.
• With doubles, both players on the serving team have the opportunity to serve and score points until they commit a fault
• Games normally go to 11 points, with the leading team needing to be 2 points ahead to win

Lakeshore Sport & Fitness in Chicago is planning an intro to pickleball class on Sundays in the fall of 2019. Please contact LPRacquet@LakeshoreSF.com for more information. The Chicago Park District is also growing their program and information on additional places to play can be found here: https://www.chicagoparkdistrict.com/taxonomy/term/2210

References:

https://www.usapa.org/

Elbow Pain, Could the Shoulder be to Blame?

by Julia Glick, PT

As therapists in a clinic located inside of a large tennis club, we are seldom surprised when a number of our patients each year present with lateral epicondylitis – or, as it is more commonly known, tennis elbow. Lateral epicondylitis pain usually occurs over the outside of the elbow where many of the forearm muscles attach, an area that experiences a lot of strain in tennis. However, even those of us who aren’t on the courts every week should be aware of it: it is also common in people who spend a lot of time at the computer or perform lots of gripping during their day. 

Despite the fact that lateral epicondylitis pain feels like it is centered in the elbow, it is important to look at the whole arm. Many people who come to us for tennis elbow have unsuccessfully tried exercises on their own that focus on the wrist and elbow, and are surprised when we turn our attention to the shoulder. Most specifically, the muscles that control shoulder blade position, such as the lower trapezius and serratus anterior, are crucial when treating the elbow, as the position of the whole arm is determined by the orientation of the shoulder blade. 

In fact, several research articles have come out in the past few years that focus on the role weakened shoulder blade stabilizers plays in lateral epicondylitis. Lucado et al. and Day et al. found that people with lateral epicondylitis had significantly weaker lower trapezius and serratus anterior musculature than people without any lateral elbow pain. In a case study performed by Bhatt et al., the research team only treated a woman’s shoulder blade stabilizers and were able to resolve her lateral epicondylitis. Essentially, these studies agree that the muscles that help pull the shoulder blade back and keep it stable also control the position of the arm and elbow: when it comes to prevention of elbow pain, shoulder blade strength and position matters.

Interested in finding some exercises that target the lower trapezius and serratus anterior to help maintain the shoulder blade in its optimal back position? I’ve included some below:

Easier Lower Trapezius

Lie on stomach and roll up a small towel under forehead and place hands on back of head/neck. Squeeze shoulder blades back and down toward opposite pants pocket and lift up elbows. Hold for 5 seconds and perform 5-10 repetitions.

Harder Lower Trapezius (Y)

Lie on stomach and roll up a small towel under forehead. Lift your arms up so they make a “Y” shape. Squeeze your shoulder blades back and down toward opposite pants pocket and lift your arms. Hold for 5 seconds and perform 5-10 repetitions. 

Serratus Anterior Wall Slides

Put your forearms on the wall and push your shoulder blades apart and into the wall. Keep this pressure into the wall and slide your arms up and down. Perform 5-10 repetitions.

Try these exercises and let us know what you think! If you do have pain that is persistent, please stop by to speak with one of our skilled clinicians, who can help you with your injury.

Resources: 

Bhatt, J., Glaser, R., Chavez, A., & Yung, E. (2013). Middle and Lower Trapezius Strengthening for the Management of Lateral Epicondylalgia: A Case Report. Journal Of Orthopaedic & Sports Physical Therapy, 43(11), 841-847. doi: 10.2519/jospt.2013.4659

Day, J., Bush, H., Nitz, A., & Uhl, T. (2015). Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal Of Orthopaedic & Sports Physical Therapy, 45(5), 414-424. doi: 10.2519/jospt.2015.5290

Lucado, A., Kolber, M., Cheng, M., & Echternach, J. (2012). Upper Extremity Strength Characteristics in Female Recreational Tennis Players With and Without Lateral Epicondylalgia. Journal Of Orthopaedic & Sports Physical Therapy, 42(12), 1025-1031. doi: 10.2519/jospt.2012.4095

Thoracic Outlet Syndrome: A Pressing Matter

by Julia Glick, PT

 If you follow the NBA you have most likely heard that Markelle Fultz, the Philadelphia 76ers’ guard, has thoracic outlet syndrome (TOS). We most commonly hear of athletes from baseball developing this, but rarely basketball – in fact, basketball player Ben Uzoh wasn’t diagnosed until he retired, even though he had previously experienced TOS symptoms. It also took visits to more than 10 clinicians before Fultz was diagnosed with neurogenic TOS. But what does that mean and why was it so hard to diagnose? 

The thoracic outlet is the area between the first rib and collarbone, through which the majority of the nerves and arteries/veins that enter the arm pass. In TOS something in this space narrows and compromises either the nerves or vasculature (arteries/veins). A person with TOS usually has pain, temperature changes, or numbness/tingling at the neck, shoulder, arm, or hand.

Part of what makes it so difficult to diagnose is that there are no standard diagnostic criteria for TOS. There are also several presentations: neurogenic, vascular, and non-specific. With neurogenic TOS, the brachial plexus (nerves that pass through the thoracic outlet) are compressed and will usually cause pain and/or weakness. Features of vascular TOS tend to look more like coldness and numbness, as the arteries and veins are compressed. Regardless of presentation, these symptoms are often difficult to reproduce because they can change based on the position of the head, neck, shoulders and arms.

There are no specific causes for TOS, which often makes it even harder to diagnose. Past trauma or overuse, such as in overhead sports, could possibly increase the likelihood of developing TOS. Anatomically, someone is more at risk if they have an extra upper rib or have any type of tightness of fascia or muscle that decrease the amount of space of the thoracic outlet.

Presently, there are several treatment options for TOS: physical therapy, injection, and first rib removal surgery. In physical therapy, the goals are to restore full range of motion of the shoulder and neck, decrease any restrictions that are impinging on the nerves as they pass through the thoracic outlet, decreasing pain, and improving strength. Fultz has been attending physical therapy, and his agent has reported improvements: they hope he will return in the 2018-2019 season. Here’s hoping for a full recovery for Fultz! 

References: 

Baumann, M. (2018, December 4). What baseball can tell us about Markelle Fultz’s latest diagnosis. https://www.theringer.com/nba/2018/12/4/18126446/markelle-fultz-thoracic-outlet-syndrome 

Bell, S. (2018, December 10). What is thoracic outlet syndrome, and what does it mean for Markelle Fultz? http://www.espn.com/nba/story/_/id/25455660/what-thoracic-outlet-syndrome-does-mean-markelle-fultz

Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD007218. DOI: 10.1002/14651858.CD007218.pub

Retrieved from: https://twitter.com/wojespn/status/1070074789409153024  

Retrieved from: https://twitter.com/ESPNNBA/status/1077668580706209792

Smith, J. (2018, December 4). Sixers announce Markelle Fultz out indefinitely, reveal plan for injury. https://sixerswire.usatoday.com/2018/12/04/sixers-markelle-fultz-out-indefinitely-shoulder-injury/ 

Wojnarowski, A. (2018, December 5). 76ers’ Markelle Fultz has thoracic outlet syndrome, to miss 3-6 weeks. http://www.espn.com/nba/story/_/id/25453907/markelle-fultz-philadelphia-76ers-expected-miss-3-6-weeks-shoulder-rehabilitation

Staying (David) Wise on the Slopes

By Jill Jonda, PT

The 2018 Olympic games have come and gone! As we sat in front of our television screens, watching elite athletes perform with skill, speed, and drive to win, a lot of us tend to want to get out there and try to channel our own Olympic skills. As we saw athletes like Mikaela Shiffrin, Lindsey Vonn, and David Wise swiftly ski down a slope or half pipe without missing a beat, we may have thought, “I can do that!” Those athletes make complex arduous maneuvers look effortless. Unfortunately, when people who may not be as skilled try things that Olympic athletes make look so easy and natural, we tend to see more injuries. Before you hit the slopes, it’s important to be aware of common injuries and how to prevent them.

Because of the structure of the ski boot, the angle it puts on the knee, and of course the variability in the terrain of the snow, one of the more common body regions injured while skiing is, in fact, the knee.  Some of the most common knee-related injuries associated with downhill skiing include medial collateral ligament (MCL) sprain, anterior cruciate ligament  (ACL) sprain or tear, and meniscus tear. An injury to all three of these areas is often referred to as the “unhappy triad.”

That may sound pretty intense, but it’s no reason to cancel your trip and try to get your deposit back on your skis and helmet. If you want to have a good time and avoid the risk of injury, follow these steps listed below:

First, you want to understand your skill level.  All too often injuries occur because we end up doing too much too soon and get ourselves into quite a pickle.  If it’s your first time out in a while, take it easy and stay on the easier hills. Better yet, schedule a training session with one of the professionals and get a tune-up on your skills.

Second, it’s always important to warm-up before any type of physical activity, and is especially important for a demanding activity, such as downhill skiing.  A dynamic warm up will help to increase blood flow, prepare the nervous system for increased activity, and improve overall range of motion which all helps to reduce the risk of injury.

Third, it’s important to strengthen key muscles that help prevent aberrant movement of the knee. The hip abductor muscles (specifically, the gluteus medius muscle) help to stabilize the pelvis when weight is shifted onto one leg, which, in turn, prevents inward and torsional stresses on the knee.  If the femur bone becomes internally rotated and adducted (or “knock knee”), this causes a valgus force at the joint, which is the setting of most of these knee injuries. In the same way, the abdominal musculature is also essential in maintaining control and stability while skiing.  A strong core can help to block too much trunk displacement over one leg if you happen to “catch an edge” or lose your footing over a patch of ice and can prevent a fall.  Strong quadriceps and hamstring muscles also assist in demonstrating proper knee joint mechanics, especially as you squat closer to the ground to pick up speed as you ski down the slope.

Here are some options for strengthening exercises you can try before your next ski adventure:

Remember to always be safe and know your limits if you want to stay injury-free on the slopes.  If injury does occur, however, go see your physical therapist!

Swimmer's Shoulder: What You Should Know

by Stephanie Korso, PT

Swimming is a phenomenal way to improve cardiovascular fitness, burn lots of calories, strengthen muscles and prevent disease. As a non-contact sport, there is little risk for acute and catastrophic injuries, but there is still risk for injury. Prevention, early recognition and early treatment are key to managing swimming injuries and remaining active.

The most common swimming injury is swimmer's shoulder, which refers to any shoulder pain related to swimming. Up to 90% of swimming injuries involve the shoulder, and as many as 73% of swimmers may report shoulder pain during their career. The repetitive nature of swimming contributes to overuse and predisposes swimmers to shoulder injury.

Although swimmer's shoulder can involve any shoulder dysfunction, such as tendinosis or impingement syndrome, shoulder instability is the most common. This is because the same factors that improve swimming performance also contribute to shoulder instability:

Increased Shoulder Range of Motion
Increased shoulder range of motion helps reduce drag and allows for greater stroke length, both of which contribute to increased swimming speed. However, increased range of motion also contributes to increased ligament laxity and increased strain on rotator cuff muscles, which contributes to decreased stability.

Increased Shoulder Adduction and Internal Rotation Strength
Up to 90% of forward propulsion in swimming comes from the upper body. The pectoralis major and latissimus dorsi muscles, responsible for shoulder adduction and internal rotation, are the primary muscles that create the propulsive force needed in swimming. Increased strength in these muscles contributes to increased swimming speed, but it also leads to muscle imbalance and further instability.

Prolonged, Fatiguing Shoulder-Intensive Training
An experienced swimmer knows that swimming involves both shoulder strength and endurance. Training involves long work-outs that fatigue muscles. As rotator cuff and scapular muscles fatigue, shoulder instability increases.

The primary goals in management of swimmer's shoulder are to reduce inflammation, increase stability and return the athlete to full activity as soon as possible. Initially, the athlete will need to modify activity so that no pain is experienced. During this time, the athlete will implement exercises to decrease muscle imbalances, improve rotator cuff and scapular strength, and improve muscle endurance. The athlete may then gradually increase activity as pain decreases. Physical therapy is often helpful not only to guide progressions of strength exercises, but to also improve spine mobility and help release overworked pectoralis major and latissimus dorsi muscles.

As the saying goes, prevention is better than the cure. Therefore, incorporating exercises to strengthen the rotator cuff and scapular muscles into training regimens prior to onset of pain is optimal.

References:
Weldon EJ III, Richardson AB. Upper extremity overuse injuries in swimming. Clinical Sports Med. 2001; 20(3), 423-438.

Weiss Kelly A. Non-contact sports: Running, swimming, and dance - identifying common injuries. Pediatric Annals. 2010; 39(5), 279-285.

Khodaee M, Edelman GT, Spittler J, et al. Medical care for swimmers. Sports Med. 2016; 2(27).

Swing Into Spring

by James Bansberg, PT

Spring is finally here, and it's time to get on the green. It's been a long time since your last round, though, and your golf clubs aren't the only things gathering dust - your joints and muscles have also hibernated all winter. It's time to get everything back into golfing shape and hit the ground swinging!

Physical fitness has become a top priority for professional golfers in recent years, and rightfully so: many golfers, such as Davis Love III, contribute their lengthy, successful careers to proper conditioning, strength and flexibility. This doesn't mean you need to start deadlifting heavy weight like McIlroy, however - many basic strength and flexibility exercises can be done in the comfort of your home and don't require you to break a sweat.

Flexibility

Though stretching is one of the hardest things to get golfers to do consistently, proper flexibility will not only improve swing mechanics and speed, it will also lengthen your golfing career by reducing stress on joints. Including a stretching routine in your usual workout or signing up for a weekly yoga class can address this. (If you're not sure hoe to get started on your own, we've included a link to a basic flexibility routine at the bottom of this post.)

Core Strength

The core acts as a bridge between upper and lower limbs. When core stability is weak, the body compensates and channels unnecessary pressure and motion through vulnerable areas, leading to injury. With greater core strength and stability, we gain better trunk control. Improved core strength also translates to improved power - studies show there is a relationship between driving distance, swing speed, ball speed and muscle strength.

Warm Up

After a long, cold winter without golf, it can be incredibly tempting to step out of bed, up to the tee, and just swing away. Do yourself a favor, however, and resist that temptation. Head to a driving range first to work out the kinks, get a feel for your swing, and get those golf muscles working optimally. Start with your wedges and work up from there, only grabbing your driver once you feel back in the "swing" of things.

Golf Stretching Routine: http://www.stretching-exercises-guide.com/golfing-stretches.html

Resources:

Torres Ronda L, Sánchez-Medina L, Gonzáles-Badillo JJ. Muscle strength and golf performance: a critical review. J Sports Sci Med. 2011;10(1):9-18.

The Harm of Overtraining in Adolescents

by Stephanie Korso, PT

This is part two in our two-part series on overtraining.

If you have been following our blog, then you are probably already familiar with overtraining and ways to prevent overtraining, especially with regard to endurance running and weightlifting. In case you are tuning in for the first time, however, here is a brief summary of what you need to know:

• When we train, we stress our system and then allow it to recover. This then allows our system to adapt so it can tolerate greater stress in the future. With any training program, there is a risk of overtraining.
• Overtraining involves a loss of balance between stress and recovery. Not only does this contribute to overuse injuries, pain syndromes, and decreased performance, but overtraining can also have negative physiological effects. It can contribute to altered hormone levels, systemic inflammation, immune system suppression, excessive fatigue, poor concentration, sleep disorders, and even depression.

While it is possible for anyone to be affected by overtraining, some people are at higher risk than others. Adolescents are at high risk for overtraining because there is pressure for early sport specialization and there are increased opportunities to play on multiple sports teams (school, park district, travel, etc.). Overtraining in adolescents is especially concerning because it can affect puberty, contribute to poor academic performance, and limit socialization. Furthermore, injuries sustained during adolescence, especially if not appropriately managed, can limit sport participation throughout high school, college, and even adult life.

The best treatment for overtraining is prevention. For adolescents, the following formula is recommended to avoid overtraining: hours trained per week < years old. That means, if Kevin is 12 years old, he should avoid playing more than 12 hours of baseball each week to help prevent overtraining and its potential negative consequences.

If overtraining syndrome is present in adolescents, relative rest for 6-12 weeks is recommended. Then, as young athletes begin returning to sport, they should gradually increase activity volume before increasing intensity. If signs of overtraining reappear, then activity levels should be again be modified to allow proper recovery. 

Stretch the Truth: Resistance Bands vs. Free Weights

by Katie Hopkins, PT

Whether you’ve used them or not, resistance bands are a common sight in any fitness area: the array of rainbow-colored tubes is easy to spot. First appearing in a patent for “a gymnastic apparatus” by a Swiss inventor in the late 1800s, resistance bands were once primarily used for rehabilitation and fitness, gaining popularity among therapists during the 1960s. As the modern fitness revolution took hold, the bands became attractive to the general public for their effectiveness, variety, convenience, ease of storage, affordability, and travel capabilities.

There’s more to their popularity than just hype, too: studies have shown that resistance bands can increase muscle strength, muscle size and decrease body fat at a similar rate as weight training.  The muscle activity and muscle peak load are similar during training for resistance bands and free weights, and they both provide exercise with free range of motion, variable speed of movement and progressive resistance.

Where resistance bands differ is in their functionality. Bands do not rely on gravity to provide resistance and give a continuous tension throughout the range of motion.  The resistance of the band increases as the range of motion increases, allowing the muscle to work all the way through the range. Resistance bands also translate better into functional movement patterns for daily tasks and sports related training: exercises can be done in multiple directions and planes relating more to natural body movements, such as twisting one’s trunk, reaching, kicking a soccer ball or swinging a tennis racquet. Resistance bands can decrease the ability to “cheat” while performing an exercise, as momentum does not provide a big advantage.

Katie can be reached at katie@lakeshore-pt.com.

TLC for the ACL

by Amy Goldstein, PT

No matter what sport you follow, there's a good chance you've heard of athletes suffering from an ACL tear. The anterior cruciate ligament (ACL) is a knee ligament that attaches the front top portion of the shin bone (tibia) to the back bottom portion of the thigh bone (femur). One of four ligaments in the knee, the ACL prevents the tibia from sliding forward and medially from the femur. ACL tears are one of the most common knee injuries, with over 100,000 occurring annually in the US.

While it may not be surprising that contact sports such as football and soccer are a common source of ACL injuries, it is possible to tear the ACL without any direct contact at all. Changing direction rapidly, stopping suddenly, landing from a jump incorrectly or landing with a hyperextended knee can also cause injury to the ACL. Females are 3.5 times more likely to tear their ACL than males, and ACL injuries are most prevalent among 15-19 year-olds.

So what can be done to prevent injury? Evidence has suggested that strengthening the muscles of the leg and core, as well as working on neuromuscular control and balance of the leg, can help prevent a tear of the ACL. Strengthening the hamstrings, gluteal muscles and external hip rotators can help to prevent the inward collapse that occurs during an ACL injury, while working on neuromuscular control and balance helps to improve the timing of the muscles in the leg. Athletes can also work on jumping mechanics to improve landing form and to prevent excess strain on the ACL. Typically, a strengthening program of 3 times a week for at least 6 weeks is required to notice a change.

Amy can be reached at amy@lakeshore-pt.com.