Keeping Knees Healthy this Fall

by Constance Taras, PT

 As fall is now upon us, so too is the season of football. For a few unlucky players, however, the season is already over, with preseason injuries benching them for the rest of the season. In the NFL, an average of 23 ACL injuries occur before the first game of the season is even played, and it doesn’t stop there: according to the ACL Recovery Club, a total of 51 players tore their ACL during the 2017 season. The good news is that current evidence strongly supports the use of knee and ACL injury prevention programs to decrease the risk of injury and ensure a successful (and long) season for any athlete.

The knee joint is a hinge joint held together statically by 4 main ligaments: anterior cruciate

ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Although there are many, the main dynamic stabilizers of the knee consist of the quadriceps, hamstrings, calf, and gluteal muscles. The knee is meant to move in one plane of motion creating both flexion (knee bent) and extension (knee straight). It does, however, allow our bodies to move laterally, pivot, and change directions quickly when healthy. If the knee demonstrates decreased strength, muscle imbalance, range of motion, or flexibility in the surrounding tissues, it can be predisposed to injury.

To help prevent injury, the literature cites a combination of dynamic stretching, running drills, strength training, plyometric drills, and core exercises that should be included in knee injury prevention programs. These should be completed for at least 20 minutes several times a week, starting in the preseason and carrying through the regular season. Examples of each are outlined below.

Dynamic Stretching 

High knees, butt kicks, font/side leg swings, Frankenstein walk

Running Drills 

Forward running, backward running, zig zag cone drills, bounding

Strength Training

Double- and single-leg squats, banded hip strengthening, Nordic hamstring curls

Plyometric Drills 

Skater jumps, double leg and single leg hops, box jumps

Core Exercises

Front planks, side planks, bridges

Make sure to tailor your program to be sport-specific and elicit the help of your local physical therapist for ideas on your personalized knee injury prevention program!

Sources Cited:

“Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention” (J Orthop Sports Phys Ther. 2018;48(9):A1–A42.

“JOSPT Perspective for Patients Knee Injury Prevention: Exercises to Kepp You From Getting Sidelined” published in Journal of Orthopaedic & Sports Physical Therapy, 2018 Volume:48 Issue:9 Pages:734–734 DOI:10.2519/jospt.2018.0509

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).

Planes of Motion

by Meredith Franczyk, PT

We don't often think about it consciously, but as three-dimensional beings we naturally also move in more than one dimension. In fact, there are three distinct places of motion - sagittal, frontal and transverse - and all are required for our bodies to move with functional smoothness.

The most common plane of movement, the sagittal plane, divides the body into right and left halves. In this plane, we use the strength of our muscles to move forward or backward (flexion and extension). Key muscles such as the quadriceps, gluteals and biceps are typically worked in the sagittal plane: for example, a lunge forward or backward, which can be made more challenging by adding another sagittal exercise such as a bicep curl.

If we take an imaginary line and divide the body into front and back halves, this is the frontal or coronal plane. Movements in this plane are always sideways motions, called abduction (away from the center of the body) and adduction (toward the center of the body). Some of the muscles that work in the frontal plane include the middle deltoid, adductors (inner thigh) and gluteus medius. These muscle groups work as stabilizers to control the forward and backward movements in the sagittal plane. Sidestepping with a band around the ankles is an example of a frontal plane exercise.

The transverse plane, the plane most overlooked in exercise routines, divides the body into top and bottom halves. Movements in this plane are rotational in nature and critical in sports for pivoting, batting and golf swings. Common transverse plane muscle groups include the gluteal and adductor muscle groups and the rotator cuff. An example of an exercise in this plane would include a chop with a medicine ball.

(Left) Sagittal plane exercise. (Center) Frontal plane exercise. (Right) Transverse plane exercise.

A well-balanced fitness program should incorporate exercises along each plane of motion. By incorporating multi-planar movements in our warm-ups, strength training and stretching, we can reduce overuse injuries and muscular imbalances.

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.

Arthritis and Exercise

by Katie Hopkins, DPT

It’s one of the most common causes of disability in the U.S., according to the CDC, and about 1 in every 5 adults is diagnosed with it. Two-thirds of those diagnosed with it are under the age of 65.

Would it surprise you to learn that I’m talking about arthritis?

It is a common misconception that arthritis is an ailment only for the elderly. In fact, arthritis can describe a variety of conditions, including rheumatoid arthritis, osteoarthritis, lupus, fibromyalgia, and gout. Of these, the two most common types of arthritis diagnosed are osteoarthritis (OA) and rheumatoid arthritis (RA). While both have symptoms that include swelling around the joints, those with osteoarthritis tend to experience more joint pain, stiffness and achiness while rheumatoid arthritis sufferers experience more muscle stiffness, achiness, fatigue and weakness.

Due to weakness and fatigue, patients with RA often have difficulty lifting items over 5 lbs., climbing a flight of stairs or walking more than 1/4 of a mile. In fact, studies show that people with RA are anywhere from 33% to 55% weaker than healthy controls. An aggressive exercise regimen is often recommended to combat muscle atrophy and fatigue, as this keeps patients functioning at a higher level in their daily lives. Research shows that patients with RA benefit from both short-term and long-term aerobic capacity and dynamic strengthening programs to produce and maintain higher levels of function.

Conversely, patients with OA tend to suffer from more joint pain and stiffness affecting their range of motion and muscle function. Hips and knees are two joints commonly affected by OA, and OA in these joints tend to lead to the most functional limitations and greatest decrease in quality of life. Research studies indicate that resistance training - along with aerobic exercise - lead to the most changes in patients with OA in their knees. While there has not been as much research done specifically on hip OA, preliminary studies do show that therapeutic exercise programs are as effective for the hip as they are for the knee. Perhaps one of the most notable factors in osteoarthritis research is that long-term results tend to diminish when a prescribed exercise program is not updated or a patient does adhere to the same levels of exercise independently.

The research supports the effectiveness of an individualized physical therapy program in treating symptoms of arthritis. A physical therapist can help you to determine what specific exercises are best for you and your joints and how to manage your symptoms long term.

References:

Farr JN, Going SB, McKnight PE, Kasle S, Cussler EC, Cornett M. Progressive Resistance Training Improves Overall Physical Activity Levels in Patients with early Osteoarthritis of the Knee: A Randomized Controlled Trial. Phys Ther. 2010;90(3);356-366.

Fernandes L, Storheim K, Nordsletten L, Risberg MA. Development of a Therapeutic Exercise Program for Patients with Osteoarthritis of the Hip.  Phys Ther. 2010;90(4);592-601.

Iversen MD, Brandenstein, JS. Do Dynamic Strengthening and Aerobic Capacity Exercises Reduce Pain and Improve Functional Outcomes and Strength in People with Established Rheumatoid Arthritis. Phys Ther.  2012;92(10);1251-1257.

Lin CC, Taylor D, Bierma-Zeinstra S, Maher CG. Exercise for Osteoarthritis of the Knee. Phys Ther. 2010;90(6);839-842

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. 

The Advantage of a Small Physical Therapy Practice

by Sally Fansler, PT

Imagine you're in pain and are looking for relief through physical therapy. You've heard the big names tossed around, but you're concerned: will they give you the attention you need to recover? Will they know who you are each time you walk in the door?

Small physical therapy clinics often have a distinct advantage over their corporate counterparts. While large entities can build brand recognition by consolidating service and decreasing cost, smaller practices aim to set themselves apart with attention to detail, ultimately allowing for more effective care for their patients. 

A smaller private practice boasts an intimate atmosphere that often feels more comfortable and less generic, allowing the patient and the therapist to focus on treatment and goals without unnecessary distractions. As a result, the therapist and the patient are able to form a solid connection that easily translates to enhanced delivery of care. Through one-on-one treatments with ample time, the physical therapist becomes firmly invested in the patient's treatment, tailoring it to his or her needs and adapting as progress is made. 

Without a complex administrative hierarchy, the staff at a small physical therapy clinic is also able to make every patient feel like a priority. The theme song from Cheers, “Where Everybody Know Your Name," comes to mind and is the perfect analogy for a small, comfortable spot for physical therapy treatment. 

With an unyielding commitment to care and a desirable atmosphere, the benefits are clear. A small practice with a warm environment excels in the areas that count.

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.