I appreciate everyone who has been checking out my blog on Tumblr as this is where it all began. I do want to let you know that my new website just launched and “Critter’s Corner” has been incorporated in to the new site. I can now be found at the following URL. Hope to see everyone there
ILIOTIBIAL BAND SYNDROME…FOAM ROLLING DOES NOT EQUAL STRETCHING
Iliotibial band (ITB) syndrome is a debilitating condition that affects lower extremity function and is commonly associated with pain at the level of the distal lateral thigh and knee. The ITB is a superficial thickening of tissue that is an extension of the gluteus maximus, gluteus medius, and tensor fascia latae (TFL). It inserts onto the lateral aspect of the patella by way of the lateral patellar retinaculum as well as Gerdy’s tubercle and the fibular head. In the event one seeks medical consultation for ITB syndrome by a physical therapist, chances are that they will be introduced to the foam roller. A foam roller is to the ITB as a steam roller is to pavement. More specifically, a foam roller will function to break down any trigger points and tissue inconsistencies in the structures of the lateral thigh (vastus lateralis, biceps femoris, ITB) and desensitize the region. Unfortunately, physical therapists oftentimes substitute foam rolling for proper stretching of the ITB. If the Ober’s test, which is used to assess for ITB tightness, remains positive after foam rolling then the therapist should focus more of their treatment on stretching the ITB and related structures. While I appreciate the “role” of foam rollers in treating ITB syndrome and encourage their use, especially as part of a home program, make sure to understand that foam rolling does not equate to stretching.
Nearly everyone is familiar with rotator cuff tears (RCTs) these days. The prevalence of RCTs is not surprising given the fact that people tend to fall into deleterious postures throughout the day, consistently overload their arms while performing routine activities, and often assume harmful overhead positions for an extended period of time while sleeping. Furthermore, most people, who engage in a strength training regimen, tend to perform high risk exercises with too much resistance and improper form while lacking adequate stability at the scapulothoracic articulation (where the shoulder blade interfaces with the rib cage). The cumulative effect of these forces and positions is rotator cuff pathology. As a physical therapist, I often use metaphors to teach physical therapy interns and patients to help them better understand rotator cuff injuries. In the case of rotator cuff disease, I liken the rotator cuff tendons to a piece of rope that has started to fray. The last thing that the tendons or rope want to see is repetitive motion, especially when coupled with external resistance. The rotator cuff tendons would more appropriately benefit from a greater balance in the surrounding elements, proper mechanics at the joints of the spine and shoulder girdle complex, and more fluid motion. So how does this affect the rehabilitation process? Rather than jump to prescribe shoulder exercises involving 3 sets of 10 repetitions, first identify the major impairments that may be contributing to the problem. For example, is the thoracic spine able to adequately extend and are the ribs able to externally torsion on the side of the involved shoulder? Is the scapula able to posteriorly tip or tilt as the arm elevates? Is there posterior shoulder tightness that may cause anterosuperior migration of the humeral head, which alters the arthrokinematics of the glenohumeral joint. Is there adequate scapulothoracic stability that will afford the arm a stable base to move from? Are there altered length tension relationships in the surrounding soft tissue, which may predispose one to subacromial impingement. Do the periscapular muscles possess adequate strength? Are there postural considerations such as forward head and/or rounded shoulders that need to be corrected? By addressing such impairments, an ideal environment for healing will be created for the damaged rotator cuff tendon(s) and patients will most likely enjoy improved function of this vital muscle group. Lastly, remember that the rotator cuff is a group of precision muscles that are best trained from a resistance standpoint of 40-60% of one’s maximum voluntary contraction (MVC) so make sure not to excessively overload them as it will only add insult to injury. I should also reminder readers that not all rotator cuff tears are amenable to conservative management and sometimes surgery is indicated. Long live in the shoulder!
Physical therapists routinely prescribe the rowing exercise to patients presenting with scapular dysfunction based on the work of Moseley and colleagues (AJSM 1992). In most cases, patients are instructed to perform 3 sets of 10 repetitions when performing this exercise. If you have not yet tried placing an isometric emphasis on the rowing exercise, I would strongly encourage you to do so. Anectdotally, I have found that an isometric row is superior to an isotonic row for improving scapular stability and shoulder function. Generally, I will start with 5, 30 second holds and increase the duration of the hold up to a minute. The isometric row can be performed in either a seated position or in standing provided there is a buttress for the abdominal region to further stabilize the body. Additional research, however, is needed to further compare these two flavors of the row. As I like to tell my patients…holding is healing. I hope you find this exercise to be as much of a game changer as I have.
I am completely serious when I say that this is my next athletic endeavor. I am determined to run on water and have the proper mechanics and speed. I will look to chronicle my attempts at this feat so stay tuned over the summer. I apologize ahead of time if you think that I’ve lost my mind. Hope your belief systems are not holding you back!
On June 12th, I will be speaking at the Shawangunk Running Company in New Paltz, NY. The title of this talk is “Training for the Long Run” and will focus on running related injuries (RRIs), risk factors, and increasing one’s longevity and performance in the sport. Pertinent research will be discussed in conjunction with physical therapy and strength and conditioning principles to provide a program that can be customized to each attendee. Whether you are a beginner or a seasoned runner, you will come away with a wealth of information that will help you stay injury free and lengthen your span as a runner.
During a weekly roundtable discussion that I take part in, an orthopedic surgeon asked the group to identify a good example of power in sport. While there are several powerful athletes, the individual who immediately comes to my mind is professional cyclist Mark Cavendish. Enjoy the show and keeps your eyes out for Mark in this year’s Tour de France.
This post is about BELIEVING IN YOURSELF & TESTING YOUR LIMITS.
At the age of 12, I was told that I was not cut out to play overhead sports secondary to having shoulder problems. At 16, I was told that there was a high probability I would never play competitive tennis again after sustaining a knee injury. At 20, I was told that running for exercise was out of the question after injuring the other knee. At 31, I qualified for the 2010 Half Ironman World Championships in Clearwater.
If you are thinking about buying a sports car, don’t wait too long! As we all know, human beings are not immortal and as we age, our musculoskeletal system may not afford us the same physical abilities. So before it gets too late, pull the trigger on buying that dream car because if you continue to put it off, you may not be able to enjoy it. Here’s to enjoying life and doing what brings you happiness
Here is the last part of the 4 step trunk stabilization progression. Complete 3 sets of 15 in a slow and controlled manner. Once you have accomplished this and want to further challenge yourself, repeat the same progression with your eyes closed.
This is part 2 of the hooklying stabilization progression. The only difference is that the elbows are no longer providing support. Complete 3 sets of 15 on each side focusing on quality of motion. Enjoy your weekend!
A blog for sports medicine and fitness professionals based on the most current concepts and available research as well as my own clinical perspective.
Readers of this blog should apply all the information including medical opinions and the latest data, at their own risk. Individuals who know that they are in need of medical attention or treatment should seek out the appropriate licensed healthcare practitioner first, and not use this information as a substitute before being examined by a medical expert.