Evidence-Based Assessment and Treatment of Shoulder Disorders and Other Related Shoulder Pathologies

Recently Ryan Koepp and Andrew Ernst attended the continuing education course, Evidence-Based Assessment and Treatment of Shoulder Disorders and Other Related Shoulder Pathologies.

The presenter was Robert McCabe, MS, PT, OCS who works for the Andrews Institute in Pensacola. During the course there were many topics covered.  Most of the topics were review as the day went on.

Many confirmed what we at OSR already practice with our treatment and management of shoulder disorders.  While at this conference I did take away some great new ideas.  First, the presenter showed many manual therapy techniques for stretching the shoulder capsule and for promoting proper shoulder blade motion.  These I will definitely be incorporating into my practice.

Second, we were shown many different rehab exercises.  There were some exercises I would have never thought of.  Most of them were for shoulder/shoulder blade stabilization and activation exercises.  I can already say I have incorporated these new exercises in with some of my patients and they have loved them.

Overall the course was beneficial and taught me a few new things I can start implementing into my practice.    
Check out the Andrews Institute website.  They have some very informational material.  http://www.theandrewsinstitute.com/

Achilles Tendon

The Achilles tendon is a vital part of our body.  If its strained or injured you will know.  With the recent injury to Kobe Bryant of the LA Lakers there has been a lot of talk about the Achilles Tendon.

Here is some important information for you to read if you want to know more about the Achilles tendon and keeping it safe.

Kobe's Injury:
http://www.ace-pt.org/2013/04/18/kobe-bryants-achilles-tendon-injury/

Protocol after repair:
http://www.arizonaorthopedicsurgeons.com/wp-content/uploads/2010/12/Achilles-Repair.pdf

Achilles Tendonitis:
http://orthoinfo.aaos.org/topic.cfm?topic=a00147

Stretching of the Achilles Tendon:
http://hpcsport.com/publications/staticstretching2.pdf


Now keep your Achilles Tendons safe!

Pitching in Baseball

Pitching with the Entire Body

Most people think of shoulder and arm strength when they think of pitchers, yet there is more to it than that.  50% of pitching velocity comes from the legs and trunk.  In addition to the shoulder being a vital part of the throwing motion, the legs and core are just as, or more, important.  The legs are the part of the body that initiates the throwing motion.  Also the core is the bridge for the energy created in the legs to be transferred to the shoulder, arm and hand.  Focusing on the entire body can increase performance and reduce injuries.

When speaking with George Jensen, pitcher for the St. Paul Saints and instructor at Hit Dawg Academy, he expressed that leg strength is essential for having optimal stride length, while still staying “on top” of the ball.  Jensen stated, “I saw the largest gains in velocity when I was working on lower body strengthening.”  He went on to say that hitting the weights in college, especially squatting type exercises, were the most beneficial.  Jensen discussed with me that he used to be a short strider and mainly relied on his arm while pitching (a common cause of injuries).  After increasing his leg strength he was able to stride further and get closer to an optimal stride length, which is about 80-90% of the athlete’s height.  It was no coincidence that in his years at college, where he focused on strengthening, the Tampa Bay Rays drafted him in 2010.

I spoke with another pitcher, Chris Odegaard, a former draft pick by the Arizona Diamondbacks in 2009.  He states that energy created in the legs can be completely irrelevant if the core is not strong enough to transfer the energy to the throwing shoulder.  Chris said that they focused on core work in college, however, when he got to the minors for the Diamondback, he said they took it to another level.  Odegaard said that the Diamondbacks emphasized how important it was to have a balanced and strong core to maximize energy transfer.

Injuries can also occur when the entire body is not involved in the pitching motion.  As far as delivering the ball, it is very common for pitchers that are lacking leg strength to take a shorter stride as George Jensen discussed above.  This creates added stress to the shoulder and elbow to make up for the lack of energy that should have been created by the legs and trunk.  On the other side of the delivery is the follow through.  This is another crucial phase in throwing that can lead to injuries as well.  Properly following through to the plate allows the larger muscles of the legs and trunk to assist in slowing the arm down after delivery.  The rotator cuff of the shoulder and structures within the elbow are, once again, put under additional stress if the legs and core are too weak or improperly used.

Working on shoulder strength is great as a pitcher, however, it is not the only body part used while throwing.  Build strong legs and a balanced core, which will help prevent injury and improve your skills.  

Good luck this season!

Anterior Shin Splints and Overstriding

Last week, we discussed the several locations of the lower leg that the term "shin splints" may be applied to. When trying to relieve the pain from "shin splints," it is important to evaluate the multiple causes.

Anterior shin splints common involve pain on the front of the shin, slightly toward the outside half of the shin. There is a muscle here that is responsible for slowing down how fast your toes hit the ground after striking the ground with your heel.


If you are involved in a running sport, and have this pain be sure to check your running technique. Overstriding (your heel hitting infront of the line of your knee) may be provoking the problem (picture of runner in red shirt below). This can be corrected by speeding up your running cadence so that you land with your foot closer to the line of your knee on each running step (picture of runner in blue shirt below). You will likely also notice that you might land more on the hindfoot, midfoot, or even forefoot instead of striking so hard with your heel.



As with any injury, start with RICE, and have the injury appropriately evaluated and treated before you start working on sports drills like running. There are many causes for pain in this area of the shin, and they are not always muscular. Another very common possibility includes bone fractures. Once your shins are feeling better, check out your running technique and see how your foot hits the ground.OSR Physical Therapy does offer professional running analysis at all 3 of its locations.

Interview with WNBA star Lindsay Whalen

Athletic trainers can play many roles within the health care realm.  Often, that can lead to a misconception of what an athletic trainer’s role actually is.  So when I had the opportunity to speak to Minnesota basketball star Lindsay Whalen, I thought, who better to discuss an athletic trainer’s role?  She started her journey at Hutchinson High School in Hutchinson, Minnesota and has played for the University of Minnesota Golden Gophers, Connecticut Sun and Minnesota Lynx of the WNBA, the gold medal winning USA basketball team of the 2012 Olympics and champion European basketball teams. With each of her basketball endeavors, she has been working with athletic trainers along the way.  I had the opportunity to ask her a few questions.

Q:        How do Athletic Trainers play a role in your day-to-day life as a professional basketball player?

Lindsay:        During my WNBA season and overseas seasons I would say that the athletic trainers for our teams play a huge role in my day-to-day life. And those roles increase with each season in both leagues. I think that each year I try and learn more from our athletic trainers and take their advice more and more. It just helps me continue to play at a high level and I know that if I do the things they are telling me to I will be able to have a longer career. My first few years in the league I was pretty much only in the athletic training room to get tape and then take an ice bath after practice. But now I am in the athletic training room for at least an hour before each practice and game and also about a half hour after getting therapy and icing.

Q:        As a professional athlete, what is your view as an athletic trainer's role with the team?

Lindsay:        As a professional athlete I feel that athletic trainers help us stay healthy and provide us with therapy, exercises, and discussions about ways to help us stay on the top of our games. I also think they have a huge part in keeping us on the right nutritional path, hydrated, sleeping enough, and just generally being there for us on a day to day basis. They are also a huge part of the team because we almost spend more time with them than the coaches. Having a good working relationship is really key, especially as a professional athlete during a long season.

Q:        You've played basketball at many levels and across the world.  From high school, college, WNBA, Europe and Olympics.  Does the role of an athletic trainer differentiate between those and if so, how?

Lindsay:        I guess I would say that in High School we did not really have an athletic trainer. I think we had someone who came in for games but other than that we did not get therapy or taping or anything. Then overseas, things are different than home and a lot of times the therapy and taping is much different. I wouldn't say it is better or worse. They use different methods than we do in the US. College, WNBA, and the Olympics are all much of the same as far as therapy, taping, and time spent with the athletic trainer and doing therapy. And like I said earlier, the longer you are with the team, or playing, the more time you end up spending in the athletic training room.

At OSR Physical Therapy, our athletic trainers utilize the same education and skills and work towards achieving our goal of providing the best care patients.

Here is Lindsay pictured with Chuck Barta, ATC for the Minnesota Lynx

The role of the glutes . . .in almost every sport!

While you are reading this whether standing, sitting, or lying I want you to contract your quads. You notice how easily you can ignite them and squeeze the femur? Next with the same amount of little attention contract your glutes. Relax. You are probably thinking what is she talking about, that was simple. But now really focus and contract those glutes again, notice this time that if you are like the majority of people your hamstrings and probably other surrounding muscles are squeezing too. Relax again. Now really focus, use your mind and activate only the glutes this time, I usually tell patients to think of pinching a penny between the cheeks. Try squeezing both, next relax only your right while keeping your left contracted, than squeeze both again next relaxing just your left; this is what we call Glute Winks. You have just discovered one of the most underappreciated and underused muscle groups in the body. Also more importantly one of the top leaders to insidious knee pain. I work with two high schools, three gymnastic clubs and three dance studios; knee pain is one of my top complaints along with ankle sprains but that’s for another blog… or is it?

Glute weakness and your brain’s control over its contraction strength along with it in the activation pattern have been linked to pain and injuries including but not limited to knee pain, plantar fasciitis, ankle pain, hamstring strains and tears, adductor strains, IT band syndrome and patella femoral syndrome (PFS).

The glute muscles are responsible for a variety of things in terms of moving the leg and stabilizing the pelvis. The glutes are influenced by a variety of factors including pelvic asymmetry and soft tissue restriction, to whether or not the foot is on or off the ground during a particular phase of movement. When the glutes work with the abdominals the hip joint is stable, the femur is controlled, the knee is stable, and the ankle is stable. Going through motions the gluts are responsible not only for stabilization but extension, rotation and abduction. Being the great compensator it is, we adapt for everything, the body starts using other muscles to get relative motions and stability at the hip, knee, ankle and foot. The body starts using the Hamstings, Calves, Adductors, Quads, Psoas, Tensor Fascia Lata (TFL) to take over for the glutes. 

There is a growing body of research that shows that in both athletes and non-active populations, hip strength and recruitment leads to less pain and injury throughout the lower extremity. So the next time you are having pain in the lower body whether while or after activity check your glutes. Make sure you are making good use of them and making them do their part. And if you are having trouble cuing them in take the time to make them wink ; )

If you would like more information read the article by David Cieslowski, DPT, CSCS. “Better Skiing Starts with the Brain-Butt Connection” from The Master Skier Cross-Country Ski Journal.

Golf

With the weather warming up, many golfers will be returning to the links after being dormant for the winter months.  At OSR Physical Therapy, we are not the ones to talk to about lowering your handicap, but we can give you a few tips to get your body ready for the golf season.  Devoting a few minutes each day to preparatory stretching and exercise for the shoulders, core, and leg muscles can help lower the risk of injury and make those first few rounds less painful (at least physically).

To become the most flexible joint in the body the shoulder sacrifices stability.  The rotator cuff is composed of the muscles that stabilize the shoulder joint.  It is important to have sufficient rotator cuff strength to allow this joint to move in a fluid motion without causing pinching.  To isolate the rotator cuff muscles, perform high repetition exercises with low weight.

The low back is a common area to feel pain and discomfort during the golf season.  Many people fail to realize that weak abdominal muscles increase the strain put on the muscles of the back to compensate for the abdominal weakness.  Performing front and side plank exercises is a great way to strengthen the different layers of the abdominal musculature.

It is important to stretch the muscles of the hips and low back due to the rotation that occurs during a golf swing.  Focus on stretching the hip flexors and hamstrings to improve the range of motion in your hips.  To stretch out your low back, try lying on your back with your knees bent.  Keep your shoulders flat on the floor and rock your knees from side to side.

Here are some videos of other helpful stretches:

 

Try these few things out over the next month as the snow melts and you will surely have less muscle pain and stiffness as you return to playing the game of golf.