The Injury Analyst

We've been hearing alot from personal trainers and health fitness gurus about functional training. No more are the days where you see someone serious about working out doing sitting isolated bicep curls. Now it's all about hitting many muscle groups at the same time. Whether it is Crossfit with deadlifts and pullups or famous trainers having you whip ropes and hit tires with a sledge hammer, we are turning back the clock to the days of strength training using moves that simulate what you might need to do in real life... if you were a field worker or in demolition. So is the new school (or very old school) right or do we need to focus on giving each muscle some love and isolate?

What is known is that working functionally using many muscle groups is more efficient. If you have only a limited amount of tiime at home or the gym, getting all muscles involved will be a good multitasking tool. Working functionally is also better to burn more calories. Recent research is showing that interval strength training is the best way to burn calories and shed weight,. Working out just your calves and then your triceps will not get your heart rate high enough to be considered a cardiovascular workout. Doing squats where you will be hitting your calves, hamstrings, glutes,quads and lumbar paraspinals will jack your heart rate up and then you could move to pullups where you get your biceps, lats, traps, abs and forearm muscles (based on grip). You almost get the full body workout with just  two exercises.

Now that I've gone on about the wonders of multimuscle group workouts, lets discuss who shouldn't be doing it. If you were ever injured, chances are your body started to compensate with other muscles and deactivation of the injured muscle. Hopefully you were tuned into this compensation and corrected accordingly. But like most of us, we continue our lives compensating and not using certain muscles that are needed to be biomechanically proficient. Bigger muscles usually take over for small stabilizing muscles (think multifidi and lumbar paraspinals or lats and parascapular muscles) and imbalances grow. Now when you try to scale a wall or lift heavy objects, the imbalances are perpetuated. Big muscles are needed and therfore dominate the movement and small, stablizing muscles stay quiet. Your body needs the robin hood of working out becaue the strong get stronger and the weak get weaker. Corrective exercises are meant to isolate deactivated or weak muscles to restore balance in your body. A person who is doesn't have his or her body working at that level might be creating a higher risk for injury down the line.

What does this mean? If you have a balanced body, go ahead and workout functionally. Those small stabilizing muscles will assist and stabilize so the big, power muscles can move and do the activity. If you have previous injuries and feel like your body is not working in harmony, start with small weights and isolate those muscles that are weak. Once you've gotten all the parts to start ticking and the assembly line of muscles are all coordinated and working in unison, pick up that sledge hammer and feel free to join the rage of functional strength training.

Don't Know If You Are Balanced, Try This:

Try a functional exercise (safely) at a relatively low weight for your capabilities. When you wake up in the morning, take an inventory on which muscles are sore and which muscles don't seem to have been touched. If your soreness is spotty, chances are there are imbalances. If your body is like a verizon coverage map (im not pro-verizon, just anti-everything else), feel free to contiue with functional training.

Note: To be safe, you should be ok'd by a doctor as well as have a musculoskeletal expert assess the imbalance before starting on a weight training regimen.

J.M.

Johan Santana has been reported to elect a surgery that will repair the anterior capsule of his left shoulder. In other words, the front of his ball and socket joint is busted. Having a dysfunction in the anterior part of the shoulder capsule or tissue is quite common. These types of injuries usually lead to a tear in the socket tissue or labrum. In this case, Johan will have a more extensive problem, begging the question if he will ever be the same again after this.

Why is it common to have an anterior shoulder problem and not posterior? I can give you three answers that relate to vanity, velocity, and very bad posture.

1) Vanity - When you want to see how strong a guy's upper body is what is your go-to question? In my day it was "how much can you bench?" This refers to the bench press that shows how well your pectoralis major muscle can lift enormous amount of weight away from your body while you lie on a bench. These muscles are functional with sumo wrestlers and offensive lineman, giving them power and strength to push their opponents. For the average guy, it is one of the favorite glamour muscles that lends us to "shirt-off" on the beach (tied with "abs" or rectus abdominus). What is bad for the guy who needs a man bra is that your pectoralis major attaches to the front of your ball or humerus and can pull it forward, slightly out of socket if excessively tight or over-active. In order to balance this muscle pull and keep the humerus within its place in the socket, one would have to workout the posterior muscles that attach to the humerus including two of our four rotator cuff muscles, the infraspinatus and teres minor muscles. Unfortunately, those muscles don't get the girls.

2) Velocity - For a pitcher, there are many muscle groups that need to work in unison with perfect coordination to throw a ball 95 miles per hour with perfect accuracy. The pectoralis major is a major player in this well orchestrated act. After the cocking phase of a pitcher's windup, the pitcher is found to be in excessive external rotation of the shoulder or his hand behind his head at shoulder level. Now that he has his arm in this position (think sling shot), what comes next is a powerful forward push with his shoulder and body going towards the plate and the pec muscle internally rotating the joint at rapid speeds. After using his pectoralis major for this motion 90-100 times a game and 20-30 times a season, no wonder this muscle will become dominant and bring the ball forward in the socket and infringe on the anterior capsule where it doesn't belong.

3) Posture - For the average computer guy or gal, typing away with arms in front in a kyphotic or hunched position, is normal for 8 hours a day, 5 days a week. Trying to stay with the baseball theme I can only think of "If you build it, it will come". If you constantly put your arms (and therefore your shoulder joint) in front of you or anteriorly, thats where things will stay permanenetly. Unlike the first two options where constant use of the pectoralis muscle is the main culprint, bad posture is the result of putting your body in an undesired position for a long period of time which makes the body adapt and stay there.

Whether your are making millions as a major leaguer or the average guy, everyone has the potential for shoulder problems. Fixing your posture early and keeping your muscles and joints symmetrical are the best ways to keep the ball in the joint versus out in front. 

Don't Get It, Try this:

By looking in the mirror, one can usually detect rounded posture. Now put both hands on a door post and lean forward (have one leg forward for balance). Feel an intense stretch? Those pecs need to be lengthened. Feel a clunk? Thats the humerus wanting to dislocate. Feel both sensations? Think about fixing that shoulder before stepping on the mound.

Robert Griffin III was held out of Week 15 game against the Browns. He and his father insisted he was going to play that game with a last minute scratch due to not being cleared by his doctors. If RG3 thought he was good to go, why was he held out of the game? Was it just precaution? Was it more than a grade 1 LCL (lateral collateral ligament) sprain? When being held out of play, there should be a good reason. Maybe they just wanted to see how their backup quarterback would fare. Probably not.

Assuming a player has full strength and range of motion as well as pain-free movement, only one thing can create an increased risk for another injury: proprioception (or lack thereof). Proprioception is the ability of a joint or limb to discern its position in space. It is the neuromuscular connection between the central nervous system and the affected limb. In this case, RG3's knee. In simpler terms, it is the ability of the knee to make hard cuts and uncertain motions in a smooth way. The way I explain it to my patients is the ability of the knee to "not be akward" during sports. When having surgery or getting injured, changes take place in the body. Muscles shut off, compensatory movements begin and hesitant movements form. A player that usually could take a hard cut off his leg,  might change his push off pressure to avoid using the muscles surrounding the injured area. When this happens, mechanics change and the chance of reinjuring the area or creating an environment for a new injury escalates.

Research says that when a player tears his/her ACL (anterior cruciate ligament), he has a higher likelihood of tearing the ACL of his other knee. With the concept of proprioception and change towards compensatory mechanical changes, it is much easier to understand why an athlete can injure his perfectly strong and healthy left knee when his right knee is affected. It also makes sense why RG3 is wearing a brace going into week 16 game against the Eagles. When you don't trust your own knee and the ability of the internal stabilizers/movers (muscles) of the joint to hold up, you need an external force such as a brace to give you that confidence. Research has shown that a neoprene brace for patella femoral pain syndrome can help reduce pain although tests show that it is not strong enough to actually stabilize the knee cap. What the brace does is actually give more proprioceptoive input for increased "awareness" of the knee and compression which gives some psychological confidence that the knee wil hold up. RG3's biggest assets are his legs (ok maybe his right arm has some value) and if he doesn't want cut his career short, he will need to train progressivley until his knee is in full concert and perfect harmony with the rest of his body.

Laurie Cloyes is a women's professional disc golf player with career achievements including winninig the 2009 United States Masters Disc Golf Championship and placing 3rd in the 2010 Ladies La Mirada Pro-Am. Some tips I picked up playing with Laurie are to keep the nose down by rotating the forearm (supination), use your trunk to rotate and let your arm guide the disc.

1. What one secret would you have for aspiring frisbee golfers whether it be mental or mechanical?

    Always have fun, don't get frustrated.  Remember as with any sport, practice makes perfect!

2. What is your best moment as a frisbee golfer in your career?

    When I got a call in 2000 from my son asking me to play Mixed Doubles in a World Championship with him and we ended up 7th in a field of 14.

    We had never played together before, it was sooooo awesome.

3. When did you realize you could compete professionally?

    When I wanted to compare my play experience against other women disc golfers.

4. What is your favorite part about playing the game?

    It's a walk in the park every time.

5. How do you keep your motivation and not lose focus after pulling the disc during a drive or missing a close putt?

    Just let it go!  Move on, there's always more disc golf to play and enjoy the scenery.

6. Mechanical errors you had to correct to get a longer drive or become more accurate.

    Stretch before playing, stay calm and don't over think the game. Have fun.

When training for any sport, whether you are a professional athlete or a weekend warrior, if the goal is to "get in shape" without any specified goal you are truly setting your bar very low. You aren't maximizing the physical and mental capabilities you can attain with goal-oriented training. 

I used to work out at the gym with the goal of doing 3 sets of an exercise to failure. What puzzled me were the people that had a sheet of paper with them, writing down every detail about their workout including amount of repititions, weight lifted, rest interval, set count,etc. I scoffed at such practices thinking that this was for the type "A"'s who just wasted precious gym time. Over time, my results plateaued which gave me a snowball effect of mental frustrations, while my fellow gymers calmly collected data and kept progressing. 

This simple idea really hit home this past year. While having a one-sided compettion with a friend, I kept asking him how many miles he ran each outing. I then attempted to beat his distance each time I stepped onto the treadmill. I am now trouncing my old record of a maximum 4 mile run with almost a 100% improvement of over 8 miles! 

After seeing true results with goal-oriented training, I discovered many benefits the athlete can get when writing things down, having a goal and reaching for that competitive spirit within us. Here are some of the main benefits from goal-oriented training:

Confidence - if i practice a speech enough times, my words will be more eloquent and my voice will project better. If I keep beating set goals for myself, I know that limits can be pushed and accomplishing goals is no problem.

Mental Toughness - To quote Joel Stein, author of Man Made: A Stupid Quest for Masculinity, " because everytime you push yourself  to try something difficult, you become less afraid of everything else".

Inspiration to Continue - seeing improvements will keep you wanting more.

Driveand Ambition - Competition can spill over into other areas of life including work, school, and personal growth.

When working with an athlete I always have one simple but important question: Whats your goal? I then follow up with "be specific". If the answer is just to "get better" we have to start digging  a little deeper. What does "getting better" mean? Faster? Stronger? If so, lets create a speed or strength goal to reach.

So for a more meaningful workout program, write down your results, aim to beat those results next session, and repeat.

Anyone ever tell you about their training for weight loss or athletic improvements? Did they ever say "I just ran _____ miles" ? A good follow up question would be " Did you run or jog?" Do you notice often the answer changes to "Oh no, iwasn't actually running. More of a slow jog." Running and jogging have become synonymously used with aerobic training, yet the effects and muscles used can be vastly different. 

Recently into a few months of endurance training of "running" and swimming, I decided to take part in a flag football game. What I thought I was getting myself into was some light sprinting, some above average defense and a coupleof catches, maybe even one for a touchdown. My expectations were not close to what I encountered. Former high school and possibly college football players, geared up head to toe in cleates, Under Armour - type sports clothingg and wrist bands. Relative to my standards, it seemed like everyone could run the 40 yard dash in 4.4 seconds. I will spare you the humiliating stats I compiled, but I rediscovered the most simple thing the day after my exhausting experience. Soreness in different places than usual. Usually after I go for a max jog, logging as many miles that my jello legs and infant lungs will let me, I usually get most of my soreness in my quads and posterior/lateral hip muscles. After football, I had (way more) soreness in my anterior hip muscles (hip flexors) and hamstrings. 

Throughout exercise physiology and strength training courses, I always encountered difference in muscle twitch fiber composition (Type I versus Type IIa/Type IIb) as being the explanation why some people are endurance runners and some track/speed athletes or "burners" (Just learned that term in a football huddle. Obviously he wasn't directing that nickname towards me). But let me give a simpler explanation. Based on the range of motion we use day-to-day or in the sports we play will determine how fast we are or for how long we can run. If one takes long strides, maximally extending and flexing the hip in all planes of movement (not just straight forward or back called the sagital plane but side-to-side and diagnol movements), one will become a burner. If one takes smaller strides, stressing the quads and and gluteus muscles, he will learn to master the marathon. So here is my simple suggestion:

For endurance training: strengthen the quads and gluteus medius/minimus with high repitiions and lower relative weight to simulate jogging. Eccentric and isometric actions should be emphasized rather than concentric.

For speed training: strengthen the hip flexors and hamstrings using low to middle resistance with powerful bursts such as in plyometrics for short periods of time, emphasizing velocity of the movement to simulate running. Concentric actions should be emphasized over eccentric and isometrics.

J.M.

"He's got some inflammation that we're going to calm down"

Ok. Now What?

"We thought in between starts was enough time to do it."

To do what?

"maybe they'll do an MRI"

To find...

"If he's going to get a (cortisone) shot"

Of course he will.

These are just some of the comments made by Boston Red Sox manager Bobby Valentine after putting Josh Beckett on the 15 day DL this weekend. The one calming factor in all this is that historically Beckett goes to Dr. James Andrews when something serious is afoot. Dr. Andrews, founder of the Andrews Sports Medicine and Orthopaedic centers and the American Sports Medicine Institute (ASMI) is world renowned not just for his surgerical prowess but for his collaboration with the top biomechanists and movement scientists in the country, including physical therapists Kevin Wilk and Michael Reinold.

 The reason he may want to supplement the usual treatment of rest and cortisone shots is his recent bouts with other lingering injuries. The key to the shoulder is in the thumb and latissimus dorsi ("lats" as they are usually referred). If we stick to the main principles with overuse injuries we can draw the lines from one injury to another.

  Principle #1: Pain inhibits muscle recruitment.

Principle #2: When one muscle in a muscle group isn't working properly, another muscle will have to carry the extra load, thereby creating a non-synergistic joint which leads to a dysfunctional joint.

 Principle #3: When one joint isn't functioning properly, the joint above or below will take on the extra task to complete the action the body is trying to take.

Now let's connect the dots. Beckett hurt his thumb. This altered his mechanics enough with his hand and wrist that he needed support from another neighboring joint: the elbow and shoulder. The extra forces needed to maintain velocity and control had to come from somewhere and that's where the lats came to play. The lats are used in the arm acceleration phase until follow through. They become overworked and now the shoulder joint is not working in synergy with the rest of the rotators of the shoulder. Now assuming those chain of events are the cause of his problems, how would a shot help? In the short term, it would decrease inflammation along with rest and ice. But where's the end game and hopefully retirement isn't where he's headed. Luckily he has Dr. Andrews waiting for him in Alabama.

Don't Get It, Try This:

Grab a ball and throw it. Now grab that same ball and try throwing the ball without bending the wrist. Notice more motion at the shoulder (hand coming forward is shoulder internal rotation) or at the trunk (rotating or twisting). Now try limiting the wrist or shoulder from coming forward. Now it all becomes trunk. Now you got the basic principle: when one joint is limited, the surrounding joints kick it up a notch to help.

 J.M.

This saddens me to write this piece. The Dodgers were having such a good year. This was supposed to be THE year. Matt Kemp left the Dodgers-Brewers matchup in the first inning with a hamstring strain, a day after coming off the 15 day DL for the same injury. Maybe you could blame Stan Conte for clearing him to play again so soon. But how much time and rest would have resolved the issue? Especially when the source of the problem probably wasn't even addressed!

The hamstring muscles are hip and knee extensors that are powerfully used in running. When one muscle is asked to do the work of another, strains are highly likely. When a muscle is asked to help out another, become a main stabilizer and push off the ground with high frequency and intensity, then your just asking for it. 

There are a few type of people in this world. Back people. Groin people. And then there are hamstring people (wouldn't be the world be a better place if this how we judged people, by the muscles they overuse?). Each person uses a combination of muscles that work as efficiently as possible. The problem is sometimes the strongest muscle is being asked too much of. I guess you can say the hamstrings are the Kobe Bryant of muscles. 

The hamstring is a powerful group of muscles that generates high forces and gives you your speed. But as big and bad as it is, it can't carry everybody else on its back (or to be more precise, your knee). There are numerous other tiny muscles that are mean't for stabilizing the hip and the Glutes Maximus/Medius are mean't to handle the forces of body weight and loading. Give the hamstring a break and get everybody else involved, I say. Then maybe Kemp can come back and bring back the glory days to the Los Angeles Dodgers.

Don't Get It? Try This:

Lie on your stomach and lift your leg off the ground. What muscle(s) do you feel the most? Hamstring? Gluteus Maximus? Back? Now lie on your side and lift your leg away from your body (towards the ceiling). What do you feel? Getting hamstring on both? Maybe you and Kemp can play cards in the dugout while my dream of the Dodgers winning it all this year slips away like a dream.

J.M. 

So the Phillies are turning fickle. I might not be totally unbiased here as a stark Dodger fan, but where is the loyalty? The man that pitched a perfect game and CY Young winner for you just two years ago is now on the trading block? I guess we could see it coming. 

In 2004, Halladay was put on the DL twice and was later diagnosed with a "tired throwing arm". His hard throwing tactics and high pitch counts were inevitably drawing him to the situation he is in today at the age of 35. According to Fangraphs.com, Halladay's velocity has been down with increasingly more shoulder soreness. What's the deal?

"Even a little soreness after throwing, pain, or being tired in the arm or having a dead arm is an indication that the player is out of his natural throwing groove. Inability to throw strikes and loss of velocity is another indication that a player is out of his natural throwing groove."  - Coach John C. Price.

A "natural throwing groove" or correct mechanics of a pitcher can be off ever so slightly and have a huge effect. Let's start with the chain reaction starting with tightness of the the shoulder joint. When the back of the shoulder joint is tight or stiff, it is harder to internally rotate your arm. In the arm acceleration and deceleration phases of picthing, or when your throwing the ball after the wind up, a pitcher needs to rotate to neutral from 165 to 180 degrees of external rotation (most shoulders only get around 90 degrees of external rotation). Let's just say Roy lost a few degrees of internal rotation when he throws. He still needs to get the ball placed where he wants it to go. He tries to maneuver so he can apparently get to neutral. But his arm is fooling him. He isn't getting to neutral. He is getting some motion from another joint to compensate for lack of shoulder motion. Whereis he getting the extra motion? 

When looking at compensations, one need look no further than the next joint usually. In Halladay's case, let's look at the scapulothoracic joint or the shoulder blade. When one is deficient in internal rotation, protracion and anterior tipping of the shoulder blade occur. In simpler terms, your shoulder blade moves outward and leans forward. Your "natural throwing groove" is off but what also happens is a tractioning of your nerves coming from the neck. When your shoulder blade slides out to the side, the distance from the neck to the arm increases. In people with good nerve mobility, this might not be a problem. Any tightness in your neck or in the thoracic outlet area, and now you have a constant tracion torque on the nerves, especially on the suprascapular nerve. Over time, your nerves aren't having it and start to get inflamed and you start to lose more motion and strength. The vicious cycle towards retirement begins.

Don't Get It, Try This: 

Put your elbow on a surface level to your shoulder with your fist towards the ceiling. Start to move your fist forward toward the table surface. At some point you will feel your shoulder blade move. The sooner it moves, the tighter your shoulder is.

J.M.

Doing sit ups is the fast track to glamour. That is why they are called the "glamour muscles" right? So why do people focus on their "abs" and work tirelessly on crunching and bicycle kicking. Well to avoid being redundant, the main reason is to look good. The rectus abdominus or the "abs" accomplishes trunk flexion or bending your back forward, but little else. It is not as much of a trunk/core stabilizer as the transverse abdominus or the obliques. In fact, after doing situps for many years, the ab muscles get tight and start to pull you over into that hunched over or kyphotic posture. So instead of gaining core stability, you are losing posture and flexibility. On the flip side, if you have that six-pack you can take your shirt off at the beach and the ladies/gentlemen will take note. I guess we are dealing with a case of priorities here.

Yoga on the other hand is about stabilization and mobility. Yoga, done properly with a knowledgable yogi, can be the most beneficial anti-pain and anti-injury tool one can acquire. Let's the take the anti-abs portion of yoga or the "cobra" pose. This pose puts the spine into extension or when you straighten your back, stretching the abdominals so a guy Chris Bosh doesn't have to worry about throwing down a monster dunk.

After being called soft by the critics since joining the Miami Heat, Chris Bosh has been taking it to the rim. Trying to show the Indiana Pacers and Roy Hibbert who's boss, Bosh reached back with that lanky frame and long left arm and demonstrtated that he isn't just a jump shooter and finesse player. The problem was that he over extended his spine when he didn't have permission from his rectus abdominus to do so. He fell to the ground and the crowd went silent. They knew their chances of winning it all this year just dropped dramatically. A strain of the abdominals might only keep you out for weeks (5 weeks on average), but focusing on some salutations instead of worrying about the glamour would have sealed the Heat's future as NBA champions.

Don't Get It? Try This.

Go on your stomach and prop your self on your elbows. Feel a stretch right below the rib cage. Maybe you need a little more cobra and a little less The Situation.

J.M.