Boston Sports Medicine and Performance Group, LLC Blog

Up the Chain it Goes...

Posted by Boston Sports Medicine and Performance Group on Sun, Apr 29, 2012 @ 15:04 PM

By Art Horne

 

 

derrick rose torn acl

 

 

With recent season ending ACL injuries to New York Knicks Iman Shumpert, and Chicago Bull’s point guard Derrick Rose coming on the same day, (not to mention Eric Maynor from the Thunder and Spanish Star Ricky Rubio earlier this season) discussion has arisen as to how these terrible injuries could have been avoided.  Although the possible contributing factors are endless, ranging from previous injury to simply fatigue, one area worth shedding more light on, especially in the case of young Rose, is the implication of the kinetic chain as a whole.

Let’s start at the ground and work our way up.

I think we’d all agree that the big toe is a big deal.   But how closely are we looking at this “pivotal” body-ground juncture?

In a study by Munuera et al, researchers found that “Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet.  There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion.” (Munuera et al, 2012). 

TRANSLATION: People with abnormally stiff or limited motion at the great toe had excessive motion at the joint just distal.

If you don’t have mobility where you need it, you’ll surely get it somewhere else.

Let’s move up the chain shall we?

In a study by Van Gheluwe and his group,  researchers looked at how a stiff or limited great toe joint changes the way we walk.  In their study, “two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics.  The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head.  Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads.  Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur.”

TRANSLATION: if you have a limited motion in your great toe, pressure changes will occur – increase pressure changes will cause pain over time (think blister on your foot).

And pain changes the way we move – period.

Let’s take a look at the ankle.

In an article  by Denegar et al, the authors outline the importance of regaining normal talocrural joint arthrokinematics following an ankle injury.   The authors note,

 “All of the athletes we studied had completed a rehabilitation program as directed by their physician under the supervision of a certified athletic trainer, and had returned to sports participation.  Furthermore, all had performed some form of heel-cord stretching. None, however, had received joint mobilization of the talocrural complex.  Despite the return to sports and evidence of restoration in dorsiflexion range of motion, there was restriction of posterior talar mobility in most of the injured ankles.  Posterior talar mobilization shortens the time required to restore dorsiflexion range and a normal gait.  Without proper talar mobilization, dorsiflexion range of motion may be restored through excessive stretching of the plantar flexors, excessive motion at surrounding joints, or forced to occur through an abnormal axis of rotation at the talocrural joint.” (pg. 172)

TRANSLATION: I repeat, Without proper talar mobilization, dorsiflexion range of motion may be restored through excessive stretching of the plantar flexors, excessive motion at surrounding joints, or forced to occur through an abnormal axis of rotation at the talocrural joint.” (pg. 172)

If you don’t have normal ankle motion, and specifically at the talus, your ankle motion (although appearing normal) is probably coming from other joints and/or in a combination with foot pronation.

 

Foot Pronation = Tibial Internal Rotation

Tibial Internal Rotation = Femoral Internal Rotation

Tibia and Femur Internal Rotation  =  Knee Valgus (or knee collapse)

Knee Valgus = BAD

 

But just because you have some extra motion doesn’t mean you’re doomed right?

No.

But, excessive motion without the ability to control that motion certainly does.  So where does knee control come from? The Hip!

But hip strength, control, and neuromuscular timing is seldom appreciated, and in the case of the basketball athlete it is certainly poorly measured, especially after ankle injury.

In a study by Bullock-Saxton, researchers investigated muscle activation during hip extension after ankle sprain and showed a changes in timing of muscle activation in the ankle sprain grouped compared to the non-injured group.

 “the results highlight the importance of the clinician’s paying attention to function of muscles around the joints separated from the site of injury.  Significant delay of entry of the gluteus maximus muscle into the hip extension pattern is of special concern, as it has been proposed by Janda that the early activation of this muscle provides appropriate stability to the pelvis in such functional activities as gait.” (pg. 333)

 

In another study examining ipsilateral hip strength/weakness after the classic ankle sprain, researchers demonstrated that subjects with unilateral chronic ankle sprains had weaker hip abduction strength and less plantar flexion range of motion on the involved sides (Friel et al., 2006)

“Our findings of weaker hip abductors in the involved limb of people with chronic ankle sprains supports this view of a potential chronic loss of stability throughout the kinetic chain or compensations by the involved limb, thus contributing to repeat injury at the ankle.” (pg. 76)


“If the firing, recruitment, and strength of the hip abductor muscles in people with ankle sprains have been altered because of the distal injury, the frontal-plane stability normally supplied by this muscle is lacking, and the risk for repeat injury increases.  Weak hip abductors are unable to counteract the lateral sway, and an injury to the ankle may ensue.”

TRANSLATION: Ankle sprains cause neuromuscular changes up the chain and specifically in the hip.  If this weakness is not addressed after an ankle injury,” frontal-plane stability normally supplied by this muscle is lacking.” 

 

Lack of frontal-plane stability + Knee Valgus = Injury

 

Of course suggesting that the above points are exactly the reason for which Rose suffered his injury is certainly a stretch and not the intention of this post, nor is it to question the treatment that he or any other NBA player received prior to their devastating injury (for the record, the Chicago Bulls Sports Medicine and Strength Staff are regarded as one of the very best in the league).  What I am suggesting however is that examining athletes and patients with the use of advanced technology to determine a state of readiness to participate, and/or examine more closely changes in gait and neuromuscular firing is certainly worth pursuing, especially in light of the ever-rising salaries within professional sports.  A quick look is certainly worth the small investment.

One thing is for sure, ACL injury is not limited to teenage females or only seen on the soccer pitch.

 

Previous Posts:

The NBA Should Have Learned From The NFL - Injuries On The Rise

Did The NBA Lock-out Ultimately End Chauncey Billups' Career?

 

See lectures directly related to gait, injury prevention, and performance at the 2012 BSMPG Summer Seminar:

1. Dr. Bruce Williams: Hit the ground running: Appreciating the importance of foot strike in NBA injuries

2. Dr. Bruce Williams: Breakout Session: Restoring Gait with evidence based medicine

3. Art Horne and Dr. Pete Viteritti: Improving Health & Performance - Restoring ankle dorsiflexion utilizing a manual therapy approach

4. Dr. Tim Morgan: Biomechanics and Theories of Human Gait: Therpeutic and Training Considerations

5. Jose Fernandez: Advanced Player Monitoring for Injury Reduction

 

 

See the most advanced player monitoring equipment currently available at the 2012 BSMPG Summer Seminar:

 

 zeo affectiva  ithlete

BioSensics  Zflo insideTracker

 

Dartfish  freelap timing   Tekscanoptosource

Click me

 

 


References:

Munuera PV, Trujillo P, Guiza L, Guiza I. Hallux Interphalangeal Joint Range of Motion in Feet with and Without Limited First Metatarsophalangeal Joint Dorsiflexion. J Am Podiatr Med Assoc. 102(1): 47-53, 2012.

Denegar, C., Hertel, J., Fonesca, J.  The Effect of Lateral Ankle Sprain on Dorsiflexion Range of Motion, Posterior Talar Glide, and Joint Laxity.  J Orthop Sports Phys Ther. 2002; 32(4):166-173.

 

Van Gheluwe B, Dananberg HJ, Hagman F, Vanstaen K. Effects of Hallux Limitus on Plantar Foot Pressure and Foot Kinematics During Walking. J Am Podiatr Med Assoc. 96(5): 428-436, 2006.

Bullock-Saxton, J. E., Janda, V., & Bullock, M. I. (1994) The Influence of Ankle Sprain Injury on Muscle
Activation during Hip Extension. Int. J. Sports Med. Vol. 15 No. 6, 330-334.

Friel, K., McLean, N., Myers, C., & Caceres, M. (2006). Ipsilateral Hip Abductor Weakness After Inversion
Ankle Sprain. Journal of Athletic Training. Vol. 41 No.1, 74-78

Smith RW, Reischl SF. Treatment of ankle sprains in young athletes. Am J Sports Med. 1986;14:465-471.

Topics: Art Horne, basketball performance, basketball training programs, BSMPG, athletic training conference, Charlie Weingroff, boston hockey conference, barefoot strength training, Andrea Hudy, Bruce Williams, Cal Dietz, Alan Grodin, Barefoot in Boston, Dr. DiMuro, Dan Boothby, Chris Powers, achilles pain, Dorsiflexion, ankle problems

Meet Chris Powers - 2012 BSMPG Summer Seminar Keynote Speaker

Posted by Boston Sports Medicine and Performance Group on Sat, Apr 28, 2012 @ 08:04 AM

 

Over the last decade no one has changed the way we approach and treat knee pain more than Chris Powers.  

Learn how the Hip is a major factor when it comes to the aches and pains associated with your knee at the 2012 BSMPG Summer Seminar!

 

Chris Powers 

Topic: Proximal Factors Contributing to Running Injuries

 

Christopher M. Powers is an Associate Professor in the Division of Biokinesiology & Physical Therapy, and Co-Director of the MBRL at USC. He also has joint appointments in the Departments of Radiology and Orthopaedic Surgery within the Keck School of Medicine.  His primary teaching responsibilities include the areas of biomechanics and the mechanics of human gait. He received a Bachelors degree in Physical Education from the University of California, Santa Barbara in 1984, his Masters degree in Physical Therapy from Columbia University in 1987, and a Ph.D. in Biokinesiology in 1996 from USC. Dr. Powers did his post-doctoral training at the Orthopaedic Biomechanics Laboratory, University of California, Irvine.

Dr. Powers studies the biomechanical aspects of human movement. More specifically, his research and publications are concerned with the kinematic, kinetic and muscular actions associated with human movement, the pathomechanics of orthopedic disabilities and issues related to rehabilitation of the musculoskeletal system. He has published over 90 peer-reviewed articles and has received several research awards from the American Physical Therapy Association, including the Rose Excellence in Research Award from the Orthopaedic Section, the Eugene Michels New Investigator Award, the Dorothy Briggs Scientific Inquiry Award and the Helen J Hislop Award for contributions to the professional literature.

Dr. Powers is a Fellow of the American College of Sports Medicine and a member of the American Physical Therapy Association (Orthopaedic and Research sections), American Society for Biomechanics, American Society for Testing and Measures, and the North American Society for Gait and Clinical Movement Analysis. In addition, Dr. Powers is on several editorial boards including the Journal of Applied BiomechanicsJournal of Orthopaedic and Sports Physical Therapy, and the Journal of Athletic Training.  He is an active member of the American Physical Therapy Association, serving as President of the Section on Research.

 

Education

  • Postdoctoral Fellow, Orthopaedic Biomechanics (1996-1997), University of California, Irvine, CA
  • Ph.D. Biokinesiology (1996). University of Southern California, Los Angeles, CA
  • M.S. Physical Therapy (1987). Columbia University, New York, NY
  • B.A. Physical Education (1984). University of California, Santa Barbara, Santa Barbara, CA

Selected Publications

  • Stefanik JJ, Zhu Y, Zumwalt AC, Gross KD, Clancy M, Lynch JA, Frey LA, Lewis CE, Roemer FW,Powers CM, Guermazi A, Felson DT. The association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: The Multicenter Osteoarthritics Study. Arthritis Care & Res (In press).
  • Farrohki S, Colletti PM, Powers CM. Differences in patella cartilage thickness, T2 relaxation time and cartilage deformational behavior: A comparison of young females with and without patellofemoral pain. Am J Sports Med (In press).
  • Chen YJ, Scher I, Powers CM. Quantification of patellofemoral joint reaction forces during functional tasks: A subject specific, three dimensional model. J Appl Biomech (In press).
  • Kulig K, Harper-Hanigan K, Souza RB, Powers CM. Measurement of femoral torsion by ultrasound and magnetic resonance imaging: Concurrent validity. Phys Ther (In pre).
  • Souza RB, Draper CE, Fredericson M, Powers CM. Femur rotation and patellofemoral joint kinematics: A weight-bearing MRI analysis. J Orthop Sports Phys Ther. 40:277-285, 2010.
  • Powers CM, Chen YJ, Scher I, Lee TQ. Multi-plane loading of the extensor mechanism alters the patellar ligament force/quadriceps force ratio. J Biomed Eng. 132:024503, 2010.
  • Fithian DC, Powers CM, Khan N. Rehabilitation of the knee following medial patellofemoral ligament reconstruction. Clin Sports Med. 29:283-290, 2010.
  • Powers CM, Blanchette MG, Brault JR, Flynn J, Siegmund GP. Validation of walkway tribometers: Establishing a reference standard. Submitted to: J Forensic Sci. 55:366-370, 2010.
  • Powers CM. The influence of abnormal hip mechanics on knee injury: A biomechanical perspective. J Orthop Sports Phys Ther. 40:42-51, 2010.
  • Wagner T, Behnia N, Ancheta WL, Shen R, Farrokhi S, Powers CM. Strengthening and neuromuscular re-education of the gluteus maximus in a triathlete with exercise-association cramping of the hamstrings: A case report. J Orthop Sports Phys Ther. 40:112-119, 2010.
  • Tonley JC, Dye JA, Kochevar RJ, Yun SM, Farrokhi S, Powers CM. Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement re-education: A case report. J Orthop Sports Phys Ther. 40:103-111, 2010.
  • Pollard CD, Sigward SM, Powers CM. Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments. Clin Biomech. 25:142-146, 2010.
  • Tsai LC, Sigward SM, Pollard CD, Fletcher MJ, Powers CM. The effects of fatigue and recovery on knee kinetics and kinematics during side-step cutting. Med Sci Sport Exerc. 41:1952-1957, 2009.
  • Kulig K, Beneck GJ, Selkowitz DM, Popovich JM Jr., Ge TT, Flanagan SP, Poppert EM, Yamada K,Powers CM, Azen S, Winstein CJ, Gordon J, Samudrala S, Chen TC, Shamie N, Khoo L, Spoonamore MJ, Wang JC and Physical Therapy Clinical Research Network (PTClinResNet), The effect of an intensive, progressive exercise program on functional performance in patients post single-level lumbar microdiscectomy. Physical Therapy. 89:1145-1157, 2009.
  • Tsai YJ, Powers CM. The influence of footwear sole hardness on utilized coefficient of friction during walking. Gait & Posture. 30:303-306, 2009.
  • Souza RB, Powers CM. Concurrent criterion-related validity and reliability of a clinical test to measure femoral anteversion. J Orthop Sports Phys Ther. 39:586-592, 2009.
  • Souza RB, Powers CM. Predictors of hip rotation during running: An evaluation of hip strength and femoral structure in women with and without patellofemoral pain. Am J Sports Med. 37:579-587, 2009.
  • Souza RB, Powers CM. Differences in hip kinematics, muscle strength and muscle activation between subjects with and without patellofemoral pain. J Orthop Sports Phys Ther. 39:12-19, 2009.
  • Sigward SM. Ota S, Powers CM. Predictors of frontal plane knee excursion during a drop landing in young female athletes. J Orthop Sports Phys Ther. 38:661-667, 2008.
  • Brennglass A, Souza RB, Meyer J, Powers CM. Identification of abnormal hip motion associated with acetabular labral pathology: A resident’s case report. J Orthop Sports Phys Ther. 38:558-565, 2008.
  • Farrokhi S, Pollard CD, Souza R, Chen YJ, Reischl S, Powers CM. Trunk position influences lower extremity demands during the forward lunge exercise. J Orthop Sports Phys Ther. 38:403-409, 2008.
  • Tsai YJ, Powers CM. The influence of footwear sole hardness on slip initiation in young adults. J Forensic Sci. 53:884-888, 2008.
  • Powers CM, Doubleday KL, Escudero C. The influence of patellofemoral bracing on pain, knee extensor torque and gait function in females with patellofemoral pain. Physiother Theory Pract. 24:1-9, 2008.
  • Powers CM, Beneck GJ, Kulig K, Landel RF, Fredericson M. The effects of a single session of posterior to anterior spinal mobilization and press-ups on pain response and lumbar spine extension in persons with nonspecific low back pain. Phys Ther. 88:485-492, 2008.
  • Burke WS, Vangsness CT, Powers CM. Quantification of glenohumeral rhythm in persons with and without impingement. Am J Orthop. 37:24-30, 2008.
  • Landel RF, Kulig KK, Powers CM. Intertester reliability and validity of motion assessments during lumbar spine accessory motion testing. Phys Ther. 88:43-49, 2008.
  • Burnfield JM, Powers CM. The role of center of mass kinematics in predicting utilized coefficient of friction during walking. J Forensic Sci 52:1328-1333, 2007
  • Ward SR, Terk MR, Powers CM. Patella alta: Association with patellofemoral alignment and changes in contact area during weight bearing. J Bone & Joint Surg Am. 89:1749-1755, 2007.
  • Sigward S, Powers CM. Loading characteristics of female athletes who demonstrate excessive valgus moments at the knee during side-step cutting. Clin Biomech. 22:827-833, 2007.
  • Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM. Surgical biomechanics of the patellofemoral joint. Arthroscopy. 23:542-553, 2007.
  • Pollard CD, Sigward S, Powers CM. Gender differences in hip joint kinematics and kinetics during a side-step cutting maneuver. Clin J Sports Med. 17:38-42, 2007.
  • Powers CM, Stefanou MA, Tsai YJ, Brault JR, Siegmund GP. Assessment of walkway tribometer readings in evaluating slip resistance: A gait based approach. J Forensic Sci. 52:400-405, 2007.
  • Kulig K, Powers CM, Landel R, Chen K, Fredericson M, Guillet M, Butts K. Segmental lumbar mobility in individuals with central low back pain: In-vivo assessment during passive and active motion using dynamic MRI. BMC Musculoskelet Disord. 8:1-10, 2007.
  • Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, DeMaio M, Dick RW, Engebretsen L, Garrett WE, Hannafin JA, Hewitt TE, Huston LJ, Ireland ML, Johnson RJ, Lephart S, Mandelbaum BR, Mann B, Marks RH, Marshal SW, Myklebust G, Noyes FR, Powers CM, Shields C, Schultz SJ, Silvers H, Slauterbeck J, Taylor D, Teitz CC, Wojtys EM, Yu B. Understanding and preventing noncontact anterior cruciate ligament injuries. Am J Sports Med. 34:1512-1532, 2006.
  • Powers CM, Chen YJ, Scher I, Lee TQ. Influence of patellofemoral joint contact geometry on the modeling of three dimensional patellofemoral joint forces. J Biomech. 39:2783-2791, 2006.
  • Selkowitz DM, Kulig K, Poppert EM, Flanagan SP, Mathews Nd, Beneck GJ, Popovich JM, Lona JR, Yamada KA, Burke WS, Ervin C, Powers CM. The immediate and long-term effects of exercise and patient education on physical, functional, and quality of life outcome measures after single-level lumbar microdiscectomy: A randomized controlled trial protocol. BMC Musculoskelet Disord. 7:1-15, 2006.
  • Ota S, Ward SR, Chen YJ, Tsai YJ, Powers CM. Concurrent Criterion-Related validity and reliability of a clinical device used to assess lateral patella displacement. J Orthop Sports Phys Ther. 36:645-652, 2006.
  • Powers CM, Chen YJ, Farrohki S, Lee TQ. The role of peripatellar retinaculum in the transmission of forces within the extensor mechanism. J Bone Joint Surg Am. 88:2042-2048, 2006.
  • Burnfield JM, Powers CM. Prediction of slips: An evaluation of utilized coefficient of friction and available slip resistance. Ergonomics. 49:982-995, 2006.
  • Pollard CD, Sigward SS, Pelley K, Ota S, Powers CM. The influence of an in-season injury prevention program on lower extremity kinematics during landing in young female soccer players. Clin J Sports Med. 16:223-227, 2006.
  • Sigward SM, Powers CM. The influence of experience on knee joint kinematics, kinetics and muscle activation patterns during side-step cutting in young females. Clin Biomech. 21:740-747, 2006.
  • Ganley KJ, Powers CM. Intersegmental dynamics during the swing phase of gait: A comparison of knee kinetics between 7 year old children and adults. Gait Posture. 23:499-504, 2006.
  • Sigward S, Powers CM. The influence of gender on knee joint kinematics, kinetics and muscle activation patterns during side-step cutting. Clin Biomech. 21:41-48, 2006.

 

Meet Chris Powers, along with Craig Liebenson, Bill Knowles, Coach Schexnayder, and Alan Grodin as they headline the 2012 BSMPG Summer Seminar this May 19-20th in Boston.

This is an event that you don't want to miss!

 

Click me

 

Topics: Art Horne, BSMPG, boston hockey summit, Charlie Weingroff, boston hockey conference, Andrea Hudy, Cal Dietz, Bill Knowles, Alan Grodin, Chris Powers

Monitoring Power Development : A Look at New Technology

Posted by Boston Sports Medicine and Performance Group on Fri, Apr 27, 2012 @ 07:04 AM

by Carl Valle

 

Kinetic

 

I decided to interview Rob Shugg from Kinetic Performance after hearing a few new definitions of what power is, and felt that we needed more sport science tools to help the performance community understand how to develop power in team sports. Track and field is very objective, but the methodologies tend to be cloudy. I wanted to get Rob's opinion on the matters of true development and monitoring of elite sport as he has many years with the Australian Institute of Sport and in the private sector with technology and performance. The BSMPG is the first conference in the US to promote Gymaware and Kinetic Performance as technology and data is becoming more and more important to help teams find the winning edge. 

Most of the US professional and college teams are familiar with linear transducers for measuring power, could you expand on the differences between Gymaware and the Tendo system, specifically with the advanced analytics and cloud benefits. 

First I’d like to give your readers a quick outline of the GymAware components:GymAware Power Tool - A linear transducer that connects via bluetooth to an iPad, iPod Touch or iPhone. 

iOS apps: 

GymAware Lite App - a stand-alone weightlifting analyzer app withextensive training, feedback and plotting functions. 

GymAware App - a cloud-connected weightlifting analyzer app offering online data and athlete management. 

GymAware/Kinetic-Athlete cloud analysis server - a web based account for managing and analysing Power Tool and other athlete performance data.So as you can see, while the Power Tool and the Tendo weightlifting analyser are both linear transducers, only GymAware offers a complete athlete performance stack, from data collection to athlete performance management. You canstill use the Power Tool like you use the Tendo unit to motivate and train athletes, but in addition you can start to look at[other variables] like dip and lift profile to improve technique. 

The GymAware Power Tool has evolved through 5 different models over the last 10 years with each new release improving accuracy and usability. There is a good comparison [here] between the latest Power Tool and the Tendo Power and Speed Analyzer. To talk about the benefits of the cloud server and advanced analytics, you first need to look at system accuracy as this is fundamental to the success of the advanced features.The high accuracy of the Power Tool opens up new opportunities in preparing athletes for competition. With high accuracy you can look for more subtle changes over time that give you real insight into the state of the athlete. 

Power is often pursued by teams, could you look at how power can act as a marker of both performance and fatigue with team sports? Currently Benchmarks and profiling seem to be important for individualization. 

There’s no doubt that power is a key factor in producing game winning performances, and power profiling to optimize power training plays a vital role in any professional team. But recently in Australia, regular (3 to 5 times per week) power and/or velocity monitoring has proved to be a very reliable way of monitoring for fatigue. At last year’s ASCA conference Dr Kristie Taylor suggested that we should 

Other performance managers have reported to us that the Power Tool measurements are so sensitive that they can see slower power recovery after games played at a particular stadium known to have a hard playing surface. Regular monitoring with GymAware adds a completely new dimension to the knowledge available to the sports performance professional. 

Kinetic Athlete is not new to player monitoring, why does Kinetic Performance's experience make you a leader in player management? I think to answer this you need to look at environment that lead to the development ofGymAware. 
 

Click HERE to continue reading...

 

Learn more about this new technology along with the most advanced health and performance monitoring tools currently available at the 2012 BSMPG Summer Seminar - May 19/20th.

 

Click me 

 

 

Topics: Art Horne, basketball conference, BSMPG, athletic training conference, Mike Curtis, hockey conference, Logan Schwartz, Andrea Hudy, Bruce Williams, Mike Boyle, Jim Snider, Mark Toomey, John DiMuro, Cal Dietz, Bill Knowles, Alan Grodin, Joel Jamieson, Jeff Cubos, Keith D'Amelio

Foam Rolling and Contractile Muscle Properties by Jose Fernandez

Posted by Boston Sports Medicine and Performance Group on Wed, Apr 25, 2012 @ 06:04 AM

article by Jose Fernandez

 

 

 

After reading last week´s posts from Coach Boyle and Carl Valle I decided to do a little research on Self Myofascial Release and foam rolling. What motivated me is that there is not a clear protocol stablished regarding when, how and for how long athletes should use foam rollers. Some coaches recommend to roll before working out and others after, some coaches prefer to just continuously roll over the muscle surface and others recommend to hold on the trigger point for a few seconds.

What is foam rolling? (by wikipedia):

“Foam rolling is a self-myofascial release (SMR) technique that is used by athletes and physical therapists to inhibit overactive muscles. This form of stretching utilizes the concept of autogenic inhibition to improve soft tissue extensibility, thus relaxing the muscle and allowing the activation of the antagonist muscle.

It is accomplished by rolling the foam roller under each muscle group until a tender area is found, and maintaining pressure on the tender area for 30–60 seconds.”

Looking at the scientific evidence, I could not find a lot of published material either. See below some of papers I found:

A comparison of the pressure exerted on soft tissue by 2 myofascial rollers

Foam Rollers Show No Increase in the Flexibility of the Hamstring Muscle Group

The Acute Effect Of Self-Myofascial Release On Lower Extremity Plyometric Performance

In this case study we used Tensiomyography (TMG) to assess the change in contractile muscle properties (contraction time and muscle tone) after applying 2 different protocols with foam rollers. Click here to see one of my previous post with a detailed explanation about TMG and the information that it provides.

Foam Rolling & TMG Case Study:

The purpose of this case study was to analyse the change in contractile muscle properties assessed with TMG before and after applying two different SMR protocols using a foam roller. Characteristics of the roller that we used can be found here.

A professional basketball player (Age:22, H: 6.2ft, W: 198.4lbs, no injuries) with more than 6 months experience using foam rollers volunteered for the test, which was performed after a day off and consisted of assessing the Left Vastus Lateralis (dominant leg) with TMG before and after applying two different rolling interventions.

Protocol 1: Holding on the trigger point

- TMG Initial assessment on resting conditions

- Roll until the area of maximum pain is found. Hold the roll on that point for 30 seconds. Immediately after the 30 seconds continue rolling 5-6 times over the whole muscle surface

- TMG Post treatment Assessment 

Protocol 2: Cotinuous Rolling

- TMG Initial assessment

- Continuously roll over the whole muscle surface for 60 seconds

- TMG Post treatment Assessment

Restults:

Protocol 1:

 

Click HERE to continue reading this article...

 

Click me

 

Topics: athletic training conference, boston hockey conference, barefoot strength training, Andrea Hudy, Bruce Williams, Cal Dietz, Bill Knowles, Alan Grodin, Jose Fernandez

University of Kansas Strength Coach - Andrea Hudy Speaks at 2012 BSMPG Summer Seminar

Posted by Boston Sports Medicine and Performance Group on Sat, Apr 21, 2012 @ 07:04 AM

Andrea Hudy    BSMPG Summer Seminar

 

There are people that talk the talk, and then there are the people that actually walk the walk.  Andrea Hudy is the latter (and she probably does it Farmer Walk Style!)

Coach Hudy has put more kids in pro uniforms and judging on the way her Jayhawks played in the national championship game this past year, they'll be plenty more Kansas alums rocking the NBA hardcourt next season.  See Coach Hudy at the 2012 BSMPG Summer Seminar as she headlines a list of the country's top basketball performance coaches including the NBA's Indiana Pacer's Shawn Windle, University of Texas Logan Schwartz and Keith D'Amelio (formally Stanford and Toronto Raptors Strength Coach - currently with Nike).

Read why KU found the right fit with strength coach Andrea Hudy below.

 

 

article by Tom Keegan

— Such silly, dangerous things can happen in the weight room, where steel clangs and challenges fly.

And then there is the facility supervised by Andrea Hudy, strength and conditioning coach for the Kansas University men’s and women’s basketball programs.

So much science goes into the planning of the workouts, the study of the progress each individual makes. Decisions are made with intellect, not emotion.

Well, most of the time anyway.

Former Kansas University reserve guard Jeremy Case, now an assistant coach at Southeastern Missouri State, is fuzzy about the details. He just remembers feeling “terrible” about what happened. Still does.

Hudy recalled more details, perhaps because pain has such a long memory.

Hudy said Case complained he couldn’t possibly do four repetitions of the weight she prescribed.

“It was a bet,” Hudy said. “I said ‘If you do that four times, I’ll do a multiple-fatigue set for 30 reps.’ He said, ‘You’re on.’ I took the bar off the rack, lowered it and I heard it (her shoulder popping.) Everybody heard it. I said, ‘I hurt my shoulder.’ He said, ‘You can’t stop now.’ I said, ‘All right, I’ll prove it to you.’ Twenty-nine reps later, I ended up in the training room.”

It’s a painful memory for more than just Hudy.

“Next day her arm’s in a sling,” Case said. “Damn, I feel so bad. Just goes to show how tough coach Hudy is. She’s no ordinary lady. Really tough lady.”

Hudy suffered a torn rotator cuff and torn labrum.

“I lost the battle, but I won the war,” Hudy said. “He didn’t think he could do four reps, and he did six.”

 

Click HERE to continue reading this article....

 

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Topics: basketball conference, athletic training conference, Charlie Weingroff, Andrea Hudy, Cal Dietz, Bill Knowles, Alan Grodin

Craig Liebenson and Clare Frank Talk Dynamic Neuromuscular Stabilization

Posted by Boston Sports Medicine and Performance Group on Fri, Apr 6, 2012 @ 07:04 AM

 

BSMPG has begun plans to host DNS Course "B" in Boston in the spring of 2013.  Due to the overwhelming response of our Course "A" offering, we have begun plans to host course "B" next spring.

 

Stay tuned to bsmpg.com for complete details.

 

Click video below to watch interview with Boston Course "A" instructor, Clare Frank who would also be teaching Course "B" upcoming.

 

 

Click below to watch an interview with Craig Liebenson as he talks about the DNS approach.

 

See Craig Liebenson at the 2012 BSMPG Summer Seminar - May 19th and 20th in Boston MA.

Hurry - this program has a limited number of seats!

 

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Topics: basketball conference, athletic training conference, Craig Liebenson, Charlie Weingroff, Andrea Hudy, Bruce Williams, Cal Dietz, Bill Knowles, Alan Grodin, Barefoot in Boston, Clare Frank

DNS Course in Boston a Huge Success!!

Posted by Boston Sports Medicine and Performance Group on Mon, Apr 2, 2012 @ 07:04 AM

This past weekend, BSMPG hosted Dynamic Neuromuscular Stabilization Course "A" in Boston. 

 

This sold out event featured Clare Frank (pictured below) and Marcela Safarova (from the Czech Republic) as course instructors and was a huge hit!  

 

Interested about attending a future DNS course?

 

Read more about the DNS approach below as well as future opportunities both within the BSMPG network and offerings through Craig Liebenson.

 

 

DNS course clare frank

 

 

Click HERE to read more about DNS and about Craig Liebenson's experiences with DNS.

 

If you missed out on this exciting course work, don't worry! BSMPG is already making plans for another course "A" offering next year as well as a course "B" for those looking to advance their skills in DNS.

 

Can't wait for next year to learn more about DNS? No problem - Craig Liebenson is offering course work for both Sports Medicine professionals as well as fitness and strength professionals in the near future.  Click HERE to learn more about these exciting opportunities.

 

See Craig Liebenson lecture in Boston this May 19-20 as he presents both a Keynote presentation at the annual 2012 BSMPG Summer Seminar as well as a breakout session the day following.  For complete details on Craig's presentation as well as a complete list of presenters and event details click HERE.  

Seats are limited for this event and are certain to sell out again this year.

 

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Topics: Art Horne, basketball conference, BSMPG, Craig Liebenson, boston hockey conference, Andrea Hudy, Cal Dietz, Bill Knowles, Alan Grodin, Dr. DiMuro, Clare Frank, dynamic neuromuscular stabilization

Craig Liebenson - Keynote Speaker at 2012 BSMPG Summer Seminar

Posted by Boston Sports Medicine and Performance Group on Fri, Mar 30, 2012 @ 07:03 AM

by Craig Liebenson 

 

 

Mid-Thoracic Dysfunction: A Key Perpetuating Factor of Pain in the Locomotor System 

Dysfunction involving excessive T4-T8 kyphosis is common. Symptoms arising from regions at a distance to the mid-thoracic area are often secondary to T4-T8 dysfunction. This article will discuss why (rationale), when (indications), what (skills), and how (practical integration) T4-8 dysfunction is addressed.

Why

Mid-thoracic dysfunction involves increased kyphosis of the thoracic spine from T4-T8, usually the result of prolonged sitting in a constrained posture. Thoracic, lumbopelvic and cervicocranial posture are interrelated as links in a chain (see Figure 1). When excessive slumping becomes habitual, according to Brügger, it is called the sternosymphyseal syndrome (Lewit 1996, 1999, Liebenson et al., 1998, Liebenson 1999).


Mid-thoracic dysfunction affects the whole body's center of alignment and posture. Head and shoulder forward posture causes orofacial, neck and shoulder disorders; slumping affects breathing by leading to inhibition of the diaphragm and overactivation of the scalenes; and lumbar disc syndromes and nerve impingement have been shown to result from repetitive end-range flexion overload (Callaghan, McGill 2001).

When

Indications for treating the mid-thoracic region arise from postural analysis, passive joint mobility testing, and active joint mobility testing. The postural sign of increased thoracolumbar hypertonus is a classic sign of overactivity of the superficial "global" muscles and indicates poor "deep" muscle function (Janda 1996, Richardson 1999, Jull 2000, Hodges 2002).


Palpation of passive joint mobility and quality of end-feel is best performed in the seated position, as shown by Brügger (Brügger 2000).


The dynamic mobility screen of choice is the standing arm elevation test (Liebenson 2001).


What

Managing T4-8 dysfunction requires a broad skill set incorporating postural advice, manual manipulation, and therapeutic exercise.

Sample Exercises for Improving T4-8 Extension Mobility

 

  • Brügger relief position - beginner

     

    Brugger's Relief Position.jpg

     

  • Back stretch on the ball - intermediate

     

    T-spine Ext. on Ball.jpg
  • Kolár's wall slide with arm elevation - advanced

     

    Kolar's Wall Slide.jpg

    How

    Knowing why mid-thoracic dysfunction is clinically important, when it should be addressed, and what techniques are therapeutic is only the beginning point for successful management of the patient with a problem in this area. Satisfactory results will result from learning how to incorporate this knowledge and skill into patient care efficiently. A moment or two per session spent explaining the relationship between function and pain is one such step. Each exercise requires a unique "report of findings" to motivate the patient to incorporate it into his or her daily routine.

    The Brügger relief position is an ideal workplace "micro-break." It activates an entire chain of muscles linked to the upright posture. To prevent the tendency to hyperextend the lumbar spine with this exercise, it should be performed with active exhalation.

    The back stretch on the ball is comfortable and relaxing. It promotes improved respiration. It can cause dizziness at first, so the patient should be guided slowly onto it until he or she has learned how to balance on the ball.

    Kolár's wall slide with arm elevation is a functional exercise, since it combines arm elevation, squatting and breathing. Patients typically feel a nice stretch in the lattismus dorsi with this exercise.

    Summary

    T4-8 dysfunction is a common source of muscle imbalance, trigger points, joint dysfunction, and faulty movement patterns. While often asymptomatic, it is nonetheless a key source of biomechanical overload involving the neck, TMJ, shoulder, arm, and even low back regions. Treatments which aim only at the site of symptoms are bound to fail if function is disturbed due to excessive kyphosis in the mid-back.

    Rehabilitation of the upright posture is fundamental to optimization of function in the locomotor system. Neurological programs for maintenance of the upright posture are "hard-wired" into the central nervous system, making rehabilitation of the mid-thoracic area of central importance, both biomechanically and neurophysiologically. The mid-thoracic region is "linked" to a multitude of common musculoskeletal pain syndromes, and the simple assessment and treatments shown here are an excellent complement to chiropractic practice.

    References

     

  • Brügger A. Lehrbuch der Funktionellen Storungen des Bewegungssystems. Brugger-Verlag GmbH, Zollikon, Benglen, 2000.
  • Callaghan JP, McGill SM. Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clinical Biomechanics 2001;16:28-37.
  • Hodges PW, Jull GA. Motor relearning strategies for the rehabilitation of invertebral control of the spine. In Liebenson CS. Rehabilitaiton of the Spine: A Practitioner's Manual (2nd ed). Lippincott/Williams & Wilkins, Baltimore, sched pub 2002.
  • Janda V 1996. The evaluation of muscle imbalance in Liebenson CS (ed) Rehabilitation of the Spine: A Practitioner's Manual, Lippincott/Williams and Wilkins, Baltimore, 1996.
  • Jull GA. Deep cervical flexor muscle dysfunction in whiplash. Journal of Musculoskeletal Pain 2000. 8:143-154,
  • Lewit K 1996. The role of manipulation in spinal rehabilitation in Liebenson CS (ed) Rehabilitation of the Spine: A Practitioner's Manual, Lippincott/Williams and Wilkins, Baltimore.
  • Lewit K 1999. Manipulative Therapy in Rehabilitation of the Motor System. 3rd edition. London: Butterworths.
  • Liebenson CS, DeFranca C, Lefebvre R 1998. Rehabilitation of the Spine: Functional Evaluation of the Cervical Spine, Williams & Wilkins, Baltimore.
  • Liebenson CS, Advice for the clinician and patient: The Brugger relief position. Journal of Bodywork and Movement Therapies 1999. 3:147-149.
  • Liebenson CS, Advice for the clinician and patient: Self-treatment of mid-thoracic dysfunction: a key link in the body axis. Journal of Bodywork and Movement Therapies 2001. 5:90-100.
  • Richardson C, Jull G, Hides J, Hodges P 1999. Therapeutic Exercise for Spinal Stabilization in Lower Back Pain, Churchill Livingstone. 

See Craig Liebenson speak at the 2012 BSMPG Summer Seminar this May 19-20 in Boston MA.

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Craig Liebenson  Craig Liebenson

SPONSORED BY:

 

zFlo

 

CRAIG LIEBENSON

LA Sports and Spine

Keynote Topic: Regional Interdependence: How Functional Pathology Limits Performance

Sunday Breakout Lecture: The Core as the Punctum Fixum in Sport: A Key to Making Movement Patterns More Efficient

Dr. Liebenson is an Adjunct Professor in the School of Chiropractic, Division of Health Sciences at Murdoch University, Perth Australia and consultant for the Murdoch University and the Anglo-European Chiropratic College M.Sc. program in Chiropractic Rehabilitation. The first ever chiropractic member of the McKenzie Institute (U.S.) Board of Directors, he serves on the editorial boards of numerous journals including the Journal of Occupational Rehabilitation; the PM&R  Journal of Injury, Function and Rehabilitation; the Journal of Bodywork and Movement Therapy; and Journal of Manual Therapy.

Dr. Liebenson is the first health care provider to receive a Certification of Recognition from the National Committee for Quality Assurance (NCQA) on Achievement of Recognition for Delivery of Quality Back Pain Care. He is actively engaged in ongoing research on the spinal stabilization system as a Visiting Scholar at Pr. Stuart McGill’s Spine Biomechanics Laboratory at the University of Waterloo. He regularly assists Pavel Kolar in his courses and has worked with both Dr. Karel Lewit and Pr Vladimir Janda beginning in 1987. Dr. Liebenson publishes extensively and is the editor of  the book/DVD Rehabilitation of the Spine: A Practioner's Manual (2nd ed), 2007.

He has had books published into Spanish, Greek, Korean and Japanese. He was the team chiropractor for the N.B.A. Los Angeles Clippers from the 2006-2007 season until 2009-2010 seasons and is currently a consultant for the M.L.B. Arizona Diamondbacks and Athletes Performance International.

Topics: Art Horne, BSMPG, athletic training conference, Craig Liebenson, barefoot strength training, Andrea Hudy, Bruce Williams, Alan Grodin, Dr. DiMuro, dynamic neuromuscular stabilization

Readings from last week

Posted by Boston Sports Medicine and Performance Group on Mon, Mar 26, 2012 @ 07:03 AM

Readings from last week.

Enjoy!

 

Cold-Water Immersion for Preventing and Treating Muscle Soreness After Exercise  

 

Predictive Factors for Ankle Sprain  

 

Assessing the SI Joint   

 

Don't forget to sign up for the 2012 BSMPG Summer Seminar featuring Dr. Craig Liebenson along with 14 other leaders from the worlds of sports medicine, performance and hockey/basketball specific training!

 

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Topics: Art Horne, basketball resources, BSMPG, athletic training conference, boston hockey summit, basketball videos, hockey conference, Bruce Williams, Cal Dietz, Bill Knowles, Alan Grodin, Dan Boothby

Advanced Athlete Monitoring For Injury Reduction at the 2012 BSMPG Summer Seminar

Posted by Boston Sports Medicine and Performance Group on Wed, Mar 7, 2012 @ 07:03 AM

Join Jose Fernandez and other top Sports Medicine and Sports Performance professionals from across the world as they desend on Boston this May 19th-20th for the 2012 BSMPG Summer Seminar.  Choose from a number of specific learning tracks or mix and match to suit your learning needs.  Keynote speakers throughout the weekend include Dr. Craig Liebenson, Chris Powers, Alan Grodin, Irving Schexnayder, and Bill Knowles. 

Register today for this once in a lifetime event! Seats are limited!

 

BSMPG Summer Seminar

 

        BSMPG Summer Seminar

 

Boston Sport Medicine and Performance Conference

Advanced Athlete Monitoring for Injury Reduction

Jose Fernandez

 

Abstract:

Professional athletes are experts at what they do, regardless how many S&C sessions they perform a week, they either have the quality to average 20 points per night or they don´t. From a physical perspective, coaches need to make sure their athletes are healthy and available to play every night. A healthy professional athlete should be capable to display a good performance just by being healthy. Everything else that can be achieved with training is a plus.

In a league where teams have to play 3-4 games a week and take more than 90 flights per season, time is limited for coaches to carry out physical training sessions with their players. A training program must be precise, specific and adjusted to the individual needs of each athlete. Coaches should focus on maintaining and reducing the loss of training adaptations throughout the season while enhancing the recovery and regeneration strategies.

At this year´s BSMPG Conference, I will be presenting ideas on how to objectively profile athletes attending to their neuromuscular characteristics and type of muscle fiber predominance. Continuing with this neuromuscular approach to athlete monitoring, innovative ways to quantify effects and duration of the training and treatments will be discussed. Being able to control the rate at which each muscle gains and looses activation after a training session or how exactly certain therapy treatment affects the functionality of any muscle group is crucial if we want to schedule training actions at the right moment, with the aim to maximize the physical performance and minimize risk of injury during the competition.

From an injury prevention perspective, new concepts to evaluate athlete´s readiness to train and assessment of change in muscle response induced by training will also be suggested, with a clear focus on practicality and applicability.

Aiming for maximal performance is a complex task. The purpose of my presentation is to offer some insight into the analysis of an athlete´s neuromuscular condition and how this can help coaches optimize training in an objective, reliable and time saving manner.

I look forward to seeing you at the BSMPG Conference in May!

 

 

Topics: Art Horne, basketball performance, BSMPG, athletic training conference, boston hockey conference, Logan Schwartz, Andrea Hudy, Bruce Williams, Mark Toomey, Cal Dietz, Alan Grodin, Joel Jamieson, Dan Boothby, Jose Fernandez