Archive for “Rehabilitation Process” Tag

The Stretching Conundrum, Part 1 – Dr. Greg Schaible

Stretching for athletes can often be a polarizing topic among rehab and performance specialists. 

On one end of the spectrum you have people who seemingly hand out stretches for every injury, and think it’s the solution to every problem. On the other hand, you have people who believe that you should never stretch, and that there are no benefits to stretching whatsoever.

Before we start talking about what is right and wrong, we first need to appreciate what stretchingstretching really is, so we can discuss the potential reasons why one may choose to stretch or not to stretch.

Ultimately, people feel the need for stretching because they feel “tightness.”

The problem here is that “tightness” is felt for a variety of reasons. There are really three reasons someone would feel “tight:”

1) A muscle is concentrically oriented, or in a state of chronically sustained contraction at low levels for a prolonged time period.

2) You just performed an intense workout, and as a result, there some eccentric microtrauma to the musculature which occurred. Your intent is that the stimulus hopefully results in recovery and a net gain of strength/hypertrophy in the long run when programmed correctly. 

3) As a protective mechanism to create rigidity or control depending on the environment, task, and situation. Example: when driving in a snowstorm, the external environment can create uncertainty or lack of control. As a means of creating a more internal perception of control, the body starts to grip the steering wheel tightly.

In all three scenarios, stretching may not be the most advantageous thing to be doing.

Perhaps the biggest issue is that many people’s current understanding is that muscles either get “long” or they get “short.” While this is a simplistic way of viewing things, it does not do the body justice, and it leads to confusion when we talk about the proper application of stretching.

Muscles are either concentrically oriented or eccentrically oriented, not necessarily long or short. 

We already knew this intuitively, with the various types of muscle contractions, but this knowledge is usually not applied properly. 

This concept makes logical sense, though.  If muscles truly got longer, then we would develop a lot of “slack” in muscle tissue because the distance between origin and insertion of the muscle does not change with static stretching. 

You certainly would not want the guidewires in a bridge to develop “slack,” as the integrity of the structural support system would be lost.

So the ability to stretch further is just building an increased tolerance to an eccentrically oriented position.  The Golgi Tendon Organs learn to accept a new position.

This happens through graded and repeated exposure to stretching. However, I see two problems with this:

1) Changes in sensation are momentary – If you are stretching to provide relief to the sensation of tightness, without addressing the cause of the tightness, you are operating at the effect level instead of addressing the cause. That’s why sensation of tightness does not always go away when gradually exposed to a stretch. Maybe it does in the very immediate short term, but you have to keep applying that stimulus in order to maintain or improve. Furthermore, because you are gradually exposing the muscle to greater and greater eccentric orientation, the muscle eventually becomes exposed to prolonged low load, long duration. This can change the passive integrity of structures responsible for stability over an extended period of time. 

2) If the sensation of tightness came from a workout and eccentric damage, it does not make much sense to aggressively eccentrically elongate the muscle as means of recovery.  Eccentric activity is what caused the soreness in the first place, so additional elongation is not the answer. Simple active movement would suffice.

3) Stretching does not take into account the orientation of axial skeletal system (origin and insertion). For example, an anterior rotation of an innominate and anterior rib flare would indicate the paraspinals and quads to be in a concentric orientation of muscle via the position of axial skeletal system. The hamstrings and abdominals would be eccentrically oriented. Note: This also happens in the frontal and transverse planes not just sagittal. 

The length-tension relationships of musculature is also important to consider. The reason for differences in length-tension relationship differences is the axial skeletal positioning. Stretching does not change the position of origin and insertion. Active contraction of the eccentrically oriented musculature does, as it provides reciprocal inhibition to concentrically oriented muscles to start experiencing eccentric control. 

So this begs the question – is stretching a complete waste of time?

No, absolutely not.

Many people simply do not understand why and when to utilize stretching, and as a result, it’s performed in a meaningless or potentially even harmful way.

Stretching does not need to be overly aggressive for most people. Before ever stretching, the position of the axial skeletal system must be taken into consideration. Establishing conscious and active exercises which force individuals to display control and competency over movement within normal ranges of movement is generally the first order of business.

If the individual still wants to lightly stretch because they find it helpful to provide “looseness” or “ease of movement” in the short term, it’s certainly fine. However, there are usually other factors to consider that will more effectively and efficiently create lasting changes within someone’s movement quality such as controlled variability, strength (eccentric, concentric, isometric), force output, and capacity.

Here are a couple examples:

Hamstring Hooklying Bridge

This activity works on controlling and improving hip extension without lumbar extension. Someone who has limited hip extension may present with the quads, paraspinals, lats in a concentrically oriented position which means that the hamstrings, glutes, and abs are eccentrically positioned. This exercise reverses that equation by concentrically utilizing the hamstrings, glutes, and abs. The purpose of the pause and breathing is to work motor control in that position with different demands placed on the musculature.

Likewise, if we wanted to work on more dissociation of the femur from the pelvis. We can try and secure the pelvis with the abdominals by performing a posterior pelvic tilt (concentric activity of the abs). Then try to hold that position as the athlete performs a leg lowering activity (eccentric activity of quads). The longer the lever arm, the more demand it places on the abdominals to secure the starting position.

Wall Press Abs Bilateral Leg Lowering

There are many different examples of the two exercises listed here. Depending on the presentation and skill level of your client, you will need to know how to alter the activity and give progressions or regressions based on motor skill level. However the concepts remain the same, and you can certainly get creative with these exercises.

In part 2 of this series, we will cover more about how you can program these concepts as well as some of your more typical methods into athletes training cycles.

 

Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. Greg is the owner of On Track Physiotherapy and owner of the popular online education resource Sports Rehab Expert. Greg works with athletes and active individuals of all ages. As a former athlete himself, he attended The University of Findlay and competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and a 6x Division II Academic All-American.

Preventing Knee Injuries With Youth Strength Training Programs

Does Your Youth Strength Training Program Promote ACL Injuries?

 

Youth Sports knee injuries

 

The good news about knee injuries these days, and Anterior Cruciate Ligament (ACL) tears in particular, is that medical science has turned what used to be a career-ending injury into something most athletes can recover from in time.

 

The bad news is that ACL tears are occurring more often than ever. Anyone involved in a youth strength training program likely knows at least one athlete who has had a severe knee injury in the past year.

 

Why do these injuries occur?

 

The ACL is a small ligament that runs diagonally inside the knee and connects the upper leg (femur) to the main shin bone (tibia). It’s job is to prevent the knee from twisting or moving side-to-side more than just a few degrees. When pushed beyond its relatively small limit, the ACL can either be partially stretched or ripped completely.

 

Youth Sports training knee injuries

 

In a sports setting, the ACL almost always gets torn during a one-time event. This can occur due to contact with another athlete, or during non-contact moments where the knee may be pushed out of position from a high level of force placed on it. Non-contact situations where this normally happens are during cutting, pivoting, out-of-control stopping, and awkward landings on jumps.

 

Surprisingly, about 70% of ACL tears in young athletes occur during non-contact events. Female athletes are between 3 and 8 times more likely than males to tear their ACL. Although all youth sports have some level of ACL injuries, soccer and basketball have the most for girls playing sports. For boys, it is football and lacrosse.

 

With nearly 150,000 tears occurring annually in the United States alone, more focus has not just gone into the rehabilitation process, but also in preventing these injuries from happening in the first place.

 

How To Prevent ACL Injuries With Your Youth Strength Training Program

 

One big piece of preventing ACL tears is to focus on both the ankle and hip joints, strange as that may seem. Knees basically go where the ankles and hips send them, so ‘prehabilitation’ measures focus on those areas.

 

For the ankle, it is crucial that young athletes limit the amount of side-to-side movement that occurs in that joint. Either during one leg standing postures or when running, the more their ankles roll the better the chance it will push their knees either in or out during faster-paced athletic events. Kids who tend to roll their ankles a lot may be much more susceptible to knee injuries when they get bigger, faster and stronger in their later years.

 

The hip joint needs to both be flexible and strong to function correctly, making it a little harder to train. For the flexibility side, stretches that specifically target the hips may be needed for those with limited ability to do a deep squat. Very young athletes (ages 11 and younger) are almost never in need of these, but once the teenage years approach and growth spurts really kick in, more stretching may be warranted.

 

Youth Strength Training Program

 

Strengthening the hips can be tricky, because most athletes with weak hip muscles have learned to move in a way that shifts the stress to their stronger leg and back muscles. You’d think a basic exercise like a squat would work the hips very well, but not for those who are leg-muscle dominant already. Isolated strength for the hip muscles plus relearning other exercise patterns, such as squatting, must both be done to stabilize and protect the knees.

 

Just as important in this equation is for young athletes to learn how to move properly. Being able to efficiently absorb the force of gravity when landing on a jump can lower your ACL tear risk substantially, and is relatively easy to learn for most focused and dedicated athletes. In addition, controlling momentum during stopping and cutting movements will further decrease your risk. These skills tend to take much more repetition to improve on, but it certainly can be done.

 

Although it is true that the younger someone starts improving these skills the better chance it will lower their future injury risk, it is never too late to build the strength, flexibility and movement skill required in sports with a great youth strength training program to keep your knees stable and safe.

 

Help young athletes train the RIGHT way, perform to their full potential and learn from the very best in industry by getting your IYCA Youth Fitness Specialist Certification today!

 

Youth Fitness Training

 

SOURCES: British Association of Sports Medicine, www.livestrong.com