Muscle Activation Patterns During Sprinting

World Athletics Championships 2007 in Osaka - ...

In order to best train to improve maximum sprinting, a good understanding of the requirements of the muscles involved in this motion must be understood.  The muscles must perform two tasks during sprinting: first, they must produce force to propel the body horizontals; second, they must produce a vertical force to counteract the pull of gravity.  These forces must be produced during the support phase of sprinting. Continue reading

Imaging of the Lumbar Spine – What Does It Really Tell Us?

Screen Shot 2014-02-28 at 3.55.44 PMPreviously, I’ve written on the knowledge of MRI results and its impact on treatment outcomes. Results of a study by Modic et al. found no prognostic value of MRI over that of the clinical assessment. Size, type, and location of disc herniations were not associated with outcome.  At the six-week follow-up, improvements were not significantly different between groups that knew the results of their MRI and those that did not.  One of the more interesting findings of that study was that those who knew their MRI results had a lesser sense of well-being despite similar outcomes to those without knowledge of their imaging.  This supports the importance of  medical professionals emphasizing that patients not obsess with results of imaging and instead focus improvements in functional status.

Further research looking at the results of imagining of the lumbar spine provides further evidence for the medical community to be more cautious in their reliance on imaging. Wtt, Vestergaard, and Rosenklint compared X-rays of people with lumbar spine and sciatic pain to those without low back pain. Their results found no significant differences in the X-rays between these two groups in regards to disc degeneration and spondylosis. Boden et al. took MRIs of participants without history of lumbar spine pain. In their asymptomatic patients under the age of 60, 20% had at least one disc herniation. 57% of participants over the age of 60 had abnormal findings. Middleton and Fish reported disc protrusions in 80% and spinal stenosis in 20% of asymptomatic individuals over the age of 60. They also provided evidence for significant levels of disc degeneration in asymptomatic women in their twenties.

Screen Shot 2014-02-28 at 3.55.35 PMJensen and colleagues reported that of asymptomatic participants in their study, 36% had normal lumbar discs on MRI, 52% had at least one disc bulge, 27% had a disc protrusion, 1% had an extrusion, 38% had more than one level of abnormality. They concluded their article stating that “given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”

Please don’t mistake these results as proof that imaging is worthless as it very frequently is needed in the treatment of back pain. Instead, us this research as evidence in the education of patients who worry about their long term quality of life following diagnosis following imaging.

References

  • Wtt, Vestergaard, & Rosenklint. A Comparative Analysis of X-ray Findings of the Lumbar Spine in Patients With and Without Lumbar Pain.
  • Boden, Davis, Patronas, & Wiesel. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.
  • Middleton & Fish. Lumbar spondylosis: clinical presentation and treatment approaches.
  • Jensen, Brant-Zawadzki, Obuchowski, Modic, Malkasian, & Ross. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain.
  • Modic, Obuchowski, Ross, Brant-Zawadzki, Grooff, Mazanec, Benzel (2005). Acute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic Role and Effect on Outcome.  Radiology, 237.

Tips for CrossFit Beginners

How To Perform The Squat

CrossFit is one of the best and most rewarding exercise programs right now.  Newbies to this style of training quickly become hooked by this community based system.  Starting CrossFit, however, can be a daunting task. Here are a few tips for beginning CrossFit and staying safe while starting.

Master the basics – squat and deadlift

Cleans, snatches, and thrusters are great but it’s best to focus first on mastering the squat and deadlift.  Learning these two first will make progressing to more advanced exercises easier.

Start Slowly (no multi-workout days)

It’s easy to get hooked to CrossFit and want to workout more frequently to improve faster.  Lots of new CrossFitters see others performing multiple workouts per day but they don’t understand that these people built their conditioning up over a long time to do this.  Jumping into multiple workouts per day early may increase your risk of overuse injuries, which will bring your progress to a quick halt.  Four workouts per week are enough for most CrossFitters.

Compete with yourself before worrying about competing with others

The competitive aspect of CrossFit can be great.  But don’t get hung up initially on what others are doing.  Work at your own pace, focusing on good technique and enjoying yourself.  Get better each day regardless of your score compared to everyone else’s.

Find qualified coaches…and use them!

English: July 2007 CrossFit Trainer certificat...

A great coach can mean a world of difference.  Speak to people at the box you are thinking of joining.  Ask about their coach’s programming and teaching style.  Are they able to teach the exercises to people of all skill levels?  Do they effectively scale the workouts?

Once you find a good coach, don’t be hesitant to ask them for help… that is why you are paying them.  Get help with your technique and properly scaling the workout.

Address mobility and stability

Many injuries are the result of poor mobility.  CrossFitters tend to work very hard on maintaining and improving mobility.  But stability cannot be forgotten when performing injury prevention work.  Focus on strengthening the glutes, abs, rotator cuff, and scapular muscles.

If your goal isn’t to compete – don’t let technique breakdown

A lot of times you will hear CrossFitters talk about an acceptable amount of form breakdown and encourage that as a form of increased intensity.  My argument would be, why do this when it may increase the risk of injury if you goal isn’t to compete.  Focus on proper form, a steady pace, and getting a great workout WITHOUT INCREASING INJURY RISK.

Good example of Crossfit Weight lifting - In C...

Constantly reassess your form (coach and videos and forums/online)

Once you’ve learned basic exercises such as air squats and are progressing to weighted versions, don’t think your form is always perfect.  Constantly reassess your form by having your coach watch you or take videos to examine yourself (or upload to the CrossFit boards to get help from others).

If a movement doesn’t feel right…don’t do it (yet)

If you aren’t comfortable with a movement work on it outside of the metcons.  Perfect your technique and build some confidence.  When you feel good with it then add it in to your workout.

If a movement is painful, your body is telling you not to do it.  Seek out the appropriate help to correct the potential problems instead of further damaging your body.

Don’t neglect the warm up

Warm ups are essential for injury prevention.  Don’t ignore them or perform them lazily.

Crossfit Trainer trying to lift  weights

CrossFit strives to address all domains of fitness – the most important should be remaining injury free!

While CrossFit may be the best program for addressing all domains of fitness (strength, endurance, flexibility, etc) you can’t improve any of these if an injury keeps you from being able to work out.  That is why remaining injury free is the most important aspect of fitness.  Take care of yourself so you can continue to improve!

Preventing Shoulder Injuries With One Simple Exercise

Anticipation: A baseball player making a pitch...

The human shoulder is an amazing structure.  Baseball players can transfer forces allowing them to throw upwards of 90 mph, weight lifters can lift and support hundreds of pounds over their heads, and shot putters can toss a 16 lb. piece of metal over 70 feet.  Unfortunately, for any athlete performing overhead activities, the structure of this joint makes it incredibly susceptible to injuries that can impact performance or put them on the sideline.

Two things are needed for the shoulder to perform optimally.  First, it must have enough mobility to move through its’ full range of motion.  Second, there must be a balance in the strength of the various muscles that move and stabilize this joint.  Minor imbalances in either of these factors can increase the risk of injury and potentially decrease performance.  For any athlete whose sport relies heavily on overhead movements, a solid Prehab routine is imperative to stay at the top of their game.

Shot Put Women Combined Competition - Heptathlon

The Face Pull Y-Press (FPYP) is a fantastic exercise that should be part of any Prehab program designed for overhead athletes.  This exercise is a combination of several common shoulder exercises allowing it to efficiently work many of the shoulder muscles needed to help reduce risk of injuries and improve performance.

To perform the FPYP, start with the resistance (resistance bands or cable stacks both work well) at lower chest level directly in front of the athlete. The athlete’s palms should face inwards with the elbows straight.  The movement is begun by bringing the hands back and out so that the forearms are vertical to the ground and the upper arms are parallel to the ground. Next, the elbows are straightened while the hands are pushed upwards creating a 135 degree angle between the ground and the arms, as if making a “Y” with your body. Finally, return to the starting position by slowly bringing the hands down and towards each other while keeping the elbows locked out.

The Face Pull Y Press

The Face Pull Y Press

English: Picture of the arm and shoulder muscles

So what makes this exercise so great?  The combination of movements hits nearly every muscle needed for stability and controlled movement of the shoulder including the rotator cuff, deltoids, and muscles surrounding the shoulder blades.  This exercise also closely resembles many positions and motions performed by overhead athletes.  The top portion of the exercise is similar to the top position of many exercises performed by competitive weight lifters such as the snatch or jerk.  The descent mimics the deceleration portion of throwing a ball or serving a volleyball.

What are the best glute exercises to use in rehab?

Side Plank Hip Abduction

For a recent inservice presentation, I looked at several research articles that compared EMG values of different exercises.  Below you will find my presentation as well as a handout I made that can be used as a quick cheat sheet in the clinic.  Check the video out and please give me some feedback!

Exercises reviewed include: front plank hip extensions, glute squeezes, side plank hip abduction, skater squats, single leg squats, step up variations, quadruped hip extensions, single leg deadliest, glute bridges, hip clamslateral band walks, pelvic drops, side lying hip abduction, standing hip abduction, squats, and lunges.

Here is my HANDOUT.

ActivePTblog: Review of all my articles over the past year

Wanted to review all the articles that I’ve written on the website over the year for those that are new to the blog.  We’ll start with different exercises we’ve discussed.

EXERCISES

Front Plank Hip Extensions for glute and core strengthening based on study by Boren et al.

Front Plank Hip Extension

Side Plank Hip Abduction for glute strengthening

Side Plank Hip Abduction

Hip Clamshell Progression for Glute Med Strengthening - The most popular article so far on the blog that discusses a hip clamshell progression.

Nordic Hamstring Curls - Another popular post involving the nordic hamstring curl (aka natural glute ham raise) which has been shown to be effective at reducing the risk of hamstring injuries.  Variations of the exercise are also discussed to allow for progression of the exercise.

Nordic Curls

Alternating Pistol Squat Jumps - A great, explosive exercise that really works the legs with the added benefit of not having to load the spine with weights. 

Back Squats vs. Front Squats - A comparison of the two most popular squat variations  based on scientific studies rather than just “bro-science”.

Torso Position in Back Squat and Front Squat

Torso Position in Back Squat and Front Squat

Runner’s Side Planks - A great exercise for dynamically working the glute meds.

Glute Ham Sit Ups  Part I and Part II - A killer abdominal exercise and several variations that can make it even better!

L-Pullups for Core Strength - Kill two birds with one stop by performing this exercise variation that increases the demand on the core musculature during a pull-up.

Improving Sumo and Monster Walks - Sumo and Monster Walks are common rehab and training exercises.  Find out what the research says regarding resistance band placement on glute muscle activation.

Pushup Review – A review of pushups including muscle activation during the exercise and variations to help you get the most bang for your buck on this time-tested exercise.

Chain Military Press - This exercise variation fries the deltoids while challenging the stabilization aspect of the standard military press.

Face Pull with External Rotation Plus Y-Press an unbelievably good exercise for Rotator Cuff and Peri-scapular Muscle Strengthening

Face Pull Y-Press

Other Articles

Exercise for Breast Cancer Survivors - how we can help breast cancer patients not just survive but THRIVE!

Two articles on different hamstring rehab protocols here and here.

Manual Muscle Testing (MMT) of Hamstrings in Lengthened State

Manual Muscle Testing (MMT) of Hamstrings in Lengthened State

What do MRIs really tell us about back pain?

Is weightlifting for children safe?

Effect of increased running rate of joint loading

Two great exercises for CrossFit injury prevention and performance here and here.

Importance of Dorsiflexion Part I and Part II - Two part series on the importance of addressing dorsiflexion limitations to reduce the risk of lower extremity injuries.

The Effects of Ankle Mobilizations on Hip Strength - My research poster completed as part of my requirements for graduation from East Carolina University’s Doctor of Physical Therapy program.

Distal fibula mobilization

Utilizing a Forefoot Gait Pattern to Decrease Symptoms of Anterior Compartment Syndrome Part I and Part II

Exercise Related Leg Pain (Shin Splints) - A review of the different conditions that make up what is typically referred to as “shin splints”.

Don’t forget to follow me on Twitter (https://twitter.com/zlongdpt) and Youtube (http://www.youtube.com/user/activePTblog) to stay up to date with my most recent posts!

Front Plank Hip Extensions

Front Plank Hip Extension

The front plank hip extension is a fantastic bodyweight exercise for strengthening the glutes and core.  Boren et al. (2011) studied several glute exercises commonly used in rehab and found that the front plank hip extension was one of the better glute exercises.  Glute medius activation with 75%MVIC for the extending leg and glute max activation was 106%MVIC!

Performance of this bodyweight exercise isn’t terribly complicated. First, assume the standard front plank position. Bend the knee of one leg to 90 degrees and maintain this knee angle throughout the movement. Finally, extend the leg by bringing the foot towards the ceiling while keeping the lumbar spine positioned in neutral.

So what makes this exercise so good? Previous research has shown that performing a prone hip extension with the knees bent increases glute activation. This is due to the hamstrings being put in a position of active insufficiency due to their shortened position. Also, the performance of the plank and maintenance of a neutral spine prevents the movement from coming from lumbar spine hyperextension. This combination means that the glutes are forced to do the work themselves.

Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201064/

Side Plank Hip Abduction for Glute Strength

Side Plank Hip Abduction

The side plank hip abduction is a fantastic exercise for strengthening the glutes.  Boren et al. (2011) studied it along with several other glute exercises used in rehab and found that it was one of the best glute exercises.  Glute medius activation with 88%MVIC for the top leg and 103% for the bottom leg. Glute max activation was 72 and 70% MVIC.  To put it simply, this exercise is a great addition to any exercise program.  Another great feature of this exercise is that it also works the abodminals as well!

Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201064/

Therapy Reads 11/22/13

Radial Tunnel Syndrome by the Sports Physiotherapist

Gray Cook on the second movement principle

The Manual Therapist on the top 5 MDT Cervical Exercises

Running Injuries and Plasma Rich Protein Injections

Dan Pope Reviews the SFMA Course 1

Wrist TFCC Injuries and CrossFit, Diagnosis and Treatment

Compression Wrapping for Ankle Sprain Rehab

James Speck reviews patellofemoral pain syndrome research

Mike Reinold on when baseball players should start their off-season throwing

Four exercises your lower back is better without (for CrossFitters) at the Movement Fix