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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

One of the bigger issues I see with athletes who have shoulder dysfunction is upper trap dominance. The upper trap needs to work in concert with he lower trap and serratus anterior for optimal shoulder function. However, in many cases, it tends to dominate the action during elevation.

I recently evaluated a professional baseball player who presented with upper trap dominance. In standing, his right scapula was elevated and slightly protracted. In many cases, you will see scapular infera in the dominant side of a thrower, but that was not the case with him. During active elevation, you could see excessive upper trap firing/activation compared to his left side. This can lead to altered glenohumeral mechanics and compression/irritation of the rotator cuff with repetitive throwing.

Performing low trap raises (the standard ‘Y’ exercise) and serratus anterior work is a no-brianer when you see something like this in order to activate the lower trapezius. But, I also like to focus on getting the client to pull the shoulder blades down and back if you will. Below is one of my favorite exercises I recently featured in PFP magazine to address this issue:

In addition, I like to use shoulder snow angels as well. Click here to see how to perform that exercise. Together, these two movements can really help eliminate upper trap dominance in your clients.

In the majority of patients I see with knee pain or knee dysfunction, I uncover gluteal weakness and poor proximal muscular stability. This can cascade into overpronation, vagus collapse, poor balance, and any number of kinetic chain issues. While this may  not be a big deal for sedentary individuals, it becomes a very big deal for athletes and those performing repetitive loading.

When searching for the best exercises to selectively strengthen the gluteal muscles, it is always wise to see what science has to say. More is not always better. I am all for efficiency and finding the most effective exercises in activating the glute over the tensor fascia lata (TFL). In this post, I am sharing a good exercise to do just that. Prior research has indicated that sidestepping and clamshells are very effective in doing just this. Click here to read a prior post on this.

The video below will walk you through his to do the running man exercise.

 

Click here to read my PFP column on this exercise.

Shoulder pain is one of the most common issues I treat in my clinic week to week, There are many causes of pain, but the most common cause of shoulder pain in active individuals typically involves the rotate cuff. These relatively small muscles are called upon to manage high and repetitive loads during sports, work and daily activity.

In some cases, there is just mild inflammation that does not limit function. In there cases, there is more acute pain that makes it hard to even raise the arm or use it for the most basic things. It can be difficult to really discern if there is significant injury as even acute tendinitis can be debilitating.

Image courtesy of Medline Plus

In a blog post I wrote for my work site, I discuss the differences between tendinitis, tendinosis and tears of the rotator cuff. Click here to read more.

If you have rotator cuff pain and are looking for a simple at-home rehab plan or injury prevention program, check out my training guide at www.rotatorcufftraining.com.

Improving proximal hip stability and reducing frontal plane collapse is critical for protecting the knee. Poor frontal plane control often contributes to anterior knee pain, IT band syndrome, shin splints, plantar fasciitis and other injuries. This exercise is an advance progression of the standing pallof press, and it is very effective for enhancing single leg strength as well as hip/core stability.

Click here to read my full column on this exercise in PFP Magazine.

Unfortunately, too many athletes who recover from ACL tears go on to suffer another injury within a short period of time. Click here to read a prior post on secondary injuries. There are differing opinions on when or if there is an exactly “right time” to clear an athlete for return to play.

We already know that athletes have persistent weakness and asymmetry at 1 year post-op and even beyond. I recently had one of my collegiate soccer players re-tear while helping out with a youth soccer camp. She had not yet done hop testing with me or been cleared for full soccer, but as she was 1 year out she did not think it would be an issue playing with 12 year-old girls. It only took 20 minutes before she suffered a non-contact re-injury and lateral meniscus tear.

Consider the following paper that reveals low rates of patients meeting return to sport (RTS) criteria at 9 months post-op:

https://www.ncbi.nlm.nih.gov/pubmed/29574548

Another paper recent published in the Journal of Sports Rehabilitation revealed marked deficits in balance and hop testing at 6 and 9 months post-op:

https://www.ncbi.nlm.nih.gov/pubmed/29466066

A recent paper in the American Journal of Sports Medicine (https://www.ncbi.nlm.nih.gov/pubmed/29659299) lists positive predictors of a return to knee-strenuous sport 1 year after ACL reconstruction were male sex, younger age, a high preinjury level of physical activity, and the absence of concomitant injuries to the medial collateral ligament and meniscus.

In 2016, research in the American Journal of Sports Medicine revealed delaying return to sport at least 9 months markedly reduced re-injury risk in those who passed RTS testing. Click below for more on that study:

https://www.ncbi.nlm.nih.gov/pubmed/27162233

So, where are we now? I employ multiple functional tests including the Y-Balance Test, FMS, single leg squatting, hand held dynamometry, hop testing, qualitative movement assessment and jump landing assessments. But, is that enough?


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