I rehab far too many athletes under the age of 18 with ACL tears. In many cases, I am rehabbing some who have suffered multiple ACL ruptures before they graduate from high school. The burning question is why do so many clients suffer a graft failure or contralateral injury so so often?
Is it related to genetics? Is sports specialization to blame? Perhaps fatigue and limited recovery is a problem. I think the answer is multifactorial, but to be perfectly honest we as a profession have yet to truly arrive at a consensus as to when the “right time” to return to play is. Opinions vary widely based on the athlete, sport, native movement patterns, graft choice, additional injuries (ligament, cartilage or soft tissue) and the provider.
As a clinician dedicated to both prevention and the best rehab, I am always re-evlauating my own algorithm and rehab techniques, while looking for scientific rationale to direct my exercise selection and decision making processes. A recent paper by Webster and Feller in the November 2016 edition of AJSM looked at subsequent ACL injuries in subjects who underwent their primary ACLR under the age of 20 utilizing a hamstring autograft reconstruction procedure.
Soft tissue tightness (lats, post shoulder, pec major/minor)
Poor muscular strength/endurance in the rotator cuff and scapular stabilizers
Glenohumeral internal rotation deficit (GIRD)
I integrate routine mobility exercises for my throwers, as well as other overhead athletes (tennis, swimming, volleyball, etc) to better prepare them for training and their sport, as well as prevent poor mechanics and compensatory motion that may lead to aberrant stress on the rotator cuff and labrum.
The following video reveals five of my preferred exercises using a foam roller to improve thoracic spine mobility, decrease latissimus tightness, and stretch the pec major/minor while facilitating lower trapezius activation.
In order you will see:
T-spine extension in supine
T-spine extension coupled with lat stretch
Retraction and downward rotation
I advise performing 5-10 repetitions of each prior to training and sport. These will help improve performance, optimize overhead mechanics and reduce injury risk associated with overhead sports.
Many of my clients need to improve shoulder and pillar stability. Combating poor glenohumeral and scapular stability and insufficient trunk stability is a must to reduce injury risk, resolve shoulder and back pain and eliminate compensatory motion with exercise, sport and life.
The following two exercises are “go to” ones I utilize to do just this.
It is no secret that elbow injuries have been on the rise in MLB as well as all levels of baseball. I see far too many adolescent baseball pitchers in my clinic with medial elbow pain. Often it is related to pathological GIRD and proximal imbalances in the shoulder complex.
Researchers have been studying biomechanics for years. It has long been a belief that younger pitchers should focus on fastballs and change-ups, while minimizing curveballs. Currently, the prevailing thought and latest evidence seems to suggest that velocity may be the bigger risk factor or determining factor in leading to UCL injuries.
A paper in the August 2016 edition of the American Journal of Sports Medicine from Rush University Medical Center sought to determine factors associated UCLR among MLB pitchers. The hypothesis was that those pitchers who underwent UCLR would have a higher pre injury pitch velocity.
This retrospective case controlled study looked at data for pitch velocity, type and number for every pitcher and game were gathered from the PitchFx database from April 2, 2007 to April 15, 2015. Data from 2013 - 2015 was excluded to avoid lead in time bias, as pitches in these seasons may contribute to injuries in pitchers who have not yet undergone UCLR. Pitchers were classified as control, pre injury or postoperative.
It is time to clear out some product inventory this year. To that end, I am offering a 50% off sale for one week only. This sale is on all physical products as well as e-books. I am also offering this discount on my printed version of the Ultimate Rotator Cuff Training Guide, of which I only have five remaining copies.
Simply enter code BFIT50 at checkout to save 50% on your entire order. Click Here to view all products.
This sale will end Monday July 18, so act now while supplies last.