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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'knee'

I came across some very good reads on Twitter last week week that I wanted to pass along. The first is a blog post by Rich Willy, a PT, professor and researcher who specializes in running and running related injuries. If you or any of your friends have suffered from nagging IT Band pain, this is a must read. In this post, he discusses proper treatment strategies:

Treating ITB Syndrome

The second pearl involves long toss and force on the elbow. Ever wonder how advising a pitcher to reduce his throwing intensity actually impacts velocity and torque on the elbow? It seems that decreasing effort level by 25% and 50% does not equate to the same reduction in actual velocity with a study using the motus sleeve. Read more below:

Baseball Pitchers’ Long Toss Perceived Effort & Actual Velocity

Finally, there has been much discussion about return to sport assessment after ACL reconstruction. Lately, many have begun to question how effective hop testing really is when it cones to determining readiness to return to sport. I use several assessments (one of which is hop testing), but I also feel psychological readiness is crucial.

This article sheds light on the connection between proper single limb landing mechanics and psychological readiness.

Association of Psychological Readiness for RTS after ACLR and Hip and Knee Landing Mechanics

 

One of the great things about being a columnist for PFP Magazine is that I often get to test out the latest fitness equipment on the market. While there are certainly some very gimmicky things out there, I have some ‘go to’ selections in my toolbox, such as the BOSU®NexGen™Pro Balance Trainer. It is the latest version of this training tool.

In my clinic, I rehab lots of athletes suffering from gluteus medius weakness, poor pillar stability and decreased hip stability. Many of my clientele are working to make it back from ACL reconstruction. One of my preferred strengthening exercises to target the shoulder, torso and hips is split squats. Once the client masters proper form on the ground, I move to an unstable setting using the BOSU®.

It is essential to challenge athletes to avoid valgus collapse. The BOSU® introduces instability at the ankle forcing the body to adapt during the split squat movement. Avoiding dynamic valgus and trunk dominance during training will help with injury reduction efforts for the client.

In the video below I produced for my PFP online column, you will see how to use this exercise effectively to improve strength, stability and proprioception.

 

Click here to read the entire online column.

Bridging is a fundamental exercise to promote hamstring and glute strength. In addition to hip strength, I look for opportunities to enhance anti-rotation/pelvic stability with many bridging progressions due to the weakness and asymmetries I see in my clinic. It will also facilitate hip dissociation.

The stability ball provides an element of instability that can further challenge hip and pillar stability. This exercise is big bang for your buck exercise that can be used in rehab and training circles. Check out the video below that is part of my ‘Functionally Fit’ column for PFP Magazine.

Click here to read the entire column.

 

One of the biggest challenges for clients overcoming knee injuries and surgery is regaining their quadriceps strength and fighting atrophy. This is increasingly so for my clientele on crutches for any extended period of time. It is paramount to use modalities early on in the rehab process such as electrical stimulation and blood flow restriction training to combat atrophy and loss of strength.

Once appropriate, I always move to single limb training to eliminate imbalance and asymmetry. While pistol squats are one of the most effective single leg quadriceps exercises, not all clients can perform this movement. So, in many cases I opt to use a single leg box squat (see video below).

For more information on specific progressions and regressions, click here to read my entire online column. Keep in mind that you should never force through any painful range of motion as this likely indicates excessive strain on the patellofemoral joint.

Knee pain is prevalent among adolescents and active adults. Patellofemoral pain and osteoarthritis are the most likely causes of pain. It may be present with squatting, lunging, prolonged sitting, kneeling, running, jumping or twisting.

Research seems to support a combination of hip and knee strengthening as a primary line of defense and treatment for knee pain. Interestingly, males with PFP do not seem to have weakness in the gluteus medusa like their female counterparts. The link below is an abstract that speaks to this difference between the two groups:

https://www.ncbi.nlm.nih.gov/pubmed/30090674

Other modalities used to address anterior knee pain include patellar bracing/taping, blood flow restriction training, dry needling/acupuncture and soft tissue work seems to bring more questions accordion to some experts.

Click here to read the 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain from the 5th International Patellofemoral Pain Research Retreat.

Clinically, I have seen good results with the following:

1. Activity modification
2. Glute and quadriceps strengthening
3. Blood flow restriction (BFR) training
4. Sequential and progressive loading based on pain response


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