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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'health'

Over the years, I have been fortunate to work with lots of athletes ranging from youth to professionals. Regardless of age or skill level, I have observed that each one approaches the recovery in their own way. Some are eager to tackle therapy, while others are apprehensive and fearful.

To be clear, the mindset of the patient is as important, if not more important than the physical part of the process as it relates to success. With ACL rehab, I pay close attention at post-op visit number one to determine if the patient is a coper, non-coper or somewhere in between. Having this awareness is crucial as I look to encourage the client and position him/her for success in the fist phase of rehab. The mindset of a patient recovering from their second or third ACL tear may differ greatly than that of a first timer.

With that said, assessing the state of mind of any athlete in the PT clinic is a must. An athlete’s identity, confidence and self-worth is often tied to his/her sport. Injuries separate the athletes from their teams and take away something very important to them. This can lead to depression, anxiety, anger, fear and loneliness to name a few.

It is imperative to connect with an athlete in the first 1-2 visits of rehab. I aim to bond with them and ensure they know I will do everything in my power to get them back to their prior level of performance. Fear of loss is powerful, and I want to partner with them to prevent the loss of playing time as quickly and safely I can though proper rehab.


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Improving rotational strength and stability in the torso, shoulders and hips is important for injury prevention and performance. The ability to resist and control rotational loads can reduce stress on the body during transverse plane activities and deceleration during sport. This exercise will demonstrate how to train rotational stability in an unstable manner using water with the Aktiv AQUA Bag. The video below is my latest online column for PFP Magazine.

The water provides an unstable training environment that is effective for beginners and advanced users. You can read the entire online column by clicking here.

 

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

 

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.

 

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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