Share   Subscribe to RSS feed

Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'rehab'

One of the more challenging issues I see in the clinic is pain in the upper hamstring region. Proximal hamstring tendinopathy, referred to medically as tendinosis, is common in runners and athletes. With that said, arriving at this diagnosis can also be challenging as proximal hamstring pain can also be caused by sciatica or referred pain from the low back region. A thorough clinical exam and good history will be able to definitively help diagnose the cause.

Chronic hamstring pain can occur as a result of a previous acute tear, or due to ongoing tendinitis that is aggravated by repetitive activity. Running, biking, rowing and even prolonged sitting can aggravate the hamstring tendons where they attach to the ischial tuberosity. There is also an ischial bursa that cushions this region that can become chronically inflamed. It is a common problem for distance runners and athletes involved in sprinting, hurdles, or cutting . Typical signs and symptoms include a deep, local pain in the buttocks/upper hamstring region that worsens with running, squatting, lunging and sitting.

Differential diagnoses include:

  • Sciatic nerve irritation (may be a co-morbidity in some cases)
  • Ischiofemoral impingement
  • Apophysitis or avulsion in adolescents
  • Deep gluteal muscle tear
  • Stress fracture (posterior pubic bone or ischial ramus)
  • Partial or complete rupture

Proximal hamstring tendinopathy is rarely painful during activities that do not involve elastic energy transfer or compression, such as walking on even ground, standing or lying down. Tears are typically accompanied by extreme hip flexion and knee extension during an acute injury (usually hear an audible pop).  In some cases, chronic pain may also be accompanied by an exaggerated pain response, referred to as central sensitization where the central nervous system conveys an amplified neural signal resulting in pain hypersensitivity.


Continue reading…

Poor landing mechanics are often cited as a predictor of ACL injury risk. In my 20 years as a physical therapist, I have rehabbed many athletes with this injury. I believe that injury prevention, whether to prevent a primary or secondary injury, hinges on the ability to train the body to decelerate and land appropriately. Some athletes simply move better than others. Nonetheless, teaching a soft bent knee landing while minimizing dynamic valgus is essential.

The following video from my online PFP column reveals a foundational exercise that can be used in prevention and rehab alike.

Click here if you want to read about another landing exercise that I utilize in my training and rehab programs.

Unfortunately, I see far too many patients following ACL reconstruction in my sports medicine practice. In any given month, I am rehabbing between 10 and 15 patients who have lost their season to this injury. Most of the time it is a non-contact mechanism of injury, often involving additional trauma to the collateral ligaments, menisci and/or cartilage within the joint.

Throughout my career, I have rehabbed several hundred athletes with ACL tears. It has always been an area of interest and passion for me as well as prevention. Blending my background in performance training with rehab, I have fostered through much trial and adjustment what seems to be a very effective approach to rehab and return to sport.  Rehabbing higher level athletes is much like working on a high performance sports cars.

alt_lead-ferrari_f12tdf_3low

If you own a high performance vehicle, you would prefer to have it serviced at a dealership where the mechanics are experienced working on similar cars, yes? I feel the same care and application is relevant with ACL rehab.  PT that is too aggressive or too conservative can impede progress and negatively impact peak performance.


Continue reading…

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?

55520068

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.


Continue reading…

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.

Plank Push-ups

Stir the Pot

The links above are for two recent exercise columns I authored for PFP Magazine.  These exercises include load bearing using the client’s bodyweight and include progressions and regressions.