Brian Schiff’s Blog

I want to wish everyone a Happy Memorial Day.  I have included a clip of a recent interview I did with the local Fox News affiliate on the rise in certain injuries I have seen in youth sports.  Unfortunately, I continue to see certain overuse injuries and other patterns of injuries that we, as strength and conditioning professionals, can reduce with proper training.

By far, I help more people with knee and shoulder problems in my profession.  As a therapist and fitness pro, I often use lingo that some do not fully understand.  In fact, I often find myself analyzing gait patterns of people at the grocery store and even the ringmaster at the circus this past weekend. LOL

I guess I am a biomechanics geek of sorts.  It just seems as if faulty mechanics stick out like a sore thumb for me wherever I go.  Now, when it comes to bony alignment, you can thank  your parents to a large degree for your shape and knee alignment.

Obviously, girls have wider hips so they naturally tend to exhibit greater tendencies to have valgus overload (knees cave in with squatting or landing) than males.  However, other factors that contribute to valgus overload are:

• Hip tightness (adductors and IT Band)
• Hip weakness (gluteus medius)
• Foot pronation (flatter or collapsing arch)
• Pain (which leads to compensation)
• Improper muscle firing patterns

So, we know valgus is bad.  Does this mean neutral and varus are free from worry.  Not so.  I have seen many people with neutral alignment fall into valgus due to imbalances, poor muscle memory and faulty motor patterns.  Varus knees are often subject to excess stress (compression) along the inside of the knee and gapping along the outside of the knee stressing the lateral collateral ligament.  Valgus knees offer increased compression on the lateral knee and gapping along the medial knee stressing the medial collateral ligament.

In the end, you simply want to know your alignment and then assess how gravity and ground reaction forces impact your joints.  Squatting and gait provide ample cues.  Once you know the imbalances, you can address them with exercises. 

I helped do orthopedic screenings last night for a local high school and noticed a few steady trends:

1. Nearly all of the soccer players had varus knees
2. All of the offensive and defensive linemen had valgus knees
3. Cheerleaders had the best single leg squat strength and balance
4. About 75% of the athletes I saw had less than exemplary single leg dynamic strength/balance

I included two very different pictures below of high school female soccer players doing a drop landing test from an 18″ box.  Obviously the valgus landing is more predictive for ACL and knee injury.

Minimal valgus at landing

Significant valgus at landing

Obviously the girl in the second picture has a higher inherent risk of a serious non-contact knee injury.  I recommend a knee prevention program for all cutting and jumping athletes, but when you see this type of valgus loading   sound the alarm and be sure to implement a corrective exercise plan to reduce injury risk.

I am putting the finshing touches on my ACL prevention DVD as I write this.  You can still take advantage of the pre order sale if you act now.  Visit www.fitknees.com for more info.

In all my years as a therapist and strength and conditioning professional, I have seen many active people affected by stress fractures or stress reactions.  If you are a runner, you may have experienced such a thing.  Likewise, people beginning a new exercise program or rapidly increasing training volume and/or intensity may be at increased risk for such an injury.

Common stress reaction injuries and stress fractures include:

• 5th metatarsal stress fracture
• Shin splints
• Medial tibial stress syndrome (MTSS)
• Tibial and fibular stress fractures
• Femoral neck (hip) stress fracture
• Spinal stress reactions/fractures

Runners, soccer players and gymnasts are often the groups of athletes most likely to suffer these types of injuries.  The repetitive impact leads to breakdown in the bone or bone edema (swelling in the bone).  What starts out as a mild ache may quickly turn into sharp pain if you fail to heed the warning signs.

Signs and symptoms of stress injuries or stress fractures include: aches or pain with increased loading (running, jumping, and stress at extreme ranges of motion), decreased range of motion, decreased strength and altered gait patterns.  Pain may lessen after resting a few days, but often returns as soon as you resume higher impact activity in the case of a stress fracture.

In my practice, I see these injuries much more often in females.  This is likely in part due to calcium deficiencies and and perhaps biomechanicaldifferences that increase force on the joints and bones.  Women also lack strength in comparison to men and weakness equates ot less force dissipation and higher chances ofinjury.  Typical treatment is rest, ice and anti-inflammatory meds.  In some cases immobilization and restricted weight bearing is necessary to allow full healing.

Below is a picture of a metatarsal stress fracture:

If you have a persistent nagging ache or pain in the foot, shin, hip or spine, see your doctor to rule out a stress injury with an x-ray.  These injuries are easily treated when diagnosed early on.  In some cases, neglect may necessitate an operation to remedy the problem.  Once you return to training, it is essential to go slow and use the 10% rule each week (not increasing mileage, volume or intensity more than 10% per week) and using a pain dictated progression in regard to exercise.

As I prepare to launch my new arthritis DVD to the general public on May 11, I wanted to give you an effective exercise (included in the actual program) using a simple box to improve quad strength.  In this three part progression, you should begin with a 4 inch box.  The order (easiest to hardest) is:

1. Posterior box step-down - in this version you lower the whole foot or toe of the non support leg to the floor and then return to upright.  As it gets easier attempt to only lightly touch down and reduce upper body support.
2. Lateral box step-down - in this version you still keep the knee in line or behind the toes and lower the non support leg’s heel to the floor and then return to upright.
3. Anterior box step-down - this is the hardest version because the weight shifts forward taking the knee over the toes (yes this is allowed in this case as it simulates descending stairs) and puts more emphasis on the quad muscle and less on the glutes and hamstrings.  Again, lightly touch the heel to the ground.

In the video below, I will demonstrate how to do all three progressions with light upper body assistance.  Once the knee is strong enough and pain free, eliminate upper body support completely as this will challenge proprioception and stability as well.  Remember to work only in a pain free range of motion. 

If you want to grab a copy of the arthritis DVD on sale, head over to www.fitknees.com as the price goes up on May 11 with the official launch.