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So, I just returned from the Combined Sections Meeting for the APTA that was held in Indianapolis.  There was lots of great networking and presentations to be sure.   I attended sessions on ACL rehab/prevention, femoroacetabular impingement, elbow injuries in throwers, running gait analysis, and shoulder plyometric training with the legendary George Davies.  I thought I would give you my top 10 list of helpful nuggets I picked up over the weekend in no particular order of importance.

1. Performing upper body plyometrics has no effect on untrained subjects so don’t waste time putting it into the rehab program, where as it does benefit trained overhead athletes.  The one caveat is it also increases passive horizontal external rotation so keep this in mind when working with athletes who have shoulder instability.

2. A new study  coming out in 2015 in AJSM revealed no major differences in throwing kinematics between those following UCL reconstruction (Tommy John) and age-matched controls.  This is good news for those worried about pitching mechanics after the procedure.

3.  According to Dr. Reiman at Duke, the orthopedic hip exam does a better job of telling us they do not have a labral tear than it does telling us they do have an intra-articular problem.  The tests have poor specificity.  In fact, he goes on to say that the “special tests are not that special.”  That brought a chuckle from the crowd including me.  Bottom line - we are not really able to conclusively say “yes you have a labral tear based on my exam today.

4. Reiman also feels we must consider look for mechanical symptoms during the lowering portion of the Thomas test, while considering the fact that fat pad impingement may cause anterior hip pain as opposed to joint pain.  Again, things are not always as they appear in the “FAI” crowd so we need to take a great history, look at the classic tests and also see how squatting and loading affects the hip.

5. More experienced pitchers do not drop the glove side arm, but instead tend to move their body toward the glove to conserve angular momentum and overcome small moments of inertia.  Less experienced pitchers rotate their trunk sooner in pitching cycles whereas pitchers who threw at higher levels rotated later and produced less torque at the shoulder.  Consequently, many players with higher elbow valgus torque and distraction force at the shoulder rotate too early.

6. Via Kevin Wilk - the best way for clinicians to assess UCL laxity is in the prone position as this locks the arm into internal rotation and pronation while avoiding compensatory shoulder external rotation.  I never thought of doing it that way, but it makes sense and I will be adding that to my exam.

7. In the ACL talk, Mark Paterno reported that based on one research paper it took less than 72 exposures before most patients suffered a second ACL injury.  Primary risk factors seem to be younger age (current studies suggest those less than 20 y/o have a higher risk of re-injury), allografts and returning to high levels of pivoting and cutting in their respective sport.  Click here for more information on return to play following ACL in Preadolescent athletes.

8.  According to Chmielewski, to effectively and fully rehab athletes after ACL reconstruction, we must consider the importance of psychosocial factors, namely fear of re-injury and low confidence.  Click here to read an abstract on kinesiophobia after ACLR. As clinicians, we need to do a better job identifying non-copers and those who are scoring lower in terms of self-reported function at 1, 3, 6 and 12 months post-op so we can better identify who may need further interventions and make sure they are truly ready to return to sport.

9. I already feel this way and preach this to my baseball kids and son, but it was music to my ears to hear Kevin Wilk say these words when asked about when young pitchers should throw curveballs: he said he would prefer they wait until they are shaving. Furthermore, he specifically advised that they learn how to locate their fastballs and master a change-up before even considering other pitches.  Amen Kevin.  So, if you are a parent or coach, you heard that from the man who has consulted with and/or rehabbed many of the MLB pitchers seeing Dr. Andrews and is clearly one of the brightest and most accomplished PT’s in our profession.  It is time we as a society start protecting the long term health and wellness of youth baseball players, instead of trying to win at their expense.

10. One of the best presentations I attended covered rehab after doing a video analysis of running gait.  Based on research at ECU, Dr. Willy succinctly said, “strengthening alone does not fix poor running mechanics.”  He demonstrated how using visual feedback, faded feedback and appropriate cuing (internal focus vs. external focus) allowed runners with overstriding and medial collapse to make significant changes that led to a pain reduction that were not previously seen with strengthening alone.  This was definitely an “aha moment” for me given I see and treat so many runners.  I use Coaches eye to evaluate their gait, but now I know how to integrate external focus and implicit cues to facilitate motor learning and truly change gait mechanics and lessen pain.  These tips will definitely help all those runners with ITB syndrome, shin splints, PFP and plantar fasciitis.

The other thing that really stuck out in several of the presentations is how much technology is really changing the way we assess and treat our patients (in a good way).  I routinely use Coaches Eye on my iPhone and iPad at the office.  Some other useful apps to explore that were mentioned include: Ubersense, Simi Move, and Spark Motion.  These apps allow for immediate client feedback and help quickly link movement patterns and dysfunction with the appropriate treatment interventions.  I hope one or more of these tips I shared from my experience last week may help you or someone you know in some way.