Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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It has been a while since my last post. To be honest, I have been busy with preparing/presenting my live seminar last week and webinars, as well as fulfilling my writing obligations and clinical role. So, I have been taking a “break” from blogging and recharging the battery so to speak.
Now I am getting back to it. The great thing about presenting though is that I am consistently reading and reviewing the latest research on topics related to my presentations and closely examine my rehab and exercise philosophy. In my clinic, I treat many runners for knee pain.
The average profile is an experienced runner b/w the ages of 25 and 50 who logs 20 – 35 miles per week and routinely competes in half marathons or some sort of triathlons.
Common injuries include IT band problems versus lateral meniscus tears versus patellofemoral pain. Often, I uncover the following things related to kinetic chain deficiencies:
- Elevated or rotated inominate
- Ankle dorsiflexion restriction (OH squat assessment)
- Poor single leg stance
- Weak lateral myofascial chain
- TFL dominance
- Excessive femoral internal rotation/adduction with single leg squats
- Tightness in hip flexors, ITB and soleus
Many currently debate the efficacy of foam rolling. Is it worthwhile? Some say yes, while others say no.
I wanted to make everyone aware of two courses that I am presenting in the next 2 weeks in conjunction with Allied Health Education:
The first is a (2) hour webinar on Current Concepts in the Recognition and Treatment of Femoroacetabular Impingement tonight, August 23 from 8-10 PM. The course is intended for PT’s, PTA’s and ATC’s looking for an in-depth presentation on the condition and its management. Click here for more information.
In addition, I am scheduled to present two (1) day seminars on “Fit Knees” in Greensboro, NC on Sept. 7 and Richmond, VA on Sept. 8. This lecture/workshop event will feature my evidence based approach to injury prevention and rehabilitation for knee osteoarthritis, running injuries and ACL injuries.
The material presented in this seminar is intended to help identify knee dysfunction and implement safe and effective rehab, corrective exercise and training strategies tailored to meet the needs of each client. Attendees will learn how the presenter utilizes the FMS, Y-Balance test and other screening tools to determine limb asymmetry and imbalances. Additionally, participants will learn how to use assessment and current research to create effective training programs, facilitate the rehab process and guide post-rehab decision making. Click here for more information.
If you have further questions, feel free to post them on the blog.
While I treat a vast number of knee ailments in my practice, the focus of my training and rehab is often more proximally directed at the hip. Understanding the role of hip muscles and how the hips and pelvis work together to impact knee alignment and closed chain function is critical in resolving knee pain and dysfunction.
Below is a “go to exercise” exercise I use for gluteus medius activation and core/pelvic stability training. Using a mini-band provides an adduction force cueing the client to abduct and activate their external rotators to maintain proper alignment. Additionally, they need to avoid a drop on one side of the pelvis (look at the ASIS).
Click here to read my entire column dedicated to this exercise in PFP’s online magazine. I hope you find this exercise and information useful for you and/or your clients.
Let me start off by saying I have the privilege to assess and treat many avid runners on a weekly basis. Some of them are triathletes and others just dedicated runners. While the age and experience level varies, I see more female runners in all.
Recently, a woman in her mid thirties came in for PT after being referred by a physician’s assistant (PA) with a working diagnosis of hip flexor tendinitis. She had developed pain running in the past few weeks. It was now at a level preventing her from running despite using NSAIDS to reduce inflammation.
Specifically, she complained of increased pain with figure 4 sitting, difficulty and pain getting up from a chair, and increased pain with running. Her pain level at the eval was 2/10 but went as high as 9/10 with running. Lots of things can cause pain in the hip joint.
Summary of clinical findings:
- Poor single leg stance on the involved hip with mild pain
- No leg length discrepancy
- Subtle antalgic gait
- AROM for hip and L-spine are within normal limits
- No pain with quad or hip flexor stretching
- Manual muscle testing reveals 5/5 strength for hip flexion (SLR and seated), abduction and adduction
- Pain with FABER testing
- Positive hip impingement sign
- Pain with deep squat
It is no secret that proper scapula alignment and muscle activation makes for a healthy shoulder. There are many forms of dysfunction that may be present.
Generally speaking problems revolve around muscular tightness/weakness and faulty movement patterns. The term “SICK” scapula is often used and refers to Scapula Inferior Coracoid Dyskinesis. Common examples of a “sick” scapula include:
- Type I – Inferior border prominence. This is typically related to tightness in the pec minor and weakness in the lower trapezius. Keep in mind the upper trapezius will naturally dominate the lower trap in the force couple with the serratus anterior for upward rotation. You may also see increased thoracic kyphosis which will inhibit the normal resting position of the scapula.
- Type II – Medial border prominence. In this case the scapula is internally rotated or protracted and there is liekly weakness present in the rhomboids and middle trapezius. The serratus anterior may also likely be weak with evidence of scapular winging. This position places the humerus in relative internal rotation and increases risk of impingement with arm elevation.
- Type III – Superior border presence. Here the scapula appears elevated in the face of an overactive upper trap and/or levator scapulae. With active arm elevation, you may notice excessive shrugging or superior humeral head migration in light of the imbalance. Again, the lower trapezius is probably weak and being overpowered.
Click here for a great graphic display from the Journal of the American Academy of Orthopaedic Surgeons of how the scapular muscles work collectively as a force couple to promote optimal movement in the shoulder.
In many of the throwers and overhead athletes I see in the clinic, they often exhibit either medial border prominence of inferior border prominence. Additionally, I frequently observe GIRD (glenohumeral internal rotation deficit) values of 20 degrees or higher in those patients who come in with symptomatic shoulders (rotator cuff and/or labral issues). What does this mean?
Well, in a nutshell, it means addressing posterior capsule tightness in the throwing shoulder is important for avoiding internal impingement and SLAP tears. Tightness (or too much GIRD) can increase the load/tension in the late cocking phase of throwing thereby contributing to friction between the cuff and labrum, as well as excessive torsion on the proximal biceps tendon. Any excessive humeral head migration with repetitive throwing is a recipe for injury over time.
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