Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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So many times, athletes and parents alike are singularly focused on the physical rehab necessary after an injury. Often, what the athlete is not talking about is the psychological impact of the injury. Suddenly, their identity and self worth may come into question. They feel disconnected from teammates and coaches. Their daily routine consists of rehab and not practice/play. Deep inside their head they are quietly wondering, “Will I ever be the same again?”
Aside from some of the obvious questions that race through an injured athlete’s mind, one of the biggest and most often unspoken concerns is the fear of re-injury. Having worked with athletes of all sports, ages and abilities, I have seen firsthand how important it is for an athlete to go through a functional and sequential progression that assures that they are able to run, jump, cut, pivot and decelerate again without pain or instability.
I have worked with hundreds of athletes over the course of my career that have suffered ACL injuries. The longer I practice, the more I become convinced that we probably have been pushing or allowing these athletes to go back to their sports before they are really ready (physically and/or mentally). Six months has long been the benchmark for most orthopaedic surgeons. The graft is well healed, but often the mind and body are not really ready.
While I have seen athletes who have great strength, stability, hop testing scores above 90% and look good on movement drills, sometimes these same athletes still have asymmetrical squat patterns, FMS scores lower than 14 or apprehension about returning to their sport. In addition, fear of re-injury is a big factor that impacts confidence and readiness to return to activity.
Consider some of these facts about modifiable factors with return to sports after ACLR from the May/June 2015 Sports Health Journal:
- Motivation, confidence, self-efficacy, optimism and low fear are associated with a greater likelihood of returning to preinjury level after athletic injury and ACLR
- Lower fear of reinjury and greater pyschological readiness to return to sport favored returning to preinjury level after surgery
- Combinable data from 10 studies suggests that fear of reinjury, psychological readiness to return to sport and one’ subjective assessment of knee function were predictive of level of return to sport
- As many as 1 in 2 athletes who do not return to their preinjury level of sport report the main reason is fear of reinjury
Whether doing prehab, rehab or training, I believe in using single leg exercises to attack asymmetries, imbalances and motor deficits I uncover in my assessments. Learning to control one’s body in space with the effect of gravity in a weight bearing position is instrumental for sport and injury prevention.
Furthermore, facilitating ankle mobility and proper knee alignment during a loaded squat pattern is something most athletes and clientele I work with need some help with. to that end, I utilize several different single leg reaching progressions and exercises. One of my favorite ‘go to’ exercises is the anterior cone reach.
I recently featured this specific exercise in my ‘Functionally Fit’ column for PFP Magazine. Click here to see the video demonstration.
This is a great exercise with progressions and regressions for clients of all ages and abilities.
I am pleased to announce that my new e-book on overcoming knee injuries and maximizing running performance is now available! As someone who has run 4 half-marathons, a full marathon and several 5Ks, I know firsthand how frustrating an injury can be. Perhaps worse than the injury itself, is the fear of re-injury when every step brings trepidation in the back of your mind that the same pain could come back at any moment.
Over the course of my fitness and therapy career, I have worked with hundreds of runners ranging from beginners to competitive runners. Many have been sidetracked by anterior knee pain and IT Band Syndrome. While there is no way to prevent all injuries, I have found that learning to assess the body and incorporate corrective strategies to eliminate asymmetries and imbalances along with proper conditioning allows individuals to run faster, longer and relatively injury free.
Up to 50% of all lower extremity injuries with runners involve the knee. I have been working on a manual that summarizes my approach to injury prevention, rehab and training for runners. You see, many people are not really fit to run when they start running. If more people knew how to detect potential issues and train adequately to prepare their bodies to run, injury rates would decrease and performance would subsequently increase.
As such, I wrote Fit For Running: Overcome Knee Injuries and Maximize Performance. This 70 page e-book covers assessment, stretching, strengthening, soft tissue mobilization, plyometric training and injury recovery guidelines. It focuses on preparing the human body for optimal performance – a manual for physical readiness if you will. It is perfect for runners of all ages and abilities, running coaches and fitness trainers working with runners.
While my book aims to target knee pain, it really offers considerable knowledge and insight that would help a runner with any overuse injury. Given the proportion of knee injuries, I chose to focus the injury/rehab portion of the manual on this topic.
Click Here to download a free sample and learn more about this great new resource.
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.
All effective prehab and rehab programs for recreational and competitive athletes should include single leg stability exercises. I like to use sliding exercises as one way to improve neuromuscular control of the core, hip and knee. Frontal plane collapse is a common issue with respect to knee dysfunction. Using sliders/gliding discs as well as theraband is an excellent way to improve strength and kinetic chain control. Below is an exercise i recently featured for Personal Fitness Professional:
This exercise is effective in injury prevention and rehab programs for those with ankle instability, anterior knee pain, hip weakness, poor landing mechanics and higher ACL risk if playing pivoting and cutting sports. It will improve core stability, hip and knee strength/stability, dynamic balance, groin flexibility and trunk control.
The band serves to enhance activation of the hip external rotators and further challenge stability of the hip and knee. The band should not pull too forcefully, but just enough to cue the desired muscle activation pattern. A slower cadence on the eccentric portion of the exercise is preferable to maximize stability and strength gains. Do not force through any painful ranges of motion, and remember that form and alignment are paramount so limit the reaching based on the client’s ability to maintain adequate control.
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