Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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It is that time of the year again. Everyone wants to lose weight and trim their waistlines. Abs, abs and more abs, right? I am all about some core training, but I am always concerned with some of the ab variations that I see commonly used at the gym and in group fitness environments.
Many exercise enthusiasts have tight hip flexors and poor abdominal control. Sprinkle in a history of low back pain or a prior disc injury along with straight leg abdominal exercises and now you have the perfect recipe for a possible back injury. Why is that? Well, the psoas originates from the lumbar spine and attaches to the lesser trochanter on the hip.
In the picture above, you can see how the muscle impacts the spine and hips. As you lower your legs toward the ground during an ab exercise, there is a reverse muscle action that takes place and resultant anterior shear force exerted on the lumbar spine. When the abdominal muscles cannot resist this motion, the lumbar spine hyperextends.
Many people will even report feeling a pop in the front of the hip while doing scissor kicks, leg lowering or throw downs. In many cases, this may be the tendon running/rubbing on the pectineal eminence. Unfortunately, long lever and/or ballistic abdominal exercises with inherently poor core stability/strength, fatigue and gravity working against you will create significant load and strain on the lumber spine. Ever wonder why you wanted to put your hands under your back while doing 6 inches? Your brain is trying to flatten the spine using your hands as it knows the hyperlordotic position is uncomfortable and threatening.
In light of this, I put together a little video for PFP Magazine revealing a safer way to work your abs and prevent undue stress and strain on your back. Check it out below.
Keep these modifications and progressions in mind the next time you hit the gym or a boot camp class focusing on core/ab training.
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.
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.
Spring training has begun, and youth baseball players all over the country are starting to practice and prepare for their upcoming seasons. My very own 14 y/o son has started his 8th grade season, while having been working with his travel team on the weekends since mid December.
As a physical therapist, former player, father, and assistant coach on his 14U team, my first concern is always the health of a player. I see several baseball players in my sports medicine practice ranging in age from 9 year olds to MLB platers. Diagnoses include internal impingement, SLAP tears, little league elbow/shoulder, OCD, UCL sprains, rotator cuff tendinitis, instability, fractures and scapular dyskinesia.
One of the hardest things to do in my profession is get inside the head of a young athlete. Many will refrain from mentioning pain for fear of letting down a parent or coach, or out of concern for losing playing time. Society has become too focused on early specialization and winning from an early age. In addition, “travel baseball” has been somewhat diluted and water down by lots of dads who want their sons to play year-round. I often see kids being abused on terms of too little rest or improper recovery after they pitch and catch.
The biggest, most athletic and hardest throwing kids undergo the most strain as they are asked to shoulder the load at pitcher, catcher and shortstop early on. Many coaches are counting innings in tourneys and not pitches based on tournament guidelines. Too many kids are pitching on consecutive days without proper rest all in an attempt to win meaning less tournaments at a young age. Fortunately, we are making progress in the sports medicine world thanks to the efforts of Dr. James Andrews and others.
High schools are adopting pitch count regulations this year, and MLB along with Dr. Andrews has developed their site, www.pitchsmart.org, to spread education about injury prevention in youth pitchers. Dr. Christopher Ahmad is on the advisory committee for PitchSmart.org, and he is also the lead author on a new paper detailing an injury assessment tool for young baseball players, The Youth Throwing Score.
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.
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.
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