Brian Schiff’s Blog

Well, Thanksgiving is upon us in 2011. I want to wish you and your family a wonderful holiday. In today’s post I will review a November 2011 article in the American Journal of Sports Medicine that looked at the effect of the Nordic hamstring exercise on hamstring injuries in male soccer players.

For those not familiar with Nordic hamstring exercises, see the photo below:

In this randomized trial, the researchers had 54 teams from the top 5 Danish soccer divisions participate.  They ended up with 461 players in the intervention group (Nordic ex) and 481 players in the control group.  The 10 week intervention program was implemented in the mid-season break between December and and March because this was “the only time of the year in which unaccustomed exercise does not conflict with the competitive season.

The trial was conducted between January 7, 2008 and December 12, 2008 with follow-up of the last injury until January 14, 2009.  In the intervention group, all teams followed their normal training routine but also performed 27 sessions of the Nordic hamstring exercises in a 10 week program (as follows)

• Week 1 – 2 x 5
• Week 2 – 2 x 6
• Week 3 – 3 x 6-8
• Week 4 – 3 x 8-10
• Weeks 5-10 – 3 sets, 12-10-8 reps
• Weeks 10 plus – 3 sets 12-10-8 reps

The athletes were asked to use their arms to buffer the fall, let the chest touch the ground and immediately get back to the starting position by pushing with their hands to minimize the concentric phase.  The exercise was conducted during training sessions and supervised by the coach.  The teams were allowed to choose when in training it was done, but they were advised not to do it prior to a proper warm-up program.

And the results…..

Continue reading…

Through my clinical practice and sports performance training, I continue to focus on eliminating core and hip dysfunction.  I think many of the knee problems I see in runners and females are related to weakness in the glutes and small lateral rotators.  There has also been quite a buzz about a recent article written in the Strength & Conditioning Journal on crunches and whether spinal flexion may actually be good for you.

This topic alone could take up several posts so, I will not delve into that today.  However, as one who has experienced sciatica and disc injury firsthand, I probably tend to fall a little more in the camp of focusing on a neutral spine and resisting external forces as I feel this helps improve performance and reduce injury risk.  In that vain, I have been continuing to develop my own core and hip stability progressions with my advanced clients/athletes.

I have been doing a series of posts for BOSU and PFP in my Functionally Fit Column.  In my last post, I covered a 3D mountian climber with hip extension.  In today’s post,  I am covering a great core exercise with the BOSU Ballast Ball focusing on hip extension with the goal of improving shoulder, core and hip stability while promoting hip extension and disassociation.

In the video below you can check out the progressions (incline and decline)

Click here to read the full article on technique and application.  The article reviews a regression for those not ready to tackle this quite yet.  I think you will find this exercise challenging and rewarding.

I have had the pleasure of authoring a bi-weekly column for PFP’s online magazine entitled “Functionally Fit” for over three years now.  This column gives me a creative avenue to display my specific training techniques and teach others how to build a better functional body in the process.

One of the greatest things about exercise is all the different options, variations and tweaks available to bring about a desired physical change in the human body.  As Alwyn Cosgrove once said, “Exercise is like medicine.”  By this, he means the right dosage and application is critical.  I could not agree more.

As training and rehab continue to evolve and become even more intertwined, we as practitioners need to continue seeking ways to get more from our exercises.  I personally use lots of different training tools in my trade, but I am always seeking to get the biggest return on my exercise investments.  Today, I am sharing one such exercise with you, the 3D Mountain Climber with Hip Extension.  Check out the video below:

In this video, I am working to improve shoulder, hip and core stability as well as strongly encourage hip disassociation. Many clients I train and rehab simply are asymmetrical or cannot disassociate their hips which leads to flawed movement patterns and leaks int he kinetic chain.

I used this exercise in our core training series we were doing with the Carolina Hurricanes in their pre-season conditioning sessions that we just recently completed. It is not easy, but delivers so much benefit for just one movement. In the video I display a BOSU balance trainer, but in my online column for PFP, I include a full buildup progression as well. Click here to read the column.

I think it is safe to say most would agree that deadlifts are great for building maximal lower body strength. Elite Olympic weightlifters are generally able to lift more loads in this lift compared to other free weight exercises.  I know personally that I like to use it to develop lumbar extensor strength, as well as in place of the squat if I want to avoid spinal compression from the weight of the bar.

In the past I have heard some strength coaches say they don’t use a hex bar for deadlifts because it is not the same as lifting a straight bar.  While not always sure exactly what they mean by that, I found a recent article in the July 2011 Journal of Strength & Conditioning Research very insightful.  The researchers looked at the difference between straight and hexagonal bar deadlifts in submax loading situations.

The concern with deadlifting has always been stress on the spine.  The study notes:

“For world class athletes lifting extremely heavy loads, lumbar disk compression forces as large as 36,400 N have been reported.”

Lifters have long been encouraged to keep the barbell as close to them as possible to reduce the moment arm. The issue with the straight bar is that it can impinge on the body.  Thus, the trap bar or hex bar apparatus was developed.  The researchers hypothesized that the hex bar would reduce the joint movements and resistance moment arms.  In addition, they hypothesized that larger forces would be produced with the submax loads.

The study use 19 male powerlifters and was conducted 3 months after their most recent competition where most were at the end of a training cycle aimed at matching or exceeding their previous competition performance.  The subjects (following their own warm-up) performed HBD and SBD at 10, 20, 30, 40, 50, 60, 70 and 80% of his SBD 1RM.  Twelve markers were placed on the body for biomechanical analysis.

Continue reading…

Femoroacetabular impingement (FAI) is often a hidden and misunderstood cause of hip pain.  I currently work with a physician who has studied under some of the best hip arthroscopists in the US, and he is performing arthroscopic procedures to resolve hip impingement.  For many years, this has likely been a source of misdiagnosed, under treated and debilitating hip pain for people.

As things advance in medicine, hip arthroscopy is expanding and allowing for easier surgical correction of these issues. However, it is not an easy surgery technically speaking.  As such, finding the right surgeon (if needed) is critical to attaining a positive outcome.  Who normally gets it?  Unfortunately, many people are predisposed to it, much like we see the natural genetic architecture (shape) of the acromion affecting impingement in the shoulder.

If you have an overhang of the hip acetabulum (socket) or non-spherical shape of the femoral head (or both) this can compromise the joint space and injure the joint cartilage and/or labrum.  Destruction can occur at a very young age.  I am currently rehabbing a 19 y/o male who recently underwent hip arthroscopy to debride his labrum and smooth out the hip socket and re-shape the femoral head.  He had extensive damage at an early age due to his joint architecture and shows some signs of impingement on the other side as well.

How do you know if you have hip impingement?  Generally, you may have hip joint pain along the front, side or back of the hip along with stiffness or a marked loss of motion (namely internal rotation).  It is common in high level athletes and active individuals.  However, other things may cause hip pain as well such as iliopsoas tendonitis, low back pain, SI joint pain, groin strain, hip dysplasia, etc. so a careful history, exam and plain films are necessary to confirm the diagnosis.  If suspected, an MR athrogram is usually ordered to confirm if there are labral tears present.  Physicians also use an injection with anesthetic to see if the pain is truly coming from the hip joint.  This may be done under fluoroscopy to ensure it is in the joint space.

Signs and symptoms of FAI may include:

• Pain with sitting
• Pain or limited squatting
• Stiffness and decreased internal rotation
• Pain with impingement testing (see picture below of hip flexion, adduction and internal rotation – examiner will move the hip into this position and marked stiffness/loss of internal rotation and pain indicates a positive test)

Conservative treatment typically involves limiting or avoiding squats, strengthening the core and hip stabilizers as well as attempting to maximize mobility of the joint.  Due to the fact that by the time pain brings patients in to see the doctor there has already been marked labral and joint damage, a cautious and proactive approach to managing hip pain is warranted especially in younger active patients and athletes.

The types of lesions seen are either Cam or Pincer lesions.

Cam lesion – involves an aspherical shape of the femoral that causes abnormal contact between the ball and socket leading to impingement

Pincer lesion – involves excessive overgrowth of the acetabulum resulting in too much coverage of the femoral head and causing impingement where the labrum gets pinched

You can also see a mixed lesion where Cam and Pincer lesions are involved.  FAI may lead or contribute to cartilage damage, labral tears, hyperlaxity, sports hernias, low back pain and early arthritis.

The good news is that these patients typically do well post-operatively.  Dr. Philipon et al reported in 2007 in the Knee Surg Sports Traumatol Arthrosc. (click here to read the abstract) on 45 professional athletes who underwent arthroscopic management of FAI with an average follow-up of 1.6 years.   In this time period 78% of them were able to return to their sport.

Following surgery, weight bearing may be restricted for the first 4 weeks or so to protect the labrum if it is repaired.  With a simple debridement and re-contouring of the acetabulum, weight bearing may be initiated earlier.  Avoiding twisting motions and excessive external rotation is a must in the first month or so as well.  Typically, impact and twisting restrictions are lifted around 3 months post-op.

In the end, proper diagnosis and treatment is necessary to preserve the hip joint and maximize function and return to sport.  If you or someone you know suffers from chronic and persistent hip pain that has failed conservative treatment, then consider getting a second look to rule out FAI.