Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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I work with lots of runners, both recreational and competitive, who are seeking to improve performance or overcome injuries. The most common issues I see are iliotibial band syndrome (ITBS) and patellofemoral knee pain (PFP). With every runner, I routinely perform FMS and video analysis to get a better understanding of their movement patterns, gait mechanics and asymmetries.
Without question, they tend to ask me if there is a better way to run. Obviously, every accomplished runner has his/her own opinion on the matter. Some prefer forefoot or midfoot strike, while other do just fine with a heel strike pattern. In essence, we do not have any sound research or biomechanical evidence to declare one a winner. Since I work with many injured runners, I am always seeking to find the most efficient ways to reduce injury risk and eliminate pain.
A paper just published in the September 2015 American Journal of Sports Medicine by Boyer and Derrick sought to answer the question of how shortening the stride length or altering foot strike pattern may impact certain variables. Specifically, the authors sought to compare step width, free moment, ITB strain and strain rate, and select lower extremity frontal and transverse plane kinematics when stride length was shortened 5% and 10% in habitual rearfoot and habitual mid-/forefoot runners using both strike patterns while shod.
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.
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.
This exercise is an excellent way to increase hip disassociation and more specifically hamstring flexibility. Foam rolling and/or myofascial compression therapy prior to stretching may further enhance range of motion. This exercise can be used with runners and clients struggling with tendonitis, IT band issues and patellofemoral pain. It is also helpful in eliminating asymmetry that appears on the active straight leg raise on the FMS.
This exercise can be used as part of a mobility workout, warm-up, regeneration day or at the end of a workout. Remember that maximally dorsiflexing the foot will increase dural tension and place more stretch across the back of the knee. So, relaxing the foot (or placing the rope more along the mid foot) will reduce this tension and allow for a more concentrated stretch in the hamstring. For clients with a history of sciatica, I would suggest avoiding the stretch with the foot in full dorsiflexion as a general precaution.
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