Brian Schiff’s Blog

Why is it that athletes performing a movement they have done so many times suddenly tear their ACL?  We have been studying ACL injury and prevention for many years now, and despite our best efforts, we have not made marked progress in preventing the number of ACL injuries.  In addition to anatomical variants and perhaps some genetic predisposition, I feel that the earlier push for sports specialization in our society resulting in increased training/competition hours is a major factor.

The term ACL fatigue may or may not be familiar to you.  But in essence, this theory would suggest that after a certain number of impacts/loading, the ACL becomes weakened and less resistant to strain.  You could almost compare this to a pitcher who suffers an injury to his medial collateral ligament with too much throwing.

As someone who is consistently rehabbing athletes with ACL tears and screening athletes to assess injury risk, I am always interested in how we can keep people from suffering such a devastating non-contact injury. A recent article in the American Journal of Sports Medicine sought so assess ACL fatigue failure in relation to limited hip internal rotation with repeated pivot landings.

We already know that hip mobility is often an issue for our athletes.  Researchers at the University of Michigan sought to determine the effect of limited range of femoral internal rotation, sex, femoral-ACL attachment angle, and tibial eminence volume on in vitro ACL fatigue life during repetitive simulated single leg pivot landings.

Continue reading…

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.

Continue reading…

Rotational stability within the shoulders, torso and hips is critical for optimal performance in sport and injury prevention. Often, clients will exhibit asymmetries with respect to trunk stability with pillar assessments and the Functional Movement Screen (FMS).  I often see 2/1 scores on the RS.  Addressing any asymmetry is important for athletes and weekend warriors involved in cutting, pivoting, and rotational sports.

There are several exercises that can be used to increase rotary stability.  One exercise I recently featured for PFP Magazine in my online column, Functionally Fit, uses a bottoms-up kettlebell hold with trunk rotation to accomplish this.  This particular exercise can be used to increase anti-rotation strength and improve rotary stability.  The pictures below illustrate a knee bent (beginner) and knees straight (advanced) version of the exercise.

The knee bent position allows for easier control of the lumbar spine while keeping the shoulder blades flat on the floor. cadence should be slow and deliberate avoiding momentum that may be caused by gravity.  Once this variation becomes easier, progress to the straight knee version below.

Form is everything here so be sure to use a weight that you can control, while slowly lowering the legs each direction.  This movement pattern blends in nicely with movement prep/pillar prep activities that work on hip disassociation as well.

Click here to see my video and full column for PFP Magazine on this exercise.

Manufacturers tout the benefits of compression stockings by telling runners they improving running performance via aiding or increasing venous blood return.  They assert that the compression around the calves increases the calf muscle pump mechanism thereby increasing end-diastolic volume and cardiac output during exercise and allowing for higher intensity output.  However, research to date has not supported this assertion.

Running a marathon presents a large physical challenge as a runner needs more than 30,000 foot strikes to finish a 26.2 mile race.  Studies to date have revealed that compression stockings may reduce muscular vibrations and oscillations in the calf with prolonged running.  They may also help decrease subjective feelings of pain following exercise bouts, but the use of them is still controversial as science also suggests they do not alter running performance.

A recent study in the Journal of Orthopaedic and Sports Physical Therapy sought to investigate the benefit of wearing graduated compression stockings for running pace, prevention of muscle damage and maintaining muscle performance during a real marathon race.  They had 34 experienced runners (running at least 5 years and completed no less than 3 marathons) take part int he study: 17 in the control group wore socks, while 17 runners wore foot-to-knee graduated compression stockings.

Runners were excluded if they were on medications in the 2 weeks prior to marathon, suffered a musculoskeletal injury in the 3 months prior to competition, and not completing the marathon.  The stockings were commercially available (NRG Energy – Medilast Sport) and covered from the foot to the inferior pole of the patella with graduated pressure.

Participants were given a pair of stockings 2 weeks before the marathon and encouraged to wear them at least 3x prior to race day.  Forty eight hours prior to the race a blood sample was taken, O2 saturation was measured, lower leg volume was assessed and maximum countermovement jump height was assessed.  On race day, participants wore their selected garments and were not given any instructions about food or drinking, while running at their own pace.  The same measurements taken pre-race were again measured following the race.

Results

• Total race time similar between groups
• Average running pace similar throughout the race
• Change in body mass during the race was similar
• Perceived exertion and lower limb soreness the same immediately after the race
• At 24 hours post-race soreness was reported to be less in stockings group, but this difference was no longer present at 48 hours
• Blood and serum responses were not different between groups
• Blood markers for muscle damage revealed no differences between groups in pre-race and post-race values
• Lower leg volume and countermovement jumps decreased in both groups after the race and no statistical differences or benefits to wearing the compression stockings

Summary

The use of compression garments in experienced runners is an ineffective strategy to reduce muscle damage over the course of a marathon.  Further, they do not reduce immediate post-race perceived soreness, nor do they increase performance compared to those runners wearing socks.  This is the first study to look at garments in a real race covering this distance.  Additional studies should be done to look at the impact of these garments on novice or less experienced half and full marathoners.

If you want more information on how to prevent injuries, resolve common running related pains and maximize your running, be sure to check out my comprehensive guide at www.FitForRunning.com.

Reference: The use of compression stockings during a marathon competition to reduce exercise-induced muscle damage: are they really useful? Areces F et al. J Orthop Sports Phys Ther. 2015 Jun;45(6):462-70.

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

Continue reading…