Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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Facilitating better lower leg stability is always a priority in my rehab and training programs. I have long been an advocate of single leg training to resolve asymmetry and reduce compensations and injury risk. Once a client masters form on the ground, adding in more proprioceptive challenges can take their training to a new level.
Today I wanted to share a previously unpublished video I shot for my ‘Functionally Fit’ column that demonstrates a single leg squat exercise on the BOSU Elite Trainer. It is a relatively new exercise tool that offers some tweaks on the original BOSU balance trainer.
Core strength and stability deficits are apparent in many people. The ability to restrain movement while keeping a stable base or pillar is essential for injury prevention. Building prerequesite pillar (hips, torso and shoulders) stability is important before loading a pattern and moving more explosively. This exercise I recently featured for PFP Magazine incorporates a progression for both options.
Application: Poor hip, trunk and shoulder stability elevates injury risk with daily activities and sport. This movement introduces controlled hip extension, torso rotation and shoulder elevation, while aiming to improve pillar strength and stability. The handle bar moves around the bar facilitating a safe and smooth motion. Using both hands allows for more control initially allowing the client to incrementally adjust the amount of rotation while they learn to move in a 3D manner. Working in a slower manner will effectively train anti-rotation strength /control as well.
The exercise progression provides an option to train explosively to develop power from the ground up using both upper extremities similar to a push press except introducing some rotation to the movement. Overall, this exercise offers a great way to train the entire kinetic chain in a multiplanar fashion.
Precautions: Clients with any existing rotator cuff and/or labral pathology or low back dysfunction should proceed with caution initially mastering controlled form with light loads and not push through any discomfort. Be sure to use proper body mechanics when lifting the bar off the ground as well.
I currently present an on demand and live webinar intended for physical therapists through Allied Health Education (www.alliedhealthed.com) on femoroacetabular impingement (FAI) regarding the recognition of this condition and current treatment principles. Currently, I see on average 3-5 new patients per month with acetabular labral tears and/or those recovering from hip arthroscopy for this issue. As such, I am always staying abreast of the current literature on it.
There is a new research design study that was just published in the August 2014 edition of the Journal of Orthopaedic & Sports Physical Therapy regarding hip pain as it relates to these patients. Specifically, the authors point out that some but not all of the hip pain may be attributed to intra-articular pathology. They suggest that extra-articular contributions from soft tissue (or myofascial pain) may account for hip pain thereby making the diagnosis and assessment of these patients even more complex.
The authors raise some interesting questions about lingering posterolateral hip pain that does not respond to injections or arthroscopy at all. Further, they assert that these patients may have more than one source of hip pain, as well as the possibility that the true source of the pain may not be related to the labrum at all. based on their experience they find that taut and tender gluteal, external rotator and tensor fascia latae (TFL) muscles are present in people with acetabular labral tears who also present with posterolateral hip pain. Previous research has identified myofascial taut bands or nodules as sources of such pain.
Increasing hip strength and stability is a common focus in training and injury prevention programs. Current research indicates hip and knee strengthening is more effective than knee strengthening alone in those suffering from anterior knee pain. I routinely use mini-bands to strengthen the hips and maximize proximal stability.
Many clients struggle with poor proximal hip stability that shows up as excessive frontal plane adduction and compensatory trunk lean. This exercise targets the hips and closed chain control needed for those participating in jumping, running, cutting and pivoting activities. It is an excellent way to warm-up and activate the hips as well as reduce patellofemoral overload and prevent knee injuries.
Every month there are new papers on ACL surgery and rehab appearing in the literature. I do my best to stay up on them as this is one area of my practice I am extremely passionate about. I am driven to understand as much as I can about both prevention and rehab, but find myself increasingly focused on preventing secondary ACL tears in my patients.
I feel poor movement patterns, muscle imbalances and inefficient neuromuscular control are major risk factors for athletes suffering a primary ACL tear. We also know being female markedly increases injury risk. Research also tells us that males are more likely to suffer a re-tear of the same side, whereas females are more likely to suffer a contralateral injury.
A study just published in the July issue of the American Journal of Sports Medicine looked at the incidence of second ACL injuries 2 years after a primary ACL reconstruction and return to sport. In a nutshell, the findings were:
- 24 months after ACLR and return to sport, patients are at greater risk (6x) to suffer a subsequent ACL tear compared to young athletes w/o a history of ACL injury
- Female athletes in the ACLR group are 5x more likely to suffer a second injury
- The contralateral limb of female athletes is at greatest risk
Click here to read the full abstract
This information is not surprising as I have seen it firsthand in 17 years as a physical therapist. What we do not have much information about is how do the younger patients (e.g 15 and under) really recover from this injury. When should they be cleared? I worked with a young female soccer athlete who tore her ACL and medial meniscus at age 13. She worked diligently with me in rehab 3x/week for about 6 months and then continued training with me at least 2x/week until she was about 1 year out from surgery.
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