Brian Schiff’s Blog

Using a stability ball for hamstring exercises is commonplace in fitness and rehab settings.  I feel the use of isometric exercise is often under rated and under utilized because it is viewed as boring or easy by clients.  I like to use some variations of hamstring bridging on a stability ball focusing on isometric holds with various static positions and dynamic upper extremity movement patterns.

Utilizing time under tension with isometrics is a an excellent way to challenge the CNS and increase muscle activation.  Once a client can master a stationary double leg bridge, this exercise sequence offers some fun and challenging progressions to an otherwise standard and perhaps otherwise boring isometric exercise.

I like to think of these types of exercises as a way to fine tune motor control and resist unwanted motion in a static position as well as with dynamic movement.  Not all clients will be able to progress to the dynamic portion, but use these variations to progress and regress the exercise accordingly.  Adjust the length of the isometric based on the ability of the client.  Beyond a great training tool for the hamstrings, you will realize greater hip, core and pelvic control too.

The video below demonstrates some progressions:

To see the full written description with progressions, visit www.fit-pro.com to read my column Functionally Fit.

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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It is no secret that running is synonymous with overuse injuries. Despite the best intentions, human nature craves more and more, while the competitive nature in us all to push a little harder also tends to get the best of us at times. One of the most rewarding parts of my job and profession is putting together plans that restore health and maximize performance.

The following story highlights both in an endurance athlete who I had an opportunity to work with last year. Normally I write about research, training and exercise on this blog. This post allows me to share the insight and perspective of one of my clients. I know that many of my readers have battled injuries. I am confident that this story of recovery and learning how to use the RIGHT training will resonate with you.

Click here to read about Anthony’s journey back to running

Many people struggle to activate their gluteal muscles while running, jumping or performing athletic activities. Turning on these muscles and “priming” the body to utilize the glutes in its normal neuromuscular programming is helpful in improving alignment and reducing injury potential.  The band rotation exercises cue external rotation with the resistance pulling the knees toward one another.

Activating these muscles prior to doing multi-joint lifts, sprinting, plyometrics, etc. is beneficial in promoting optimal activation/stabilization in order to control excessive pronation with deceleration and eccentric training. The rotations can easily be added to the dynamic movement prep or even used as part of the normal training program. I also like to use them prior to incorporating side stepping and forward/backward walks with the bands.

The video below is one I created as part of my Functionally Fit series for PFP Magazine.  It is a staple in our rehab programs and movement prep routines for our athletes at EXOS Athletes’ Performance at Raleigh Orthopaedic as well.

I am a big proponent of cryotherapy in my rehab whether dealing with acute or even more chronic inflammation. I routinely use cryotherapy with compression via Game Ready in the clinic for post-op knee surgeries, ankle sprains, rotator cuff pathology, Little League shoulder, labral repairs, etc. I was recently contacted and asked to review a cryotherapy solution on the market – Power Play.  Full disclaimer: I am not affiliated with POWERPLAY in any way nor was I paid to write this review.

My intent in writing this review is to share information about the product itself and its efficacy for use in the clinic as well as for the general public. Power Play shipped me the standard kit which includes a carrying case, the cold compression ankle and knee wrap as well as the pump and wall charger.   The entire package is easily portable for the ATC on the go, and works well in the clinic because it has three ports on the unit making multiple treatments for patients with various body parts a cinch.

Below is a picture of one of my patients recovering from ACL reconstruction using the knee wrap:

The different body part sleeves include gel wraps that attach to the sleeves via velcro along with a stocking to protect the skin from the wrap.  POWERPLAY advises placing the wraps in the freezer or refrigerator prior to use.  I noticed that if you place them in the freezer and pull them out for immediate use they are stiff and do not conform as well as desired to the body.  As such, I would advise taking them out at least 10-15 minutes prior to use.

In terms of compression, the default setting on the display reading is 50 mmHg of compression.  You can increase compression in 5 mm increments up to 70 mmHg.  This is easily done with the touch of a single button.  The compressor runs for 20 minutes and then shuts off on its own, so if you desire lass than 20 minutes you would need to set a timer (not a big deal).

POWERPLAY pump

Overall, the unit is convenient to take on the road and very easy to use.  The company states it will run the unit for 8-12 hours on one charge, and I find this to be accurate so far.  Patient feedback is that they like the wraps and the level of pressure, and they are comparing it to the traditional GameReady clinic cryotherapy I use with them on a routine basis.  The POWERPLAY unit is also definitely cold enough and comparable to all other forms of cryotherapy we have in the clinic.

I find the entire package is reasonably priced for the overall quality and portability of the product.  I think it would be a worthwhile investment for PT clinics, ATCs on the go and a client looking to have a high quality cryotherapy solution at home while recovering from an injury or surgical procedure.  I have long been a fan of cold and compression so I like this product, and I look forward to trying out their shoulder wraps next!  Click here to learn more about POWERPLAY.