Rotator cuff tears are common injuries, especially among active middle age men. As researchers and scientists seek for better ways to promote healing and more optimal surgical outcomes, PRP continues to get lots of attention. If you want a basic primer on PRP, click here to read one of my earlier posts on it.
In a recent study in the October 2011 American Journal of Sports Medicine, researchers looked at the effects of PRP on patients undergoing surgery for full thickness rotator cuff tears. This is the first prospective cohort-control study to investigate the effect of PRP gel augmentation during arthroscopic rotator cuff repair. Forty two patients were included in the study (average age of 60), with 19 undergoing arthroscopic repair with PRP and 23 without.
Outcomes were assessed preoperatively and at 3, 6, 12, and finally at a minimum of 16 months after surgery (at an average of 19.7 +/- 1.9 months) with respect to pain, range of motion, strength, and overall satisfaction, and with respect to functional scores as determined using multiple assessment tools. At a minimum of 9 months after surgery, repaired tendon structural integrities were assessed by magnetic resonance imaging.
Below are images defining a full thickness rotator cuff tear:
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)
In my practice, I take care of many athletes ranging in age from 10 and up. Many of the injuries I see are related to over training and overuse. Common things I see in the clinic on a daily basis include but are not limited to:
Tendonitis
Shin splints
IT Band Syndrome
Patellofemoral pain
AC joint pain/arthritis
The list can go on and on. There are many factors (inherent and training related) that contribute to such problems. I personally believe many problems can be prevented with better education, smarter training, coaching predicated on individuality and physical response, and of course adding in more recovery. Cross training is also a must – just look at what sport specialization at an early age has done to current injury rates.
You need not look any further than the declining age of patients walking through the door with what I term “repetitive microtrauma” injuries. I saw a 14 year old cross country female runner a few weeks ago who had her second stress reaction injury inside of 12 months. In addition, the rise in the number of Tommy John surgeries performed in the past decade with respect to those having them at an earlier age may serve as a harsh warning sign about doing too much too soon or doing too much of the same thing year round.
I say all this simply to say we must not be oblivious to the rise in these types of mechanical injuries. Throwing, swimming, and running are all activities that become dangerous if done in excess, and they also produce predictable injury patterns. So, if you are curious about some risk factors and how to better balance your training and manage these types of injuries, then check out a webinar I just did for Raleigh Orthopaedic Clinic last week (click on the screen shot below to view the webinar)
This presentation is ideal for athletes, parents, weekend warriors and sports coaches looking for practical, straightforward information on this topic with some foundational guidelines that can be applied objectively and immediately to injury management and recovery. If this information helps just one person avoid an injury or accelerate their recovery then I will be thrilled! Please feel free to forward this post to friends, share it on FB or tweet it!
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.
So, conventional wisdom and research continues to point to the need for promoting increased gluteus medius and maximus strengthening to promote better knee stability and ward off many other kinetic chain breakdowns. While there are many examples of how to train these muscles, the question is what are the best exercises to promote hypertrophy of these groups.
Whether training or administering rehab, it is important to understand how best to activate these muscles as time may be limited. I think it bears mentioning that core function is closely tied to pelvic posture/alignment so it will be no surprise as you see the best exercises in this post according to recent research released in the International Journal of Sports Physical Therapy. To promote muscle strength, higher MVIC correlates to better strength gains. So, looking at the %MVIC of exercises clinicians and fitness pros alike can better rank the order and appropriateness of certain exercises to maximize health and performance of their clients.
According to a the study at Belmont University, the authors looked at 18 different exercises using surface EMG to study activation of the gluteus maximus and medius. Below is a summary of the top 5 exercises stimulating greater than 70% MVIC for each muscle group:
Gluteus Medius
Side plank abduction with dominant leg on bottom (103% MVIC)
Side plank abduction with dominant leg on top (89% MVIC)
Single leg squat (83% MVIC)
Clamshell 4 (hip clam – 77% MVIC)
Front plank with hip extension (75% MVIC)
Gluteus Maximus
Front plank with hip extension (106% MVIC)
Gluteal squeeze (81%)
Side plank abduction with dominant leg on top (73% MVIC)
Side plank abduction with dominant leg on bottom (71% MVIC)
Single leg squat (71% MVIC)
Click here to read the abstract of the study. I think it is fairly obvious based on the data presented in the article that core stability and training should be integrated with hip strengthening. I presented a column in Functionally Fit last year on plank with hip extension and abduction using a BOSU. This is more advanced concept than just the traditional plank, but a very good exercise. See the picture below:
Click here to read the entire column on the BOSU plank with hip extension/abduction. This particular exercise requires hip disassociation and core stability. I just finished a new column for PFP Magazine on BOSU clamshells so stay tuned for that one as it reveals a side lying progression to optimize hip strength as well.
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