Brian Schiff’s Blog

In many of my recent posts, I have focused on injuries and recovery.  I am going to start a new series today on improving speed and agility.  You see, even though I consult with hundreds of clients every year on injuries, I also train many athletes for peak performance who are well athletes seeking to maximize performance and stay injury free.

While I will be the first to admit I may not be the most innovavtive coach out there when it comes to unique drills, I do get great results and have very few of my athletes get hurt.  I believe this stems from a sound understanding of biomechanics/kinesiology as well as understanding how force application affects the body.  It is the application of exercise that makes a great coach “great.”

Getting it “just right” takes an exact formula and this is not a universal formula for athletes, even if they play the same sport.  With that said, they are fundamantal issues I see athletes tend to struggle with or need improvement on such as:

• Poor running form
• Inefficient planting and cutting
• Inability to decelerate quickly and efficiently
• Difficulty maintaining a low center of gravity
• Difficulty changing direction quickly

To address these issues, we use certain drills in our speed camps, clinics and athlete performance training.  I thought I would spend the next few blog posts showing you some of the very drills we use to improve performance, reduce or eliminate the weaknesses mentioned above and of course dramatically reduce injury risk.

Repetition is key as we want to fine tune the motor patterns and give the athletes the proper patterns to feed forward in practices and games.  This can only really be accomplished through proper instruction, proper selection of drills and reinforcement of proper form with lots of repetition.

In today’s video, I included a 2 cone figure 8 drill that we used in a 2 hour lacrosse clinic.  It is a realtively simple drill, yet so many athletes struggle to decelerate efficiently, round the cone tightly and then move toward the next cone.  Making large turns reduces speed and often decides who wins on the field.  Learning to stay low and turn properly improves quickness and reduces knee injury risk.

This drill is usually done for 15-30 seconds (2-3 sets) to work on conditioning but allow for enough time to get the repetitions desired.  Start with the cones no more than 10 yards apart and as the skill level and form dictates, move the cones closer to increase the difficulty of the drill.  Be aware that the demand is higher with a shorter distance and you should judge distance based on the athlete’s ability to do the drill properly.

Stay tuned as I will share more videos of drills I use in the coming days and weeks to make you or the athletes you train more effectively.

I recently relased an article on coaching mistakes in our local market.  In it, I talk specifically about 5 critical mistakes coaches make with respect to athletes.  The article will likely ruffle some feathers.  I am not anti coaches in any way (I am one).  However, I do believe coaches need to be educated about how to integrate training to maximize sport performance and reduce injury risk.

Today, I witnessed another example of how good intentions coupled with lack of proper insight about the impact of conditioning can harm an athlete.  We had a new lacrosse athlete in our facility today working with one of my performance coaches.  At the end of the session, my coach asked me to look at the athlete’s knee as the client apparently had anterior knee pain.

The staff member and father informed me that the lacrosse player’s coach was having everyone on the team not participating in a fall sport train for the Columbus half marathon coming up in October.  The aim was simply to accomplish team building (an admirable goal) and keep them fit.  You may know where this is heading.

I performed a movement screen on the athlete and discovered decreased hip strength and reduced ankle mobility.  The player had obvious imbalances on both sides, left greater than right.  The player then mentioned shin splints on the left leg as well for the past week (now 3-4 weeks into the 1/2 marathon training).

So, after performing a thorough knee eval, I concluded the athlete has anterior knee pain and left sided shin splints related to muscle imbalance and overuse with the recent addition of 4 days of distance running.  Is running bad?  In a word, no.  But this type of running for this particular athlete is not helping further performance goals.

The father enrolled the athlete in our program to work on speed, agility and power for lacrosse.  The bottom line is that this 1/2 marathon training is going to work against the very training adaptations my staff is working to achieve, not to mention now causing more knee pain and shin splints.

I am not opposed to the idea of scheduled conditioning for athletes not participating in a sport.  However, coaches need to step back and ask themselves what is the best way to condition their players for optimal performance and injury prevention.  In this scenario, I have all the confidence in the world the coach has the very best intentions for his players. 

Unfortunately, the results may be less than expected here – more importantly they may be counterproductive as the wrong energy system training and adaptations are being emphasized, while some players may suffer injury.

In my professional opinion, the player should probably consider dropping out of the half marathon training for three very important reasons:

1. Resolve pain and shin splints
2. Focus on fixing muscle imbalances
3. Maximize the training with us

This seems so simple, right?  Well, I see situations like this every week in my facility.  I see too many injured athletes.  Why?  In many cases it has to do with faulty conditioning principles or over training.  My mission is to educate coaches about how best to blend injury prevention with performance conditioning relative to their respective sport.  We have to remember that one size never fits all either.

Thoughts, comments or questions?  Let me know.  I am happy to address them in a constructive and positive public forum.

Over the past few weeks I have had numerous questions and comments on the blog about SLAP tears.  So, I thought I would add another post with more in depth information on classification of tears, typical treatment and outcomes.  This is a relatively common injury that many know so little about.  To see a diagram, click here.

Different types of SLAP tears

1. Type I – Fraying of the edge fo the superior labrum
2. Type II – detachment of the biceps anchor from the glenoid labrum (most common)
3. Type III – Bucket handle tear of the superior labrum with otherwise normal biceps anchor
4. Type IV – Bucket handle tear of the superior labrum extending into biceps tendon causing detachment of the biceps anchor

Other surgeons have expanded on these classifications as well, but i will not go into that depth here.  You should know that some sub classify type II tears into anterior, posterior and combined anterior and posterior lesions.  In effect a SLAP tear can cause a microinstability thereby leading to articular sided rotator cuff tears.  In plain terms, a posterior labral tear could create a posterior partial thickness rotator cuff tear and an anterior labral tear could create an anterior cuff tear.

The shoulder exam itself often reveals pain with passive external rotation at 90 degrees of abduction (picture the cocking phase of throwing here).  Weakness and instability may also be present depending on the type of tear and if there is already a cuff injury present as well.  There are a number of diagnostic clinical tests done including the O’Brien test, Speed’s test, crank test and biceps load test to name a few.  Many have been successful at confirming labral pathology.  In the end, the MRI is the gold standard in confirming an injury.

Non-operative treatment is often unsuccessful in most cases.  Patients with Type I tears may do better than most (JOSPT February 2009).  Therapeutically, we often see GIRD.   GIRD stands for glenohumeral internal rotation deficit, meaning the affected shoulder has significant posterior capsule tightness and decreased internal rotation (common among overhead athletes and throwers).  Restoring this motion may prevent injury that often occurs between the supraspinatus tendon and the posterior superior labrum.  Research is unclear if GIRD increases risk for a labral tear.

In addition to this stretching the posterior capsule, it is critical to strengthen the scapular muscles and rotator cuff to restore optimal mechanics and motion between the humerus and scapula.  Due to poor posture, flexibility issues and muscular imbalances, the average person may have an altered scapulo-humeral rhythm.  If non-operative treatment fails, one typically opts for surgery.

Arthroscopic surgery is the standard procedure today with debridement of the labrum and reattachment via sutures.   In many cases, surgeons debride rotator cuff tears with less than 50% torn, while opting for primary repair if greater than a 50% tear.  According to a leading surgeon, David Altchek, he will excise a longitudinal biceps tear that is less than 1/3 of the diameter of the tendon, while optiong to repair one that is greater in size back to the major portion of the tendon.

Common rehab timetable 

• Max protection for 0-3 weeks in sling with limited external rotation and overhead activity
• No biceps strengthening for 2 months
• Focus on motion restoration in weeks 3-8
• More aggressive strengthening begins at week 8
• Return to throwing begins at month 4 in most cases

These are some rough guidelines and progressions vary based on each case and the type of tear and associated damage as well as desired activity level.  About 90% of patients experience good to excellent results with Type II repairs in the short to mid term follow-up, but there is not extensive long term data out there.  It should also be noted that throwers and overhead athletes tend to exhibit lower satisfaction with repsect to return to pre-injury levels after surgery.  Recent studies also seem to indicate throwers with an overuse related injury do not do as well as those with a specific traumatic injury resulting in a type II tear.

I hope this post is helpful for those suffering from labral tears or who suspect they may have one.  It is an intricate injury but quite disabling to function with long term implications for the health and function of the shoulder.

In last week’s post I revealed my core lower body reaches using one leg for stance and the other leg fro dynamic movement.  Today, I will show you 3 fundamental upper body patterns I use with many of my athletes.

They include anterior hand touches, ipsilateral hand touches and contralteral hand touches.  You may progress from a 12″ cone all the way to tape on the floor.  The rotational reaching should only be added after the other two progressions have been mastered.  Perform 1-2 sets repetitions for these exercises.

The purpose of these exercises is:

1. Increase strength
2. Increase stability
3. Improve proprioception
4. Improve mobility
5. Reduce injury risk

I highly recommend incorporating some of these simple yet effective training strategies if you are a field or court athlete or someone who works directly with this population.  In addition, any clients prone to ankle sprains or with a history of knee injuries should be doing some form of these routinely if they are still actively competing.

As fall sports near, many athletes are taking to the field again.  We have been busy training soccer, field hockey, football and lacrosse athletes this summer.  I am doing a speed clinic for a local varsity female field hockey team in 2 weeks.  One of the things I always educate coaches and players on is single leg reaching progressions.

Why?  Because they can be implemented on the field quickly and easily without equipment.  In addition, they address balance and strengthening together.  Most athletes I see need hip strengthening anyway, and these drills will provide dynamic strength work for them.  This will inevitably decrease injury potential.

I have included a series of single leg reaches that you can easily implement in your training protocols as well.  If you are not using these, please consider adding them immediately.  You may be surprised to find that even your best athletes may struggle with some of these or have poor balance/stability.  Any athletes with hypermobility will benefit from the stability training and likely see fewer ankle and knee injuries.

I will show you a series of lower leg reaches today as follows:

1. Anterior reach
2. Posterior reach
3. Anterior to posterior reach
4. Lateral reach
5. Diagonal cross-over reach

Stay tuned, as I will share my single leg upper body reaching progression in the next post.