Brian Schiff’s Blog

Many athletes and clients I work with lack adequate pillar and shoulder stability. Whether this is related to acquired laxity, inherent instability or simply a lack of proper muscular control, I think it is important to assess baseline stability in anyone performing overhead lifts, ballistic upper body training and in overhead athletes.

In my clinic, I work with lots of baseball players, swimmers and volleyball players. Most females tend to struggle with hyper mobility (loose shoulder joints) whereas many of my males tend to have soft tissue tightness and in some cases limited internal rotation (GIRD). Both males and females tend to have a need to improve dynamic shoulder and pillar (core) stability to reduce injury risk and optimize mechanics.

The following exercise is one I use to both assess anti-rotational control/stability as well as train the body to resist torsional forces. In the video below, you can see how to assess your baseline strength and stability.

This exercise is very effective in working improving glenohumeral and scapular stability as well as enhancing shoulder, torso and hip stability. In my opinion, athletes with poor stability in this assessment should not perform unilateral Olympic lifting or ballistic overhead training as they may lack the necessary neuromuscular control to execute the proper movement pattern.

This is the fourth corrective exercise I have featured in my “Functionally Fit” online column for Personal Fitness Professional Magazine.  All of the correctives are based on screening assessments from the FMS.

The active straight leg raise (ASLR) assessment (as part of the FMS) is an essential part of any assessment I do on my athletes and runners.  It provides a great look at a client’s ability to stabilize their spine/pelvis and we observe hip separation with one hip moving into flexion and the other fixed hip moving into greater relative extension.

Why does hip disassociation matter?  Simply put, a lack of ideal separation can negatively impact step and/or stride length, reduce propulsion and create other compensations that increase energy expenditure and reduce overall running form.  Some deviations that may occur include hip drop, increased rotation or circumduction of the swing leg, excessive torso rotation, increased knee flexion and diminished stride length to name a few.

Execution: Lie on your back.  Using a doorway, place one leg against the doorway in a position that allows you to keep the lumbar spine flat while the other leg is extended and on the floor.  Next, flex the down hip to the height of the other fixed leg extending the knees.  This leg will remain unsupported.  Now, point the toes of the unsupported leg and reach out toward the ceiling.  Slowly lower the leg to the floor or the lowest point where you can still maintain a neutral lumbar spine (a bolster may be placed beneath the leg if needed).  Perform 10 repetitions and repeat 2-3 sets on each side.

Progress the activity by lowering the leg further and/or sliding closer to the doorway to increase the hip flexion and total hip separation.  Do not allow the lumbar spine to extend as this is a common compensatory motion for limited mobility in the iliopsoas.

Application:  This activity will improve active mobility of flexed hip as well as promote continuous core stability and available hip extension of the opposite hip.  It challenges the client’s ability to disassociate the lower extremities while maintaining stability in the pelvis and core.  Keep in mind it is more than just a hamstring flexibility activity as it also addresses static (pelvis/spine) and dynamic (hip) stability in asymmetrical hip separation pattern.

This separation pattern is essential for optimal running mechanics.  Poor hip disassociation can lead to asymmetrical or bilateral movement flaws, thereby reducing performance and leading to compensatory motion with an elevated risk for injury. This simple technique can be done daily to enhance hip mobility and pelvic/hip stability.

The News and Observer (our local paper here in the Triangle) recently ran a great story on overuse injuries in young athletes.  I firmly believe this is one of the fastest growing injuries I see in the clinic and in many cases it is preventable.  One of the biggest issues now is this commonplace idea that gifted athletes should play the same sport year-round to get ahead.

I remember growing up as a kid and playing football, basketball and baseball in the fall, winter and spring.  While AAU basketball and Legion ball existed, most kids were still playing multiple sports.  Over my 15 years as a physical therapist I have witnessed several of these one sport stars see their playing time and bodies take a hit due to injury.

The American Orthopedic Society for Sports Medicine (AOSSM) and the American Academy of Orthopedic Surgeons (AAOS) state that overuse injuries account for nearly half of the 2 million injuries seen among high school athletes each year.  While soccer and swimming seem to send many athletes into PT, any repetitive throwing or overhead activity bears considerable risk for an eventual shoulder or elbow problem as well.  Some of the common injuries I typically see are:

• Patellofemoral pain
• Shin splints
• Rotator cuff injury
• Bursitis
• Shoulder instability
• Little League elbow

Little League Elbow (medial epicondylar apophysitis)

These injuries are just some of the most common ones I see.  In the article, the reporter focused on baseball and throwing.  With that in mind, consider research published in the American Journal of Sports Medicine this past February from renowned surgeon James Andrews that revealed players who pitch more than 100 innings in a calendar year are 3.5 times more likely to be injured.

He goes on to say that “these injuries are the result of a system that prepares genetically gifted athletes to play at the highest levels, but eliminates most players because their bodies cannot withstand such intense activity at such an early age.”  Sadly, he told the reporter that in 1998 he performed the Tommy John procedure on 5 kids high school age or younger, while in 2008 he did the same procedure on 28 children in the same age range.  This injury is usually caused by throwing too much too soon.

Consider the following data on suggested pitch counts per game (source James Andrews, MD & Glenn Fleisig, MD):

• 8-10 y/o = 52 plus/minus 15 pitches
• 11-12 y/o = 68 plus/minus 18
• 13-14 y/o = 76 plus/minus 16
• 15-16 y/o = 91 plus/minus 16
• 17-18 y/o = 106 plus/minus 16

Unfortunately, I can personally relate to this blog post and story.  I was a promising young pitcher up until the point I threw my arm out in travel baseball at age 13.  The pain got so bad in my arm I could barely throw a ball 10 feet.  I remember the orthopedic surgeon telling me that I could not throw again the rest of the summer.  The pain (and memory of it) was so bad I elected to focus on position play and not to pitch again until my senior year of high school.  At that point, my arm was no longer the same as I had missed three years of practice and development.  Now, I too had become one of those kids whose body was never the same.

So, as a rehab and strength & conditioning professional, I want to help educate and promote better awareness to athletes, parents, coaches, trainers, AD’s, ATC’s and anyone who is involved in the care and training of young athletes.  Fortunately, people are taking positive steps to reduce overuse injuries.  One great initiative is STOP – Sports Trauma Overuse Prevention and you can learn more by clicking here to visit their website.

In the end, we must continue to educate everyone that the old motto of “No Pain, No Gain” is NOT the way to handle overuse injuries as this mentality may ruin the careers of young athletes or lead to an otherwise preventable injury and/or premature musculo-skeletal damage.  Pain truly is a warning signal the body gives us to detect mechanical problems and make changes in our training/activity level until we sort out the cause and solution.  I hope you will join me in supporting this mission and working hard at making sports fun, safe and free of overuse injuries for young athletes of all ages in the years to come.

References – The News & Observer – May 15, 2011