Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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Eliminating tightness in the TFL can reduce tension in the IT band as well as reduce knee pain associated with Runner’s knee or patellofemoral pain syndrome. Foam rolling prior to stretching is a good idea, but I think this stretch is a good one for all runners to add to their toolbox whether it be prior to or after a run. Check out the stretch from my online PFP column below:
I am currently working to attain my transitional doctorate in physical therapy (tDPT) at Northeastern University. As I continue to work full time as a clinician, it has been really cool to apply the learning with my current caseload. At this time, I am in a motor control class that is both fascinating and challenging. In week three, we examined pain and the impact it has on neuroplasticity (the brain’s ability to adapt or change).
In the sports medicine realm, I generally think many practitioners solely focus on the musculoskeletal system or physical impairment. As such, interventions are developed around tissue constraints, ROM deficits, weakness, etc. Too often, we look past the power and impact of the brain and how it plays a vital role in healing and return to play. For some patients, there is a maladaptive response to injury/surgery and a hypersensitivity of the central nervous system or central sensitization that occurs. Pelletier (2015) notes that structural and functional changes can occur. (1)
Two critical concepts to consider here are:
- Sensory amplification – sensory and motor representations change resulting in perceptual changes in body image, motor control changes, and even a persistence or amplification of pain
- Experience dependent plasticity – patient’s response to pain is related to prior experience and may experience maladatpive imprinting where the pain outlasts the physical insult
Kleim (2008) gives a great lesson on experience dependent plasticity and states that learning is essential for the brain to adapt to damage self taught behavioral changes can be maladaptive or positive and specific forms of neural plasticity and associated behavioral changes are dependent on specific kinds of experience (2). While one would assume that chronic pain is rare in athletes, I would counter and say it is probably just overlooked as we tend to expect athletes to “push through the pain” because of the driven culture we live in. Coaches, parents and even teammates can affect the mindset around injury and recovery.
In many cases, my clients are unable to perform traditional strengthening exercises for the lower body due to anterior knee pain or weakness. Beyond loading, using the time under tension principle is a great way to add strength for those who cannot squat, lunge, etc. Below are two great videos of isometric ‘go-to’ exercises that will help improve strength and functional capacity in those who are otherwise limited in their workouts.
I hope you can use these exercises or some variation of them to increase strength and overcome injury and dysfunction.
Knee pain is prevalent among adolescents and active adults. Patellofemoral pain and osteoarthritis are the most likely causes of pain. It may be present with squatting, lunging, prolonged sitting, kneeling, running, jumping or twisting.
Research seems to support a combination of hip and knee strengthening as a primary line of defense and treatment for knee pain. Interestingly, males with PFP do not seem to have weakness in the gluteus medusa like their female counterparts. The link below is an abstract that speaks to this difference between the two groups:
https://www.ncbi.nlm.nih.gov/pubmed/30090674
Other modalities used to address anterior knee pain include patellar bracing/taping, blood flow restriction training, dry needling/acupuncture and soft tissue work seems to bring more questions accordion to some experts.
Click here to read the 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain from the 5th International Patellofemoral Pain Research Retreat.
Clinically, I have seen good results with the following:
1. Activity modification
2. Glute and quadriceps strengthening
3. Blood flow restriction (BFR) training
4. Sequential and progressive loading based on pain response
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.
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