The Best Rehabilitation Approaches for Overcoming Shin Splints.

During this time of year when people are running more outdoors for exericse, shin splints are an extremely common problem. Anyone who has ever suffered from shin splints will tell you how frustrating and painful it can be.

Shin splints are a general term used to describe pain at the front of the lower leg. There are a number of different causes of shin pain, the most common of which is due to irritation of the lower leg muscles, (particularly Tibialis Posterior and Soleus) at the point where they join onto the shin bone (1). This type of problem is sometimes also known as medial tibial stress syndrome (MTSS) and should be differentiated from other causes of pain which may be due to stress fractures of the tibia or neural/vascular problems.

Symptoms should be checked by an appropriately qualified health professional for clarification of diagnosis. The evidence to support or contest the recommended treatments for shin splints is poor.  A recent critical review of the available literature concluded that rest was as effective as any other treatment tested (2) . It could be argued however that this conclusion is more a reflection of the quality and range of studies undertaken as opposed to the actual value of treatments. 

Physical Therapists offer number of treatment options to patients in an effort to cure shin splints which include:

• Massage
• Ice
• Orthotics/Insoles
• Strengthening
• Calf Stretching
• Surgery (via referral to orthopedic surgeon)
• Rest

The primary aim of treatment is to relieve the inflammatory changes that have occurred at the muscular attachment of the lower leg muscles. Massage, ice and rest are all used to help achieve this goal. Stretching and the use of insoles/orthotics aim to decrease the load placed on the muscles and thus reduce the traction forces at their point of attachment onto the shin.

Strengthening can be used to increase the body's ability to cope with the stresses placed upon it. Strengthening should focus not only on those muscles local to the area, but also on those further up the leg and the ‘core'.

In extreme cases surgery can be useful to reduce the pain associated with shin splints. This however is not an option to be considered lightly full uninhibited return to sport is not always achieved (3).

Prevention is better than cure (and often is the cure!)

Whichever treatments are utilized the recurrence rate of shin splints is high. Unfortunately too many people stop running and enjoying the exhilaration of exercise because of their shin pain, this is often an outcome of poor advice and a failure to completely rehabilitate their initial injury. There is no ‘blueprint' for exercises to correct the causes of shin splints; an individualized programme is required. Positive results have been demonstrated in the use of custom made orthotics (2) (4).

Despite mixed reports in the literature regarding the ‘best' interventions for the treatment of shin splints, what does seem to be clear is that a multi-faceted approach should be taken (5). Not only should the treating clinician aim to reverse the inflammatory changes causing symptoms, it is also important to identify and correct the causative factors to prevent recurrence and increase recovery time.

With a methodical and graduated approach which includes structured training plans, education and advice regarding appropriate selection of footwear and training surface alongside manual therapy, it is possible to cure shin splints and prevent recurrence.

References

1. Bradshaw, C, Hislop, M and Hutchinson, M. Shin Pain. [ed.] P Brukner and K Khan. Clinical Sports Medicine. 3rd Edition. Sydney : McGraw Hill Medical, 2006.

2. Medial Tibial Stress Syndromme - A critical review. Moen, M H, et al. 7, 2009, Vol. 39, pp. 523-546.

3. Outcome of surgical treatment of medial tibial stress syndromme. Yates, B, Allen, MJ and Barnes, MR. 10, 2003, Journal of bone and joint surgery - American Volume, Vol. 85, pp. 1974-1980.

4. Medial Tibial Stress Syndromme - Evidence based prevention. Craig, D I. 3, 2008, Journal of athletic training, Vol. 43.

5. Comprehensive management of medial tibial stress syndromme. Knenner, B J. 3, 2002, Journal of chiropractic medicine, Vol. 1.

New Show on Medicine and Physical Therapy for Athletes - Athlete 360!

I recently was advised to check out a new TV show called Athlete 360.  The show discusses the various injuries professional athletes suffer from and how they overcome those injuries.  The show's host, Dr. Mark Adickes a Harvard trained Orthopedic surgeon and former offensive lineman for a Super Bowl winning Washington Redskins team, meets with different athletes each show and discusses their injuries including treatment options such as surgery, physical therapy, and other medical treatments. 

Recent current or former professional athletes on the show include former NBA player Dikembe Mutombo, former NFL lineman Mark Schlereth, MLB pitcher Steve Sparks, and professional golfer Stacy Lewis to name a few.  Here is a link to view the episode with Mark Schlereth which I really enjoyed: 

http://ow.ly/1HPPj

To get more information about the show, visit Athlete 360 on Face book or Twitter at the following links:

Athlete 360 on facebook - http://www.facebook.com/Athlete360TV
Athlete 360 on twitter - http://twitter.com/Athlete360TV

If you are like me and wonder what it takes for professional athletes to overcome their injuries, I think you will really enjoy the show.  Thanks for your consideration.

How Use of a Foam Roller Can Help You Overcome Muscle Injuries

Our muscles produce movement through the generation of force as they contract. Muscles take on many different shapes sizes and capabilities, but one thing that they all have in common is the way that they react when injured.

Damaged muscles release chemicals that cause pain which alerts the body to the stress placed upon it. Scar tissue forms around the injured area in an attempt to heal the damage.

Despite the body's remarkable ability to detect injury and heal itself, the system is not without inherent faults. The chemicals which are released during injury can accumulate and cause lasting pain. The newly forming scar tissue is less organized and less elastic than the original(1).

It is possible to facilitate a more efficient healing process through the use of soft tissue mobilization. In doing so you can return from injury more quickly and as strong as before with less risk of re-injury.

The use of foam rollers is an excellent way to help treat injured muscles; it is extremely effective and becoming more and more widely used by our patients.

A foam roller is a firm foam log about 15cm in diameter and 1.5 meters long (the black tubes you may have seen in our clinic).  It can be used for a variety of exercises which help stretch the body and activate the core, but it is arguably most useful for the massage like effects it can produce on muscles.

The foam roller can be used to produce a massage like affect; you lie on the roller with the affected muscle(s) on top. Slowly rolling over the target area using body weight to produce force mobilizes the soft tissue in much the same way that a massage would. In the picture to the right, the foam roller is being used to massage the person's hamstring muscle.

Effects of foam rolling on injured muscle

The major benefits of foam rolling on injured muscle tissue are twofold:

• Increase in local blood flow

Chemicals, toxins and debris that surround the injured area can be cleared and flushed away via increased blood flow to the area. This debris is often a painful stimulus when collected in one place so by clearing it, we can reduce pain and discomfort.

• Breakdown of scar tissue

We need scar tissue to form in order to repair the injured area; however this scar tissue has a tendency to become excessive, tight and immobile. Rolling to break down fibrous scar tissue increases the flexibility and pliability of the muscle.

Precautions of Foam Rolling

Mobilizing an injured muscle too soon could be detrimental; rolling too soon might risk re-injury or excessive scar production (2). Injured muscle needs a little time to form scar tissue and actually begin to ‘knit' the injured areas back together. 48-72 hours is usually enough time for the scar tissue to form without it starting to become too tight.  

When used correctly foam rolling will help to maximise recovery from a muscle injury, it can be used instead of, or in addition to physical/manual therapy. The use of a foam roller to aid recovery from muscle injury should be based on an accurate diagnosis; you should always seek professional advice if you are unsure.

References

1. Kolt, G S and Snyder-Mackler. Physical therapies in sport and exercise. 2nd Edition. London : Churchill Livingstone, 2007.

2. The effect of early mobilization and immobilization on the healing process following muscl injuries. Jarvinen, M and Lehto, M U K. 1993, Sports Medicine, Vol. 15, pp. 78-89.

Tennis Elbow Prevention and Treatment

The successful treatment of any injury depends not only on resolving the presenting problem but also addressing the factors which contributed to the cause of the problem. In order to do this the clinician must look towards the kinetic chain to understand where the problem might have come from.

What is the kinetic chain?

The kinetic chain referrers to a biomechanical model of movement; segments or joint of the body work as a whole to achieve motion. This chain of movement transfers forces from proximal (near to the body) to distal (away from the body). For example when kicking a football the kinetic chain of movement passes from the trunk through the hip, to the knee, onto the ankle and then is transmitted through the ball as it is struck by the foot. They say that a chain is only as strong as the weakest link, this is certainly true here. Any disruption to the kinetic chain, i.e. if one body part is not functioning normally, will mean that it places stress/strain on the other segments which will ultimately result in injury.

Consider the example of a tennis serve; an activity which uses the upper limb. The kinetic chain of the upper limb is as follows:

How can the trunk and shoulder cause problems at the elbow?

If the shoulder is not able to fully rotate inwards, then the wrist will have to compensate in order to get the racquet face to the ball at the correct moment (1), this places undue stress on the tendon which is likely to develop into injury if this pattern is repeated.  

The Kinetic Chain and Tennis Elbow

The pain around the outside of the elbow joint that is associated with lateral epicondylitis (tennis elbow) develops when there is an abnormal level of stress on the tendon of the wrist extensors which attach the forearm muscles to the lateral epicondyle of the elbow. Issues surrounding the trunk and shoulder can be the cause of this undue stress to the tendon.

Rotator Cuff and Mid Thoracic Strengthening in the Treatment of Tennis Elbow

The rotator cuff consists of the tendons of 4 different muscles: Infraspinatus, Teres minor, Supraspinatus and Subscapularis. These muscles are responsible for providing stability at the shoulder by drawing the head of the humerus (arm bone) towards the glenoid fossa (socket of the shoulder joint). They also produce rotational movements around the shoulder. When strengthening around the shoulder the articulation between the scapula, ribs and thoracic spine (middle back) cannot be forgotten. The muscles around the middle back and shoulder blade work to extend the thoracic spine, and tuck the shoulder blade in towards the rib cage. This serves to place the glenoid fossa into its optimum position for movement of the shoulder.

By stabilizing and generating force within the first two links; it is possible to improve the efficiency of the kinetic chain, thus, helping to not only remove the stressful stimulus that may have caused the elbow injury, but also to prevent further problems in the future.

References

1. Occult periarthrosis of the shoulder - A possible progenitor of tennis elbow. LaBan, MM, Iyer, R and Tamler, MS. 11, 2005, American journal of physical medicine and rehabilitation, pp. 895-898.

 

Posture Correction Exercises to Treat Neck Pain

Neck pain affects many people; it can be the result of a range of conditions that affect the muscles, joints, ligaments, discs or nerves. Frequently poor posture contributes to this problem. Postural correction exercises are therefore used in the treatment of this problem.

There are a range of posture correction exercises but they can be broadly grouped into 4 areas:

1.     Chin Tucks

These exercises aim to restore alignment of the head relative to the torso. It is common particularly in neck pain sufferers for the chin to poke forwards when standing or sitting.

2.     Breast Bone Lift

Avoiding too large a curve in the middle back can be achieved through ‘opening the front of the chest'.

3.     Shoulder Blade Squeeze

Retracting the shoulder blades prevents the shoulders from rounding.

4.     ‘Spine Neutral'

Finding the middle range of pelvic tilt helps to activate the core muscles and ensures the spine is in its most efficient position.

The spine should naturally follow a shallow ‘S' shaped curve. In this position the joints are stacked one on top of another. The muscles are orientated in their most mechanically advantageous position and there is minimal stress through the spine. Any abnormal curves will perpetuate neck pain through stress on muscles ligaments and joints.

Posture correction exercises aim to strengthen the muscles that support the spine and control the weight of the head so that normal spinal curves can be maintained.

Chin Tucks 

It has been shown that neck pain sufferers demonstrate weakness and lack of endurance of the deep neck flexor muscles ⁽¹⁾. Chin tuck exercises help to restore function of the deep neck flexors and even if used in isolation can be helpful in reducing neck pain ⁽¹⁾.

Breast Bone Lift

This approach is also called thoracic extension or 'opening through the front of the chest'.  The thoracic spine (middle back) naturally has a slightly forward curve, however, where this curve is excessive it creates an imbalance between the muscles at the front of the chest which adaptively shorten and the muscles at the back which weaken.

Shoulder Blade Squeezes

Pulling the shoulder blades backwards is called retraction. Retraction exercises are used in conjunction with improving thoracic extension to reduce muscle imbalance. By strengthening the muscles which pull the shoulder blade onto the chest wall, one of which is the lower trapezius, it is possible to reduce stress on the upper trapezius. If the upper trapezius is overactive it can lead to the development of trigger points. Trigger points are tight bands or ‘knots' within a muscle they cause pain in a particular distribution and are very often factors for consideration in neck pain of any source.

Spine Neutral

Spine neutral refers to the awareness of a mid range position between maximum tilt forwards at the pelvis and maximum tilt backwards. Where people exhibit poor posture often they have a tendency towards too far forwards which creates a big arch in the lower back or too far tilted backwards as is seen in slumped posture. The position of the pelvis is key to the alignment of the curves of the spine. Improving the strength of the ‘core' muscles helps to maintain this position allowing the spine to follow the normal natural curves which are observed in good posture.

The use of posture correction exercises have been shown to improve neck pain ⁽²⁾. Not only will they reduce the stresses on ligaments, muscles and joints that may have caused the problem initially, they will also help to prevent further episodes of pain and movement restriction.

References

1. The effeect of therapeutic exercise on the deep cervical flexor muscles in people with chronic neck pain. Jull, GA, Falla, D and Vicenzino, B. 2009, Manual Therapy, Vol. 14, pp. 696-701.

2. Evidence for exercise therapy in mechanical neck disorders. Sarig-Bahat, H. 2003, Manual Therapy, Vol. 8, pp. 10-20.

Useful Manual Therapy Techniques to Improve Shoulder Impingement Outcomes

The shoulder gives the most degrees of freedom of any joint in the body. The rotator cuff is an extremely important structure in providing a vital balance between mobility and stability. The rotator cuff consists of the tendons (a tendon is an extension of a muscle which attaches that muscle onto a bone) of 4 different muscles: Infraspinatus, Teres minor, Supraspinatus and Subscapularis. These structures are vulnerable to injury. One of the most common of all shoulder injuries is impingement.

Impingement occurs when the rotator cuff tendons get pinched in the space between the arm bone and the arch of the shoulder blade, which is known as the sub acromial space, as they pass from their muscle to their attachment at the front of the shoulder. This causes a mechanical stress to the tendon which results in swelling and/or damage. This pain is usually felt when lifting the arm up straight in front of you or out to the side as this is when the sub acromial space is at its smallest.

Rotator cuff impingement can be difficult to cure. Stretching or strengthening exercises and non steroidal anti inflammatory (NSAID's) are often prescribed as treatments for impingement. Another valuable treatment option is manual therapy. Manual therapy has been shown to improve the outcomes for rotator cuff impingement treatment ⁽¹⁾. Manual therapy helps to relieve the mechanical stress on the tendon which causes the damage and helps the damaged tendon to recover more quickly.

What is Manual Therapy?

Manual Therapy is a term used to describe a ‘hands on' treatment approach where joints, muscles ligaments and other soft tissues are mobilized or manipulated by a therapist to achieve a therapeutic benefit.  The benefits for the shoulder and rotator cuff muscles in using these techniques includes increased flexibility, increased tissue healing, improved muscle function without impingement, and a patient's increased tolerance to performing functional activities without impingement pain following treatment.

There are a range of techniques which fall into the category of manual therapy, those most commonly used for the treatment of rotator cuff impingement are:

• Soft Tissue Massage
• Friction massage
• Manipulation
• Mobilization

Soft Tissue Massage

Soft tissue massage is the systematic application of pressure and movement on the soft tissues of the body with the intention of facilitating normal range of movement.

Friction Massage

Deep  tissue friction massage is the application of a massage technique whereby superficial tissues are rubbed against deeper tissues. It is useful in assisting the body's own healing mechanisms and as such can help to speed up the healing of injured tendons.

Manipulations

Manipulation is a passive joint movement performed with the aim of increasing joint mobility. It incorporates a small amplitude quick thrust movement at the end of the available joint range.

Mobilizations

Joint mobilization involves the application of a passive force to increase joint range of motion. Mobilizations are performed up to the end of available joint range, but always within that range.

Although manual therapy has been proven to improve rotator cuff impingement recovery, it is not clear which of these manual therapy interventions is better ⁽²⁾. It would seem logical to assume that a combination of these treatments would prove to be of benefit in promoting recovery from rotator cuff impingement.

References

1. The effect of manipulation on the structures of the shoulder girdle as additional treatment for symptom rekief and for prevention of chronicity or recurrence of shouder symptoms. Bergman, GJD, Winters, JC and G, Heijden. 2002, Physical Therapy, Vol. 25, pp. 543-549.

2. Comparison of conservative treatment with and without manual physical therapy for patients wth shoulder impingement syndrome: a prospevtive, randomized clinical trial. G, Senbursa., Baltaci, G and Atay, A. 2007, Knee surgery sports traumatology and arthroscopy, pp. 915-921.

How Exercise Helps to Improve Your Performance in the Workplace

According to the National Institute for Occupational Safety and Health, over 30% of employees report high levels of stress and experience associated health problems on an ongoing basis. While there are a number of reasons for the cause of stress at work, its effect frequently results in illness and injury. The common disorders ensuing from a stressful work environment include psychological, emotional, behavioral and cognitive ailments. If left unchecked, simple issues may evolve over time into serious illnesses such as cardiovascular disease.

The lack of exercise on a daily basis can exacerbate many of the ailments associated with workplace pressures. However, many of the symptoms of such distress may be alleviated by making lifestyle choices which benefit employees both mentally and physically.

Your health may be at risk if you are experiencing symptoms relating to workplace stress. If you suffer from depression, anxiety, fatigue, lack of concentration, or experience aches, sleep disorders, or pain, then you would benefit from a change in lifestyle habits which encompass a suitable form of daily exercise.

You will need to cope with these pressures because although the causes may not be in your control, you will suffer the effects of job stress. To mitigate these effects, you may need to make lifestyle choices such as taking care of your diet and achieving work-life equilibrium. The set of stress inducing factors you deal with are unique to your individual situation. Implementing a daily exercise routine is just one step in the multi-faceted approach to helping yourself to improve workplace performance. The benefits of following such a routine have been shown to increase morale, improve mood and energy levels, and to achieve focus and induce relaxation.

How does exercising on a daily basis help you improve your performance on the job?  Exercising daily has been proven to improve your mood and overall health, which has a positive impact on your ability to achieve your work goals.

A research study in the International Journal of Productivity and Performance Management by Sameer Kumar, et al (1) conducted a cost-benefit analysis of a company's employee wellness program and healthcare costs. It determined that improving employee health resulted in enhanced worker performance and thereby increased the organization's productivity. Thus it established a direct link between employee health and work productivity.

A second study in the Journal by J.C. Coulson et al (2) measured the specific effects of exercise in the workplace by a group of employees. The employees recorded data on days they exercised as well as on days they did not exercise. On comparison, a direct link between exercise and employee productivity was established. It was found that on the days that the group of employees chose to exercise, they experienced a positive change in mood, which led to enhanced performance outcomes.

If you are experiencing symptoms or know a person who has difficulties related to the workplace, including muscle aches, changes in appetite, sleep deprivation, and fatigue, we can help by customizing a plan to incorporate exercise in your daily routine. Our programs will help you cope with your career goals and help you improve your workplace performance over time.

References:

(1) Operational Impact of Employee Wellness Programs: A Business Case Study Kumar, Sameer; McCalla, Michael; Lybeck, Eric: International Journal of Productivity and Performance Management. 58(6):581-597, 2009. DOI: 10.1108/17410400910977109

(2) Exercising at Work and Self-Reported Work Performance Coulson, J.C.; McKenna, J.; Field, M. International Journal of Productivity and Performance Management. 1(3):176-197, 2009. DOI: 10.1108/17538350810926534

Improve Your Walking Speed, Balance, and Functional Capability with Resistance Training.

Resistance training exercises have been shown to improve muscle strength, metabolism, and endurance.  But what effect does resistance training have on improving your overall lifestyle.  In other words, how does it help you to do your daily activities such as walking, lifting objects, work, or maintain balance?

Many people rely on other forms of exercise to stay in shape, maintain balance, and normal function.  These include aerobic or cardiovascular exercise, yoga, and pilates.  Although these are all great forms of exercise, one needs to remember that resistance training is a key exercise component that should be included with other forms of exercise to maintain total body fitness and function.

This is why our programs here emphasize a variety strength training exercises even when a member is performing an "Energy Day" or cardiovascular routine.  Resistance exercises increase core strength and stability allowing you to bend down and pick up items with decreased risk for injury and improved balance. 

Resistance training improves balance by increasing lower extremity and core muscles ability to stabilize joints against ground forces and other forces the body comes up against.  Finally, resistance training of the lower extremities improves explosive power and muscle endurance allowing for increased walking speed with less fatigue and risk for balance loss.

A study by Holviala, Jarrko H.S. et al. backs these statements.  Holviala and company looked at how a 21-week resistance-training program improved balance, functional capacity, and strength in middle age to older women.  The program was performed twice a week by a group of 48 women ages 52 and up.  Results showed significant improvements in functional balance, walking speed, and extensor strength of the lower extremities (1). 

So when you are going through a strength training day, remember the benefits of doing so will help you either maintain or improve your capacity to perform all of life's daily functional, work related, and recreational activities including walking faster and maintaining your balance. 

Reference:

1) Effects of Strength Training on Muscle Strength Characteristics,Functional Capabilities, and Balance in Middle-Aged and Older Women. HOLVIALA, JARKKO H.S.; SALLINEN, JANNE M.; KRAEMER, WILLIAM J.; ALEN, MARKKU J.; HÄKKINEN, KEIJO K.T.  The Journal of Strength & Conditioning Research. 20(2):336-344, May 2006.

How 40 Minutes of Exercise Helps Lower Blood Pressure in Hypertensive Individuals!

High Blood Pressure is one of the many cardiovascular conditions that places a significant health risk on a large portion of the population. Why do you think there are so many commercials promoting blood pressure management medications or drug commercials warning against the use of a particular drug if you are taking blood pressure medications?

On average, ~70% of people treated for a Stroke, Heart Attack, or Congestive Heart Failure have blood pressure readings that are equal to or greater than 140/90. High blood pressure can also lead to other more serious conditions including atherosclerosis (hardening of the arteries), kidney damage, vision loss, erectile dysfunction, and memory loss.

Your risk for developing high blood pressure increases even more if you have Diabetes, are overweight or obese, smoke, have high cholesterol, or are inactive. As indicated earlier, there are medications that address high blood pressure and high cholesterol, but these medications only work effectively if they are combined with other lifestyle changes. These changes include a healthier diet, losing weight, and increasing activity levels including exercise.

How does exercise help to lower blood pressure? Regular exercise has been proven to help people reduce stress, weight, and improve heart health; all of which contribute to lowering blood pressure. If fact a recent study in the Journal of Strength and Conditioning Research by Marcio Mota, et al (1), looked at a group of 15 white collar workers who averaged 43 years old and all had hypertension and provided them with a routine of 20 minutes of treadmill running and 20 minutes of resistance exercise. They compared this group to a control group of hypertensive white collar workers that did not do any exercise.

The study found that the systolic and diastolic blood pressures of the people in the exercise group remained significantly lower not only within 1 hour after the exercise routine, but up to 7 hours later (after they completed their work day). So, within only one session of exercise, these individuals benefitted for a significant part of the day from lower blood pressure.

The take home here is, if you or anyone you know is at risk for or has high blood pressure, we can assist you in lowering it by developing a customized exercise and nutrition program. Our programs will also help reduce the risk for heart disease and stroke, along with giving you more energy for your daily activities.

If you are unsure of whether or not you have high blood pressure, call the All-Access Fitness Academy @ 508-845-3974 and schedule yourself for a FREE fitness assessment. A Fitness Academy trainer will take your blood pressure during the assessment and discuss fitness options for a healthier lifestyle.

Reference: Effects of Treadmill Running and Resistance Exercises on Lowering Blood Pressure During the Daily Work of Hypertensive Subjects Mota, Márcio R; Pardono, Emerson; Lima, Laila C J; Arsa, Gisela; Bottaro, Martim; Campbell, Carmen S G; Simões, Herbert G: The Journal of Strength & Conditioning Research. 23(8):2331-2338, November 2009. doi: 10.1519/JSC.0b013e3181bac418

ACL Injury Causes and How Proper Strength and Conditioning Can Help Decrease Your Risk for This Type of Injury.

One of our primary concerns when treating any of our patients who are athletes is further injury prevention. More specifically, what we do within our treatment plans to help our athletic patients decrease their risk for other common yet traumatic injuries.  One such common injury is an anterior cruciate ligament (ACL) tear at the knee.   The ACL prevents anterior translation of the tibia in respect to the femur during walking, recreational, and sport related activities.  These types of tears occur as a result of both contact and non-contact movements where the increase in force of the movement is too much for the ligament to hold.  The movement event places increased stress on the knee joint, typically with forces in both rotational and horizontal planes in respect to the knee, which causes the ACL to tear.

Research has shown that athletic women suffer this type of injury on average of 3 times more than men competing in the same sports. It has been suggested that women are more susceptible to ACL tears due to the differences in hip and knee alignment they go through during adolescence.  As a result, they are more susceptible to the rotational and horizontal forces mentioned above during sports participation, especially during cutting movements, quick direction changes or when landing from a jump.

One recent study by Imwalle et al., published in the Journal of Strength and Conditioning Research looked at the possible link between cutting movements and non-contact ACL injuries using a subject sample of high school women soccer players. The study compared rotational forces placed on the hip and knee during 45 degree and 90 degree cutting movements.   The researchers found that hip and knee internal rotation were increased more during the 90 degree cut versus the 45 degree cut.  As a result, the subjects’ knee abduction increased during a 90 degree cut, putting the subject at greater risk for an ACL injury.   The researchers concluded that targeted neuromuscular strength training to the trunk and hips may improve the athletes’ ability to control knee and hip internal rotation during cut movements, and therefore decrease their risk for ACL injury.

Our patient strength and conditioning plans fall in line with this research.  Our programs focus on core strength with target areas that include the low back, gluteus maximus, gluteus medius, and abdominals.  Targeting these muscle groups improves the participants’ ability to control hip and knee internal rotation during cutting movements.  Furthermore, our therapists look at our patient/athletes’ form during agility and plyometric activities that put greater stress on the knees, then correct that form via verbal cues and other training techniques.  The take home point is an increase in strength and conditioning to target muscle groups helps our athletic patients avoid common non-contact injuries after they are discharged from physical therapy.

Reference: Relationship Between Hip and Knee Kinematics in Athletic Women During Cutting Maneuvers: A Possible Link to Noncontact Anterior Cruciate Ligament Injury and Prevention.  Lauren E. Imwalle, Gregory D. Meyer, Kevin R. Ford, and Timothy E. Hewett; Cincinnati Children’s Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, The University of Cincinnati College of Medicine, Cincinnati, OH, and Graduate Program in Athletic Training, Rocky Mountain University of Health Professions, Provo, Utah.  Journal of Strength and Conditioning Research: Volume 23, Number 8, November 2009, pgs. 2223-2230.