Knowledge is Power
Our goal is to ensure that every patient at Burlington Sports Therapy thoroughly understands their injury and the newest concepts related to it.
Call us: (905) 220-7858 - or - contact us by email
Through Dr. McDowall’s treatment process, I have gained back almost full mobility of my neck.
David J.
February 28, 2010
Although this area of our website has been primarily used for research reviews and pointers, it is also intended for relaying important notices to our patients. What’s more important than this?
Lucy Mae McIntyre was born three weeks early on Thursday, February 25th 2010 weighing in at a whopping 6 pounds 3 ounces. She enjoys crying, sleeping and eating. Thankfully, she has already told us that she wants to be a soccer player!
February 14, 2010
Recently I was lucky enough to go to Costa Rica for a week of surfing. Needless to say it was a great time, but as I’ve experienced in the past, my shoulders are now paying the price. For this week’s blog I thought I’d suggest a few exercises for any fellow novice / occasional surfers out there. With some diligence, you’ll either catch waves easier or avoid the type of pain I’m currently experiencing!
Standing Extension – Stand with the elbows close to straight, squeezing the shoulders back and down. From the approximate height shown, extend the arms to a neutral position, primarily activating the latissimus dorsi muscle.
Prone Paddle – While lying with the arm outstretched overhead, pull the resistance down the length of your body, mimicking the surfing paddle. The resistance can be moved up and down to challenge different components of the paddle movement.
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January 31, 2010
The incidence of injury among distance runners is estimated to be between 37-56%. Of these, pain in the area of the patellofemoral joint (near the “knee-cap”) is one of the most common complaints. Thankfully, some recent research has uncovered some of the risk factors for this condition.
Traditionally, it has been understood that the risk factors for patellofemoral pain have been related to different aspects of the knee. Some of these include malalignment of the patellofemoral joint, imbalance in the muscles around the joint, weakness in the quadriceps or abnormalities in the bone. Interestingly, the scientific research has not been able to agree on whether fallen arches have any bearing on this condition.
A 2008 study published in the British Journal of Sports Medicine has helped to identify that patellofemoral pain can be related to impact. Specifically, they found that those who developed patellofemoral pain ran with a higher impact (at footstrike) in the outside of the heel and in the second and third toes (during push-off). So what does this mean?
Traditionally, patellofemoral pain has been attributed to alignment factors. Given the new literature, we now know that it can also be related to impact. Although we don’t recommend that you change your running technique without the help of a qualified professional, you may want to lighten your step if you’re known to be heavy on your feet!
Treatment for patellofemoral syndrome can vary. Frequently (but not always) the goal of treatment is to manually treat and “release” the lateral structures of the quadricep, hamstring and the iliotibial band combined with strengthening aimed at the gluteals and the inside of the quadricep. Quite often, this involves the use of active release technique and graston technique. For more information, please contact us at 905.220.7858 info@burlingtonsportstherapy.com
References
Powers CM, Chen PY, Reischl SF et al. Comparison of foot pronation and lower extremity rotation in persons with and without patellofemoral pain. Foot and Ankle International 2002; 23: 634-640.
Thijs Y, Clercq D, Roosen P, Witvrouw E. Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. British Journal of Sports Medicine 2008; 42: 466-471.
Wen D, Puffer JC et al. Lower extremity alignment and risj of overuse injuries in runners. Med Sci Sports Exerc 1997; 29: 1291-1298.
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January 17, 2010
Last June we posted an entry on the prevention of anterior cruciate ligament (ACL) tears. In that article, we learned that muscular co-contraction was very helpful in preventing an acute tear of this ligament. Today’s blog is going to review some of the more current understandings in sports medicine with respect to ACL tears, including some practical ways that coaches, parents and players can help identify those athletes at risk.
Most ACL tears are non-contact, occurring during deceleration, landing or pivoting. In soccer, 58% of injuries are non-contact.
Athletes who run and change direction in a more upright position are at more risk of ACL injury.
Females are 4 to 6 times more likely to injure their ACL (some of the points below will help to explain this difference).
Hormonal changes have been shown to influence ligaments (like the ACL). Such hormonal changes occur during monthly cycles and growth spurts.
Having “loose” joints can predispose you to ACL injury. For example, a positive measure of knee hyperextension increases the odds of anterior cruciate ligament injury five-fold. Greater knee laxity and increased general joint laxity are more prevalent in girls. As boys get older there is a trend toward decreased joint flexibility and ligament laxity. Relative to boys, girls show more joint flexibility and ligament laxity with age.
A trend toward knee valgus (pictured below) has been well established in the literature as a risk factor of ACL tear. Females tend to land from jumping in a more valgus position than males. They also tend to land harder, suggesting less muscular recruitment and thereby less stabilization of the knee.
Prevention of ACL tear would significantly reduce the chances of arthritis in adulthood. There is an estimated ten fold increase (incidence) after ligament injury.
Active and passive flexibility training may be contraindicated for preventing ACL tears. Flexibility training does not provide protective effects from injury as has been previously reported in the literature.
Prevention works. According to a recent study of 1435 female varsity soccer players, those who did the proper preventative exercises showed a three fold reduction in non-contact ACL tears. There is a growing body of research validating ACL prevention programs.
References
Barber-Westin SD, Noyes FR, Galloway M. Jump-land characteristics and muscle strength development in young athletes. The American Journal of Sports Medicine 2006: 34(3); 375-384.
Chappell JD, Limpisvasti O. Effect of a neuromuscular training program on the kinetics and kinematics of jumping tasks. The American Journal of Sports Medicine 2008: 36(6); 1081-1086.
Gall F, Carling C, Reilly T. Injuries in young elite female soccer players: an 8 season prospective study. The American Journal of Sports Medicine 2008: 36(2); 276-284.
Garrick JG. Preparticipation orthopedic screening evaluation. Clinical Journal of Sports Medicine 2004: 14(3); 123-126.
Gilchrist J, Mandelbaum B, Melancon H et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. The American Journal of Sports Medicine 2008: 36(8); 1476-1483.
Gioftsidou A, Ispirlidis I, Pafis G, Malliou P, Bikos C, Godolias G. Isokinetic strength training program for muscular imbalances in professional soccer players. Sport Sci Health 2008: 2; 101-105.
Hagglund M, Walden M, Ekstrand J. Lower reinjury rate with a coach-controlled rehabilitation program in amateur male soccer: a randomized controlled trial. The American Journal of Sports Medicine 2007: 35; 1433-1442.
Hewett TE, Myer GD, Ford KR, Slauterbeck JR. Preparticipation physical examination using a box drop vertical jump test in young athletes. Clinical Journal of Sports Medicine 2006: 16(4); 298 – 304
Hewett TE, Myer GD, Ford KR et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes. The American Journal of Sports Medicine 2006: 33(4); 492-501.
Lehance C, Binet T, Croisier JL. Muscular strength, functional performances and injury risk in professional and junior elite soccer players. Scandinavian Journal of Medicine & Science in Sports 2009: 19; 243-251.
Myer GD, Ford KR, Hewett TE. Methodological approaches and rationale for training to prevent anterior cruciate ligament injuries in female athletes. Scandinavian Journal of Medicine & Science in Sports 2004: 14; 275-285.
Myer GD, Ford KR, McLean SG, Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. The American Journal of Sports Medicine 2006: 34(3); 445-455.
Myer GD, Ford KR, Paterno MV, Nick TG, Hewett TE. The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. The American Journal of Sports Medicine 2008; 36(6): 1073 – 1080.
Wingfield K, Matheson G, Meeuwisse W. Preparticipation evaluation – an evidence based review. Clinical Journal of Sports Medicine 2004: 14(3); 109-122.
January 3, 2010
Quite often we have new patients come to our clinic with a diagnosis of “sciatica”. This term has become popular for describing any condition that involves leg pain related to lower back dysfunction. Believe it or not, “sciatica” is not a diagnosis and there are many different conditions that involve symptoms of nerve irritation in the legs. For a treatment to be effective your condition must be diagnosed properly. Has degenerative lumbar spondylolisthesis been considered as a potential diagnosis for your leg symptoms? Has it been ruled out as a cause of your low back pain?
Lumbar spondylolisthesis is a condition in which one vertebra “slips” forward on the one below. There are many different types of spondylolisthesis, one of the most common being degenerative. In this type, the slippage is linked to wear and tear in the joints of the lumbar spine. But what has some of the more recent research uncovered about degenerative lumbar spondylolisthesis?
The 4th and 5th lumbar level is the most commonly effected, with the quadratus lumborum muscle and the iliolumbar ligament often playing a role. The Quadratus Lumborum muscle and the iliolumbar ligament are both soft tissue structures that generate pain. Often times, treatment targeted at these areas can result in drastic improvement in pain associated with spondylolisthesis and lumbar degeneration.
Although frequently seen with this condition, disc degeneration is not an important predisposing factor for slippage. In fact, certain progressions of degeneration in other areas of the vertebrae can actually help to stabilize the slippage!
Other risk factors for degenerative spondylolisthesis in the lumbar spine include being older than 50, being female, having previous pregnancies, being African American and having generalized joint laxity.
Physiotherapy and Chiropractic both have something to offer the patient with spondylolisthesis. Effective treatment for degenerative lumbar spondylolisthesis involves maintenance of proper motion in the hips and other areas of the lumbar spine. This can be achieved through the use of gentle spinal movement techniques, active release technique and graston technique (which are treatments performed by our Chiropractors). Ensuring that certain muscles in the lumbar area assist in stabilizing the spine is also important. This can be achieved through proper education on the right and wrong way to strengthen a spine with spondylolisthesis (which is a service provided by our Chiropractors and our Physiotherapists). As previously mentioned, diagnosis is the key to proper care. Call us today, we can help. Our doctors are trained and qualified to order and read the appropriate x-rays necessary to accurately diagnose your lower back pain. From there, they can make up to date, evidence based recommendations for your treatment and home exercise! 905.220.7858 info@burlingtonsportstherapy.com
References
Kalichman L, Hunter D. Degenerative lumbar spondylolisthesis: anatomy, biomechanics and risk factors. Journal of Back and Musculoskeletal Rehabilitation 21 (2008) 1-12.
Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: review of current trends and controversies. Spine 30 (2005) S71-S81.
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