As mentioned in previous posts, certain sports are associated with certain injuries.  As baseball season is upon us, it may be a good time to introduce you to some of the newer concepts associated with dysfunction in the throwing shoulder.  Repeatedly throwing (as with baseball) places an enormous demand on the different tissues of the shoulder.  Ask any competitive baseball player if their shoulder has ever been sore and you’ll soon understand why much of the research on athletic shoulder injuries is performed on pitchers.  Over the last few years there have been some interesting articles and studies published in sports medicine journals that have changed the way that many practitioners assess, diagnose and treat these injuries.

Many baseball players come to our clinic complaining of pain in the shoulder while throwing that makes them unable to throw at their usual velocity and accuracy.  Often referred to as the “dead arm” in throwing athletes, clinicians now have some useful ways to detect changes in the shoulder that may be causing the problem.  Although not the actual clinical tests we would use, the following may give you an idea as to whether you have a shoulder at risk…

Is there a difference from left to right in how far you can bring your arm backwards?

Is there a difference from left to right in how far you can reach up your back?

Do the contours of your shoulder blades look different when you’re at rest?

Do the contours of your shoulder blades look different when you move your arms?

Although some of the above findings may help detect the shoulder at risk of injury, it’s important that you have your condition properly diagnosed by your chiropractor or sports medicine doctor.  If you experience pain, stiffness, the dreaded “dead arm”, or if you simply plan on throwing a lot this summer, give us a call!

References

Burkhart SS, Morgan CD, Kibler B. The disabled throwing shoulder: spectrum of pathology part 1: pathoanatomy and biomechanics. The Journal of Arthroscopic and Related Surgery 2003; 19(4): 404-420.

Burkhart SS, Morgan CD, Kibler B. The disabled throwing shoulder: spectrum of pathology part 3: the SICK scapula, scapular dyskinesis, the kinetic chain and rehabilitation. The Journal of Arthroscopic and Related Surgery 2003; 19(6): 641-661.

McClure P, Tate A, Kareha S et al. A clinical method for identifying scapular dyskinesis, part 1: reliability. Journal of Athletic Training 2009; 44(2): 160-164.

Tate A, McClure P, Kareha S et al. A clinical method for identifying scapular dyskinesis, part 2: validity. Journal of Athletic Training 2009; 44(2): 165-173.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Last week we dispelled the myth that certain types of soccer cleats predispose you to ligament injuries in the knee.  Given the time of year (and the fact that we have a certain passion for the game) we’re going to continue looking at injuries in soccer.

According to the literature, the incidence of injuries in soccer players is as high as 1.3 injuries per player each year.  It is also worth noting that 22-42% of soccer injuries are re-injuries and 58% of injuries are non-contact.  So how can we reduce those numbers?

FIFA (the governing body of soccer) has recognized this problem and taken a step toward changing it.  The “FIFA 11″ is an exercise and warm-up program designed to prevent and reduce injuries in soccer.  The program was developed by experts using current published literature and was designed to be easily implemented with players of all ability.  In keeping with newer trends in musculoskeletal medicine and training principles, there is little to no focus on static stretching of muscles.  Rather, the program emphasizes core strength, eccentric muscular contraction, proprioception, dynamic stabilization and plyometrics.  (You’ll find a link to the FIFA 11 at the bottom of this blog).

As practitioners, we often see athletes in our clinic with injuries that may have been prevented with the appropriate guidance.  For some players, certain exercises need to be prescribed while for others certain exercises need to be discontinued.  Whatever the case may be, it’s important that players consult with a knowledgeable practitioner who is able to diagnose and identify predispositions to certain injuries and who is able to provide the appropriate preventative recommendations.

If you’re a soccer player or coach who is interested in preventing injuries this summer, we encourage you to review the FIFA 11 and consider it as part of your training and warm-up program.  We also recommend that you check this area of our website over the course of the summer as we’ll be posting a few more articles relating to the prevention of soccer injuries.  Feel free to contact us if you’re interested in coming to the clinic for an assessment that will help identify those factors that predispose you to common soccer injuries.

As always, feel free to post your comments and questions.  Good luck this summer, and go Arsenal!

http://www.fifa.com/aboutfifa/developing/medical/the11/index.html

References

Nielsen AB, Yde J. Epidemiology and traumatology of injuries in soccer. American Journal of Sports Medicine 1989: 17; 803-807.

Engstrom B, Forssblad M, Johansson C, Tornkvist H. Does a major knee injury definitely sideline an elite soccer player? American Journal of Sports Medicine 1990: 18; 101-105.

Hawkins RD, Fuller CW. An examination of the frequency and severity of injuries and incidents at three levels of professional football. British Journal of Sports Medicine 1996: 32; 326-332.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinics in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractics clinic in Burlington.

Soccer shoes have changed considerably over the last ten to fifteen years.  It’s now easier to find red, white, blue or neon shoes than it is the traditional black leather.  Although many of these changes in soccer shoes are cosmetic, there is some published research suggesting that certain types of cleats may lead to an increased rate of ligament injuries in the knee.  

(Blade cleats pictured above, rounded cleats pictured below)

The popularity of “blade” cleats in soccer shoes has increased over recent years.  Many players have expressed skepticism of these cleats though, arguing that they provide too much traction and can therefore lead to more injuries.  Perhaps this idea stemmed from a 3 year prospective study which found a high resistance to torsion and increased anterior cruciate ligament injuries for those players wearing these cleats.  A more recent study examined the forces acting on the knee when a player makes a rapid turn wearing either the traditional rounded cleats or the newer blade type cleats.  Although the study had some limitations (a limited number of participants and the testing was performed on artificial turf) the authors found no significant difference between the two shoe types.  If anything, their results mildly suggested that rounded cleats were more likely to cause ACL injuries, given the increased quadriceps activation found with ground contact. 

So what does all of this mean?  It means that the literature is conflicting.  Until further research is performed and recommendations have a stronger foundation of support, our chiropractic clinic in Burlington recommends that you choose the same cleat type as your favourite player!

References

Gehring D, Rott F, Stapelfeldt B, Gollhofer A. Effect of soccer shoe cleats on knee joint loads. Orthopedics & Biomechanics. Int I Sports Med 2007: 28: 1030-1034.

Lambson RB, Barnhill BS, Higgins RW. Football cleat design and its effect on anterior cruciate ligament injuries. A three-year prospective study. Am J Sports Med 1996; 24: 705-706.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinic in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractic clinic in Burlington.

Every sport has its own set of demands on the body.  From previous blogs we’ve learned that hockey players are somewhat prone to adductor injuries and swimmers often experience shoulder impingement.  For this blog, we’re going to examine the common and problematic condition of lateral elbow and arm pain experienced by many tennis, squash and racquetball players.

Tennis elbow or lateral epicondylitis are common terms used to describe pain around the lateral area of the elbow and arm.  Some people get it confused with medial epicondylitis or golfers elbow, which are similar conditions affecting the inside of the elbow.  In a previous blog entitled “Tendinosis, Tendinitis or Tendinopathy” we learned that tennis elbow is not an inflammatory injury, so the commonly known term of epicondylitis is a misnomer.  A more current term for tennis elbow would be tendinosis or tendinopathy of the wrist extensors.  At the present time, the most accepted explanation for the pathology of tennis elbow is that repeated contraction of the wrist extensor muscles (particularly the extensor carpi radialis brevis) causes microscopic tearing in the tendon.  Eventually, this can progress to the degenerative condition called tendinosis (or tendinopathy).  For tennis, squash and racquetball players, the vibration transmitted from the racquet to the arm during contact is injurious. Although the backhand stroke is the most problematic, forearm strokes and gripping of the racquet can also aggravate the condition.  But what else has the published, peer reviewed literature taught us about tennis elbow and treatment for tennis elbow?

Racquets have certain properties that can be modified to assist in limiting the progression of tennis elbow.  Decreasing the string tension and using a stiffer racquet causes less vibrational force to be transmitted up the arm.  Contact point of the ball also makes a difference; when the ball contacts the “sweet spots” of the racquet there is less vibration.  Beginners tend to hit the ball too close to the hand and they also tend to grip the racquet too forcefully, both which are problematic for the extensor tendons.  Given these findings, it may be helpful for those players prone to this injury to consult with a coach or professional who can assist in modifying equipment and technique.

While there has been much talk in the literature about the non-inflammatory nature of these tendon injuries, there is also a newfound interest in the value of eccentric exercise for the treatment of tennis elbow (and golfers elbow for that matter).  Eccentric contraction of a muscle involves lengthening a muscle / tendon unit while placing it under tension.  An easy to understand example would be the lowering phase of a bicep curl, where the bicep muscle is under tension while lengthening.  Eccentric exercise has been shown in many studies to be helpful in remodeling damaged tissue in tendinosis injuries.  For the geeks out there, it counteracts the failed healing response by promoting collagen fiber cross-linkage formation within the tendon.

Below you will find a suitable exercise for eccentric training related to tennis elbow.  Keep in mind however, that although there has been some research published that supports this approach, there is still lots of research that needs to be done before it can be considered a definite recommendation for tendinosis injuries.

In the starting picture on the left, the extensor tendons are shortened and the elbow is slightly flexed.  Slowly lowering the can will elongate the extensor tendons while placing them under tension.  The picture on the right is the ending position.  To repeat the exercise, place the can in the other hand while the exercising hand returns to the starting position.  This allows the injured tendon to shorten again without resistance.  Place the can back on the injured side and repeat the lowering (eccentric) phase of the exercise.  As always, we recommend that you have your injury properly examined by a healthcare professional that is qualified to diagnose your condition (like a chiropractor) before you try any exercises.  Although eccentric exercises can be helpful for tendinosis injuries, they can easily aggravate injuries, including other conditions that mimic tennis elbow.  Call our clinic today to have your condition diagnosed and treated effectively! 

References

Bunata RE, Brown DS, Capelo R. Anatomic factors related to the cause of tennis elbow. The Journal of Bone and Joint Surgery Am. 2007; 89: 1955-1963.

Croisier JL, Foidart-Dessalle M, Tinant F, Crielaard JM, Forthomme B. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. British Journal of Sports Medicine 2007; 41: 269-275.

Hennig EM. Influence of racket properties on injuries and performance in tennis. Exercise and Sport Sciences Review 2007; 35: 62-66.

Woodley BL, Newsham-West RJ, Baxter DG. Chronic tendinopathy: effectiveness of eccentric exercise. British Journal of Sports Medicine 2007; 41: 188-199.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinic in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractic clinic in Burlington.

Custom foot orthotics are specially designed shoe inserts that are fabricated from casts of your feet. They are designed with specific consideration toward any biomechanical abnormalities in your feet and are known to have a beneficial affect on foot, ankle, knee, hip and lower back pain.  

According to the literature, custom foot orthotics have been shown that they can prevent or treat numerous foot and lower limb injuries.  Plantar fasciitis and tibial stress fractures are two of these conditions, both which are very common and very frustrating injuries for active people.  Orthotics have also shown to be helpful for those who over-pronate, a foot-type that has been related to different knee conditions like patellofemoral disorder. 

In our opinion, not everyone needs orthotics.  If you have a relatively normal foot posture and normal foot biomechanics, orthotics should not be expected to have much benefit.  For some people, their foot pain can be resolved or prevented by changing to a shoe that is more suitable for their foot-type or their activity.  For others, a more cost-effective option like an over-the counter support will offer enough stability to either prevent or treat their condition. 

The prescription of custom foot orthotics is therefore very individual and should take into consideration a large number of factors.  Such factors as the persons foot posture and biomechanics, their sport and activity level, current and previous injuries all play a role.  Our best advice is to consult with a suitable healthcare provider who not only understands these factors, but also how they relate to your ankles, knees, hips and pelvis, so that they can decipher whether you are a suitable candidate for orthotic intervention. 

References

Hume P., Hopkins W., Rome K., Maulder P., Coyle G., Nigg B. Effectiveness of foot orthoses for treatment and prevention of lower limb injuries. Sports Medicine 2008; 38(9): 759-779.

Crawford F., Thomson C. Interventions for treating plantar heel pain. Cochrane Database Systematic Review 2003; (3): 396-412.

Rome K., Handoll HH., Ashford R. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Systematic Review 2005; (2): CD000450.

Roos E, Engstrom M, Soderberg B. Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International 2006; 27: 606-611.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinic in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractic clinic in Burlington.