Hip Labral Tears: What Effect Does Specialized Rehab Have?

September 12, 2014

With the NFL season in full swing now the prevalence of injuries during games and practice unfortunately become almost a daily occurrence with teams and players. The constant grind along with excessive impact that these players put on their bodies put them at more of a risk for potential injuries. Hip injuries in the past few seasons have come into the limelight with players like Brandon Marshall, Percy Harvin, Corey Wooten, and Ed Reed having to undergo surgical procedures to repair a torn hip labrum. So how does something like this happen and how do these athletes return to a high level of play?

 

The labrum in the hip is a strong piece of cartilage that sits on the outside rim of the hip socket. It acts as a sort of gasket for the hip joint and helps the hip to form a suction seal for stability. With a tear in the labrum the hip joint loses stability and in turn causes increased pain especially with rotational movements and during higher impact activities. Many times arthroscopic surgery, which involves sewing together and re-attaching the labrum to the acetabulum (socket) of the hip joint. This provides the athlete with the ability to perform higher-level activities like jumping and cutting with proper stability, and without pain.

 

Structured rehab and return to sport programs are imperative for athletes such as these to return to a high level of sport. In the case of Brandon Marshall after undergoing his arthroscopic procedure, in the 2010 season he caught 86 passes for 1,014 yards and followed that up in 2011 with 81 catches for 1,214 yards and six TDs. After undergoing another arthroscopic procedure on the hip in January of 2013 he put up tremendous numbers including setting single season Bears receiving records for 2013. Other players such as Percy Harvin were also involved in specialized rehab and return to sport programs to combat the years of wear and tear they have put on their bodies. As a rehab professional it would be irresponsible to return a worker back to work before making sure that they could do their full job duties, so why is it different for returning to high level sport? It is necessary for us to provide this high level of return to sport rehab so that the athlete returns to sport safely and efficiently.

 

Imagine driving a car that can only run in first and second gear. You are able to start, but if you want any power and speed you can’t have it. A torn labrum inhibits that athlete from switching into third and fourth gear. Involvement in a structured rehab and return to sport program tunes the athlete’s engine so that it performs at its maximum ability. At Accelerated Physical Therapy we have a team of trained hip specialists that are able to screen athletes for potential hip problems, and provide that primary rehab and return to sport rehab in order for them to return to their high level of sport.

 

Please provide your thoughts on hip labral injuries, and how you feel a structured return to sport program is essential for these athletes.


Preventing and treating ACL injuries in young athletes

September 12, 2014

Accelerated Physical Therapy is tackling the growing rate of ACL injuries among youth athletes. A team of more than 50 physical therapists throughout Illinois and Indiana is specially-trained to both prevent and treat ACL injuries.

This team is part of a program called 3P: Prevention, Progression and Performance. Here’s what it offers to athletes involved in ACL injury-prone sports, such as football, basketball and soccer:

Prevention

To help prevent an athlete from sustaining an ACL injury, Accelerated’s specially-trained ACL physical therapists use proven research to help a patient strengthen muscles surrounding the knee, core, hip and lower leg. This, in turn, supports the knee’s ligaments, including the ACL. Some of the prevention program elements include:

  • Basic ACL education
  • Stretching muscles which surround the knee, hip, core and lower leg
  • Strengthening of the core, gluteus medius and hamstring muscles
  • Agility drills
  • Identification of biomechanical flaws
  • Jumping and cutting-specific exercises

Progression (Rehabilitation)

Following ACL surgery, it is extremely important to work with a physical therapist trained in ACL rehabilitation. Typically, a physician will recommend that a patient undergo rehab for 12 weeks, with functional assessments at 14 weeks, six months and one year post-op. The specially-trained Accelerated physical therapists have developed an expertise in ACL rehab over many years.

Performance (Return to Play)

Each patient and each injury is unique. So, when an athlete has finished post-surgical rehabilitation, it is important to assess if he/she is ready to participate in sports with a limited risk of re-injuring the ACL. (Re-injury can be as high as 20-30 percent.)

The Accelerated return to play program is a collaboration of several research-based programs and is a comprehensive assessment of an athlete’s readiness to return to his/her sport. Customized for each patient’s sport, the program includes a fatigue component, which determines an athlete’s readiness after a work-out or practice.

A physician or physical therapist typically recommends a return to play program (functional evaluation) at 12-14 weeks and then periodically thereafter at six and 12 months to make sure things are progressing well.

Accelerated’s return to play specialists use a combination of assessment tools, including video analysis, to evaluate the patient performing these movements:

-       Single leg squat test

-       Drop-box Jump

-       Tuck jump

-       Land within footprint

-       Lateral hop (ice skate hop)

-       Double leg squat, single leg hop, lateral hop, cut 90° right, cut 90° left, ladder “Z” cutting

If deficits are identified, and the patient may be at-risk for re-injury, the physical therapist will discuss an individualized program with the patient and his/her physician.

For more information or to speak with an ACL specialist in your area, visit www.acceleratedrehab.com or call 877-97-REHAB.


Is your youth athlete at risk for an ACL injury?

September 12, 2014

Fall sports have begun and, for many young athletes, painful anterior cruciate ligament (ACL) injuries will follow. The ACL is one of the four main ligaments of the knee that connect the femur (thigh bone) to the tibia (shin bone). When injured, this ligament can tear, causing instability, pain and, often, a “popping” sound.

According to a recent study published by the American Academy of Pediatrics, ACL injuries in athletes under age 18 have increased over the past two decades, especially among those who play football, soccer and basketball. The American Academy of Orthopedic Surgeons estimates that 200,000 athletes will sustain an ACL injury this year alone. Furthermore, research shows that nearly 30 percent of those who have had an ACL repaired will re-injure it in the 24 months following surgery.

Accelerated physical therapists and athletic trainers agree that ACL injuries are on the rise among both male and female athletes. They point to young athletes specializing in one sport too early, playing a single sport year-round and the increasing pressure to compete at higher levels.

Yet, there is good news. The American Academy of Pediatrics study reported that athletes can reduce their risk of injury as much as 72 percent by engaging in a comprehensive knee strengthening and conditioning program.

The first step in a good prevention program is a screening (or evaluation) to determine if an athlete is at risk for an ACL injury. This should be conducted by a qualified healthcare provider.

This fall and winter, Accelerated athletic trainers and physical therapists trained in treating ACL injuries are performing ACL injury screens at many area high schools and club team locations. They are evaluating soccer, football, basketball and volleyball players to identify biomechanical deficits in the athletes’ movements. After a one-on-one evaluation, the athletes are given a low, medium or high risk score. If an athlete is considered medium or high risk, he/she may be referred to a local sports medicine physician who will determine if a prevention program will be beneficial. (Note: in Indiana, patients may schedule a physical therapy appointment without a doctor’s prescription.)

Accelerated is also offering free ACL injury screens* to youth athletes throughout Illinois and Indiana. This can be scheduled by calling 877-97-REHAB.

 

*Not for federally funded payers.


The hip bones connected to the, shoulder bone?

September 10, 2014

Do you remember the song, “Dem Bones” by James Weldon Johnson? Well in case you don’t have the patience to sit through a child’s song with a dancing skeleton, the gist is the human body is connected in more ways than we may ever realize. The interdependence of our body’s joints, muscles and bones may not be a prevailing thought in a healthy person because when everything is working, we tend to not ask questions. But for Josh Beckett, a three-time MLB All-Star, who has been on the disabled list since August 3, 2014 and diagnosed with a torn labrum in his left hip. Beckett is wondering if this injury has currently ended his season… and possibly his career.

You may be scratching your head on Beckett’s injury, wondering how on earth a pitcher hurt his hip. “I thought pitchers injure their elbow or shoulder. Those are the injuries I read in the headlines”. Well, if we look further down the kinetic chain and into the mechanics of a pitcher it all makes sense.

A Pitcher generates power from his legs, throughout his entire pitching motion. That power is produced from his legs and core and transferred to his shoulder, elbow and eventually hand. The more work your legs and core do, the less stress that is placed on the shoulder and elbow.

As a pitcher plants his front side (for a right handed pitcher, his left foot), his trunk is flexing over his hip and due to the pelvic rotation, there is internal rotation and flexion stress on his hip, leading to hip impingement. Doing the pitching motion 100+ times a game for over 15 years at a professional level (not counting his youth, high school and college ball) and you can understand how Beckett has a pretty serious overuse injury on our hands.

Even though Josh’s injury made the headlines, overuse injuries in pitchers has become more common in overhead throwers as we become better at diagnosing hip injuries. It is important as sports medicine professionals that we have a firm understanding of both pitchers mechanics and risk factors for hip impingement.

At Accelerated Physical Therapy we have a ‘Hip Preservation Team’ as well as an ‘Overhead Throwing Team’ where we specialize in identifying, preventing and treating these conditions.

Do you think Josh will return from this? Have you seen an increase of hip injuries in overhead throwers?

 


Will Tanaka’s Elbow Survive Without Surgery?

September 3, 2014

Have you ever tweaked a muscle and you knew right away something wasn’t right? That’s exactly what happened on July 8,2014 while playing the Indians, Masahiro Tanaka, the NY Yankees huge offseason pitching acquisition left the game knowing something wasn’t right. An MRI on his elbow revealed a partial tear of his UCL and a faced a tough decision as to how to treat it.

Surgery or no surgery, that is the question.

The UCL or better knows as “Tommy John Ligament” is a relatively small ligament on the inside of your elbow that resists the tremendous forces created by pitching. Studies have revealed that every pitch thrown has enough force to tear your UCL if there was no help from the secondary stabilizers such as bones and other surrounding soft tissue structures. If this ligament is compromised and does not do its job, the surrounding soft tissue structures, flexor-pronator muscles will have to work harder to support the medial elbow. Additional work will have to be done along the kinetic chain, especially the shoulder to make up for the loss of velocity. It is no surprise that Tanaka recently started to have general arm soreness after mound progression and simulated game throwing.

In my opinion, he will most likely wind up going under the knife to repair this torn ligament and could very well return next year as the dominant thrower he left as. I do understand and respect the Yankees decision to try non-op rehabilitation as current literature has shown that the return to play rates for UCL reconstruction are not as high as once thought. That discussion will be for another post.

As sports medicine professionals, it’s our job to identify those at risk of UCL injuries. At Accelerated Physical Therapy we have video analysis systems that can identify flaws in mechanics and help correct them before the body breaks down. We film youth baseball pitchers throughout the Midwest to help put the brakes on this injury that continues to plague America’s pastime.

I would like to open up this forum to any comments on UCL injury and your thoughts on Tanaka’s future.

 


Hot tips for summer running

July 21, 2014

As the weather heats up this summer, so does marathon training. Be sure to use caution when running in the heat. High temperatures can lead to overheating and dehydration—two problems known to harm health and performance.

According to a recent study in the Journal of Athletic Training, runners who began a 12K race on an 80-degree day already dehydrated completed the race about two and a half minutes slower than when they ran fully hydrated.

Kate ReicherDehydration occurs when too many fluids are lost through sweat and/or not drinking enough. In the process of sweating, water and electrolytes are lost and, after prolonged periods of time, body functions are compromised. Common signs of dehydration include thirst, headache, confusion and abnormal fatigue.

Overheating occurs when your body is unable to cool itself due to the amount of water evaporating from your skin. The most common symptoms of overheating are headaches, fainting, dizziness, and after long periods of time, heat stroke.

According to Denise Smith, Accelerated Physical Therapy running specialist, dehydration and overheating can cause serious symptoms, but simple adjustments to your training schedule can help you avoid these conditions altogether.

She suggests these five tips for hot weather running:

  • Run at the right time–Even at the hottest time of the year, temperatures are coolest in the morning and at night when the sun’s rays aren’t as strong.
  • Wear appropriate clothing–Running gear that is a light color, lightweight and is breathable will help cool you down significantly. Light colors absorb less heat and clothes with vents or mesh will allow for air-flow and breezes to decrease your body temperature.
  • Consume sports drinks–In high temperatures, electrolytes are so crucial and just drinking water isn’t enough. Many sports drinks increase your water-absorption rate and replace the electrolytes lost through sweat. Drink a sports drink about one hour before your run to fill your body’s electrolyte stores. Always drink again after you run.
  • Be smart–It can take some time for bodies to fully acclimate to the high temperatures and humidity. Instead of starting your training with high intensity runs, take your time and gradually increase the length and speed of your runs.
  • Embrace the breeze–If possible, begin your run going with the breeze and finish your run against it. The wind will cool you down when you are running into it, so use that to your advantage when you are at your hardest part of the run… the end.

If you would like to discuss your summer training program or are experiencing pain that concerns you, call Accelerated Physical Therapy at 877-97-REHAB and ask for a running specialist. We can schedule you for an appointment within 48 hours at your nearest Accelerated location.


New Techniques Give Runners a Leg Up

July 3, 2014

Running is a great way to stay healthy, but too much running can lead to overuse injuries. A recent study by Harvard University shows that up to 74 percent of middle and long distance runners sustain injuries each year.

The Accelerated running team is comprised of experts who understand the biomechanics of running and are available to help runners who have sustained an injury and want to get back in the race. The team also works with runners who want to prevent an injury from occurring. They are certified to teach the best methods for increasing speed while remaining injury-free.

Here are some new techniques and methods Accelerated physical therapists are using to help patients accomplish their goals:

IMG_1102 edittedThe Pose Method®. Accelerated Pose Method-certified physical therapists enjoy working with runners who, after adopting this new technique, can experience greater efficiency while running—and fewer experience injuries.

Developed by three-time Olympic running coach Dr. Nicholas Romanov, the Pose Method uses gravity, key body poses and body weight to increase efficiency. It consists of three elements: “Pose – Fall – Pull” and uses gravity as the primary force for forward movement instead of muscular energy.

Guided by an Accelerated physical therapist certified in the Pose Method, runners learn how to adjust their body position and use gravity to conserve energy and increase speed. This is typically done in in an Accelerated center, but can also be taught outdoors. The Sproing® cardio/strength training machine is often incorporated into the evaluation, which includes video analysis of the patient’s gait and form.

The Pose Method emphasizes a whole body pose, which vertically aligns shoulders, hips and ankles with the support leg, while standing on the ball of the foot. The runner then changes the pose from one leg to the other by falling forward and allowing gravity to do the work. The support foot is pulled from the ground with efficient use of the hamstring, while the other foot drops down freely, in a change of support. This creates forward movement, with the least amount of energy use and effort. This simple sequence of movements: the fall and the pull, while staying in the pose, is the essence of this technique.

In addition to increasing efficiency, the Pose Method can help reduce the incidence of some of the most common running injuries.

Sproing is the first soft-platform training machine that absorbs impact as runners train. The machine offers the softness of an elliptical and the workout of a treadmill. Using bungee resistance instead of a moving platform, Sproing has two interchangeable platform surfaces—one filled with air for easier training and the other filled with special high-density foam for an intense beach-surface workout. These platform types allow for customized workouts consisting of cardio, strength and power movements.

Sproing is great for rehabbing an injury, endurance training or full-body workouts. Specifically, it is designed to:

-       Allow athletes to train at various speeds

-       Improve running form and cadence

-       Help prevent injuries with its low impact technology

-       Unload force on the lower body

-       Improve strength, balance and stability

-       Provide handrails and harness to help patients feel more comfortable

 

Alter G®*. The Alter G Anti-Gravity Treadmill is great for runners with lower body injuries and patients with neurologic conditions alike because its gravity-altering mechanism customizes the force with which your feet strike the ground. It can help you:

-       Walk or run with no pain at a normal gait

-       Reduce stress on joints and injured areas of the lower body

-       Give you confidence and ability to walk or run longer—and recover faster with less pain

*This is only available now in the Accelerated North Naperville (115 E. Ogden Avenue, Naperville) location.

In addition, Accelerated running specialists offer training packages for runners of all levels whose goals may include: running faster, running longer and running without pain. The packages include a Runner’s Evaluation.

Runner’s Evaluation. This assessment tool helps identify mechanical deficits in runners of all ages and skills. It includes a full gait analysis by a licensed physical therapist trained to identify a runner’s flexibility, range of motion, muscular strength and running pattern. It can also detect whether the patient has injury-prone areas and/or gait deficits that can be corrected through individualized training and exercise programs.

Using state-of-the-art video analysis software, a physical therapist will videotape a patient running to identify his/her physical condition and movement dysfunction during activity. Each runner receives a copy of his or her video analysis, making it easier to visualize mechanics and follow the physical therapist’s instructions.

The lessons include a combination of a musculoskeletal screen, multiple video analyses and varied drills and exercises that will address deficits found.

The running packages are in four-week increments and can be completed in large or small groups, as well as in one-on-one training. Performance in any sport that involves running will benefit from this program.

Other therapies used to treat injured runners are:

Dry Needling

Astym®

Graston Technique®

FMS

For more information on any of these treatments or to schedule an appointment with an Accelerated running specialist, please call 877-97-REHAB.

To download a free brochure with running injury prevention tips, click here.


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