Posts Tagged ‘anatomy’

Shoulder Injuries, Part I

Tuesday, June 30th, 2009

Shoulder injuries are far too prevalent in many sports.  These injuries tend to fall into two groups.  The least common are those injuries caused by a sudden traumatic force, as seen with the football player being tackled and landing oddly, causing a dislocation or separation of the shoulder.

The more common injury type is the overuse injury that occurs in athletes who are involved in weightlifting, throwing, swimming, swinging clubs or racquets.  The majority of these injuries are preventable with a program of specific shoulder exercises and an understanding of the workings of the shoulder joint.

The shoulder is the most mobile joint in the body.  The shoulder joint looks like a golf ball sitting on a tee.  The humeral head (ball) sits in the glenoid (socket) which is shaped like a shallow dish.  A circular structure of soft tissue, the labrum, deepens the dish.  The stability of the shoulder joint is provided by the labrum and the tendons of the rotator cuff.  The rotator cuff is comprised of four small but very powerful muscles.  They wrap around the humeral head to keep it located in the glenoid.  The rotator cuff also internally and externally rotates the upper arm (humerus).  Above the rotator cuff tendons is a water-filled sac or bursa that reduces friction and cushions the rotator cuff tendons as they slide under the cowl of bone on top of the shoulder, the acromion.

The shoulder works in a balancing act, a force couple, between the deltoid and the rotator cuff. As you raise your arm the deltoid contracts to bring your arm up.  The rotator cuff muscles contract in synchrony to depress the humeral head ointo the glenoid. If your rotator cuff muscles are weak or your deltoid overpowers them, then the shoulder subluxes (partially dislocates) and rides up against the acromion.  This in turn pinches the tendons and bursa between the two.  This is called impingement.  Repeated often enough and the tendons and bursa become irritated and swell.  This leads to tendonitis, bursitis or even a small tear in the rotator cuff tendons.

Part II will discuss factors which predispose you to rotator cuff pathology, ways to reduce the likelihood of injury, and treatment options.

Tags: , , , , , , , , , , , , , , ,
Posted in Educational | No Comments »

Ankle Sprains, Part II

Monday, April 13th, 2009

Phase 2 – Rehabilitation phase
The rehabilitation phase begins when swelling stops increasing and pain lessens. This means the ligaments have reached the point in the healing process where they are not in danger of being re-injured from mild stress.

Improve mobility and flexibility
Seated foot tapping may be beneficial for an ankle that has reduced mobility. Initially plantar flexion (down) / dorsi flexion (up) and then progress to inversion (in) / eversion (out) as pain allows.
For the first 2 to 7 days after injury you can start to move the ankle straight up and down but do not turn it in or out. This will help increase mobility and start to strengthen it up. Do as much as pain will allow. Try 2 sets of 40 reps while the ankle is iced and elevated and increase as you can.
As swelling and pain lessen, you can start to invert and evert the ankle (move the soles of you feet inwards and upwards and outwards and upwards). This will start to put more stress on the damaged structures, so be careful not to do too much.
Stretching the Achilles tendon regularly is important. Have available a specific Achilles stretching board throughout the day (or lean into a desk or counter, keeping heels on the floor) to ensure a few minutes of stretching daily.

Strengthening the ankle joint
Again as the ankle improves you can start to do strengthening exercises where you pull the foot and toes up and hold for 10 sec’s and then push down and hold for 10 sec’s This can also be done for inversion and eversion as pain allows. Try 3 sets of 10 reps twice a day and build on that. Begin using your hand to resist these ankle movements.
Continue to apply cold therapy to the joint regularly – at least 3 times a day for 20 minutes.
If you see no further improvement with ice then start to apply heat in the form of a hot bath / bucket or via a specialist with ultrasound.
Strapping and taping may still be beneficial here.
You should be able to maintain fitness by swimming or cycling if pain allows.

Re-establish co-ordination and proprioception
Proprioception exercises are thought to be important in avoiding recurrent ankle sprains. Early weight bearing is thought to help reduce proprioception loss. Try balancing on one leg with your eyes closed. This will improve proprioception (the neuromuscular control you have over your muscles). This will have been damaged when you injured the ankle. Aim to be able to balance for 1 minute without wobbling.
Return to full fitness / functional training
In order to start the functional rehabilitation phase (activity and sports specific training), it is important the athlete has full range of motion and 80 to 90% of pre-injury strength. When you can comfortably do all of the above then you are ready to start phase 3 and begin your return to activity.
Cardiovascular exercises is important and should begin the first day after injury depending on what pain will allow. It is important that the athlete maintain some kind of CV exercise not just for the physical benefits but for psychological well being as well. Stationary cycling, running in water and swimming are all possibilities depending on severity of injury and what pain will allow.
Running may begin as soon as walking is pain free. It is a good idea to tape the ankle before starting running training particularly during early sessions until confidence, proprioception and strength has returned. A laced ankle brace can also provide support and is less expensive in the long run, particularly if laxity in the ligaments means a support needs to be worn permanently.
Running should begin on a clear flat surface such as a running track. Grass or bumpy surfaces will increase the risk of re-injury. Jog the straights and walk the curves.
Speed should be gradually increased over time to a sprint.
Sports specific drills using cones can be introduced. Changing direction, running in a figure of 8 pattern and zig zagging between cones.

In the final article, Ankle Sprains Part III, we will discuss ways to reduce the liklihood of ankle sprains.

Tags: , , , , , , , , , , , ,
Posted in Educational | No Comments »

Ankle Sprains, Part II

Monday, April 13th, 2009

Phase 2 – Rehabilitation phase
The rehabilitation phase begins when swelling stops increasing and pain lessens. This means the ligaments have reached the point in the healing process where they are not in danger of being re-injured from mild stress.

Improve mobility and flexibility
Seated foot tapping may be beneficial for an ankle that has reduced mobility. Initially plantar flexion (down) / dorsi flexion (up) and then progress to inversion (in) / eversion (out) as pain allows.
For the first 2 to 7 days after injury you can start to move the ankle straight up and down but do not turn it in or out. This will help increase mobility and start to strengthen it up. Do as much as pain will allow. Try 2 sets of 40 reps while the ankle is iced and elevated and increase as you can.
As swelling and pain lessen, you can start to invert and evert the ankle (move the soles of you feet inwards and upwards and outwards and upwards). This will start to put more stress on the damaged structures, so be careful not to do too much.
Stretching the Achilles tendon regularly is important. Have available a specific Achilles stretching board throughout the day (or lean into a desk or counter, keeping heels on the floor) to ensure a few minutes of stretching daily.

Strengthening the ankle joint
Again as the ankle improves you can start to do strengthening exercises where you pull the foot and toes up and hold for 10 sec’s and then push down and hold for 10 sec’s This can also be done for inversion and eversion as pain allows. Try 3 sets of 10 reps twice a day and build on that. Begin using your hand to resist these ankle movements.
Continue to apply cold therapy to the joint regularly – at least 3 times a day for 20 minutes.
If you see no further improvement with ice then start to apply heat in the form of a hot bath / bucket or via a specialist with ultrasound.
Strapping and taping may still be beneficial here.
You should be able to maintain fitness by swimming or cycling if pain allows.

Re-establish co-ordination and proprioception
Proprioception exercises are thought to be important in avoiding recurrent ankle sprains. Early weight bearing is thought to help reduce proprioception loss. Try balancing on one leg with your eyes closed. This will improve proprioception (the neuromuscular control you have over your muscles). This will have been damaged when you injured the ankle. Aim to be able to balance for 1 minute without wobbling.
Return to full fitness / functional training
In order to start the functional rehabilitation phase (activity and sports specific training), it is important the athlete has full range of motion and 80 to 90% of pre-injury strength. When you can comfortably do all of the above then you are ready to start phase 3 and begin your return to activity.
Cardiovascular exercises is important and should begin the first day after injury depending on what pain will allow. It is important that the athlete maintain some kind of CV exercise not just for the physical benefits but for psychological well being as well. Stationary cycling, running in water and swimming are all possibilities depending on severity of injury and what pain will allow.
Running may begin as soon as walking is pain free. It is a good idea to tape the ankle before starting running training particularly during early sessions until confidence, proprioception and strength has returned. A laced ankle brace can also provide support and is less expensive in the long run, particularly if laxity in the ligaments means a support needs to be worn permanently.
Running should begin on a clear flat surface such as a running track. Grass or bumpy surfaces will increase the risk of re-injury. Jog the straights and walk the curves.
Speed should be gradually increased over time to a sprint.
Sports specific drills using cones can be introduced. Changing direction, running in a figure of 8 pattern and zig zagging between cones.

In the final article, Ankle Sprains Part III, we will discuss ways to reduce the liklihood of ankle sprains.

Tags: , , , , , , , , , , , ,
Posted in Educational, Specials, Uncategorized | No Comments »

The Athletic Knee, Part I.

Wednesday, March 25th, 2009

You’re out playing a soccer game, a tennis match, or maybe even down hill skiing when all of a sudden you lose your balance and feel a “pop” in your knee. For a moment, the pain is excruciating, but then it becomes more tolerable. However, your knee starts to swell and it is painful to walk on. So, you are helped off the field, court, or get a sled ride down the mountain. Unfortunately, you have just joined the nearly 200,000 others who will tear their Anterior Cruciate Ligament (ACL) this year.

With a general increase in organized sports and year round training, games and tournaments, it is not surprising that the exposures and risks for ACL injuries has increased as well. If you are female athlete (especially those participating in soccer, basketball or gymnastics) your risk of injuring your ACL is 2 – 10 times greater than your male counterparts, and the numbers are growing! With the advent of Title IX legislation and the rise in opportunities for female athletic participation, a whole new number of athletes have become at risk of injury.

ANATOMY
The ACL is one of the four principle ligaments which help to stabilize the knee. The ACL is anterior or in front of the Posterior Cruciate Ligament (PCL) and crosses it from inside to outside. The other two major ligaments are the Medial Collateral Ligament (MCL) on the inside part of the knee, and the Lateral Collateral Ligament (LCL) on the outside part of the knee. The ACL functions to prevent the Tibia (shin bone) from being pulled off the Femur (thigh bone). The quadriceps (thigh) muscles in front help to extend the knee and the Hamstring muscles in back help to flex or bend the knee. The hamstrings are vital as they actively help to prevent the quads from pulling the tibia off the femur.

RISKS
The probability of tearing your ACL is increased if you are involved in a contact or collision sport that includes cutting, twisting and jumping. However, it is important to note that non-contact ACL injuries (where no one hits you) are responsible for 70% of these injuries, where direct contact accounts for only 30%. Again, female athletes have an increased incidence of non-contact ACL injuries than do male athletes (up to 10%).

GENDER DIFFERENCES
Some of the factors increasing the risk of injury to the female athlete include:

• Anatomical Structure: women tend to have wider pelvises than men and tend to be more “knock-kneed”, putting increased stresses across the knee joint.
• Muscular Activation: female athletes do not contract the hamstrings as quickly as male athletes and are unable to protect the ACL from shearing forces.
• Ligament Structure: the female ACL is smaller in diameter than the corresponding male ACL.
• Hormonal Differences: Some have even suggested a hormonal reason, however this remains relatively inconclusive.

Coming in The Athletic Knee, Part II, we will discuss the methods used to reduce the liklihood of non-contact ACL injuries to the knee….

Tags: , , , , , , , ,
Posted in Educational | No Comments »