Injury Prevention Getting it right before the season starts Nate Porcher DC ART DNS FMS Copyright...

Copyright Dr. Nate Porcher

Injury PreventionGetting it right before the season

startsNate Porcher DC ART DNS FMS


Quickly About Me Prospect HS Alum

Taylor University in Indiana – Track and FB Letterman

Trinity International University in Deerfield – FB and Baseball Letterman

National University of Health Sciences –Doctor of Chiropractic

Hundreds of hours of postgraduate training in Functional Evaluation, Rehabilitation, Soft Tissue Correction, Strength and Conditioning

Spent some time working in the training room with athletes at Benedictine University in Lisle

Sports Medicine-Focused practice in downtown Arlington Heights—Foundation Sport & Spine


Topics Covered Common Injuries—why they occur

Prevention of Injuries

The Role of the Diaphragm in Core Stability

Tri-planar Training for Sagittal Plane Athletes

SHIN SPLINTS!!!!

The Benefits of having a sports healthcare practitioner as part of your team—PRESEASON SCREENING, management of injuries that have occurred


How often do injuries occur?

The most common running injuries Shin splints/stress fractures

Hamstring or other muscle pulls/tears

Plantar fasciitis/Heel pain

Patellar Tendonitis/knee pain

IT Band Syndrome

Low back stiffness/pain

What other injuries plague your program?


What are your current methods of Injury Prevention?

How have these reduced soft-tissue injuries?

Once injuries occur, how are you managing them?


Main cause of most of these

injuriesIn General: OVERUSE (of a bad motor strategy)

In Particular:

IT Band Syndrome—weak core/glutes

Shin Splits—more complex (will cover in depth later)

Patellar tendonitis—weak glutes, poor core/pelvic stability, weak tibialis anterior, and dominant quads/hip flexors

Plantar Fasciitis—weak foot intrinsics, weak tibialis anterior, poor hip extension

Low Back Pain—weak core/glutes/improper motor patterns


The “Intangibles” Anatomy Fallen Arch, hip anteversion,

integrity of connective tissue in the body, etc, etc.

Body Chemistry/Nutritional Status


Re-Envisioning the CORE


The Role of The Diaphragm

Is it just for breathing?

Let’s take a closer look at the design of the diaphragm

In my clinic—diaphragm function tested on day one, and diaphragm rehab starts day one.


One muscle, two amazing functions

Breathing function Diaphragm

contracts/ drops

Decreased pressure in thoracic cavity

Air rushes in

O2/CO2 exchange happens

Diaphragm relaxes

Elasticity of ribs and lung tissue forces air out

Postural function Diaphragm

contracts/drops

Pelvic Floor contracts, stiffens

Abdominal muscles reflexively contract (TrA, Obliques, QL, rectus abdominus

Intra-abdominal pressure increases greatly

Punctum fixum is created


Creating the Punctum Fixum

What’s the big deal? Why the diaphragm?

Punctum Fixum – FIXED POINT i.e. intra-abdominal pressure stabilizes the

anterior hip capsulethe glute medius attaches to the hip and pelvisstable hip increases glute med firing/stabil-ability

i.e intra-abdominal pressure stiffens the abdominal fascia, T/L fascia, and stabilizes the rib cagecreates a solid basis for the obliques to pull up and over

Need an example?


The role of the ribcage position over the pelvis

Intra-abdominal pressure is compromised by poor posture

This will cause buckling of the lumbar spine and poor core stability, poor base for oblique systems

How do you know it’s not working

Observations:

GOOD

NOT AS GOOD


How do you know it’s not working?

Here are a couple of tests:

Diaphragm Test with Breathing IN


Another test


One more test Intra-Abdominal Pressure (IAP) Test


How to destabilize the core:

Situps, Crunches, V-ups, supine toe-touches THROW THEM OUT!!

“The spine only has so many bends before a disc will herniate.” Stu McGill –University of Waterloo

3,350 Newtons of compressive force in the disc with them

PLUS, They’re NOT FUNCTIONAL!!


Some basic exercises for stabilizing the core

Use (some of the tests) as the exercises Have athletes gain awareness/ability to use

the diaphragm first as a muscle of respiration

Have them start to gain awareness/ability of the postural/stabilization function

Side bridge/plank progression

4-way bench planks

Supine IAP test in Triple Flexion (knees, hips, and ankles at 90 degrees

Can add physioball as an advancement

More Exercises Bird Dogs– must maintain proper stabilization

strategy of core and KEEP BREATHING.

Complex exercises

Variations of Side Planks (remembering to have intra-

abdominal pressure)


Once the Core is Solid

Implementing the role of the oblique muscle slings Dynamic movements using the slings to move

Chops, Lawnmowers (for power)

i.e. throws, running, etc.

Dynamic movements using the slings to stabilize

i.e. throws, running, etc.

Continuing Onto Global Exercises

This idea of increasing abdominal pressure NEVER GOES AWAY with any exercise! Guess why these guys wear belts when lifting?


Triplanar Training for the (primarily) Sagittal

Plane Athlete

What exactly does that mean?

Review of Planes of Movement Sagittal

Coronal/Frontal

Transverse

Examples of Poor Stabilization

Another Example

Another Example!

Combined Frontal/Transverse Plane Instability

Contrasting Those Examples With Olympic Athletes

Two Bads and One Good


Making Basic Lifts Tri-planar

Sometimes with movement, sometimes with stability

Use Dumbells or (better yet), Kettelbells Squats

Goblet, 90, Overhead

Lunge. 90, overhead

Single-Leg RDL


Making it even better with Therabands®

Lunges, step-downs with Therabands®

Tri-Planar Squats (from the last few slides)


Tri-Planar Plyos Jumping Lunges

Tri-Planar Box Jumps

Burn-outs

SHIN SPLINTSDr. Nate Porcher DC ART DNS FMS


Why do all my athletes have shin splits?

Medial Tibial Stress Syndrome: 1st things 1st—Rule out Stress

Fracture/Compartment Syndrome

2nd—Understand the tissue pathology

3rd—Determine the appropriate course of action

4th—Implement the appropriate course of action


RSI of soft tissues in general and shin splints in

particular RSI—Repetative Strain Injury


What’s the latest Research Say?

Bennet et. al. The relationship between isotonic plantarflexor endurance, navicular drop, and exercise-related leg pain in a cohort of college cross-country runners. International J Sports Phys Ther. 2012 Jun; 7(3): 267-78.

Greater Navicular drop tend to have greater chance of leg pain

History of shin splints in last month 12X more likely to re-develop

In other words...

Yuksel et. al. Inversion/Eversion Strength Dysbalance in Patients with Medial Tibial Stress Synrome. J Sports Sci Med. 2011 Dec; 10(4): 737-42.

Prolonged pronation will lead to longer lasting traction stress on the soleus fascia, which in turn can facilitate the development of MTSS (all due to stronger evertor muscles)

Also, likely due to less eccentric power/strength/endurance of the medial soleus

Rathleff et. al. Dynamic midfoot kinematics in subjects with medial tibial stress syndrome. J Am Podiatr Med Assoc. 2012 May-Jun; 102(3): 205-212.

More navicular drop, faster navicular drop


My thoughts... If they need orthotics—send them, this will help with navicular drop

velocity and depth. Still—orthotics are not the final solution, but one piece in the puzzle!

Should be combined with “short foot” training, coronal plane glute med training

=less contralateral hip drop, less internal rotation lower leg, less pronation of the midfoot.

Isokinetic strength does not equal plyometric power.

Eccentric strength of the lower shank external rotators (i.e. GLUTE MED/MIN) is a driving force behind decreasing overpronation in the foot.

Exercises that get the soleus to adapt rapidly from an eccentric muscle to a concentric one should be implemented (plyos, blind box drops, tri-planar burnouts

Correct tissue pathology, because ice, rest does not heal fibrotic, tight, painful scar tissue. Send them for this too!


How to I break the cycle? Break up the adhesions:

Best two ways: ART® (Active Release Techniques®), and FAKTR® (Functional and Kinetic Treatment w/ Rehabilitation®)

Correct joint restrictions to proper biomechanics Subtalar eversion restoration

SI joint mobilization (if it’s no moving, the glute med won’t fire properly!!)


How do I break the cycle?

Dampen the inflammatory cascade: With proper nutrition (Diet high in Omega-3 FA, avoidance

of high Omega-6 foods)

Re-Train: The short foot muscles (dampen forces through the ML

arch and T Arch)

The G Meds/Mins to dampen internal rotation forces experienced from ground reaction forces.

Plyo/reaction strength/power of Gasroc/Soleus mm.

Any other multiplanar instabilities with tri-planar training.

Use Corrective Taping, when warranted KinesioTex Tape—change muscle firing, help drain.


Pre-Season Functional Movement Screening

Gray Cook—The guy behind the FMS™ screens “What often happens is people are putting

exercise and performance on top of dysfunctional movement, which can impair performance and cause injuries”


Who should get screened? All athletes who are pain-free, and wanting to

perform at a high level. (Sound familiar?) WHY?

The screens identify imbalances side to side

The screens identify the weak link in the chain

The screens point to corrective exercise strategies to help optimize later training and prevent injury

(The athlete who experiences pain with the screen should be referred to a healthcare provider)

The screen should always be used as a follow-up tool to monitor progress


How to implement the screen

Pre-season screening by certified FMS practitioner

Develop categories for athletes with different types of dysfunction to fit into

Develop programs for those athletes--add it into their resistance program

Be judicious about what full-body lifts to use with athletes who have poor dynamic function, ease them into them once base function is corrected/core is strengthened

When an athlete has pain—send them for professional eval RIGHT AWAY Don’t let the injury progress to a season-ending situation!


Thank you!


Image Resources Title page:http://www.erinchapmanfitness.com/wp-content/uploads/2013/05/shin-splints-ice-1.jpg

http://www.runaddicts.net/wp-content/uploads/2010/06/injuries-664x300.png

Diaphragm diagram: http://balancedbodymind.com/wp-content/uploads/2013/10/ijspt-08-062-f002.jpg

Diaphragm diagram 2: http://www.muscleimbalancesyndromes.com/wp-content/uploads/2012/04/Kolar-inspiratory.jpg

Turtle Shell 6 pack:http://www.ign.com/boards/threads/attn-people-that-give-fitness-advice-to-others-on-the-boards.452450163/

Exercises: http://www.gymra.com/blog/strength-training-for-running/#!prettyPhoto

Westside Barbell: http://www.criticalbench.com/westside-barbell.htm

Running: http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=Eck7FY0cvHEasM&tbnid=gT32iH-T1v3f2M:&ved=0CAEQjxw&url=http%3A%2F%2Fwww.iachiropractic.com%2Fblog%2F10-things-i-learned-2012%2F&ei=Vo3NUvoRho3aBYitgJgK&psig=AFQjCNEaDgmd43LiMONBGmbeOiEbF3Sn7A&ust=1389289159110539

Diaphragm tests: All copyright Prague School

http://runnersconnect.net/wp-content/uploads/2013/05/RC8_GluteMedius_Role-300x195.jpg

Shin splits:http://www.drxuacupuncture.com/wp-content/uploads/2011/07/Fig-7.23.jpg



http://balancedbodymind.com/wp-content/uploads/2013/10/ijspt-08-062-f002.jpg



http://www.muscleimbalancesyndromes.com/wp-content/uploads/2012/04/Kolar-inspiratory.jpg

http://www.muscleimbalancesyndromes.com/wp-content/uploads/2012/04/Kolar-inspiratory.jpg

http://www.gymra.com/blog/strength-training-for-running/#!prettyPhoto

http://www.gymra.com/blog/strength-training-for-running/#!prettyPhoto


How to reach me: Nate Porcher DC ART DNS FMS

Email: [email protected]

Office: (847) 342-3000

Web: www.foundationsportspine.com

Location:

115 N. Arlington Heights Road

Suite 104

Arlington Heights, IL 60004

mailto:[email protected]

http://www.foundationsportspine.com/

Date post:	16-Dec-2015
Category:	Documents
Upload:	yadiel-glen
View:	216 times
Download:	0 times

Injury Prevention Getting it right before the season starts Nate Porcher DC ART DNS FMS Copyright...

Documents