Monday, January 21, 2019

Arm Care Part I- Strengthening

  As mentioned in my last post with the rapid approach of baseball and softball season I wanted to share some arm care tips.  Baseball arm care gets a lot of attention due to the nature of pitching and the common injuries that occur.  That isn't to say that other overhead athletes (like myself who plays volleyball and softball) couldn't absolutely benefit from these exercises too.  The shoulder is a ball and socket joint with a ton of mobility that allows us to perform motions like throwing.  The trade off for all the mobility is often a lack of stability.  This means it is critical to keep your shoulder strong especially as an overhead athlete.

Thanks to the work of many researchers out there who have shared their awesome findings (Mike Reinold, Kevin Wilk to name a few) we have EMG studies telling us the exercises that get the most activation for each muscle.  Mike Reinold discussed at the last SF Giants Sports Medicine Conference the importance of continuing to perform the exercises that we know work even if they aren't the flashy ones we're seeing on Instagram. That being said what should we include as part of our strengthening program for the rotator cuff and scapular muscles?  Here are a few of the basics that are key for a healthy arm.



Sidelying external rotation gets the most bang for your buck when strengthening the rotator cuff.  Use a towel roll under your arm for 20% more muscle activation. 
This is a definite "oldie but goodie" as external rotation can also be strengthened with a band.  Bands give a different kind of resistance compared to weights and it is important to slowly return to your starting position so you can reap the eccentric benefits. Keep the towel roll in the mix for this one too for extra muscle activation.

Prone Y's are great for strengthening scapular muscles particularly lower trapezius.  If you don't have a table a ball or a bench in the gym also works.  Make sure you start with a light weight, often the upper trap is tempted to compensate with this one.
Another great exercise for lower trapezius activation is the banded W.  This can be done sitting or standing.  I really like sitting on the ball because it helps to cue some extra postural engagement.
Finally a great exercise for serratus anterior is banded wall slides.  With this exercise pay careful attention that you keep your mid back slightly rounded (so that it is not flat).  This helps with upward rotation of the scapula and is a critical muscle for overhead athletes.
These are a few great basics to add to your arm care routine.  Aside from strength we also train overhead athletes to build dynamic stability.  Often that involves manually resisted exercises but next time I will go over some good options you can do on your own.  Keep those arms healthy everyone! 

And if you are having pain come see me!  Sports like baseball require full body movement assessment from the ground up.  Make sure you are moving well and pain-free so you can stay in the game and perform at 110%!

Tuesday, January 15, 2019

San Francisco Giants 4th Annual Sports Medicine Conference

Last weekend was spent learning the latest in baseball rehabilitation at the SF Giants Sports Medicine Conference.  It was a wonderful opportunity to reconnect with former colleagues from the Bay Area and the Giants sports medicine team!

Not a bad view at the conference
A wide variety of information was presented on some of the latest surgical and non-surgical treatment options and rehabilitation for the shoulder, elbow, hand, and knee.  We also had an update on the latest in concussion management from a baseball perspective.  As well some great discussions on injury prevention.  There was a common trend among multiple presenters emphasizing the need to address the entire kinetic chain in baseball pitchers and work from the ground up. The body is not designed to throw hard for the number of repetitions that pitchers undergo.  During the presentation by Stan Conte it was reiterated that if you don't use your legs and core (or you are lacking mobility down the chain) you end up throwing with your arm and that is where trouble often presents. A sound strength and conditioning and arm care program are key in staying healthy and throwing hard. 
Hearing perspectives on dealing with injuries and working with the medical team from Dusty Baker and Duane Kuiper
We learned some great techniques for restoring mobility after throwing as well as updates on dynamic stabilization training and best exercise practices. It was further discussed by Mike Reinold during his presentations that research continues to show that the best exercises are ones that have been our staples and are not necessarily the flashy ones you may see on Instagram.  Sticking to these basics as a part of your arm care program and (ideally) having a professional who helps you restore mobility and provides manual resistance training are how the pros are taken care of.
Mike Reinold demonstrating some dynamic stabilization training progressions
We also had a great opportunity to hear a players perspective of coming back from injury.  Joe Panik discussed how the medical team coordinated to get him back to play after his thumb injury. 
Player guest speaker Joe Panik

It is always an inspiring experience to hear research, clinical pearls, and current practices from the professional level.  From the medical doctors, to the athletic trainers and physical therapists, and strength coaches everyone shared some excellent information that can be directly relayed into practice.  Spring is rapidly approaching and if you are looking for a Physical Therapist to take care of any pain that may present or to maintain mobility and arm care programming check us out!

More posts to come on some more detailed baseball tips as we head for spring training and into season!  Follow us on Facebook and Instagram @gonextlevelpt


Tuesday, January 8, 2019

Aerobic Exercise Speeds Concussion Recovery


The recommendations for activity following concussion have been changing with the current guidelines being a shorter period (24-48 hours) of rest following injury.  We are now finding that this shorter period of rest and early subthreshold aerobic activity are beneficial in speeding recovery after concussion.



A recent study by Leddy et al looked at adolescent males who came to a concussion clinic less than 10 days from injury.  They were grouped into an exercise and rest group.  The exercise group completed the Buffalo Concussion Treadmill Test (used to determine an appropriate submaximal heart rate) and performed 20 minutes of exercise daily on the bike or treadmill.  This was compared to the group that was advised to completely rest from physical activity.  The exercise group recovered in mean of 8.29 days from initial visit and 13.04 days from day of injury.  The rest group recovered in 23.93 days from initial visit and 28.43 days from day of injury.  These findings indicate recovery time from initial visit was significantly faster for the exercise group.  Also, none of the exercise group participants had delayed recovery (>30 days of symptoms) while four participants in the rest group had delayed recovery. From day 4 forward the exercise group had a significantly lower total symptom score compared with the rest group. 

This study is an excellent start in support of early subthreshold aerobic exercise following concussion injury.  The study also had some interesting discussion about the benefits of aerobic exercise including:
·         Enhances neuroplasticity acutely to promote neuron growth and repair
·         Reduces heart rate at rest and reduces submaximal exercise heart rate by reducing sympathetic activity
·        By improving Autonomic Nervous System balance aerobic exercise may also improve sleep (a big deal in many patients after a concussion injury)

The recommendations continue to move towards a more active approach to concussion management.  A Physical Therapist can assess you and help determine the appropriate prescription for aerobic exercise since too much can exacerbate symptoms and delay recovery. We say this for so many other types of injuries in Physical Therapy and now we can also apply it to concussions…Exercise is Medicine!!!


Leddy JJ, Haider MN, Hinds AL, Darling S, Willer BS. A Preliminary study of the effect of early aerobic exercise treatment for sport-related concussion in males. Clin J Spsort Med. 2018;1-8.

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