Arm Care Part 2-Dynamic Stabilization

In the last blog we talked about some of the most important arm care exercises for strength.  This time we will add on and go over some nice options for building dynamic stability.

The shoulder is the most mobile joint in the body.  Often times when we see shoulder trouble it is not an issue of mobility but rather a lack of stability. If we think about the function of the "core" muscles of the shoulder (the rotator cuff) they are not designed to be prime movers of the shoulder but rather help hold (stabilize) the ball in the socket. In baseball during pitching these muscles help control the deceleration phase.  If stability is lacking it often leads to shoulder pain and can trickle down the chain where the forces impact the elbow and cause problems there.

In Physical Therapy we utilize a lot of manually resisted exercises to help improve dynamic shoulder stability where the therapist applies forces with their hands in different directions in certain positions or exercises.  However, there are some great exercises that can get those dynamic stabilizers firing and can be done at home or the gym.  Here are a few examples to get started with! (Shout out to my model Craig Valentine, owner of my home Loomis Kettlebell Gym and Del Oro baseball alum).

Kettlebell Arm Bar: This is a great exercise for getting the stabilizers going in the shoulder.  The offset weight of the bell cues those muscles to fire to keep the arm from moving.  The goal here is to really engage the lat muscles and "pack your shoulder" holding the arm strong.  Start light with this exercise as these muscles aren't the big movers.

Sidelying External Rotation Catches:  We talked in the last blog about sidelying external rotation with the weight being one of the very best exercises for strengthening the cuff.  Here we put a little spin on the same exercise making it more dynamic by doing a drop/catch with a small medicine ball (two pound weighted ball shown here).  You can start slow as you learn to control the movement and then increase your tempo from there.

90/90 Wall Dribbles: With overhead athletes we want to make sure we train these muscles in the functional positions of your sport.  So getting the arm up into an overhead range is important.  These are surprisingly fatiguing but train great stability!

 Wall Clock Dribbles: Again this is another exercise that allows you to move and work the stabilizers through a greater range of motion also making sure we engage those muscles overhead.

Prone Ball Drops: Here we get some more scapular stabilizers involved and change up the position by lying prone over a ball.  These are also very fatiguing so start with short bouts and work your way up from there.

Now we have both strength and stability arm care covered!  Hope everyone's spring seasons are getting off to a pain-free start.  And as always keep those arms strong and healthy!!! Follow us for more tips on Instagram and Facebook @gonextlevelpt

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%!

Is there a higher risk of lower extremity injury after a concussion?

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

I always have my eye out for the latest research in the world of concussions and some very interesting studies have been emerging lately. The question being asked is do athletes have an increased risk of sustaining a lower extremity injury following a concussion?

One study by Lynall et al in 2015 retrospectively looked at injury data in Division I collegiate athletes.  They found these athletes were almost twice as likely to experience lower extremity musculoskeletal injury after concussion when compared with controls.

Another more recent study in May 2017 found similar findings with collegiate athletes.  Herman et al reported that the odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussion athletes.

Yet another recent study by Lynall et all published in November 2017 looked at high school athletes. This study found that for every previous concussion, the odds of sustaining a subsequent time-loss lower extremity injury increased 34%.

So, what gives with all this increased injury risk?  It is suspected that lingering deficits in gait and dynamic balance may have something to do with it.  Lynall et al has proposed there may be reduced cortical excitability impairing the brain’s ability to effectively control and coordinate movement after concussion.  Further, this may have something to do with delayed reaction and movement time.  If we think about this in relation to the high physical and cognitive demands of athletics it is easy to see where the potential for injury may occur.

With this information how do we make a change to help lower the risk?  Currently many concussion protocols primarily utilize neurocognitive testing, static balance tests, and symptom reporting.  It is proposed that utilizing more functional balance assessments would be beneficial (especially using sport specific tasks such as cutting and jumping).  This sounds a lot like what I do at Next Level in my exertion assessments.  During an exertion evaluation the athlete completes multiple dynamic tasks testing the vestibular system at high levels and elevating the athlete’s heart rate.   We consider the specific nature of each sport and look to progress all aspects before return to play including cutting, changing direction, accelerating/decelerating, jumping, running, throwing, coordination, reaction time, and cognition.  The goal of future research will be to take a deeper look at functional movement after concussion and come up with a dynamic assessment that is easy to implement in our concussion protocols across all levels of athletics.

Exertion Physical Therapy-where we jump, cut, change direction, and get sport specific :)

My take home message from this research is that concussions are something that should be taken seriously for many reasons.  If you have a concussion it is important to get evaluated to make sure everything clears (including those dynamic balance and sport specific tasks) before returning to sport to avoid the risk of musculoskeletal injury.  Hopefully soon everyone in athletics will have more detailed assessment tools and we can see the incidence of these injuries go down.

References

Lynall RC, Mauntel TC, Padua DA, Mihalik JP. Acute lower extremity injury rates increase after concussion in college athletes. Med Sci Sports Exerc. 2015;47(12):2487-2492.

Herman DC, Jones D, Harrison A, et al. Concussion may increase the risk of subsequent lower extremity musculoskeletal injury in collegiate athletes. Sports Med. 2017;47(5):1003-1010.

Lynall RC, Mauntel TC, Pohlig RT, et al. Lower extremity musculoskeletal injury risk after concussion recovery in high school athletes. J Athl Train. 2017;52(11):1028-1034.