Notes - ITCCCA

Transcript Notes - ITCCCA

Injury Prevention

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

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 Copyright Dr. Nate Porcher

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 Copyright Dr. Nate Porcher

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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 injuries In 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 Copyright Dr. Nate Porcher

The “Intangibles”

 Anatomy  Fallen Arch, hip anteversion, integrity of connective tissue in the body, etc, etc.

 Body Chemistry/Nutritional Status Copyright Dr. Nate Porcher

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  Postural 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     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

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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 capsule  the glute medius attaches to the hip and pelvis  stable hip increases glute med firing/stabil ability  i.e intra-abdominal pressure stiffens the abdominal fascia, T/L fascia, and stabilizes the rib cage  creates 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 Copyright Dr. Nate Porcher

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 Copyright Dr. Nate Porcher

Another test

One more test

 Intra-Abdominal Pressure (IAP) Test Copyright Dr. Nate Porcher

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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!!

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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 Copyright Dr. Nate Porcher

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.

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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

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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 Copyright Dr. Nate Porcher

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Making it even better with Therabands®

Lunges, step-downs with Therabands®  Tri-Planar Squats (from the last few slides) Copyright Dr. Nate Porcher

Tri-Planar Plyos

 Jumping Lunges  Tri-Planar Box Jumps  Burn-outs Copyright Dr. Nate Porcher

SHIN SPLINTS

Dr. Nate Porcher DC ART DNS FMS



Why do all my athletes have shin splits?

Medial Tibial Stress Syndrome:   1 st things 1 st —Rule out Stress Fracture/Compartment Syndrome 2 nd —Understand the tissue pathology   3 rd —Determine the appropriate course of action 4 th —Implement the appropriate course of action Copyright Dr. Nate Porcher



RSI of soft tissues in general and shin splints in particular

 RSI—Repetative Strain Injury Copyright Dr. Nate Porcher

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 Copyright Dr. Nate Porcher

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!!) Copyright Dr. Nate Porcher

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” Copyright Dr. Nate Porcher

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 Copyright Dr. Nate Porcher



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!

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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

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 Copyright Dr. Nate Porcher