Archive for injury prevention tennis

Single Leg Hip Stability Using Bands

Posted in Z.S. Tennis with tags , , , , , , , on May 5, 2011 by zenithstrength

Today’s post continues along the line of knee health and hip stability as we look to get more  creative in challenging  hip stability to help alleviate knee issues. There are times when the athlete may not be able to perform a single leg reach with their body weight without their knee going everywhere and may need assistance to create a bit of stability, so we need to create an exercise regression.

We started using the Jungle Gym to create a regression and perform a single leg reverse lunge while holding on to the handles. By holding the handles you create a bit more stability and also deload the knee-joint while  getting some good glute medius activation and hip extension as well.

They are also great for athletes who may be dealing with some knee issues and are working on increasing  knee and hip flexion range of motion.

One of the keys is to make sure the tibia stays vertical to keep this a hip dominant lift and take stress of the patella, something that both Mike Robertson and Charlie Weingroff have talked about extensively.

As you progress you can add band tension to increase the eccentric load on the hips and quads  and work on improving hip extension power as the video shows below:

In addition you can perform single leg jumps from this position as the athlete progresses.

Give it a try and let me know what you think.

Stay healthy,

Shyam

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Top 3 Exercises to Improve Shoulder Internal Range of Motion

Posted in Z.S. Tennis, Z.S. Training with tags , , , , , , , , , , , on March 7, 2011 by zenithstrength

Lack of internal range of motion or more commonly know in our industry as the “GIRD” is prevalent in sports that involve an overhead motion. Pitchers, tennis players, quarterbacks, swimmers are all susceptible to this.

Basically the rotator cuff and posterior musculature is under high amount of force during  the deceleration phase of throwing or serving.

The result is usually decreased range of internal motion after a hard session of throwing or serving.

Now there are many factors that can lead up to shoulder internal range of motion deficits but the most important factors to consider are Total motion of the Glenhumeral joint on both sides. Total motion= ER+IR.

In order to determine whether a  client  has a deficit in shoulder internal range of motion you would need to compare the measurements of both shoulders. Here’s where it gets fun. According to Myers et.al there is a range of GIRD and 19.7 degrees is the threshold you don’t want to cross. Ideally you want to be in the 12-17 degree range.

As far as total motion is concerned if there it should be similar on both sides and if there is a loss of total motion on the throwing side you are increasing the likelihood of injuring your shoulder.

Now here’s the real scary thing regarding treatment. I have had a few of my clients come in with shoulder issues who have seen a PT prior and  there are PT”s out there who do not distinguish between internal and external range of motion and in my opinion do a terrible job in rehabbing the injury based on a poor diagnosis. Just doing rotator cuff exercises and using electric stim will not get the job done. Make sure your therapist  uses soft tissue modalities in addition to manual stretching. If he/she doesn’t  the bottom line is that you need to go to a qualified PT or Sports Chiro who knows what the heck they are  doing to get you better.

Enough of the ranting.

Here are my 3 favorite exercises to improve shoulder internal range of motion.

1. The cross body stretch.

I learned this from Mike Reinold from the Optimal Shoulder Performance dvd and has become my favorite internal stretch to use

Its a gentle stretch that increases internal range of motion after only 4-5 passes.

2.The sleeper stretch. For those who don’t have the luxury to have therapist or strength coach perform the cross body stretch this is the self help alternative. Some people like this stretch while others avoid it. The key is to make sure that you stabilize the shoulder-blade and be careful not to torque the shoulder. You should use 5% pressure when pulling down into the stretch. Make sure you don’t feel any pain in the anterior shoulder capsule. Below is a picture of Eric Cressey performing the sleeper stretch.

You can do the cross body version as well but again, make sure that you don’t torque your shoulder into internal rotation.

We like to use the Rotater for the sleeper stretch as it helps to keep the humerus relaxed and it works well for our third stretch.

3. The sleeper stretch may not work for everyone and some people may feel a pinch in the anterior capsule  so we have this version with the arm behind the back. Again be careful you don’t torque your shoulder. I like to use the Rotater for this stretch as well.

You can also use  bands to get a distraction of the humerus and turn your  head to add a trap stretch as well. Often if someone has internally rotated shoulders the upper traps will be  tight and over active.

Here’s the  video of the internal stretch with bands.

Try these stretches out to help improve you shoulder internal range of motion and you will be on your way to  preventing shoulders issues in the future.

Stay Healthy.

Shyam

Are Our Youth Athletes Soft

Posted in Guest posts, Z.S. Basketball Training, Z.S. Tennis with tags , , , , , , , on February 23, 2011 by zenithstrength

Here’s a guest post from Dr. Craig Liebenson one of the premier Sport Chiros and injury experts in the world.

His article talks about playing in pain and the consequences of playing a sport year round and the evidence showing that playing year round is not in the best interests of an athlete who wants to reduce the likelihood of injuries. He also discusses certain risk factors that can predispose an athlete to overuse injuries and what to look for during the initial assessment.

Enjoy.

Many a High School coach expects youth athletes to play through pain. Is this survival of the fittest? Or a recipe for disaster? Could Stephen Strassberg’s arm injury have been prevented? Let’s take a look at some facts. A successful athlete will learn how to tell the difference between hurt & sore. If they don’t they won’t make it. Today we are seeing an epidemic in overuse injuries in the youth. Girls with non-contact ACL injuries in basketball, soccer, etc. Boys having Tommy John surgery for elbow problems. Growth plate injuries or stress fractures from running, basketball, tennis & baseball.

Are year round programs, early specialization, and single sport athletes desirable? 3 reasons not to play a sport year round. Certain sports such as gymnastics & figure skating have always been early specialization sports. While most good football, baseball or basketball players traditionally played 2 or 3 sports – until now! Coaches pressure kids into choosing. Is this working?

The American Sports Medical Institute USA Baseball Medical & Safety Advisory Committee Guidelines state,  ”Baseball pitchers should compete in baseball no more than nine months in any given year, as periodization is needed to give the pitcher’s body time to rest and recover.  For at least three months a year, a baseball pitcher should not play any baseball, participate in throwing drills, or participate in other stressful overhead activities (javelin throwing, football quarterback, softball, competitive swimming, etc.).”

In high school 9th graders are lifting weights with 12th graders. This even though many 9th graders may not even biologically have achieved development commensurate with their chronological age! So in fact, the 4 year chronological gap may be even greater in biological age.

Lets look at the knee as an example of the problem of overuse injuries. Patello-femoral pain syndrome (PFPS), also know as runner’s knee, is the most common type of knee pain. Pain is felt around and under the knee cap. Almost anyone can get it, but if mostly affects the highly active person due to overuse or the sedentary person due to underuse. It is very common in teens. A few of the most common clinical presentations seen in practice include patello-femoral tracking disorders, iliotibial band syndrome (ITBS), post-operative functional limitations after anterior cruciate ligament rupture, partially torn medial meniscus, knee osteoarthritis, and post-operative functional limitations after knee arthroplasty.

While knee pain is common, it’s tricky to find good information about it. An excellent source is Mike Reinold, ATC, PT’s website. He is the Head Athletic Trainer and Assistant Director of Medical Services of the Boston Red Sox Baseball Club The Problem Getting good care for knee pain is a challenge. The conventional wisdom about PFPS is often based on outdated thinking. As an example when the revolutionary text Myofascial Pain and Dysfunction: The Trigger Point Manual was reviewed in the New England Journal of Medicine the reviewer stated, “while pain is the most common reason people seek health care modern medical education for pain is sorely lacking.” The book’s lead author, Janet Travell, M.D. was White House Physician for John F Kennedy.

Chronic musculoskeletal problems and overuse syndromes are particularly baffling to modern medical management. In the esteemed Journal of Bone and Joint Surgery in 2002 Freedman et al wrote that “It is … reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” And, in  2005 Matzkin et al wrote that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.”

Where are we at?

A consensus is beginning to emerge from cutting edge think-tanks. Ronald Bahr MD, PhD from the Oslo Sports Trauma Research Center said, “Overuse injuries may represent as much of a problem as acute injuries in many sports.”

A new Norwegian study (Soligard T, et al) (Warm-Up article)  published in the prestigious British Medical Journal (2008) shows that a 20 minutes warm-up program developed by the Oslo Sports Trauma Research Center in collaboration with FIFA significantly reduces injury risk in female youth football players. John Brooks, a sports injury expert put the study’s results in perspective:  “The wider sporting population at all levels should adopt this warm-up programme to reduce injury in all sports”.

For all overuse syndromes a sports medicine-orthopedic specialist should be seen who will perform an orthopedic and functional examination to rule out serious conditions, discover “weak links”, and help you identify specific goals of treatment. Once your pain is under control, and your health care provider has ruled out serious conditions, you can begin your rehabilitation process. If your pain persists or worsens be sure to consult with your doctor.

Assessment

There are two distinct aspects to assessment. Orthopedic & functional. Orthopedic assessment is focused on the mechanism of injury (more important for acute problems) and the diagnosis of the pain generator (i.e. sprained ligament, fracture, tendinitis, etc.). The orthopedic assessment includes orthopedic tests and often imaging. While the functional assessment is more geared to identify the source of biomechanical overload in the kinetic chain. The source(s) of overload are the predisposing and precipitating factors which lead to activation of a pain generator. The functional-biomechanical assessment is more appropriate for chronic or recurrent problems. A common finding in the functional assessment is a breakdown in the kinetic chain arising from dysfunction in the subtalar region such as hyperpronation. Poor ankle mobility at the tib-fib joint or limited ankle dorsiflexion mobility can also lead to compensatory sub-talar hyperpronation and subsequent problems up the chain. Other foot/ankle issues to assess include inhibition of the fore foot muscles of the transverse arch (toe flexors) or poor balance.

When evaluating hip-pelvis dysfunction gluteus medius insufficiency is one of the first dysfunctions to assess. Poor hip abduction strength/coordination is another consideration. Mobility of hip extension (psoas),  abduction (adductor muscles), internal/external rotation should all be screened.

Checking for quad dominance and determining if the posterior chain (glute-ham) complex is controlling sagittal plane motion during squats/lunges is critical.

Another factor in any knee complaint is overall posture and abdominal-core function. Without appropriate core control such as during a stability ball walk out,  ham curl with the ball, or Russian ham curls the knee could become the symptomatic link in the kinetic chain.

Treatment Approaches

Modern care for knee pain consists of 4 components. First-Aid, Sparing , stabilizing, and  functional integrated training (FIT).

1. First-Aid If your pain is flaring up or acute, ice or anti-inflammatory medication may help. Use the R.I.C.E. formula:

  • Rest: Avoid putting weight on the painful knee.
  • Ice: Apply cold packs for 10-20 minutes, several times a day.
  • Compression: Use an elastic bandage such as a simple knee sleeve that fits snugly without causing pain.
  • Elevation: Keep the knee raised up higher than your heart.

2. Sparing strategies

It has been said the knee has “no place to hide”. Functionally it’s fate is often sealed by the foot or hip to which it is linked in the kinetic chain (see figure ) (Griffin 2000). There are various sources of biomechanical overload for the knee. One of the most common is inward collapse of the knee secondary to either foot hyperpronation or weakness of the outside of the hip. A key factor in the lower quarter kinetic chain dysfunction is gluteus medius weakness. It is essential to make a patient aware of the dangers of valgus overload of the knee. Basic flexiblility (i.e. psoas/piriformis/adductors) exercises should be taught.

Video of Inner Knee Collapse During Landing a Jump

Dynamic Warm-Up – The 11+ from FIFA

Dynamic Warm-Up from JBMT

3. Stabilizing strategies

Terminal knee extension exercises (heel raise, pillow push) have been recommended to train the vastus medialis oblique. Heel slides have been recommended to train hamstring/quadriceps co-activation . Gluteus medius training (the clam shell),  glut max exercise (bridge, hip thrust, etc), and hamstring training are essential from an isolated stability perspective.

4. Functional Integrated Training (FIT)

Neuromuscular functional training has been shown to improve both performance and lower-extremity biomechanics The four main components of this training are plyometric and movement, core strengthening and balance, resistance training, and speed training.  The lateral band walk and the supported functional reach are 2 excellent examples.

Dead lifts, split squats, reverse lunges, and box squats are all excellent examples of  functional exercises which can be utilized to train mobility and stability. These are performance enhancement challenges which nearly all patients with knee problems should be progressed to.

Selected Bibliography:

Bobbert MF, van Zandwijk JP 1999. Dynamics of force and muscle stimulation in human vertical jumping. Med Sci Sports Exerc 31:303:310.

Ganley KJ, Powers CM 2005. Gait kinematics and kinetics of 7-year-old children: a comparison to adults using age-specific anthropometric data. Gait Posture. 21(2):141-5.

Hewett TE, Paterno MV, Myer GD 2002. Strategies for enhancing proprioception and neuromuscular control of the knee. Clin Orthop Relat Res 402:76-94.

Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P 2005. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 33(4):492-501.

Hewett TE, Myer GD, Ford KR 2005a. Reducing knee and anterior cruciate ligament injuries among female athletes: a systematic review of neuromuscular training interventions. J Knee Surg 18(1):82-8.

Liebenson CS 2006. Functional problems associated with the knee-Part one: Sources of biomechanical overload..  Journal of Bodywork and Movement Therapies, 10;306-311.

Liebenson CS 2007. Functional problems associated with the knee-Part two: Rehabilitation fundamentals for common knee conditionsJournal of Bodywork and Movement Therapies, 11;54-60.

Liebenson CS 2002a. Advice for the clinician and patient: Functional training part one: new advances.  Journal of Bodywork and Movement Therapies, 6;4:248-253.

Liebenson CS 2003. Advice for the clinician and patient: Functional training part two: integrating functional training into clinical practice.  Journal of Bodywork and Movement Therapies, 7;1:20-24.

Liebenson CS 2003a. Advice for the clinician and patient: Functional training part three: transverse plane facilitation.  Journal of Bodywork and Movement Therapies, 7;2:97-103.

Liebenson Functional training for performance enhancement. Journal of Bodywork and Movement Therapies,

Mascal CL, Landel R, Powers C 2003. Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports. J Ortho Sp Phys Ther  33:647-660.

Myer GD, Ford KR, Palumbo JP, Hewett TE 2005. Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. J Strength Cond Res 19(1):51-60.

Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Ortho Sp Phys Thera 2010;40:42-51.

Top 3 Shoulder Exercises to improve External Range of Motion

Posted in Uncategorized, Z.S. Tennis, Z.S. Training with tags , , , , , , , , on December 28, 2010 by zenithstrength

Working with a lot tennis players and overhead throwing athletes  means that we are usually dealing with shoulder issues and reducing the risk of rotator cuff injuries.

There is a lot of  “stuff” to look for when dealing with overhead athletes and shoulder issues. Generally, you want to take a look at T spine rotation range of movement, internal and external rom and scapula stability issues like winging.

For more information on  training athletes and clients with shoulder issues check out Optimal Shoulder Performance, by Eric Cressey and Mike Reinold. There is  a ton of info regarding training the injured shoulder and specific shoulder pathologies such as internal vs external impingement and manual techniques to improve dynamic stability of the  rotator cuff.

Alright now to get into the importance of  external range of motion.  Basically the service motion, specifically the cocking phase requires the athlete to externally rotate the shoulder through an extreme range of motion. This is also similar to throwing a baseball.

Take a look at the images  of the service and throwing motion.

Without the flexibility to externally rotate the shoulder the athlete is predisposed to myriad of potential injuries.

Below is a list of our 3 favorite exercises to improve external range of motion.

1. Wall Slides. These are great for lower trap activation and since you are improving external range of motion you will also lengthen the pecs if they are tight.

2. Side Lying extension with rotation

This exercises helps to stretch out the pec minor while also improving thoracic extension with rotation.

The pec minor internally rotates the shoulder so stretching it out helps improve your external range of motion.

Check out the video on how to perform the exercise.

3. No Money Drill with bands.

In addition to performing these drills, make sure to stretch out your pecs and lats as they work to internally rotate the shoulder. When these muscles are tight they reduce the external range of motion of the shoulder and also affect the ability of rotator cuff to stabilize the humerus. When you stretch out the internal rotators you end up gaining motion into external rotation and this works similarly with  the hips and  how tight hip flexors limit hip extension from the glutes. By strengthening the hip extensors you end up improving flexibility in the hip flexors.

Here’s a great lat stretch that we use with a jump stretch band.

Stay healthy and train hard.

Shyam

Hip Mobility Check List

Posted in Z.S. Basketball Training, Z.S. Tennis, Z.S. Training with tags , , , , , on November 29, 2010 by zenithstrength

At Zenith Strength, one of the first things we teach our clients and athletes is the importance of hip mobility. You need mobility in order to move well and if you are an athlete who plans on minimizing knee, back and shoulder injuries you need to make sure you are addressing you hip mobility on a daily basis.

My friend and colleague Daniel, introduced me to a site dedicated to mobility. Check it out here.

Below is a compilation of some of the top mobility exercises for the lower body, focusing primarily on hip mobility put together by Kelley Starrett, a DPT who really knows his stuff.

Check it out.

 

Train hard and stay healthy.

Shyam

Speed Training for Young Athletes

Posted in Guest posts, Z.S. Training with tags , , , , , , , , , on October 13, 2010 by zenithstrength

Today’s post is a guest post from Eric Cressey of Cressey performance located in Boston. His take on speed and quickness training for young athletes was dead on and I had to share it.

Check it out here.

Cressey brings up some great points in his post about preparing athletes i.e. improving mobility, stability and strength before performing tons of agility and deceleration drills. Due to the high amount of forces on the joints during sprinting which can be up to 4 -6 times body weight, the body must have adequate strength to be able to decelerate and absorb the forces without injury to the knee-joint.

Check out his video as he discusses the absolute speed to absolute strength continuum and explains that you must build a solid strength foundation and build upon that to create a faster/quicker athlete.

Building stronger, faster, quicker athletes takes time and involves a progression of building stability and strength. Some kids may be more ready than others to begin different movement drills, but adding these drills to a young athlete who isn’t prepared for it is an injury waiting to happen.

In Strength,

Shyam

 

Tuesday Training at the Facility

Posted in Xtreme Tennis Conditioning, Z.S. Tennis, Z.S. Training with tags , , , , , , , , , , on October 3, 2010 by zenithstrength

Here’s a glimpse of the workout from Tuesday the 28th of September working with the tennis players from Eagle Fustar full-time program.

We have top players training including, Eric Johnson who is ranked in the top 30 Nationally in the boys 18’s, Jelena Pandzic just got to the finals of a WTA pro event several weeks ago.

In the video we are working single leg  and hip stability with the RDL’s. We have started to incorporate the slideboard for lateral mobility and strength. In this case, we use the band around the knees to force the  hip to stabilize the front leg while sliding into a lateral lunge and also strengthening the abductors and adductors of the sliding leg.

We also have the athletes work on shoulder stability with the push up plus strengthening the serratus anterior to stabilize the shoulder blades.

We finish off with heavy prowler pushes to work on improving acceleration strength and teaching the athletes to drive into the ground with big strides.

We will be posting more training videos coming up soon.

In Strength,

Shyam