"Text Neck" How Texting is Ruining Your Posture!

Article from Washington Post - Lindsey Bever

The human head weighs about a dozen pounds. But as the neck bends forward and down, the weight on the cervical spine begins to increase. At a 15-degree angle, this weight is about 27 pounds, at 30 degrees it’s 40 pounds, at 45 degrees it’s 49 pounds, and at 60 degrees it’s 60 pounds.

That’s the burden that comes with staring at a smartphone — the way millions do for hours every day, according to research published by Kenneth Hansraj in the National Library of Medicine. The study will appear next month in Surgical Technology International. Over time, researchers say, this poor posture, sometimes called “text neck,” can lead to early wear-and-tear on the spine, degeneration and even surgery.

“It is an epidemic or, at least, it’s very common,” Hansraj, chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine, told The Washington Post. “Just look around you, everyone has their heads down.”

Can’t grasp the significance of 60 pounds? Imagine carrying an 8-year-old around your neck several hours per day. Smartphone users spend an average of two to four hours per day hunched over, reading e-mails, sending texts or checking social media sites. That’s 700 to 1,400 hours per year people are putting stress on their spines, according to the research. And high-schoolers might be the worst. They could conceivably spend an additional 5,000 hours in this position, Hansraj said.

“The problem is really profound in young people,” he said. “With this excessive stress in the neck, we might start seeing young people needing spine care. I would really like to see parents showing more guidance.”

Medical experts have been warning people for years. Some say for every inch the head tilts forward, the pressure on the spine doubles.

Tom DiAngelis, president of the American Physical Therapy Association‘s Private Practice Section, told CNN last year the effect is similar to bending a finger all the way back and holding it there for about an hour.

“As you stretch the tissue for a long period of time, it gets sore, it gets inflamed,” he said. It can also cause muscle strain, pinched nerves, herniated disks and, over time, it can even remove the neck’s natural curve.

It’s a risk for some 58 percent of American adults who own smartphones.

Michelle Collie, a doctor who heads Performance Physical Therapy in Rhode Island, told CNN last year she started seeing patients with mobile technology-induced head, neck and back pain some six or seven years ago.  Poor posture can cause other problems as well. Experts say it can reduce lung capacity by as much as 30 percent. It has also been linked to headaches and neurological issues, depression and heart disease.

“While it is nearly impossible to avoid the technologies that cause these issues, individuals should make an effort to look at their phones with a neutral spine and to avoid spending hours each day hunched over,” according to the research.

Speaking to TODAY, Hansraj gave smartphone users tips to avoid pain:

• Look down at your device with your eyes. No need to bend your neck.
• Exercise: Move your head from left to right several times. Use your hands to provide resistance and push your head against them, first forward and then backward. Stand in a doorway with your arms extended and push your chest forward to strengthen “the muscles of good posture,” Hansraj said.

“I love technology. I’m not bashing technology in any way,” Hansraj told The Post. “My message is: Just be cognizant of where your head is in space. Continue to enjoy your smartphones and continue to enjoy this technology — just make sure your head is up.”

Get Strong! Stay Strong!

Chris

Drink Coffee. You May Live Longer?

In two very large prospective epidemiological studies, drinking coffee was associated with a lower risk of death by all causes.

This effect is particularly profound in type II diabetics, one study showing that coffee drinkers had a 30% lower risk of death during a 20 year period.

Bottom Line: Coffee consumption has been associated with a lower risk of death in prospective epidemiological studies, especially in type II diabetics.

Lopez-Garcia E, van Dam RM, Li TY, Rodriguez-Artalejo F, Hu FB. The Relationship of Coffee Consumption with Mortality. Ann Intern Med. 2008

S. Bidel, G. Hu, et al.  Coffee Consumption and Risk of Total and Cardiovascular MortalityAmong Patients with Type II Diabetes.   Diabetologia.  Clin Exp Diabetes Metab. 2006.

Volleyball Vertical Core Training: R.I.P. Sit Ups

VERTICAL CORE TRAINING

R.I.P.  Sit Ups

Most would agree that a strong core is essential to volleyball and injury prevention.  So, what is the core and how do we train it to maximize performance?  Generally speaking, the core consists of the low back, the lateral trunk, the abdominals and the hips.  Many just focus on the abdominals.  For years, largely based on traditional anatomy and body building routines, athletes and coaches believed that endless variations of sit ups were the way to a “strong core.”  As our knowledge of functional anatomy and sport performance has grown, we began to realize that training for performance often required a different approach.  Hence, “functional” and “sport specific” training emerged.  Simply stated, the more an exercise/movement looks and feels like the volleyball activity to be performed, the greater the carryover to that activity.  We also realize that all forces must go through the core, whether they are generated from the top down or the bottom up.  If the core is weak or inefficient, energy will be “leaked” and the end result is decreased performance and/ or injury from compensation.

When designing exercises to enhance performance, one must look at the activity or skill and ask, how does gravity, ground reaction forces and momentum effect the body and how do all the muscles and joints interact to complete the skill or movement?  Let’s examine the sit up.  One lies on their back and attempts to flex their spine and lift the shoulders off the ground, in essence only contracting the abdominal muscles.  From a performance or function perspective we would ask, when in a volleyball game or practice would you be lying on your back doing this?  I’m hoping your answer in never!  Are the gravitational forces the same?  Are the ground reaction forces the same?  Is the momentum the same?  Do all the body parts interact similar to a volleyball skill/movement?  The answer is rarely, if at all.  In volleyball, the body is primarily in a upright vertical position with various components of vertical, horizontal and rotational movement acting against gravity, producing and reducing ground reaction forces and momentum.  Therefore, training the core in an upright position would be a better choice to facilitate better muscle, joint and balance receptor activity, ultimately leading to better carry over to the volleyball skill/activity.  Not to mention saving your spine and discs the beating we now know they take from repetitive sit ups.  The overall object is to enhance the athlete’s ability to load in order to more effectively explode.

If we examine the function of the abdominals (only one aspect of the core, but everyone’s favorite) they are designed to stabilize the spine in an upright position and control extension and rotation.  They (and the entire core) connect the hips and the shoulders.  Think of walking.  When the left foot goes forward the opposite arm swings forward.  This allows the abdominals to elongate into extension and rotation to then create a better contraction to assist in taking the next step and propelling you forward efficiently.  The exact same mechanism is at work with hitting in volleyball, but to a greater extent and you’re in the air, not lying on your back!  The muscles must be appropriately lengthened (wind up) to facilitate a more explosive contraction (hit).  The lateral trunk muscles help stabilize and control lateral movement and the posterior trunk muscles assist in controlling forward movement of the trunk during passing and maintaining the down ready position.  Our muscles maximize their ability to contract by being eccentrically (lengthened) elongated prior to concentrically (shortening) contracting, like a rubber band. Think of serving,  the athlete extends and rotates their trunk as they reach back elongating all the musculature (loading) and then rapidly contracts forward (exploding) to forcefully hit the ball.  The more efficiently the athlete can “load,” the more effective they will unload. This cannot be trained via the sit up.  The legs, core and arms have to work and be trained in a coordinated fashion.  Remember, we are training for go, not show!

Below are a few examples of vertical core exercises to enhance your volleyball training and assist in injury prevention.   These are easily done using just a volleyball and can be progressed to using medicine balls or small hand weight.  The speed of the movement can also be varied.  Always ensure good control and avoid excessive back bending.  Perform 2-3 sets of 12-15 reps.  

                                                      

2 Hand Overhead Posterior Reach

1 Arm Overhead Post. Rotation Reach

2 Arm Overhead Post. Rot. Reach

2 Arm Overhead Sidebend Reach

Forward Lunge & Reach

5 Reasons for all the Tommy John Injuries in MLB

Reposted from mikereinold.com

The baseball season is only a few weeks old and we’ve already seen an impressive amount of MLB pitchers need Tommy John surgery.  This pace could lead to a record breaking amount of injured pitchers.  While many have speculated about the causes of this rise, I wanted to share my perspective as someone that has worked with healthy and injured players from Little League to Major League Baseball.

Injuries Are Higher in the First Month of Season

It’s probably not going to be as bad as we think.  The big league trends have been studied and have shown that MLB injuries are higher in the first month of the season.  I feel like every year at this time we all comment on how Tommy John surgeries are on the rise and will reach new records.  Over the course of the season, this tends to slow down and even out.

Looking at the amount of Tommy John surgeries over the last decade, the number per year is fairly consistent, especially if you consider 2012 an anomaly.  Sports Illustrated showed a nice graph of this recently.  Perhaps this year does show another trend upward.  But I wouldn’t be surprised if we saw a slow down and ended up right around 20 Tommy John’s this season.

Preparation for the Season

So considering that injuries are higher during the first month of the season, what could be the reason for this?  I think there are probably two reasons why we see so many Tommy John surgeries near the beginning of the season: 1) poor preparation, and 2) lingering issues.

I think a big factor is preparation for the season.  Over the last two decades we have improved offseason strength and conditioning.  I don’t think it is that players are sitting around on the couch all offseason.  Rather, I think it has more to do with their throwing programs.

There are two ends of the spectrum, the established player that knows that they have a spot on the roster, and the player trying to make the team.  For the player trying to make the team, they need to show up on day one of camp ready to go and ready to impress.  This requires more throwing in the offseason and a more aggressive progression, knowing that roster cuts are just a week or two away.  These players also tend to throw through soreness, fatigue, and tightness in spring training and avoid the training room like the plague.

I’m not sure if this is fixable, though creating a more unbiased and proactive medical department may be a start.  Players shouldn’t fear coming into the training room, but many do.  It is the organizations job to assure players that treatment is preventative with the goal of staying on the field and enhancing performance.  This education starts in player development.

The established player, especially the veterans, may be trying to save some bullets and start throwing a little later, and ramp up a little slower.  I actually like this approach as the goal is to pitch all the way through October.  This is where spring training may need to be evaluated.

Spring training usually begins with several bullpens and live batting practice in the first week.  Some teams will throw up to 5 pens and live BP’s in 10 days.  The starters would then start pitching every 5th day for 1-2 innings.  That represents a huge jump, and then a huge slow down.

This was always my least favorite week of the year, and I think most of the pitchers agreed.  Guys arms were hanging every year. Players go from a casual offseason progression to an excessive amount of high intensity pitches in a short amount of time.  It is a grind.  This approach may be necessary for some, but I’ve talked to many MLB pitchers that disagree.  There are reasons for this progression that range from tradition, to roster decisions, to simply a lack of time to prepare all the pitchers.

I was always a fan of pitchers coming to camp a little early to ease into this progression.  Pitchers do not need to work through a “dead arm.”  That is just silly.  The goal is to avoid the dead arm.

I also feel that many players have been dealing with elbow issues in past seasons and hope that a good offseason will heal them up.  Realize that although it may come as a surprise to you when you hear of a MLB pitcher needing Tommy John surgery, many times both the team and the player have been following their elbow symptoms and trying to avoid the surgery.  They give it a good offseason but come to camp and still have symptoms.

Velocities are Increasing

Another interesting trend that we are seeing is a large jump in average velocity in MLB.  We know that velocity is one the factors that is associated with Tommy John injuries.  A recentarticle by Travis Sawchik of TribeLive noted the trend in MLB towards higher velocity.  In 2008, the average fastball in MLB was 90.8 MPH, in 2013 the average fastball was 92.0 MPH.  in 2003, Bill Wagner was the only MLB pitcher to throw 25 pitches over the speed of 100 MPH.  In 2013, there were 8.

Take this with a grain of salt as I tried to look at this myself using Pitch/FX data, but my data shows almost a 1 MPH increase in velocity from 2007 to 2013.  More interesting is that there has been a near linear increase in velocity each year (with the exception of 2010, as 2009 saw a large jump).  On average, as you can see with the straight line, velocity is trending upward each year.

When I was a kid playing Little League we would all wish we could throw 90 MPH.  90 MPH is close to unemployed now.

This comes down to simple physics.  F = M*A.  Force equals mass times acceleration.  If the trend in velocity continues to rise, the trend in Tommy John injuries will also continue to rise and pitchers will be experiencing these injuries earlier in the career.

Teams still want to draft for velocity, which isn’t surprising, we just need to realize that these guys are going to break down faster.  That is OK, just don’t be shocked when the 26 year olds all start getting Tommy John instead of the 32 year olds.

What Goes Around Comes Around

We are starting to see the results of what these kids did 10 years ago.  The excessive pitching from youth and high school baseball is catching up.  There is a lifespan on your ligament.  Many kids are injuring themselves as kids and may not even know it.  Remember that week your elbow was soreness in High School?  Yup, that may have been the beginning.

In addition to avoiding overuse, which has repetitively been proved to be the #1 factor in youth pitching injuries, youth pitchers need to proactively manage their soreness and injuries.  Don’t ignore your symptoms, get them worked on by a physical therapist.

My friend Dr. Glenn Fleisig from the American Sports Medicine Institute said this to me once: “If you give a kid a pack of cigarettes in Little League, they probably aren’t going to get cancer right away, but they may down the road.”  What we do to our arms as youth carries over to our career.

If you ask a lot of MLB pitchers about a decade ago what position they played in Little League and High School baseball, many would have said shortstop or center field.  If you asked that same question now there is no doubt in my mind that most pitched throughout their youth.  We are specializing early.  You could argue that this creates a better pitcher, and I bet it does, however they are breaking down earlier.  Just like velocity, it is a trade off.  (photo credit)

Pushing Past Our Physiological Limits

Similar to the overuse and early specialization we have seen in pitchers, we are now seeing a large trend towards focusing on velocity at an early age.  I get it, velocity is what gets you drafted.  Perhaps that is the actually problem.

However, I feel like we are excessively trying to push pitchers past their physiological limits to develop velocity.  But at what cost?  It is not advisable for youth players to begin aggressive long toss and weighted ball programs that are not customized to their unique body and goals.  Yet this is exactly what we are seeing.  Kids do not want to wait to grow, develop, get strong, and perfect their mechanics, they want velocity now.

So they start aggressive long toss and weighted ball programs on a weak frame, before their body matures, and with poor mechanics.

I am not against long toss and weighted balls, I am against the sloppy use of these training techniques.  These are tools in a system that absolutely must be customized for each player.

We are seeing a trend towards being too aggressive.  If throwing a 6 oz overweight ball has been shown to increase velocity, than throwing a 2 lb overweight ball will increase it even more!  If long tossing to 180 feet has been shown to increase velocity, then throwing to 300 feet will increase it more!  Realize there is always a diminishing return with a huge rise in risk.  I’ve written about this when discussing baseball long toss programs and the concept of theminimum viable exercise (your should read these both).

There are ways to safely and effectively increase velocity that do not require you to excessive push past your physiological limits.  I’ve written about this in the past and if you are a parent, coach or athlete you should read this article about how baseball players can enhance performance while reducing injuries.

To summarize, I don’t think Tommy John injury rates in general are going to slow down, as I don’t think any of the above factors are going to change anytime soon.  If what I wrote above is correct, we should see Tommy John surgies increase even more over the next decade.  Remember, what we are seeing now is the summation of the last 10+ years of players career.

I hate seeing all the articles in the media asking about why injuries continue to rise despite the greater focus on injury prevention.  It’s not the medical teams fault.  It’s not the strength coach’s fault.  It’s not the players fault.  It’s the nature of baseball right now.

Get Strong! Stay Strong! (and be smart about it)

Chris

Do ACL Hamstring Grafts Fail More than Patellar Tendon Grafts

From mikereinold.com

This month’s issue of the American Journal of Sports Medicine included two studies comparing the revision rates of ACL reconstruction between hamstring grafts and patellar tendon grafts of over 25,000 people.  The overall number of people studied between the two groups was really compelling to me as a sample size this big is certainly worth discussing.
In recent years the graft choice for ACL reconstruction has been slowly shifting towards favoring hamstring grafts rather than patellar tendon grafts.  Recent reports have noted 84% of ACL reconstructions in Denmark and Sweden use hamstring grafts, 60% in Norway, and now are even becoming more popular in the US with 44% of ACL reconstructions using a hamstring graft compared to 42% using a patellar tendon graft.
Many research papers have been published showing that both grafts result in very good stability of the knee with excellent subjective outcome scores.  The major complaint of patellar tendon grafts is the increased risk of issues after surgery, such as patellofemoral pain and loss of motion.  Despite the reports of good stability and subjective outcomes, revision surgery is probably a more important factor to consider.

Do ACL Hamstring Grafts Fail More than Patellar Tendon Grafts?
The first study reviewed the nationwide Danish Knee Ligament Reconstruction Registry, which included 13,647 people undergoing ACL reconstruction between 2005 and 2011.
The revision rates for hamstring tendon grafts were 0.65% at 1 year after surgery, and 4.45% at 5 years after surgery.  The revision rates for patellar tendon grafts were 0.16% at 1 year after surgery, and 3.03% at 5 years after surgery.
Essentially, hamstring grafts had a 4x greater risk of revision in year one and 1.5x at 5 years following ACL reconstruction.
ACL reconstruction revision rates

The second study reviewed the nationwide Norwegian Cruciate Ligament Registry, which included 12,643 people undergoing ACL reconstruction between 2004 and 2012.
The revision rates for hamstring tendon grafts were 5.1% at 5 years after surgery, and 2.1% for patellar tendon grafts.  This study also looked at different age groups and found this increased rate to be consistent across all age group.s  However, the younger group (age 15-19) had a 9.5 revision rate at 5 years using the hamstring graft in comparison to 3.5% using a patellar tendon graft.
Together, there was a 2x greater risk of revision overall when using the hamstring graft, but closer to 3x greater risk for younger people

 Both Grafts are Great Options for ACL Reconstruction
When we really assess the numbers, it is clear that both graft options are great choices with low revision rates.  Even though we are comparing the two, realistically the revision rates after ACL reconstruction are low for both hamstring grafts and patellar tendon grafts.  There are many factors that go into deciding which graft to use.  Also realize this does not apply to skeletally immature patients.  This revision information is just a piece of the puzzle.

The patellar tendon graft has less failure rate and has been reported to heal faster in animal models due to the bone-to-tendon interface.  While this is true there are also reports of increased anterior knee pain and loss of motion.  I have discussed this in the past, but I really do believe that many of the issues with patellar tendon grafts after surgery are minimized or eliminated with proper physical therapy (in addition to excellent patient compliance).  This is especially true if these factors are the primary emphasis of the early phases of ACL rehabilitation.

SEE ALSO: 6 Keys to the Early Phases of Rehabilitation Following ACL Reconstruction Surgery
That all being said, hamstring grafts have also been shown to result in less strength of the hamstrings after surgery.  Considering the role of the hamstring to assist the ACL in control anterior tibial translation, this has to be considered when reviewing the higher ACL reconstruction revision rate when using hamstring grafts.  Perhaps it really has nothing to do with the graft itself and more to do with the hamstring strength.

Regardless, the revision rate following ACL reconstruction is higher when using a hamstring graft than when using a patellar tendon graft.


Get Strong! Stay Strong!
Chris

Is Ice Right for Soft Tissue Injuries?

Copied From:

Emerg Med J, 2008 Feb;25(2):65-8

Collins NC

Abstract

AIMS:

The use of ice or cryotherapy in the management of acute soft tissue injuries is widely accepted and widely practised. This review was conducted to examine the medical literature to investigate if there is evidence to support an improvement in clinical outcome following the use of ice or cryotherapy.

METHODS:

A comprehensive literature search was performed and all human and animal trials or systematic reviews pertaining to soft tissue trauma, ice or cryotherapy were assessed. The clinically relevant outcome measures were (1) a reduction in pain; (2) a reduction in swelling or oedema; (3) improved function; or (4) return to participation in normal activity.

RESULTS:

Six relevant trials in humans were identified, four of which lacked randomisation and blinding. There were two well conducted randomised controlled trials, one showing supportive evidence for the use of a cooling gel and the other not reaching statistical significance. Four animal studies showed that modest cooling reduced oedema but excessive or prolonged cooling is damaging. There were two systematic reviews, one of which was inconclusive and the other suggested that ice may hasten return to participation.

CONCLUSION:

There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.

Is this the beginning of the end of the "ice" age?

Get Strong! Stay Strong!

Chris

Children that Exercise have Healthier Knees as Adults

Written by Jeff Behar & copied from: mybesthealthportal.net

Being more physically active in childhood is linked to greater knee cartilage and tibial bone area in adulthood, according to new research findings presented at the 2012 American College of Rheumatology Annual Meeting in Washington, D.C.

While physical activity in childhood is often recommended as a means to improve adult joint health and function, little evidence exists to illustrate the correlation between childhood physical performance measures and bone structure in adulthood later on. The goal of the study was to determine if physical activity in youth was associated with more knee cartilage and tibial bone area (the bone that forms the distal part of the knee joint) 25 years later, says Graeme Jones, MD, PhD, investigator in the study and professor of rheumatology and epidemiology at Menzies Research Institute in Hobart, Tasmania.

Real-time data was gathered in 1985 on the childhood physical performance in a diverse group of 298 people in Australian. Of these, 48.7 percent were female and ages ranged from 31 to 41. The participant’s knee cartilage and tibial bone area were measured using T-1 weighted, fat-suppressed magnetic resonance imaging.

Although Dr. Jones and his colleagues had questionnaire responses on the physical activity level of the children taken in 1985, they found that current-day measurements revealed more accurate information.

Adjustments were made for age, gender, body mass index (BMI) and past joint injuries that may affect the cartilage or bone area. The results showed that childhood physical activity, including physical work capacity, leg and hand muscle strength, sit-ups, and long and short runs had a significant, consistent association with greater tibial bone area. In addition, higher childhood physical work capacity measures were associated with greater tibial cartilage area. Other types of physical activity in childhood were associated with greater cartilage area, but these measures were less significant after adjusting for medial tibial bone area.

Dr. Jones and his colleagues do not know exactly why or how physical activity may build bone and cartilage years later. “The mechanism is uncertain, but I would contend that bone area gets larger to cope with the extra demands put on it by higher levels of physical activity, and then this lead to more cartilage, as cartilage covers the surface of bone,” he says.

While the study’s findings lend greater support to the effort in many developed countries to encourage children to be more physically active, cartilage and bone are still vulnerable to damage later on that could contribute to OA, says Dr. Jones.

“Physical activity is good, but if people have an injury while doing the physical activity, this is bad. So injury prevention is important. Avoiding a high body mass index is also important, and physical activity will help with this.”

This study was funded by NHMRC of Australia.

Get Strong! Stay Strong!

Chris