Tennis or Golfers Elbow Anyone?

Elbow pain can be a painful and debilitating problem. Pain located on the medial side is referred to as “golfers elbow” or  medial epicondylitis and pain that is on the lateral side is often referred to as “tennis elbow” or lateral epicondylitis. 

Now you don’t have to play golf or tennis to develop these problems. Pain in the elbow usually occurs as a result of repetitive use from typing, hammering, grip/ lifting or swinging a club or racquet. It can occur over time or with a sudden episode.

 Symptoms include pain with; grip, turning door handles or car ignition, fully extending or bending arm, typing, using the mouse.  Swelling and tenderness are also present. Pain can range fromminor irritation to significant limitations in use of hand/ arm.

Often times treatment includes limitation of exacerbating activity, stretches, use of a forearm strap and various pain modalities like ice, electrical stimulation and iontophoresis.  Iontophoresis is a treatment that utilizes an electrical current to drive a medication into the target tissue. We have found this to be quite effective in decreasing pain. This particular treatment requires a doctor’s prescription and is administered by the physical therapist. 

We have also found that stretching and strengthening the hip further enhances the recovery from elbow pain. The hip you ask? Yes, the hips (and trunk) are the power generators for the body. Think of hitting a baseball, swinging a golf club or tennis racquet. In order to swing, lift, push, or pull forcefully you must rotate the hips and trunk to increase force generation. If unable to load the hips/trunk due to weakness or limited motion (tightness) you will likely compensate by using the arm muscles more. Over time this can lead to tissue stress and “bam” the elbow starts to hurt. By improving hip mobility and the working relationship between the elbow, shoulder, trunk and hips we have seen marked improvement in our ability to address this painful condition. Due to the fact that we sit a lot and sleep in the fetal position our hips naturally get tight and develop muscle imbalances. Like we always say, “it’s all connected.”   

Seeking a rehab professional who understands function and the relationships of human movement can greatly improve your chances of overcoming your elbow pain.

Get Strong! Stay Strong!

Chris

Get Your Booty to "Bark"! Muscle Function

OK, since I enjoy talking about function and biomechanics lets talk about how to turn on your butt!  Thought that might get someones attention.  Any way, the Gluteal/hip/ butt muscles are the "powerhouse" muscles.  We call them the big house or the cannon.  The first thing to do before "shooting" the cannon is to "load" the cannon.  In function this simply means you need to efficiently load (eccentrically)the gluteus muscles in order to effectively unload or more forcefully create a concentric contraction.  During the loading or pronation phase ( front foot hits the ground in lunge or gait)

   the function of the gluteus muscles (max, min and med) is to eccentrically control hip flexion in the sagittal plane, hip adduction in the frontal plane and femoral/hip internal rotation.  If you look at an anatomy picture of the gluteus maximus you will notice that the fiber orientation is primarily in the transverse plane.  This baby was designed for femoral/hip rotation (a significant component of lower extremity pronation)

The gluteus attaches proximally to the saccrum and the illiac crest and distally to the greater trochanter and blends with the tensor fascia latae (TFL) to form the illiotibial band.  The ITB attaches distally to the anterior/lateral aspect of the tibia.

So, for example, when you are walking and your foot hits the ground and begins to pronate, the calcaneus everts causing the tibia to advance forward and internally rotate (see "When Foot Hits Ground" post).  This creates a quick "pull" on the ITB, which creates a quick stretch on the gluteus thereby stimulating the butt to contract.  This is further accentuated by the femoral internal rotation that also eccentrically lengthens the gluteus maximus.  Remember that neurologically a muscle responds to a quick stretch (eccentric load) by concentrically contracting. Therefore, if one has limited calcaneal eversion (after ankle injury or immobilization) they will not be able to effectively and efficiently turn on the butt which leads to compensation and further problems.  There in lies the beauty of function!

Get Strong! Stay Strong!

Chris

What Do the Adductor Muscles Really Do?

Despite their name, the adductor muscles work primarily as strong sagittal plane hip flexor or extensors. For example, if you are walking (or running) and the right leg is forward, the right adductor works as an extensor and the left as a flexor and then they switch as you alternate legs in the cycle. Have you ever went out and ran or sprinted for the first time? Where did you feel sore? Right, in the groin and inner thighs (as well as the rest of your body if was your first time).
The adductors (generally) attach proximally to the pubic bone and distally attach to the posterior medial aspect of the femur, giving them their mechanical advantage in the sagittal plane. In single leg stance or the single leg phase of gait running or kicking they work with the gluteus medius and the quadratus lumborum to stabilize the pelvis and limb in the frontal plane on the stance side. Now, in activities such as gymnastics, ballet, and karate where the leg is lifted or rapidly "thrown" out to the side the adductors will actually adduct the leg to bring it back into position to hit the ground.

Due to its atachment to the pubic bone, the adductors when activated, can stimulate (turn on) the pelvic floor muscles.  So, squeezing something between the legs while doing a bridge or squat for example can increase pelvic floor activity, which is important for women who have had multiple childbirths and people with core stabilization issues.

Some examples of functional exercises that activate the adductors include:  lunges - forward, lateral and posterior lateral w/ rotation, step up w/ opp. leg hip flexion (w or w/out resistance from cuff or cable), single leg balance w/ opp. leg reaches, and resisted walk, jog or running (cable, bungie, sled).

Once you understand what the bones are doing in all 3 planes (against gravity, ground reaction forces and momentum) and you know where the muscle attaches proximally and distally, you can begin to figure out its true function and design exercises to actually improve the bodies abilitiy to move.  Unfortunately, school doesnt usually teach us that.  Think back to anatomy.  We are taught that the adductors adduct the leg.  Well, now we know that in function they rarely ever do that!  Good luck and have fun!  There is always more to learn!

Get Strong! Stay Strong!

Chris

Shoulder Pain? Its Not Always the Shoulder!

Shoulder pain can range from nagging to debilitating depending on the problem and severity.  Generally, in the under 40 crowd shoulder problems usuually consist of impingement and instability.  Impingement occurs when the "ball" of the ball and socket joint "rides" up during shoulder movement and pinches the rotator cuff and bursae.  This can result from trauma or fatigue from repetitive movement.  Instability is from a laxity in the capsule (fibrous tissue.  Like the wrapper of a lollipop) that holds the ball and socket joint together.  This can occur from repetitive motion or trauma.  Some people are born with more laxity in their joints that predisposes them to these typess of problems.  These are the people that are "double jointed."  They don't actually have 2 joints they are just very flexible in their joint tissue.  This can range from mild to severe.  This creates "extra" movement in the joint that can irritate the tissue, rotator cuff and/or injure the cartilage of the socket (the labrum).  The over 40 crowd usually suffers from rotator cuff tears, although they can also have impingement and tendonitis.  Aging of tissue and the longevity of activity makes the older individual more prone to rotator cuff tears.  This can happen through gradual wear and tear leading to the cuff tear or from trauma such as a fall or heavy pulling movement.

Many factors can lead to shoulder problems and multiple steps can be taken to prevent or at least reduce your risk of shoulder injury.  Posture is a big problem for many people.  The rounded shoulders compromise the shoulder joint space and contribute to muscle imbalance and impingement.  Tight hip flexors can also contribute to shoulder pain.  The tightness in the hip flexor can "pull" the pelvis forward which can pull the shoulders forward leading to pec tightness which further pulls the shoulder forward.  Taken further this shortens the abdominal muscles (shutting them off) and contributes to an unstable back.  When looking at movement through a functional eye you would see that overhead activity requires extension and rotation through the spine and the same side hip.  So for example, if your hip flexor is tight and/or your shoulders or upper back was rounded and you were trying to change a light bulb, even if your shoulder motion was normal, your ability to work overhead would be limited and your chances of developing shoulder pain would be high.  The moral of the story is that it is all connected and that to successfully correct shoulder problems you must try to find and address the cause.  This requires understanding the functional relationships of the body.  Many times easier said than done.

In general, make sure your exercise programs are balanced and you are not just working the "mirror muscles," stretch your hip flexors, watch your posture especially when sitting, drink plenty of water (most of your tissue is water) and eat a balanced, nutritious diet (give your body the nutrients it needs to be healthy and support the growth and repair processes).

Get Strong! Stay Strong!

Chris

Knee Pain?...No Problem!

Many suffer from knee pain.  It can range from intermittent aching to severe debilitating pain. The symptoms may include pain, stiffness, swelling, popping, difficulty climbing stairs, squatting and sitting for long periods. X-rays often reveal varying degrees of arthritis, but sometimes are normal.  Barring traumatic injury many of the symptoms of knee pain can be attributed to muscle imbalances and faulty biomechanics.  This leads to increased wear and tear and tendonitis from overuse.  Through advanced study and greater understanding of biomechanics and functional anatomy we realize that most knee pain has nothing to do with the knee.  The knee pain is a symptom, but the cause is usually elsewhere.  Many times we have found the foot and/or the hip to be the weak link. The foot and hip are  both very mobile joints, while the knee is primarily limited to flexing and extending.  The phrase “it’s all connected” is the central theme to human movement. For example, if the foot flattens out more than normal (overprontes) it will cause the knee to collapse more than normal towards the midline.  This will put stress on the medial knee joint, compress the lateral knee joint, cause the knee cap to track off center and subject the muscles to work harderto try to control and stabilize through a greater range of motion.  Another example would be tightness of the hip flexors and weakness of the gluteal muscles which are present in most people due to the fact that we sit a lot and sleep in the fetal position.  We refer to this as “dormant butt syndrome”. When the hip flexors are tight they cause weakness in the gluteus maximus (the butt, tooshee, cannon or powerhouse) through a phenomenon called reciprocal inhibition (when one muscle is tight it causes weakness in the opposite muscle).  The butt is a strong stabilizer/ motion controller of the lower extremity. When it is weak it also allows the knee to collapse into the midline placing more stress on the joint and soft tissues.  Over time the knee is subject to more wear and tear and many of the symptoms of knee pain begin to creep up. So if your knee pain persists it is a good idea to seek out a knowledgeable professional to help you. Knee pain doesn’t have to put an end to your fun, if the right approach is taken.

Get Strong! Stay Strong!

Chris

Do You Have Dormant Butt Syndrome??

Yes, I said dormant butt syndrome, DBS for short! I see it all the time in the clinic. In athletes and people of all ages. The cause of DBS is usually tight hip flexors, again, which most people have. This is due to repetitive hip flexion from walking, running, sitting, driving and sleeping in the fetal position. Other causes include injury and inactivity. If you remember back to previous posts the gluteus maximus generally attaches proximally to the sacruum, and illiac crest and wraps around the hip to distally attach to the greater trochanter (the big bony bump on side of hip). Although we think of the gluteus maximus as a powerful hip extender it is actually built for rotation. Just look at the fiber orientation (yes, you may have to crack open the old anatomy book). So, functionally its main function is to eccentrically control internal rotation of the femur in the transverse plane during the loading phase of gait or running, eccentrically control hip flexion in the sagittal plane and assist the gluteus medius in stabilizing hip adduction in the frontal plane. The ability to appropriately load enhances their ability to concentrically contract during the unloadong or propulsive phase. If the gluteus maximus is inhibited (which V. Yanda taught us) from a tight hip flexor, then the hamstrings and erector spinae group become overactive to compensate. This leads to the possibility of hamstring strains, low back pain, knee pain and possibly even plantar fascia. A simple way to check for DBS is to have patient lie prone and ask them to do a leg lift. Palpate the gluteus and the hamstring and see which contracts first. Many times I feel the hamstring contract then the gluteus. It should be gluteus then hamstring. Sometimes ive seen people have a 5/5 manual muscle test and not even fire the gluteus. They used all their hamstring and erectors to lift/hold the leg up. Some general strategies include a basic muscle re-education of laying prone over table or bed and actively squeezing butt then lifting leg. Sequence can also be done with bridge exercise. Stretching the tight hip flexor, of course, and functional hip dominant exercise like single leg balance w/ arm reaches, multi planar lunges, sled walks, various step up and downs. So now get moving and wake that sleepy butt up!

Get Strong! Stay Strong!

Chris