Dec 22, 2014

Stiff Ankles Could Pose a Serious Risk When It Comes to ACL Injury Risk.

Howdy Folks, today I wanted to discuss a growing body of literature that highlights a relationship between ankle dorsiflexion and movement patterns (kinematics) that are associated with anterior crucial ligament injuries. One such article that was recently published online by the Journal of Athletic Training was conducted by Dill et al1.

Photo Taken from Dill et al journal article.
What did these authors do exactly? They actively recruited and grouped subjects by their levels of ankle dorsiflexion. Specifically, they wanted a population of subjects with limited (Less than or equal to 5 degrees) ankle dorsiflexion and subjects with normal amounts (> or equal to 15 degrees) of ankle dorsiflexion. A unique aspect of this study was that the authors used a weight-bearing lunge test for assessing ankle dorsiflexion.

 It could be argued that this test is both more functional and easier to assess in the clinic compared to nonweight-bearing ankle dorsiflexion measurements. They also took non-weight bearing ankle dorsiflexion range of motion measurements but the authors hypothesized that this measurement may have caused discrepancies in previous studies because this method isn’t a good representation of the functional movements and tasks that were assessed. The weight-bearing lunge test can be assessed using common smartphone apps like Clinometer or the iPhone’s compass application if an inclinometer is not readily available.

Photo Taken from Dill et al journal article.

What are the functional tasks that they tested? Well they had the subjects perform an overhead squat, a single-legged squat, and a jump-landing task. These tasks have been in previous research and are common in clinical settings as well to assess lower extremity movement patterns that help evaluate risk of ACL injury. These are relatively easy to perform tasks and are representative of common physical activities and functional movements in general.

What did these researchers find? They found NO differences between normal and limited ankles when using the traditional nonweight-bearing ankle dorsiflexion range-of-motion assessment. However, there were significant differences when they looked at the two different groups for both the single-legged squat and the overhead squat using the weight-bearing lunge test. They did NOT find a difference in movement patterns when they looked at the jump landing task. 

Previous research by Fong et al2 found a difference with the jump landing task but the current study utilized an immediate countermovement jump for maximal height but the latter researchers did not. This could have been the reason for the differences in findings because the immediate countermovement jump may not have required a significant amount of ankle dorsiflexion to complete.

The next question that you may be asking yourself is what are the kinematics that are associated with increased loading of the anterior cruciate ligament and which of them were present in the subjects with limited ankle dorsiflexion? Well excessive frontal plane, and transverse plane motion accompanied with an anterior tibial shear force (in the sagittal plane) place the greatest stress on the anterior cruciate ligament. Noncontact injuries to this ligament are associated with a minimally flexed or relatively extended knee position. That being said, the subjects with ankles that had limited ankle dorsiflexion did not flex their knees as much as the subjects with normal ankle dorsiflexion during the single-legged squats and overhead squat. This means their knees were relatively extended and as mentioned earlier that is not ideal when it comes to loading of the anterior cruciate ligament. Additionally, the limited group had less ankle dorsiflexion displacement compared to the normal group as well.

So what should you take conclude from all of this and take back with you into the clinic? Well, for one it should be noted that using a non-weight bearing ankle dorsiflexion assessment may not be sensitive enough. The weight-bearing lunge test was much better at identifying these subjects with altered movement patterns. This test is much more field-expedient, is reliable, and can be assessed without the need of a goniometer. Finally, it is evident that there is a growing body of evidence that limitations in ankle dorsiflexion result in kinematics that are associated with increased loading of the anterior cruciate ligament of the knee. This is just another example of how the entire kinetic-chain is important when screening for or assessing injuries. Do you currently assess ankle dorsiflexion when looking to return patients to physical activity or when preventatively screening for risk of injury?

  1.      Dill KE, Begalle R, Frank B, Zinder S, Padua DA. Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing Lunge Ankle-Dorsiflexion Range of Motion. J Athl Train. [Epub Ahead of Print].
  2.      Fong CM, Blackburn JT, Norcross MF, McGrath M, Padua DA. Ankle-dorsiflexion range of motion and landing biomechanics. J Athl Train. 2011;46(1):5–10.



Dec 13, 2014

November Blog Traffic & Income Report

blog seo, blogspot, how much money do youtube ads make, how to make money blogging, how to make money online, how to start a blog, how to write a blog, sports medicine blog,
Welcome readers to my second monthly traffic & income report. I started this tradition last month by reporting my statistics for October. You may have noticed that this is only my second post this week. I attribute this to it being finals week so the only things that I have done are studied for my own exams, given the class that I lecture their final exam, taken exams, ate and slept, and trained brazilian jiu jitsu to help relieve stress and use as an excuse for a study break. It is interesting to me to see how my perception of injuries and their etiology related to brazilian jiu jitsu has evolved since my days as an undergraduate athletic training student to now.

I really do love this sport/art.

The Numbers:


So let's get down to the numbers because if you've actually read this far down you are probably truly curious about them. There is an issue with the statistics for November because at the very beginning of last month I implemented a new template for the blog. However, when I did this I forgot edit the html code of my blog to include the tracking code that I use for Google Analytic's statistics. Due to this error I lost out on about a week worth of statistics so please keep that in mind. Nevertheless, November did not fair as well as October for both YouTube and the blog itself.

Traffic

blog seo, blogspot, how much money do youtube ads make, how to make money blogging, how to make money online, how to start a blog, how to write a blog, sports medicine blog,

Regardless of whether or not I lost out on some statistics I definitely do not think it was that many lost page views. It is evident that I just happened to have a much lower amount of hits overall. This is evident by my ad performance. So what could possibly have attributed to this change? Here is the breakdown of those views.

blog seo, blogspot, how much money do youtube ads make, how to make money blogging, how to make money online, how to start a blog, how to write a blog, sports medicine blog,

What pops out first and foremost obviously is the difference in bounce rate and the pages per session statistics. Despite having similar amounts of users and sessions it was evident that people were viewing much less pages per visit to my website and thus a greater percentage of people were leaving after viewing the first page on my blog. I attribute this to me blogging about brazilian jiu jitsu related topics and sharing them with that community. These readers often are just interested in the initial article or one of the other very few articles related to brazilian jiu jitsu that I have written to date. Past readers may have found many articles to be related and therefore spent more time on my website reading multiple pages.

This statistic could potentially get better if I continued to develop more content related to brazilian jiu jitsu and injuries or if I ceased to continue writing on that topic. However, I could be wrong and that could be the nature of not establishing a readership with that community but as I establish one with them it would modify the behavior of readers. Maybe that behavior is a trait of readers of that community. How about we continue on to the revenue and ad statistics.

blog seo, blogspot, how much money do youtube ads make, how to make money blogging, how to make money online, how to start a blog, how to write a blog, sports medicine blog,

Revenue Breakdown by Source:

blog seo, blogspot, how much money do youtube ads make, how to make money blogging, how to make money online, how to start a blog, how to write a blog, sports medicine blog,

It is obvious that there was a decrease in ad revenue compared with the last three months. If you aren't careful it looks like adsense earnings have really declined in the past few months but the biggest drop there should probably be associated with the addition of Sovrn Ads. 

I am really curious how some of these graphs and stats will change over the next year. It is very unpredictable still at this point and things are still changing at a very rapid rate. For instance, my YouTube earnings for the month of December after only 13 days have just about surpassed the entire month of November. I had actually expected a huge increase in YouTube performance for November because of my "Movie Monday" series, and when that didn't occur I was confused. Now that I see a big increase so far this month I wonder if it is just a delayed response. If you have any questions or want clarification on anything don't be afraid to ask. Additionally, if you have any ideas or pointers I would love to hear them as well. 

Dec 8, 2014

Movie Monday: A Clinical Pearl For Assessing Great Toe Mobility

Another Monday means another movie to be shared with all of you. This week's video is a clinical pearl to keep in mind when assessing great toe dorsiflexion/extension (whatever nomenclature you like for sagittal plane motion at the great toe). This is especially important when dealing with runners and running injuries due to the influence of the great toe  during gait. Specifically, the ability to extend the hip, achieve terminal stance and proper toe-off. This is another pearl that I learned from Jay Dicharry and his book, Anatomy for Runners/The Healthy Running course.


The major point of this video is that the position of the ankle can have an effect on motion at the toe. This is important to consider because at terminal stance/toe off the ankle is placed in dorsiflexion and the toe must also dorsiflex as well to allow for a proper "ankle rocker" mechanism to occur. Failing to check toe mobility in both positions could lead to an improper assessment. The big toe really can be a lynch-pin when it comes to movement so we want to ensure it can do what it is supposed to do. Have a great day!

Dec 3, 2014

There's No Such Thing as a "Bad" Posture

what is bad posture, how to correct posture, does posture cause pain, no such thing as bad posture, playful movement, mobility, move it or lose it.

Many of us have been scolded since childhood to "sit up straight", to stop slouching, to keep our chins up and other various cues in attempt to hammer home "perfect posture" habits. However, the more I think about it and think about human movement I start to think more about how there isn't really such a thing as bad posture. When I say this...I mean that there is nothing wrong with putting your cranium into a forward head position, nothing wrong with arching your low back, rounding your shoulders, and for you PRI people out there...favoring a Left AIC pattern.

There are some clinicians, coaches, and parents that hammer home the importance of "proper posture" and even go to such lengths as bracing, taping, or even strapping down body parts to limit people into their ideal of perfect positioning. Remember the fcliche scenario with the girl in boarding school that must learn to walk and sit with a book balanced upon her head? There are also some clinicians and researchers that scoff at the idea of trying to place blame on posture for pain and injury because of some of the existing literature.

what is bad posture, how to correct posture, does posture cause pain, no such thing as bad posture, playful movement, mobility, move it or lose it.

The real problem or dysfunction I feel is often times the target of these "postural correction interventions" and that is limitations. I believe the only true "bad" posture is one that a person can not get out of very easily or very often. Prolonged limitations in movement or habitual overuse of a certain movement is where the problem is really located. My neck is supposed to go forward, my shoulders meant to round, my thoracic spine to slouch but they were never meant to stay in those positions. I want to be able to both protract and retract my shoulders, utilize the left AIC and then get out of AIC. We don't want to get stuck but most of us spend 90% of our life either laying in bed, sitting in a chair, or standing. There is very little variance for many people.

We need routine, habitual movement through entire ranges of physiologic motion. I'm not saying we need to train or load our bodies at every range or in traditional "bad" positions. I am also not arguing that certain biomechanical alignments are better able to produce force, perform better, and be more efficient at reducing risk of injury.

what is bad posture, how to correct posture, does posture cause pain, no such thing as bad posture, playful movement, mobility, move it or lose it.

It might be flavor of the moment to talk about "play" but think about how children or even animals in the wild move about for instance. Their movements are often random, varied, and the interactions between each other and the environment is very dynamic. I think about movements like parkour, MovNat, the teachings of Pavel and Ido Portal as a step in the right direction but they are still the minority. I would love to play on an "adult" playground but unfortunately as I write that it sounds more like something that is advertised on billboards near truck stops or in spam emails. Take a second and think about it though...Can you touch your toes? When was the last time you got into a full squat, sat cross legged on the ground, hung from a tree branch, or did a bear crawl? These were all once routine and daily movements for many of us humans.

We really do need to change our "culture" and ways of thinking when it comes to movement. It is entirely true when it comes to the human body and human movement that if you don't use it...you will lose it. Perhaps a better slogan would be, "Move It, or Lose It." We shouldn't be taping people's shoulders in place for 8 hours straight at work as much as we should be getting the person to move not just their shoulders or head but their entire body more frequently. We also shouldn't be blaming benign structural positions or postures necessarily. We need to go deeper and further back in time...If that makes any sense to you. You do not need perfect alignment or positioning at all times to be pain free, you are not doomed if you have rounded shoulders, and its okay to go ahead and slouch sometimes. There is a time and place for everything.


Dec 1, 2014

Movie Monday: Tibial Internal Rotation Self-Mobilization


Good Morning Readers! As you may have noticed last week was a busy week for me with the holidays and I only ended up getting one post done for all of you. My fiance and I actually drove across the country to see family and then had to drive back. I don't really want to sit in a car anymore in the foreseeable future. I don't understand how people can sit at a desk for 8-12 hours a day...It was killing me and made my body feel terrible.


Today's video will feature an easy way to have somebody work on tibial internal rotation on their own. Perhaps they don't respond very well to and/or they have pain when performing this tibial internal rotation mobilization with movement variant...then this may be something to try instead. Additionally, it is pretty simple and most people can do this with very minimal instruction. Nevertheless, it should be pain free and you should Test-Intervene-Retest to see if this technique makes a difference. You don't want to repeatedly try and mobilize a segment like the tibia if the reason it is limited is due to bony abnormality.

Give it a try and let me know what you think. I forgot where I learned this one but I think I remember some story associated with this technique about how a power or Olympic lifter used it to help his tibial IR before setting a world and or/personal record. Credit goes to whomever that was, sorry for not remembering.

Nov 24, 2014

Movie Monday: An Easy Way To Assess for Glute Inhibition


Howdy Folks. Today's video is a simple test that I use when assessing gluteus maximus function of my patients.  I learned this test from Jay Dicharry, MPT, SCS, the author of Anatomy For Runners and he also taught it as part of his Healthy Running seminar.


It is a simple bridge test that looks at the ability to activate the glute max as the primary hip extensor, with a minor contribution from the hamstrings, and a neutral lumbar spine. We don't want to see lumbar extension when trying to extend the hip. A proper activation strategy with this test is not a "good thing" to see but instead should be viewed as a necessity for athletes and perhaps the non-athletic population as well. 

A person could have "strong glutes" and still fail this test if they don't know how to use them. Additionally, if a person failed this test and had weak glutes with manual muscle testing then it may be a waste to prescribe glute strengthening exercises when in reality they need to work on activation first.

Lets Recap:

What We Do Want To See/Feel:

  • Neutral Lumbar Spine
  • Stable Lumbopelvic control
  • Patient to "feel" the effort come from their butt/glutes and hamstrings, Jay taught us 70% - 30% contribution, respectively.
  • An ability to hold steady for 20-30 seconds with easy. It may be beneficial to do this for reps as well.

What We Don't Want to See/Feel:

  • Hamstring "Cramping"
  • Lumbar Extension
  • Patient to "feel" the effort come from their low back
  • Tilting/dipping/rotation of the pelvis when transitioning from double leg to single leg.
  • Excessive Effort and/or Labored Breathing
  • An inability to maintain the bridge position or excessive shaking while doing so

Nov 19, 2014

My 4 Favorite Areas to Treat With the EDGE Mobility Ball.

EDGE mobility ball self treatment, how to use a massage ball to increase mobility, how to prevent injuries, massaging plantar fascia, foot pain and range of motion,
"C'mon baby make it hurt so good."...except I don't make it hurt.
Howdy Readers! Today's post will be short and sweet and it really isn't all that informative. I just wanted to take a moment and share with you all the four areas that I have found to be most effected by me using the EDGE mobility ball.

I have been playing with this thing since I got the Mobility/Stability Combo Pack and I have really taken a liking to it. I'm not saying these are the four places where other people should use it, they are just my favorite for my body! There is a lot of other areas that can be treated with the ball.

Fibular Head/Lateral Gastrocnemius (Calf)

EDGE mobility ball self treatment, how to use a massage ball to increase mobility, how to prevent injuries, massaging plantar fascia, foot pain and range of motion,

The lateral calf/fibular head area is often a must treat area when I assess my patient's when doing IASTM or working on restricted ankle dorsiflexion. It is no surprise that this is an area in need of treatment for myself either considering my history of terrible ankle mobility. 

Suprapatellar Pouch/Quadriceps Tendon

EDGE mobility ball self treatment, how to use a massage ball to increase mobility, how to prevent injuries, massaging plantar fascia, foot pain and range of motion,

I don't have tight hip flexors but man do I have a mobility issue in my quads. I actually had a slight calcification of my distal quadriceps tendon when I had an x-ray done this past summer. If I don't work at this very often on my left side I actually get issues when trying to achieve full knee extension like in a plank position.

Posterior Shoulder - Teres Major & Minor/Infraspinatus/Lats

EDGE mobility ball self treatment, how to use a massage ball to increase mobility, how to prevent injuries, massaging plantar fascia, foot pain and range of motion,

I have pretty poor shoulder mobility in many different directions. However, after spending 5 or 10 minutes on a few areas around the posterior shoulder and my lats while doing large arcs or shoulder circles I was able to rapidly improve my shoulder motion. I'm talking about going from a -1 FMS score to a modest 2. Instantly.

Intrinsic Foot Musculature/Plantar Fascia/Abductor Hallucis/Flexor Hallucis Brevis


EDGE mobility ball self treatment, how to use a massage ball to increase mobility, how to prevent injuries, massaging plantar fascia, foot pain and range of motion,

Need a free pedicure? Roll this ball along the plantar aspect of the foot for a few minutes and you will be bound to hit a few "spots". This is definitely something I need to try and do more of considering how terrible my great toe extension/dorsiflexion is. This is something you can do sitting at a computer desk or watching TV...No reason not to spend a couple of minutes getting better.

In fact, using something like this mobility ball, a foam roller, or a stability/corrective exercise only take a few minutes out of your day to complete them. You can do a large majority of them while doing other mundane tasks like brushing your teeth, watching TV, checking emails, reading blogs, or surfing Reddit. There isn't really a good excuse to not being on top of this if you have issues. As Gray Cook would say, " it took a habit to get you into that pattern, and not it's going to take a habit to break that pattern. "

That's it for today, don't forget to sign up for my giveaway!

Nov 18, 2014

EDGEility Tool Free Giveaway!



Howdy Readers! To go along with my Ultimate EDGE Mobility/Stability Combo Pack Review that I posted yesterday...I am giving away one of the pieces of the pack. I am going to be giving away one EDGEility tool courtesy of Dr. E himself, the man behind the entire EDGE Mobility System. Want to know what this tool is and haven't seen my review video yet? Well check it out and see if you want one...for free!



You can enter below by liking my Facebook Page or following me on Twitter. The entry period will go until next Tuesday Night at Midnight! Good Luck! 



Nov 17, 2014

Movie Monday: The Ultimate Mobility/Stability Combo Pack Review

how to increase mobility, edge mobility system review, how to improve mobility, brazilian jiu jitsu, improve balance, review edgeility tool, soft tissue release tools, how to treat your own soft tissue,

Howdy Readers! Today is Monday so that means it is time for another movie! This week I have a video product review for you. In this video I will be looking at the Ultimate Mobility/Stability Combo pack from The EDGE Mobility System. I am no stranger to the EDGE Mobility System but recently they started to sell their products as combo packs instead of just singular items. However, you can still buy each item individually as well!


how to increase mobility, edge mobility system review, how to improve mobility, brazilian jiu jitsu, improve balance, review edgeility tool, soft tissue release tools, how to treat your own soft tissue,

What Does The Ultimate Mobility & Stability Combo Pack Contain?

  • 1 EDGE Mobility Ball
  • 1 EDGEility Instrument Assisted Soft Tissue Mobilization (IASTM) Tool for Self-Treatment
  • 2 pairs of EDGE Mobility Bands
  • 2 pairs of TowEDGE Toe Spacers 
  • 1 EDGE Mobility System Carrying Pouch
how to increase mobility, edge mobility system review, how to improve mobility, brazilian jiu jitsu, improve balance, review edgeility tool, soft tissue release tools, how to treat your own soft tissue,

What Did I Think of The Combo Pack?

I had a lot to say about these products and I had to edit this video a ton to get it even close to watchable in length so I apologize for it being around ten minutes in length! I will leave most of my comments for the video but I must say that I am a fan. I think that these "combo packs" would make a great Holiday gift for grapplers, brazilian jiu jitsu players, judokas, crossfit athletes, gym rats, runners, triathletes, I could really make this list go on and on. Additionally, this would be a great gift for athletic trainers, physio/physical therapists, chiropractors, and students of all these professions.



So What Do I Do With This Stuff?

If this is one of your first thoughts after getting interested in these products from my review video then don't have any fear. I have several videos and articles on how I've used the individual pieces of the EDGE Mobility System. There are many more to be found on the creator's website, The Manual Therapist. It may be worth checking the new but cheap E-Book, An Introduction to Instrument Assisted Soft Tissue Mobilization, by Ove Indergaard and I believe you can also find it on the Kindle Store.

how to increase mobility, edge mobility system review, how to improve mobility, brazilian jiu jitsu, improve balance, review edgeility tool, soft tissue release tools, how to treat your own soft tissue,

My Previous Articles Related to EDGE Mobility System Products:

Previous Videos Using EDGE Mobility System Products









Nov 12, 2014

Video Request: How To Tape Turf Toe

turf toe tape job, how to tape turf toe, toe hyper extension injury, 1st mtp joint sprain, taping for bjj injuries, taping your toe for bjj, sports medicine for bjj, athletic training, athletic trainers, toe injury, taping for toe pain,


Howdy Readers! After posting my latest Movie Monday video I was asked by an individual to post a video on how to tape the great toe when suffering from turf toe. First of all, turf toe is a forced hyperextension of the great toe or first metatarsophalangeal (MTP) joint which results in damage to the plantar aspect of the 1st MTP joint.

turf toe tape job, how to tape turf toe, toe hyper extension injury, 1st mtp joint sprain, taping for bjj injuries, taping your toe for bjj, sports medicine for bjj, athletic training, athletic trainers, toe injury, taping for toe pain,


Often times this can result in damage to a structure known as the volar plate. Due to the nature of this structure, this injury can be very debilitating for athletic activity and can even cause suffering with simple things like pushing off  with the foot while walking. This taping technique is commonly used by certified athletic trainers to allow athletes to return-to-play after minor or moderate injury and it can be used to protect, rest, and allow proper healing of the joint after initial injury.


However, this should only be used as an acute intervention and other rehabilitative exercises and manual therapies may be warranted. While limiting great toe extension may allow a person to remain physically active with such an injury or lower pain levels with activities of daily living...it is a necessary and crucial motion for the great toe joint to have. Therefore, it is imperative that pull pain free range of motion be restored after suffering a great toe injury such as turf toe.


Disclaimer

Disclaimer: Please note that some of the links on this blog are affiliate links and I will earn a commission if you purchase through those links. I have used all of these products listed and recommend them because they are helpful and are products from companies that I trust, not because of the commissions that I may earn from you using these products.

Caution

All content on this blog is meant as instructional and educational. The author and guest authors of this blog are not responsible for any harm or injury that may result. Always consult a physician or another proper medical professional for medical advice.
MyFreeCopyright.com Registered & Protected