rehabscience rehabscience

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Dr. Tom Walters, DPT, OCS  📚Kinesiology Professor @westmontcollege 👣Doctor of Physical Therapy 🔎DSc Candidate in #RehabScience — ➡️Helping Others Alleviate Pain & Move Better

💥RETURN TO SPORT💥
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Presented here is a partial movement evaluation with Dr. Chris Powers, PT, PhD with an athlete eight months out from a left ACL reconstruction.
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Tissue healing is an important factor to consider when determining whether or not an athlete is ready to return to their sport. However, other factors such as muscle strength, endurance, motor control and psychological state must also be assessed in order to give the athlete the best odds of not suffering another injury.
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The tests shown here are just a few examples that can be used to assess movement control and confidence.
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Which tests do you use and how do you determine when an athlete is safe to return to their sport?
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#RehabScience

💥NECK REHAB💥
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✅There are numerous muscles involved in controlling the neck, but, for some reason, many strength and conditioning programs neglect this region of the body. Adding a few simple exercises, like the ones shown here, may help reduce symptoms you are currently experiencing and/or work to prevent future neck injuries.
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🔎Previous research has shown that neck pain can alter the way in which these muscles function and, potentially, predispose one to future neck pain episodes. Like many pain problems, the story is complex and not totally clear on the relationship between the activity of these muscles and pain. However, some patients do report less neck pain and fewer episodes of future pain when implementing exercises that address these muscles.
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🤔In some individuals with neck pain, a number of changes to the surrounding musculature have been documented and can be broadly classified as either changes to physical structure (atrophy, fatty infiltration, fiber type) or behavior (timing and level of recruitment). It is hypothesized that specific neuromuscular training programs for the neck may work to reduce pain by creating the necessary stimuli to eliminate the negative adaptations that have occurred secondary to pain and/or injury.
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If you are struggling with neck pain, here are three strategies that may help reduce your symptoms.
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1️⃣ Soft Tissue Mobilization: In this video, @charleeatkins demonstrates how a ball can be placed to relieve tension or discomfort in the area of the upper trapezius or levator scapulae muscles.
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2️⃣ Shoulder Shrug: This exercise is great for activating many of the major muscles that run from the shoulder blade to the neck and skull. Even though a strengthening exercise may seem counterintuitive, many people experience substantial relief with this approach.
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3️⃣Lateral Raise: Another exercise that conditions many of the shoulder and neck muscles and can help to reduce tone in overactive muscles.
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📚Andersen LL, et al. Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain. 2011.
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#RehabScience

💥KNEE JOINT💥
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Great dissection of the lateral knee from @seattlesciencefoundation.
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Swipe ⬅️ to see what an extremely positive varus stress test for a torn lateral collateral ligament (LCL) looks like. Thanks to @dr.smith_dpt for the video.
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💥SCAPULA EXERCISES💥
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The scapulothoracic joint (interaction between the shoulder blades and rib cage) is an important component of the shoulder complex. When shoulder pain is present, make sure you do not neglect this area.
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In these videos, exercises that are designed to help improve scapular positioning are demonstrated. These are often helpful in terms of reducing pain and/or clicking that someone may be experiencing during shoulder movement.
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1️⃣Pec Minor Release: the pectoralis minor muscle can pull the scapula into a position of anterior tippping, which is often thought to be associated with altered scapular mechanics. By massaging the pec minor first, it may be easier to actively position the scapula before engaging in other exercises.
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2️⃣Anterior Myofascial Wall Flexibility: These simple snow angels on the ground or a foam roller can be used to stretch the pecs and the rest of the anterior chest, which can help the scapula tip posteriorly and sit in a more neutral position.
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3️⃣Motor Control: The goal in this drill is to teach your nervous system how to tip the scapula posteriorly as many of us naturally sit in a position of increased anterior tipping. With each of the next exercises, try to maintain this new position.
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4️⃣Serratus Anterior Activation: this wall drill helps one learn how the serratus anterior muscle naturally works in function. The goal here is to try to move the shoulder blades through upward rotation (think about the bottom point of your shoulder blade spinning out to the side of your body).
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5️⃣Serratus Anterior Strengthening: now that you know what it feels like to rotate the scapula using serratus, we will add body weight in order to strengthen the muscle.
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6️⃣Loaded Row: lastly, the goal with this rowing exercise is to take what you have learned about positioning the scapula and integrate it into a more traditional strengthening exercise like the row. So, don’t let the scapula tip or roll forward, but instead tip it back and pull it toward your spine as the arm draws in during the row.
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🎥Thanks to my friends @josiiiiiah and @alexisanderson204 for demonstrating these drills!
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#RehabScience

💥DYNAMOMETRY💥
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➡️For many years, clinicians have believed that the strength ratio between the hamstrings and quadriceps (H:Q Ratio) was a useful predictor of one's likelihood of sustaining various non-contact injuries including hamstring strains and ACL tears.
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🔎Two recent studies have pointed us in new directions and may have uncovered new findings that could lead to training program changes and decreased injury rates.
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1️⃣The first study (cited below) demonstrated that the traditional isokinetic test for determining the H:Q ratio was a weak predictor for determining the likelihood of hamstring injuries in 614 professional soccer players across their competition season.
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2️⃣The second study, stated that traditional testing has always been done when subjects are not fatigued. If we think about 'real-life' application, it probably makes good sense to test subjects while fatigued. So, they did just that. The authors reported that hamstring strength decreased dramatically and the H:Q ratio was decreased significantly at the end of the test. The authors pointed out that future prospective studies are needed to validate the H:Q fatigue ratio test in terms of predicting ACL and hamstring injuries.
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📚Van Dyk N et al. Hamstring and Quadriceps Isokinetic Strength Deficits Are Weak Risk Factors for Hamstring Strain Injuries A 4-Year Cohort Study. Am. J. Sports Med. 2016.
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📚MD Pinto et al. Hamstring-to-quadriceps fatigue ratio offers new and different muscle function information than the conventional non-fatigued ratio. Scand J Med Sci Sports. 2017.
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#RehabScience

💥GROIN STRAIN💥
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💪The hip adductor (groin) muscles run along the medial thigh and are responsible for returning the hip joint from an abducted position to closer in line with the body (adduction) and stabilizing the lower extremity during closed-chain activities such as standing, hopping or propelling off of one limb in a side to side fashion.
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✅Of the major adductors, adductor longus is thought to be the most commonly strained muscle, but any of the adductors could be involved. The most common site of injury is at the musculotendinous junction as the sarcomeres (functional unit of skeletal muscle) in this zone are thought to be less elastic. Injuries to the adductor group are often associated with movements such as kicking, pivoting, skating and sprinting, and a number of sports including hockey, gymnastics, soccer, martial arts, football and track and field.
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🏋🏼‍♂️Although stretching can sometimes be useful for reducing pain after a strain, the focus should be on resistance training exercises as these will work to restore tissue integrity and help prevent re-injury. In a study by Tyler et al, an adductor resistance training program was found to be an effective intervention for reducing the frequency of adductor strains in hockey players. So, whether recovering from an adductor injury or looking to prevent one, try these exercises as they will specifically target this muscle group and increase overall tissue capacity.
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📚Tyler TF, et al. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med. 2002.
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💥Achilles Rupture💥
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Here is a great post from @tatfitpro that discusses options following an achilles tendon tear and his personal experience with this injury. In my previous post on this topic, many people asked about ways to reduce the risk of suffering this injury. The major strategies here involve implementing regular exercises that increase the capacity of the tendon. The two best strategies here are resistance training (calf raises) and plyometric drills such as hopping.
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⬇️Here is some info on this injury from @tatfitpro⬇️
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The achilles tendon connects the calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone). In this MRI, you can see the white line on the posterior side of my leg that is ruptured (fully torn). There are three options after this occurs.
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1️⃣: Open surgery
A single large incision is made in the back of the leg, the sheath is cut open and the ends of the tendon are sewn together ✅Pros: 10% less likely to rerupture, slightly quicker recovery time
✅Cons: Chance of infection, interruption of the natural healing process, possible surgical complications
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2️⃣: Percutaneous surgery
Instead of one incision, a few small incisions are made to bring the tendon closer and reattach the tendon
✅Pros: Less intrusive to the tendinous sheath, decreases likeliness of infections
✅Cons: Not offered everywhere
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3️⃣: No surgery (My choice this time)
The athlete is put in a walking boot with heel lifts to cause the tendon ends to approximate and reattach. ✅Pros: no risk of infection, still likely to have full recovery
✅Cons: increased calf atrophy, vigorous rehabilitation required to gain back strength from gastroc and soleus.
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#RehabScience

💥Patellar Tendon Rehab💥
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Patellar tendinopathy is characterized by pain at the anterior aspect of the knee, especially near the inferior pole of the patella, that is worsened as knee extensor (quadriceps) demand increases. This condition is more common in males and in sports such as basketball, volleyball, football and tennis as these activities require the patellar tendon to repetitively store and release energy. When the tendon is challenged beyond it's capacity or not allowed sufficient rest, the risk of developing symptoms increases.
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Although the development and subsequent rehabilitation of patellar tendinopathy can be frustrating and lead to time off from sport, it does appear as though a exercise, especially a progressive resistance training program can be effective in restoring tendon health. Give these exercises a try and let me know if you have questions.
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1️⃣Goblet Pause Squat: the goblet squat can be a good choice for loading the quads and patellar tendon as the placement of the dumbbell causes the trunk to remain more upright, which tends to lead to increased quad recruitment. Also, isometric contractions seem to be very useful in the treatment of tendon pain problems, so adding a pause at the bottom of the motion could help expedite one’s recovery.
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2️⃣Rear-Foot Elevated Split Squat: this exercise works the quads and the glutes, but is a nice option in that most of the load is supported by the front leg. In the case of patellar tendinopathy, this may allow the individual to more easily isolate the painful leg.
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3️⃣Eccentric-Focused Decline Squat - This variation more specifically loads the patellar tendon as compared to a traditional single-leg squat. Make sure to lower down on the painful leg.
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📚Malliaras P, et al. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Review article. J Orthop Sports Phys Ther. 2015.
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📚Rutland M, et al. Evidence-Supported Rehabilitation of Patellar Tendinopathy. N Am J Sports Phys Ther. 2010.
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#RehabScience

💥RUNNING BIOMECHANICS💥
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Video motion analysis in the frontal (side to side) plane can be an extremely powerful tool when looking to understand how an individual is controlling the hip, pelvis and trunk. A lack of strength and/or motor control at the hip joint can alter biomechanics including increasing dynamic knee valgus (inward knee collapse), creating excessive contralateral pelvic drop or increasing trunk lean. Each of these changes can be associated with pain and injury.
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In runners, for example, a lack of frontal plane hip control can lead to increased hip adduction (landing leg moves toward swing leg) and may predispose a person to a number of conditions including patellofemoral (kneecap) pain syndrome, IT band region pain and low back pain.
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In many cases, the issue here does not have as much to do with muscle strength as it does with motor control. Most people get better by simply learning to control their hip better and move with a slightly different pattern. The study cited below demonstrated that a simple motor control training program where runners ran on a treadmill that faced a mirror was effective in teaching new movement patterns, such as limiting hip adduction, and decreasing knee pain.
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📚Willy RW et al. Mirror gait retraining for the treatment of patellofemoral pain in female runners. Clinical Biomechanics. 2012.
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🎥 Software: @simi_reality_motion_systems
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💥ANKLE SPRAIN💥
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Shown here are a few strategies that are often helpful when recovering from an ankle sprain. It should be noted that this is only a short list of options and different interventions may be appropriate given an individual’s stage of healing and unique clinical presentation. In no way should what a rehabilitation practitioner posts online be considered a comprehensive plan of care that will help any and all individuals with a given issue. Anyway, here goes!
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1️⃣Dorsiflexion Mobility: It is not uncommon for people struggle with regaining dorsiflexion range of motion (ROM) following an ankle sprain. For this reason, it is recommended that strategies designed to increase dorsiflexion ROM begin early. This is one method in which you can work on this direction of mobility. The key here is to make sure your knee is bent. If the knee is straight, more emphasis will be put on the gastrocnemius muscle rather than the ankle joint.
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2️⃣Evertor Training: The ankle evertors (peroneal muscles) serve as a dynamic stabilizer of the lateral ankle and can play a key role in the recovery process when passive tissues, like ligaments, may have been damaged.
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3️⃣Postural Control: Dynamic postural control is maybe the most important element when looking at reducing your risk of having another injury. The Star Excursion Balance Test (SEBT) shown here is a great test and can serve as an excellent exercise. Place tape on the ground as shown, stand on the injured leg and reach with the uninjured leg as far as you can along each tape line without touching the foot to the ground.
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Give these a try and let me know if you have any questions.
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#RehabScience

💥ACHILLES RUPTURE💥
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Although the achilles tendon is the largest and strongest tendon in the body, it is also the most frequently injured. Tears usually result from situation where the ankle is forced into dorsiflexion while the calf muscles contract in an effort to slow decelerate ankle motion (an eccentric contraction).
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This video is a great example of the injury mechanics associated with a rupture of the achilles. As the calf muscles generate force to control progression of the left ankle into dorsiflexion, we see a rupture of the tendon from its attachment to the calcaneus bone.
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🎥 Credit: @irineu_loturco
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💥ULNAR NERVE REHAB💥
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✅In this video, I have demonstrated two mobilization techniques for the ulnar nerve. These can be useful for individuals who are experiencing pain, numbness or tingling along the inside of their forearm down to the pinky and ring fingers.
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1️⃣First, we see a 'tensioner' position where the nerve is put on tension across it's entire path. In this position, you will likely experience a neural 'stretch', which can feel slightly different than a muscle stretch. Tensioners can be held for several seconds and are usually the first line of defense unless the person's pain is too severe.
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2️⃣In cases where tensioners cannot be tolerated, start with sliders. Sliders involve placing one end of the nerve on tension while the other end is slack. In this example, when the wrist is flexed (nerve on slack at the wrist), the neck is laterally flexed away from the arm (nerve tension at the neck). Then, the neck and wrist positions switch, which creates the sliding movement of the nerve. Try alternating back and forth 10-15 times and use the technique whenever you are experiencing nerve symptoms (pain, tingling, numbness).
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