This is a case history of a new patient I recently had the pleasure of meeting. It bears worth for sharing only because it should have never happened to her nor gone this far. It leaves me with questions of whether or not university athletic trainers are holding on to injuries too long without physician referrals. I mean no disrespect to my fellow trainers. Some of my most admired colleagues are athletic trainers. I believe they are well educated and trained but responsible for so many athletes with too many conditions it seems impossible to be all and do all for every one of them. Do universities need a Movement Specialist on staff in addition to the trainers so pre injury screenings can take place? Are our college athletes safe? So many questions I would love to start open discussions on.
For now, here is the story line of a girl, age 20, playing her third year of college soccer. Her 16th year overall and a tremendous athlete who knows no quit.
The following information shows the body’s genius way of compensating and how a chain reaction of body movements to correct a simple issue can lead to bigger ones.
Lets start where I did which was the end of the line. She collapsed on the field while running and complained of a burning sensation across her buttocks. The school trainer evaluated and diagnosed her with sciatica and sent her for X-rays. She was referred to me by a teammate for second opinion.
Sir Isaac Newton said: “To every action there is always opposed an equal reaction”
Here is the timeline of events:
August 2015: the player catches her RIGHT big toe on the turf causing it to jam and hyperflex (bends really far in the downward direction). She experienced intense pain and went to the trainer daily for more than two weeks. She claims it was the worst pain she has ever felt. No xrays were ordered and no referral to a physician. Eventually she could tolerate walking and running so with her desire to return to the game she started to play again.
September 2015: The player reports to the trainer with LEFT groin pain that hurts with running. He treats her for a hip flexor strain and tells her to foam roll and static stretch. She continues to play.
November 2015: She complains to the trainer that both hips feel really tight and her hamstrings are sore. He tells her to stretch and foam roll more.
December 2015 – March 2016: After a well needed break over the winter her body rested and she returned to pre-season training in February. Weight training and power lifting was the main focus without much emphasis on stretching or flexibility training. No review of her previous injuries were discussed.
April 2016: The player is running down field in a game and goes to make a cut and collapses on the field with severe burning in her buttocks. Confused and frightened she realizes she can hardly walk and in no way could she run. Same trainer diagnoses her with sciatica and recommends a course of treatment with possibility of referral for xray of her spine. At a teammate’s persistence she schedules an evaluation for movement assessment and cause of injury.
First let me break down how we approach an athlete with such an issue. First, we must understand fully what her position is and what body movements are required for good performance. Next we must know what other repetitive movements her body goes through on a daily or regular basis (school, work, hobbies,etc.). Finally we need to know what other injuries she has had in her LIFETIME not just recently.
This information, which is just through interview process, is vital to understand where her body may have started to fail and compensate. You see, it’s easy to evaluate her for her pain. Most any educated therapists could palpate her, do ranges of motion and orthopedic and neurologic testing and come up with tight hamstrings, hip flexors, piriformis, IT band, etc. and diagnose her with sciatica or maybe even a pinched nerve in her spine.Most then would come up with a program to “loosen” the tight muscles and rehab her to squat properly, strengthen isolated muscles with resistant bands or weight machines and perform static stretching daily, holding for a count of 10-30 seconds depending on what article they’ve read.
Our evaluation only starts with the interview in order to point us in a possible direction of WHY this injury occurred! We want to know WHAT hurts but more importantly we want to know WHY it hurts! What good does it do to loosen these areas and perform strength training if you never really determined what caused the body to create all of that tension?
Our movement analysis revealed a lack of motion in her right foot that caused her to fall off balance when rotating her body left and right. Her right hip was locked up and restricted with side to side motion. She had no ability to extend her spine or her hips on ether side while in the standing position. This may not mean alot to you yet but for me it was a confirmation of where her cause might be coming from.
After completion of all of our testing methods it was determined that the reason she collapsed while running down field was that her main power generators, the glutes, were turned off! If you shut off the glutes, the butt muscles, your lower back will spasm and you will fall in pain. What makes the glutes turn off? Tightness, extreme tension that causes inflammation of the hip can lead to joint locking. As previously discussed in Balancing the Hips our joints are the Commanders of the muscles. This girl had been building up tension in her hips for so long that when she was running along they inflamed and finally gave the signal to surrender. The ole ‘straw that broke the camel’s back’. Interesting to note here that the Sciatic nerve passes underneath these powerful hip muscles and can be pinched as a result of this tension.
Overtrained and overused muscles therefore overworked joints lead to inflammation. When you are not taught how to do proper flexibility training that emphasizes movement you are left with the compounding effect of tension on the joint and muscles involved. The better the athlete the harder they train. No quit No surrender. They work and work and work without worry until…..something happens. What’s the old saying, ‘you can lead a horse to water…..?’
Here’s what I think happened to our soccer player and why I think her body didn’t FAIL her but rather PROTECTED her. We are divine by design therefore will not injure ourselves but rather find ways to compensate, find the equal and opposing reaction. If you follow her history she first injured her right toe. My evaluation of this showed restricted ankle and arch movement. Her body protected the injured toe and locked up a safety zone around it to avoid movement. No one looked at this movement malfunction. Her body then tried to shift weight to the opposite side. If you are running and you can’t toe off properly you are likely going to lift your legs higher therefore using or overusing your hip flexor (September injury). When this compensation was no longer effective the body started to try to find balance through the most mobile joints we have, the hips (November complaint). A rest was helpful for some of the overuse tension but without the correction of locked joints and retraining proper movement patterns required for soccer her body soon remember all that was wrong.
It didn’t take long with the weight training and return to play for the body to tighten up. I believe that as she ran and the hips tightened and inflamed more her muscles shut down and her back spasmed to protect and down she went.
Our first treatment session attacked the source which if you have been following along it was the right big toe! Using various manual soft tissue techniques we unlocked the toe, the inside arch of the foot and gave her 3D flexibility exercises to do. The only other thing we did was release the long occurring tension in her hip capsule (joint) following up with 3D flexibility. As expected the muscles around the hip (hamstrings, hip flexors, glutes, etc) let go and allowed the stretch through our 3D system. In one session she felt light on her feet and loose for the first time in months. And the best part of all she scored a goal in the next game just 2 days later!
The body loves to move! Restoring our natural body mechanics as soon as possible is the key to preventing injury. Had the trainer known how to evaluate and treat the jammed toe back in August I believe everything else could have been prevented. If every athlete knew how to warm up and train in 3 dimensions and understood the importance of proper joint mechanics in their sport I believe that not only would you see less injuries but you’ll see an overall improvement in performance.
Move Better. Perform Better.