Deceleration Injuries in Baseball Pitchers


In reference to a right-handed pitcher I will discuss the proper biomechanics of the pitch and likely areas to accumulate stress and strain from unlikely sources.

Have you ever thought of the left foot being the cause of right shoulder injuries such as rotator cuff and bicep tendonitis?

Have you thought of the right inner thigh as the reason for slower speed in the throw?

How important is the left hip flexibility in preventing lower back pain?

If you have ever wondered about the “Why” behind the obvious “What” please read on!

It’s easy to diagnose what the injury is (tendonitis, muscle or tendon tear, stress fracture) but how many athletes undergo thorough evaluation of why it occurred in the first place? Yes, it is true that repetitive motion can cause these things but what if there was a way to prevent or slow down the destructive process?

In a right handed thrower there are a few key points to look at in their body movement. As soon as the left foot hits the ground the maximal load is on their shoulder. It’s the point where the more length you can generate the more power you’ll have. So you can imagine if the inner thigh of the right leg or hamstring on the landing leg were at all tightened it could potentially cause an early acceleration of the trunk and throwing arm. Such timing of a highly repetitive motion can accumulate tension on the anterior (front) part of the shoulder including the bicep tendon. It can also be the cause of many side arm techniques that lead to elbow injury.

And let’s look at the landing gear! How important is the ability to balance on one leg not to mention being stable while the mass and momentum of your body spins around it!? If the arch of the foot is flat or unsupported you can see how that could impact the rest of the body in the throw. The foot itself could be the culprit in early acceleration of the arm and also faulty deceleration of the body over the landing leg. Consequently a restricted hip on the landing leg could lead to the lower back compensating that extra torque which it is not designed to do. With this understanding of throwing mechanics how important do you think Flexibility is in training!? If you aren’t currently incorporating sport specific flexibility training in your daily routine it’s not too late to start.

Dr. Donna Copertino is the Director of Back in Action: Athletic performance training center and Founder and Lead Instructor of For free Sport Specific Flexibility training we recommend or Youtube channel Standard of Flexibility

Saving our Young Athletes: Help Raise Awareness!


There is an epidemic happening in youth sports. Injuries are occurring from overtraining or in my opinion under-training in flexibility and mobility.

High School athletes account for over 2 million injuries per year! (Journal of Athletic Training) Over 500,000 sprain/strain injuries occur each year in our teenage athlete population. That’s too many!

Here are my questions:

  • Why are so many sprains and strains happening in non contact sports?
  • Can they be prevented?
  • Are athletes spending time on flexibility?
  • How many injuries have caused lost time at play?
  • How many injuries have caused a lost season?
  • How many injuries have ended a career? A college Scholarship?

If you have wondered the answers to any of these questions you are not alone. Every time I see a new athlete in my clinic I ask the same questions, what do you do for flexibility training? How often do you stretch? The answers are usually astonishing, “not much” or “only a little bit”. When I ask why not they usually tell me the coaches don’t do it because there is not enough time.

What that tells me is that either they don’t know the value of it or they simply don’t know how to do it. I have offered several times and at various locations to come into the high schools and demonstrate FREE flexibility training, even sport specific programs. Every time I get the same answer, “We already have an athletic trainer here doing that and we don’t want to step on their toes bringing in someone else”. REALLY??!!

Here’s my dilemma that I NEED your HELP with:

Help me to educate TEAM SPORTS about the importance of flexibility training. DEMAND that every sport and every team have DESIGNATED time for flexibility training.

I want to pioneer a STANDARD of Training that everyone can utilize. I don’t need acknowledgment or financial gain from this, I simply want to see less children getting injured. Our motto is simple:

Move Better. Perform Better


  1. Talk to the Athletic Director at your school and ask what their policy is on flexibility training. If they don’t have one, email me that person’s contact information so I can offer help. If they do have one, ask for a copy then send it to me for review of effectiveness
  2. Begin your own flexibility training program and see if you feel better and perform better. I have some videos posted that can give you a good start. A professional video of my Standard of Flexibility is underway currently.
  3. Make some NOISE! Start talking about this among friends, family, coaches, anyone. See for yourself how much we can improve this area of youth athletics. Comment on this Blog, share it with as many as you can and let me know how loud our voice can be.

The CRITICAL age for injury is 15 years old! I see more injuries at this age than any other. This is a pivotal age in development when growth plates begin to close and that super bendable little girl/boy who we marveled at as they never seemed to tire out suddenly feels tension, restricted motion, pain! We all know that as we get older our bodies begin to stiffen.


Truer words were never spoken. Our young athletes that we enjoy watching on the field or on the court, supporting and encouraging all the way to do their best and get better NEED our protection too! They want to please the parents and the coaches and their teammates as well as themselves. There seems to be no shortage of advice on how to get stronger and play better yet no one is saying, “Rest, Relax, Sleep, Meditate, Breathe, Stretch!”

There are many aspects to being the BEST at a sport. Just look at the entourage of people that work for Professional sporting teams. It’s a full time job being a Pro. Our children admire them and we need to too. Admire their dedication and commitment to their sport but also admire all the preparatory work that takes place too.

Our kids start young in athletics and never seem to have an ‘off season’. They play multiple sports and are on multiple teams. Their developing bodies are failing by the middle of high school where performance should PEAK not slow down.

If you agree with what I am saying and you’d like to see me develop a Standard of Flexibility Program for our youth please LET ME HEAR YOU! Comment here or send me a private message.

Let’s make a change!

Dr. Donna Copertino, DC, DACRB

Director of Back in Action: Athletic Performance Training Center

Spinal Stress Fractures in Athletes. Who’s to blame?

Back in Action


There is a growing concern happening now to our young athletes. Lumbar Spine stress fractures are on the rise. Who is to blame?

Stress fractures occur because of overuse and repeated tensions, usually a torque, on the bone. It can happen as a change of activity or too much of the same activity. In the case of spinal stress fractures, in the lower back, it is commonly found in athletes who use a high amount of rotation (baseball pitchers and hitters) or in those that have to quickly change direction of movement (soccer, tennis).

“In the confrontation between the stream and the rock, the stream always wins–not through strength but by perseverance.” – H. Jackson Brown

Repeated stress on a bone no matter how strong it is will eventually wear down and break. In the cases I have been seeing lately there seems to be an alarming number involving the lower…

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Spinal Stress Fractures in Athletes. Who’s to blame?


There is a growing concern happening now to our young athletes. Lumbar Spine stress fractures are on the rise. Who is to blame?

Stress fractures occur because of overuse and repeated tensions, usually a torque, on the bone. It can happen as a change of activity or too much of the same activity. In the case of spinal stress fractures, in the lower back, it is commonly found in athletes who use a high amount of rotation (baseball pitchers and hitters) or in those that have to quickly change direction of movement (soccer, tennis).

“In the confrontation between the stream and the rock, the stream always wins–not through strength but by perseverance.” – H. Jackson Brown

Repeated stress on a bone no matter how strong it is will eventually wear down and break. In the cases I have been seeing lately there seems to be an alarming number involving the lower Lumbar vertebrae. The parts of these bones that are breaking are a result of repeated torque or rotation of the spine caused by overuse. Normal body mechanics of the spine show that on rotation and extension (bending backwards) the vertebrae get closer together and in some cases can even touch together. In a controlled and slow manner this wouldn’t be any big deal. In the case of a gymnast who does obvious extreme back bends and tumbling repeatedly compressing these joints you might easily understand how their bones could break under the pressure. But what about the less obvious sports such as soccer and baseball/softball/cricket? What are these athletes doing to cause such compression? They are not bending backward? What can be causing their spine to over-rotate or extend? What part of their body is not working and causing the back to take up the slack?

It’s really very simple. Our bodies move in the path of least resistance. As we are growing and developing as young athletes we tend to overuse the muscles of our hips. We run and play hard and sometimes there is no “off season”. This accumulation of tension around the hips might go unnoticed in younger ages because of how quickly they grow but as we develop into our teenage years our growth slows and hormones shift and we begin to feel the tightness develop. If you are over the age of 35 now are you as flexible as you were when you were 10? Can YOU touch your toes??

As we age our tissues naturally tighten. This means we need to work a bit harder to keep or gain that flexibility. It’s NOT easy especially if you never had to do it when you were younger. If we had learned how to MAINTAIN our childhood flexibility by creating a ‘muscle memory’ for the movement stretch then it would be alot easier to feel loose today.

SO who is to blame???

I blame the HIP! Not a slacker by nature but quite the opposite, a truly hard worker. Tight hips means less motion. Less motion at the hip means less rotation. If we can’t rotate through the powerful muscles of the hip then the next closest area to help out is the lower back. Take the case of an athlete swinging a bat. It takes ALOT of rotation through the spine especially if they miss the ball! Proper body mechanics would allow the HIP to decelerate the power behind that swing and not let you fall off balance if you miss the ball. Ever hit yourself in the back with the bat as you finish the swing?? Not Good! It means your hips are not doing their job.

Look at the full body movement of Soccer players as they accelerate down the field and have to suddenly decelerate and change directions. If you watch them you’ll see upper body and lower body going in opposite directions leaving the pivot point to be the lower back! If there is any loss of rotation through the hips you get excessive load and torque across the spine. Over time the path of least resistance becomes an overstressed bone in the spine that can eventually break under pressure.


This tension is NOT just muscle tightness. It is IMPORTANT to know that the real problem here is JOINT tightness. That is very different. If we can get the back side of the hip moving better it will allow a deeper motion for the muscles like the hamstring and adductors (inner thigh) to get a better stretch. If you don’t loosen up the back hip joint then the muscles can’t lengthen and your motion is altered. This is a reason that you can go through all the right stretches but never really feel loose.


I’ve put together a short video of one exercise we do with every one of our tight hip athletes. The more you do it, the more you’ll remember it and the easier your regular muscle stretches will be.

Please reference our earlier blog titled: 3D Warm up and Flexibility: Lower body for more ideas to further loosen the hips.

If you are experiencing spine pain please get a full evaluation by your movement specialist for a proper diagnosis. Please reference our previous post titled: University Athlete Away from home and Injured…

QUESTIONS to ponder…….

Are we overtraining our youth?

Should there be an OFF season for athletes under the age of 18?

Are the coaches and trainers spending the time for proper warm up and flexibility training?

Dr. Donna Copertino,DC, DACRB, FAFS

Beginner Runners….Don’t forget to Breathe!


New runners who are committed to learning the task and eager to enjoy the reward of that infamous ‘runners high’ sometimes struggle with finding their breath. There is so much advice out there, good and bad, that it can leave someone feeling so confused or frustrated that they just give up on the task before they really get started.

Breathe in through the nose, out through the mouth, or should we breathe with mouth the whole time? Or maybe you’ve read to breathe in on every second step and out on every third? Or perhaps we could try to make grunting sounds as we exhale to warn the person ahead that we are coming and about to leave them in our dust!?  No matter the tip what I believe is that BREATHING IS A NATURAL PROCESS and shouldn’t have to be learned! We also shouldn’t have to THINK while we are running. Don’t we usually run in order to escape life’s over thinking nature?

My question is not HOW to breathe but rather WHY are we not able to breathe? Sometimes there is a physiological breathing problem you may have been born with such as asthma or allergies or cystic fibrosis or maybe you’ve suffered repeated infections and your lungs are a bit scarred down. Repeated coughing can be enough of a stressor to your muscles and leave you feeling tight all over. More often than not though the runners I see who are struggling to find their breath  simply have too much muscle tension in their necks, shoulders and torso that their bodies just aren’t able to give them what they are asking.

We are too STRESSED OUT!

We are like turtles hiding in their shells with our shoulders shrugged up to our ears! Daily life with work, school, kids, families all builds up tensions in our bodies both mentally and physically. Most beginner runners, and even some seasoned ones, have difficulty breathing because of stress and tension in the muscles responsible for proper breathing. Life can be difficult at times and sometimes our tension goes right to our shoulders. Don’t we carry the weight of the world on them?? Do you find it difficult if not impossible to RELAX!? Eliminating the tightness of these muscles can be tricky.

Trying to fit in exercise into our already packed schedules is near impossible so running is the best, fastest way to do it. Seems like a great idea until you get out there and realize that what looks so simple when you watch other people do it is actually quite the daunting task. Suddenly you feel like you’ve reached a new altitude, that somehow you are at the top of Mount Everest where oxygen levels are low and you are dizzy and sweating and gasping for air when it hits you……I’ve only gone to the end of the driveway!

Don’t quit yet! If we can alleviate some of that muscle tension and retrain your body how to breathe properly you’ll be able to find your breath naturally as you pick up your pace. Our bodies know what to do. We were born to run! Sometimes it just needs a little reminder. Below you will find some simple ways to help your breathing issues as it relates to muscular tension.

There are 2 major points I’d like to make about breathing based on my experiences in the movement industry. There are about a million other facts/theories you can learn about online. What I’d like to share with you are MY successes with runners and how we came up with ways to increase the movement of their rib cage expansion and trick the shoulders into letting go. You can either read through the boring (not to me!) Anatomy lesson here or SKIP to the end and watch the video! Ah, if I only I knew what you chose!! Ha. Enjoy either way.

  1. Breathing occurs primarily from the large muscle in the abdomen called the diaphragm and secondarily from the small muscles connecting the neck to the upper rib cage called the scalenes. Shallow breathers can get away with using the scalene muscles if they do not have much exertion during their day. These little guys get overworked and tighten up very quickly. You’ll see this in a typical office worker who sits at a desk most of the day. If you don’t train your diaphragm muscle to breathe deeply it will weaken and your breathing will become inefficient should you need more air.

“If you don’t use it you lose it”

       2. The other important  area required for breathing is the rib cage and thoracic spine (trunk). There are small muscles between the ribs that allow for the ribs to expand and separate on inhalation. There are also layers of longer muscles that connect the spine to the ribs. Tightness in any of these muscles can lead to difficulty in breathing on exertion. If your body is tight in these areas is doesn’t matter how well your diaphragm contracts you won’t be able to expand your lungs if the cage they are in is locked tight!

A 54 year old woman presented to me just the other day stating that she joined a beginners running group so that she could learn to run properly. Her hope was that someone there could help her to run without losing her breath and needing to stop. At first she did well with the 30 seconds of running and 2 minutes of walking but when the group jumped to 90 seconds of running followed with 2 minutes of walking she wasn’t able to recover quick enough. The exertion during the run made it hard for her to breathe so when she stopped she couldn’t regulate her heart rate or breath rate within the two minutes.

What we found was that during a deep breath she would greatly elevate her shoulders which told us she wasn’t pulling the air in by proper use of the diaphragm. She was using the smaller secondary muscles, the scalenes, to get the air in. Also, she had very limited range of motion in her mid spine and rib cage. It’s like trying to inflate a balloon that’s inside a glass jar. It can only expand to the size of the glass. Our lungs can only expand to the size of our rib cage expansion.

As shown in the video we gave her two simple exercises to do daily. First we gave her one to help shut down the scalene muscles so that the diaphragm was forced to work. We did that by having her carry an 8kg kettlebell in each hand while walking and breathing. This heavy weight was enough to depress her shoulders and allow the diaphragm to do the work. At first she had to walk in a very slow pace and take shallow breaths as her body fought the resistance in her depressed shoulders. The small scalene muscles weren’t strong enough to shrug and lift the weights she carried.Within just a few minutes she was able to pick up the pace and breathe a little deeper. Her homework for this was to do it often every day in order to create that muscle memory so that when she needed it she wouldn’t have to think about it.

Next we gave her a movement stretch to help open up all of the other muscles that attach to the rib cage in order to allow for greater expansion. This was performed in a doorway but can easily be performed against a wall too. The instructions are simple:

  1. Stand in a doorway and turn to one side holding onto the side molding
  2. Let one hand go and reach overhead in a side bend while allowing your hips to lean out way from your reaching hand
  3. Repeat with the other hand reaching overhead while bending to the side
  4. Turn to the opposite side of the doorway and repeat the overhead reaches on each side.
  5. After warming up the ribcage and spine with these movements repeat the pattern but stop within the stretch and take a deep breath and hold 5 seconds to allow the muscles in between the ribs to stretch.

As with all of the exercises you’ll see from me it is recommended to perform frequently throughout the day in order to create muscle memory and efficiency of movement. Your body will remember something if it is performed for just a few seconds multiple times per day rather than once per day for a longer time. More often is better than more time!

Here is a video clip to demonstrate these simple exercises. As with all activity please be sure you are cleared by your movement specialist to perform such task without injury.

Breathe on and don’t forget to inhale!

Dr. Donna Copertino

You are a University Athlete, Away from Home and You are Injured. What do you do?

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Find the right TEAM of experts to work together to fix you!

Your School provides the very best they know but sometimes we need more!

Here I hope to provide you with the insight that there are professionals out there who have studied the latest in therapies, body mechanics and evaluation procedures that your school might not know about. My hope is to educate you on some of these options and how to find them.

So many times I have a patient who comes home from college on a break and they want to be evaluated for their injury that isn’t quite getting better fast enough. They’ve received the best of care by the team medical staff but still feel less than 100%.  Some have returned to play but feel as though they can’t perform as well or maybe have a fear of reinjury so they hold back. Some are fearless and play hard but get hurt soon after their return and now they are frustrated. Once in a while you get that really bad one that needed surgery but just can’t seem to get back in the game.

No matter the situation they all have a similar issue; they need help. In some cases they have to wait until they get home, talk with their parents and hope to see a Specialist that can fix them. Oh, and get that all figured out in the three weeks that they are off from school! Or better yet, in the fours days they are off because they have to get back for practice.

As a parent you want what’s best for your child. You helped them find their sport, watched them excel and finally support and admire them while they play at a University level.

If they are injured you trust that the physicians and trainers and therapists at the University are taking the best care of them. After all, it IS a Top school in a major city surrounded by teaching hospitals and the world’s best research programs. Clearly they are in good hands and wouldn’t possibly need anything more!

As an athlete you would do anything to stay in the game, work through the pain, seek a second opinion, do all of the exercises, ice, heat whatever it takes just tell me what to do!! Right?

Why is it that even our professional level athletes who have access to the best of the best sometimes go out on their own to find the latest in therapies and travel out of the country for it?

Do we need to travel far and wide to find the right expert? Or is it that we just don’t know what or who we are looking for? My point is there are great people everywhere. Maybe the problem isn’t where to go to find them but WHO exactly do we need? We need a team!

“The Whole is Greater than the Sum of all its Parts”Aristotle

Remember that when you are trying to solve a dilemma  you might need more than one expert for the solution. I like to start with these three priorities when searching for WHO might be able to help:

  1. Identify the problem (What is injured? What type of specialist do we need?)
  2. How do you Fix it? (What are our options??? Corrective Exercise, Muscle Release, rehab, Therapy? Aren’t they all the same??)
  3. How do we prevent it from happening again? (Get to the source, the cause. Who can do that?)

There are so many professions out there, so many experts in many different fields. It can be difficult to sort out if you are not familiar. It is best to go to someone that specializes in the type of problem you have.  If all we know is Orthopedics and Physical Therapy then we are living in a very narrow minded small world. Remember that there is no one person who can know all and do all for every type of injury. A good physician, trainer or therapist will know when they need help. In many cases you’ll need to work with several different types of providers in order to get back in the game. My hope here is to simply educate you on just some of the other type of professionals or credentials/certifications you can search for should you need some expert opinion. If you are a parent and your child is away and is not responding well enough to their treatment you should have this information handy to guide you in the right direction for help.


I would like to provide you with a short list of Specialists out there and websites with search engines that can help you find someone in the area you need. These recommendations are based on my nearly 20 years of experience and education and what I personally have found helpful in my practice. There are many others that are just as good so please understand that this list is not all inclusive.

I advise parents and athletes too to start NOW and assemble a team of professionals in your area that you might need to find at a moment’s notice. Sometimes you can find one Professional that has multiple credentials so you may be able to combine therapies. Many Chiropractors and Physical Therapists and British Osteopaths will study the same areas so be sure to check out the full list of what they’ve certified in.

Types of Health Professionals to have on your call list:

  • Orthopedic Surgeon – for broken bones or torn parts (Specialist in area injured)
  • Physical Therapist – rehabilitation with at  LEAST these certifications (SFMA, FAFS)
  • Chiropractor – biomechanical correction with at  LEAST 1-2 of these certifications  (DACRB, SFMA, FAFS, ART)
  • British Osteopath – biomechanical correction with at  LEAST 1-2 of these certifications  (MOst, SFMA, FAFS, ART)
  • Massage Therapist – scar and adhesions in muscle (ART, Scarworks)
  • Acupuncturist – pain control
  • Nutritionist – metabolic efficiency testing
  • Sport Psychologist – Better Mind. Better Performance

Here are some sites to reference when searching for these types of professionals.

  1. SFMA: Selective Functional Movement Assessment – helpful in finding the right diagnosis whether soft tissue tension or neurological weakness. Click on Find a Certified Member and select SFMA in your search

  1. ART: Active Release Technique – useful for tight muscles, strains, pinched nerves, inflexibility Click on Find a Provider and search by Location/Zip code. Try to find the provider with the most certifications under their name

  1. FAFS: Fellow of Applied Functional Science – these experts are the TOP in their field who understand body function in 3 dimensions. You can find many types of movement specialists here including Strength Coaches, Athletic Trainers, Physical Therapists, Chiropractors and Osteopaths. Scroll to bottom of page and Click on Fellow Locator and search by location. Be sure to switch your miles radius to the lowest area. GIFT is the program with the highest level of education.

  1. ScarWorks This search is for Scar tissue release. Go to Contact Us and send a message to find a certified provider in your area

5. DACRB: (Diplomate of the American Board of Chiropractic) – These are Chiropractors who continued their post doctoral education in the physical therapy arena.

There are so many other techniques that are out there that can be very effective in the treatment of injuries both old and new. Some of my colleagues are certified in Graston technique, Class IV Laser therapy, Gait Analysis using Optogait system or RunScribe technology. If you take away any message from this post I hope it is at least to search for more than what is traditional or commonly recommended. Find your team of experts in a variety of fields who work together for you!

Coming soon……..Video of Soccer Specific Flexibility Training!

How stubbing a Big Toe led to a Soccer Player’s Collapse six months later!


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.

The Poor Knee. Caught between a Rock and a Hard Place

imageI’m sure sometimes the knee just wants to give up! Think about it. It’s designed to be primarily a hinge joint, like the hinge of a door functioning mainly in opening and closing. What happens if the door hinge is crooked? It means something shifted and is no longer aligned properly. The door might begin to rub on the top or bottom depending on how it’s hanging right? Or possibly the hinge itself will wear out from the stress and break! Like the door our knee is designed to mainly open and close or as we say flex and extend or you might say bend and straighten. This works great if the leg is straight such as in walking a straight line. What happens when we cross our legs or need to make a turn to go somewhere? That movement requires pivoting which comes mainly from the hip socket and even from the ankle. Those joints are built for multiple directs, 3D!

The knee is caught between a rock (the ankle) and a hard place (the hip)  with nowhere to go. The lower portion of the knee (tibia) is dependent on the ankle to tell it where to go. If the foot wants to support the body to squat down to sit in a chair the ankle has to bend and the knee must obey. Just try to stand and bend your ankle without bending your knee! Impossible!

The upper portion of the knee (femur) relies on the powerful 3 dimensional ball in socket hip to tell it what to do. In the same squat analogy to sit down the hip has to bend and roll backwards. Try to do this without bending the knee! Ha. Now you just look funny!

So it’s fair to say that the simple act of sitting in a chair requires good communication between the hip and the ankle with the knee as the in between, monkey in the middle! One false move on anyone’s part and the knee gets it!  The more complicated the move the harder it is on the knee if the other parts aren’t doing their job. Most of us have experienced tightness in the legs or stiffness in the joints. What can you do about it? How can we train the knee to be ready for all of these movements?

Like everything else you’ll learn from me there is a way to help these movement patterns and that is through 3 dimensional training using lots and lots of repetitions throughout the day to create Muscle Memory!!

Here’s a few pictures of some athletes in action showing just how much our knees actually do move and why it’s important the hip and ankle are ready for action. There is one picture that shows an injury occurring that maybe could have been prevented with this type of training and there is one pic that, well, you just cannot prepare for! Ouch! Can you find them?

A video to follow will give you the start of an exercise matrix that is designed to prepare you body for movement in all directions. We use arm movements to drive the hip and knee into a change of direction. It’s in the deceleration part of the movement where the most benefit takes place. If we can control our slowing down of a movement and control a sudden change in direction then we are well prepared and at less risk of injury.

Try performing these steps with each leg without the arms, then add the arms moving in the same direction as the leg (in sync), then opposite directions (out of sync), then try it at different speeds, then try it with a 5lb medicine ball and so on with your own creativity. It seems simple but sometimes that’s what we need! You may be surprised at the results though. Enjoy!

3D Warm Up and Flexibility – Lower Body

elephant-balance-300x199The following  video demonstration shows a simple warm up for the entire body which allows communication between all joints from the ground up. It is important to establish this communication of movement to the muscles so that they become aware of the action the body is about to demand on them. Remember from our previous post about Balancing the Hip that the joint commands the muscles so why would you just do a static hold of a stretch for 30 seconds or so as a warm up? Doesn’t make sense now, right?

The second half of this short clip will show you how to warm up the back hip (hamstring, glute), front hip (hip flexor, quad), side hip (adductor, IT band) and ankle (calves, achilles). Some important things to note about these movements:

  1. The movement is full body, meaning that as you move it should start at the ankles and move up through the hips into your upper body. The communication between joints connecting as a chain is the key to proper flexibility. A restriction in one area can lead to compensations in others.
  2. Perform the warm up on both sides! If the demo shows the right foot forward be sure to do the same moves with the left foot forward.
  3. Avoid the Cheat! During what I call the ‘Stride Warm Up’ I will often instruct the athlete to hold an object overhead such as a baseball bat, golf club, Lacrosse stick or any straight item. This helps to improve the quality of the warm up by the unavoidable ‘cheats’ the body may try if, say, the upper body tension is preventing a full body stretch you might see an arm drop in compensation.
  4. Power in the Pelvis! Remember that the hip is a ball in socket joint where the ball is the top end of the femur bone and the pelvis has the socket part. When trying to warm up the HIP we are fixing the ‘ball’ in place and moving the ‘socket’ around it. So, don’t just move your arms in the directions you see, be sure to let the pelvis lead the way. I tell people to use their belly button as a guide.
  5. Kneeling before Standing. In the demo you will see the same movements performed kneeling then again standing. When starting out with 3D hip flexibility it is best to eliminate any kind of ‘cheat’ the body will look for. If we take away the knee as compensation we will allow the hip to achieve more range of motion so start with the kneeling ones until you can feel the proper warm up in the right places. You’ll begin to see how many knee injuries can be avoided by simply allowing the hip to do it’s job. More to come on KNEE safety!
  6. Speaking of safety PLEASE, if you feel pain when performing these movements consult with your movement specialist physician before continuing.
  7. m&m Principle applies! The more often you perform these movements the easier your body will remember them and the more efficient and reproducible your movements will become. More is better! Move Better. Perform better.



Balancing the Hip

hip balance

Are your Hamstrings tight?

Ever been told that your Hip Flexor needs stretching?

Suffering from IT Band Pain?

Have you stretched and stretched and foam rolled and tried therapy only to end up with the same problem of feeling tight and stiff?

If you answered yes to any of these questions then your unbalanced hip might be the culprit.

The hip is considered a ball in socket joint which means it should roll in all directions, forward and back, side to side and rotate out and in. If it does then that means you can handle a change in direction while you are in motion. Ever turn around quickly because you forgot something or someone called your name? If it happened without incidence then you have a balanced hip to thank. If you are an athlete running down a court or field and have to make a cut to the side to avoid your opponent and did so without error then your hip is likely well balanced too. But if you are like many of us the hip joint is the most common to become stiff and tight therefore restricting it’s movement.

I describe the communication between joints and the muscles that move them as the joint being the Commander in Chief and muscles being the obedient soldiers. If the joint has trauma or inflammation in or around it then it will command the muscles around it to protect it at all costs. This means that we can stretch that muscle all day long and it won’t release because it’s doing it’s job of protecting. Joint inflammation can come from overuse or disuse such as prolonged sitting or of course trauma. The key to getting the muscles to relax is to treat the joint first. Sometimes ice and medication just doesn’t work and it simply needs to be coached or taught again to move slowly and gently in all directions. We call this 3D or 3 dimensional flexibility training. If you can gently get into a traditional stretch, say of the hamstring in the back of the thigh, and begin to move your hips in different directions side to side or turning your body each way while in the stretch you will begin to feel the muscle slowly letting go. It’s because the joint is realizing that you want it to move while the muscle is trying to stretch. The ‘soldiers’ are reporting back to the ‘commander’ that all is clear and it’s ok to move out again. This 3D flexibility can be applied to all muscles and traditional stretching patterns. It should be pain free except for the tolerable feeling of the stretch. Some people can tolerate more than others but it is NOT a no pain no gain concept!

Remember that to really gain long lasting flexibility you must create Muscle Memory (m&m)! This occurs by frequent repetition of the movement pattern sooooo……IT’S BETTER TO PERFORM THESE MOVEMENTS FOR 10 SECONDS 20 TIMES PER DAY THAN ONE SESSION FOR 20 MINUTES!!!! More is better!

Perfect balance around a joint allows for efficient movement and maximal strength. What does it mean to have perfect balance? Don’t worry it doesn’t mean you have to stand on one leg while sitting in an imaginary chair, although that is pretty impressive. A balanced joint means that the tensions around the joint are equal and the range of motion of it is maximal in all dimensions. That seems simple but trust me it is less common than you think.

Your first step in gaining a balanced hip is to perform the 3D movement pattern (stretch) for each muscle surrounding the joint. Start with the larger ones like the hamstring on the back side, hip flexor on the front, ABductors on the outside and ADductors on the inner thigh. Use the principles of 3D movement described above to the stretches you already know for these muscles and you will be well on your way to moving better and performing better!