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

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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.

WHAT CAN YOU DO??

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.

HOW TO LOOSEN THE BACK HIP!?

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

http://www.drbackinaction.com

Beginner Runners….Don’t forget to Breathe!

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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

http://www.drbackinaction.com

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.

KNOW YOUR OPTIONS!

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.

www.functionalmovement.com 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

www.activerelease.com 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.

www.grayinstitute.com 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

http://www.wheelerfascialwork.com 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.

http://www.acrb.org

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!

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.