Injury Prevention Getting it right before the season starts Nate Porcher DC ART DNS FMS
Copyright Dr. Nate Porcher
Quickly About Me
Prospect HS Alum
Taylor University in Indiana – Track and FB Letterman
Trinity International University in Deerfield – FB and Baseball Letterman
National University of Health Sciences –Doctor of Chiropractic
Hundreds of hours of postgraduate training in Functional Evaluation, Rehabilitation, Soft Tissue Correction, Strength and Conditioning
Spent some time working in the training room with athletes at Benedictine University in Lisle
Sports Medicine-Focused practice in downtown Arlington Heights— Foundation Sport & Spine Copyright Dr. Nate Porcher
Topics Covered Common Injuries—why they occur Prevention of Injuries
The Role of the Diaphragm in Core Stability Tri-planar Training for Sagittal Plane Athletes
SHIN SPLINTS!!!! The Benefits of having a sports healthcare practitioner
as part of your team—PRESEASON SCREENING, management of injuries that have occurred Copyright Dr. Nate Porcher
How often do injuries occur?
The most common running injuries Shin splints/stress fractures
Hamstring or other muscle pulls/tears
Plantar fasciitis/Heel pain Patellar Tendonitis/knee pain IT Band Syndrome Low back stiffness/pain
What other injuries plague your program?
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What are your current methods of Injury Prevention? How have these reduced soft-tissue injuries? Once injuries occur, how are you managing them?
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Main cause of most of these injuries In General: OVERUSE (of a bad motor strategy) In Particular:
IT Band Syndrome—weak core/glutes
Shin Splits—more complex (will cover in depth later)
Patellar tendonitis—weak glutes, poor core/pelvic stability, weak tibialis anterior, and dominant quads/hip flexors
Plantar Fasciitis—weak foot intrinsics, weak tibialis anterior, poor hip extension
Low Back Pain—weak core/glutes/improper motor patterns Copyright Dr. Nate Porcher
The “Intangibles” Anatomy Fallen Arch, hip anteversion, integrity of
connective tissue in the body, etc, etc. Body Chemistry/Nutritional Status
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Re-Envisioning the CORE
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The Role of The Diaphragm Is it just for breathing? Let’s take a closer look
at the design of the diaphragm In my clinic—
diaphragm function tested on day one, and diaphragm rehab starts day one.
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One muscle, two amazing functions
Breathing function
Postural function
Diaphragm contracts/ drops
Diaphragm contracts/drops
Decreased pressure in thoracic cavity
Pelvic Floor contracts, stiffens
Air rushes in
O2/CO2 exchange happens
Abdominal muscles reflexively contract (TrA, Obliques, QL, rectus abdominus
Diaphragm relaxes
Elasticity of ribs and lung tissue forces air out
Intra-abdominal pressure increases greatly
Punctum fixum is created
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Creating the Punctum Fixum
What’s the big deal? Why the diaphragm? Punctum Fixum – FIXED POINT
i.e. intra-abdominal pressure stabilizes the anterior hip
capsulethe glute medius attaches to the hip and pelvisstable hip increases glute med firing/stabilability i.e intra-abdominal pressure stiffens the abdominal
fascia, T/L fascia, and stabilizes the rib cagecreates a solid basis for the obliques to pull up and over Need an example? Copyright Dr. Nate Porcher
The role of the ribcage position over the pelvis Intra-abdominal
pressure is compromised by poor posture This will cause buckling
of the lumbar spine and poor core stability, poor base for oblique systems
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How do you know it’s not working
Observations: GOOD
NOT AS GOOD
How do you know it’s not working?
Here are a couple of tests:
Diaphragm Test with Breathing IN
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Another test
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One more test Intra-Abdominal Pressure (IAP) Test
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How to destabilize the core:
Situps, Crunches, V-ups, supine toe-touches THROW THEM OUT!!
“The spine only has so many bends before a disc will
herniate.” Stu McGill –University of Waterloo 3,350 Newtons of compressive force in the disc with them PLUS, They’re NOT FUNCTIONAL!!
Copyright Dr. Nate Porcher
Some basic exercises for stabilizing the core Use (some of the tests) as the exercises Have athletes gain awareness/ability to use the
diaphragm first as a muscle of respiration Have them start to gain awareness/ability of the
postural/stabilization function Side bridge/plank progression 4-way bench planks Supine IAP test in Triple Flexion (knees, hips, and
ankles at 90 degrees Can add physioball as an advancement Copyright Dr. Nate Porcher
More Exercises Bird Dogs– must maintain proper stabilization
strategy of core and KEEP BREATHING.
Complex exercises
Variations of Side Planks (remembering to have intraabdominal pressure)
Once the Core is Solid Implementing the role of the oblique muscle slings Dynamic movements using the slings to move Chops, Lawnmowers (for power)
i.e. throws, running, etc.
Dynamic movements using the slings to stabilize i.e. throws, running, etc.
Copyright Dr. Nate Porcher
Continuing Onto Global Exercises
This idea of increasing abdominal pressure NEVER
GOES AWAY with any exercise! Guess why these guys wear belts when lifting?
Triplanar Training for the (primarily) Sagittal Plane Athlete
Copyright Dr. Nate Porcher
What exactly does that mean?
Review of Planes of Movement Sagittal Coronal/Frontal
Transverse
Examples of Poor Stabilization
Another Example
Another Example!
Combined Frontal/Transverse Plane Instability
Contrasting Those Examples With Olympic Athletes
Two Bads and One Good
Making Basic Lifts Tri-planar Sometimes with movement, sometimes with stability Use Dumbells or (better yet), Kettelbells Squats Goblet, 90, Overhead
Lunge. 90, overhead Single-Leg RDL
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Making it even better with Therabands® Lunges, step-downs with Therabands® Tri-Planar Squats (from the last few slides)
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Tri-Planar Plyos Jumping Lunges Tri-Planar Box Jumps
Burn-outs
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SHIN SPLINTS Dr. Nate Porcher DC ART DNS FMS
Why do all my athletes have shin splits? Medial Tibial Stress Syndrome: 1st things 1st—Rule out Stress Fracture/Compartment
Syndrome 2nd—Understand the tissue pathology 3rd—Determine the appropriate course of action 4th—Implement the appropriate course of action
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RSI of soft tissues in general and shin splints in particular RSI—Repetative Strain Injury
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What’s the latest Research Say?
Bennet et. al. The relationship between isotonic plantarflexor endurance, navicular drop, and exercise-related leg pain in a cohort of college crosscountry runners. International J Sports Phys Ther. 2012 Jun; 7(3): 267-78.
Greater Navicular drop tend to have greater chance of leg pain
History of shin splints in last month 12X more likely to re-develop
In other words...
Yuksel et. al. Inversion/Eversion Strength Dysbalance in Patients with Medial Tibial Stress Synrome. J Sports Sci Med. 2011 Dec; 10(4): 737-42.
Prolonged pronation will lead to longer lasting traction stress on the soleus fascia, which in turn can facilitate the development of MTSS (all due to stronger evertor muscles)
Also, likely due to less eccentric power/strength/endurance of the medial soleus
Rathleff et. al. Dynamic midfoot kinematics in subjects with medial tibial stress syndrome. J Am Podiatr Med Assoc. 2012 May-Jun; 102(3): 205-212.
More navicular drop, faster navicular drop Copyright Dr. Nate Porcher
My thoughts...
If they need orthotics—send them, this will help with navicular drop velocity and depth.
Still—orthotics are not the final solution, but one piece in the puzzle!
Should be combined with “short foot” training, coronal plane glute med training
=less contralateral hip drop, less internal rotation lower leg, less pronation of the midfoot.
Isokinetic strength does not equal plyometric power.
Eccentric strength of the lower shank external rotators (i.e. GLUTE MED/MIN) is a driving force behind decreasing overpronation in the foot.
Exercises that get the soleus to adapt rapidly from an eccentric muscle to a concentric one should be implemented (plyos, blind box drops, tri-planar burnouts
Correct tissue pathology, because ice, rest does not heal fibrotic, tight, painful scar tissue. Send them for this too! Copyright Dr. Nate Porcher
How to I break the cycle? Break up the adhesions: Best two ways: ART® (Active Release Techniques®),
and FAKTR® (Functional and Kinetic Treatment w/ Rehabilitation®) Correct joint restrictions to proper biomechanics Subtalar eversion restoration
SI joint mobilization (if it’s no moving, the glute med
won’t fire properly!!)
Copyright Dr. Nate Porcher
How do I break the cycle?
Dampen the inflammatory cascade:
With proper nutrition (Diet high in Omega-3 FA, avoidance of high Omega-6 foods)
Re-Train:
The short foot muscles (dampen forces through the ML arch and T Arch)
The G Meds/Mins to dampen internal rotation forces experienced from ground reaction forces.
Plyo/reaction strength/power of Gasroc/Soleus mm.
Any other multiplanar instabilities with tri-planar training.
Use Corrective Taping, when warranted
KinesioTex Tape—change muscle firing, help drain. Copyright Dr. Nate Porcher
Pre-Season Functional Movement Screening
Gray Cook—The guy behind the FMS™ screens “What often happens is people are putting exercise and
performance on top of dysfunctional movement, which can impair performance and cause injuries” Copyright Dr. Nate Porcher
Who should get screened? All athletes who are pain-free, and wanting to perform
at a high level. (Sound familiar?) WHY?
The screens identify imbalances side to side The screens identify the weak link in the chain The screens point to corrective exercise strategies to help
optimize later training and prevent injury
(The athlete who experiences pain with the screen should
be referred to a healthcare provider)
The screen should always be used as a follow-up tool to
monitor progress
Copyright Dr. Nate Porcher
How to implement the screen Pre-season screening by certified FMS practitioner
Develop categories for athletes with different types of
dysfunction to fit into
Develop programs for those athletes--add it into their
resistance program
Be judicious about what full-body lifts to use with athletes
who have poor dynamic function, ease them into them once base function is corrected/core is strengthened
When an athlete has pain—send them for professional eval
RIGHT AWAY
Don’t let the injury progress to a season-ending situation! Copyright Dr. Nate Porcher
Thank you!
Copyright Dr. Nate Porcher
Image Resources
Title page:http://www.erinchapmanfitness.com/wp-content/uploads/2013/05/shin-splints-ice-1.jpg
http://www.runaddicts.net/wp-content/uploads/2010/06/injuries-664x300.png
Diaphragm diagram: http://balancedbodymind.com/wp-content/uploads/2013/10/ijspt-08-062-f002.jpg
Diaphragm diagram 2: http://www.muscleimbalancesyndromes.com/wp-content/uploads/2012/04/Kolar-inspiratory.jpg
Turtle Shell 6 pack:http://www.ign.com/boards/threads/attn-people-that-give-fitness-advice-to-others-on-the-boards.452450163/
Exercises: http://www.gymra.com/blog/strength-training-for-running/#!prettyPhoto
Westside Barbell: http://www.criticalbench.com/westside-barbell.htm
Running: http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=Eck7FY0cvHEasM&tbnid=gT32iHT1v3f2M:&ved=0CAEQjxw&url=http%3A%2F%2Fwww.iachiropractic.com%2Fblog%2F10-things-i-learned2012%2F&ei=Vo3NUvoRho3aBYitgJgK&psig=AFQjCNEaDgmd43LiMONBGmbeOiEbF3Sn7A&ust=1389289159110539
Diaphragm tests: All copyright Prague School
http://runnersconnect.net/wp-content/uploads/2013/05/RC8_GluteMedius_Role-300x195.jpg
Shin splits:http://www.drxuacupuncture.com/wp-content/uploads/2011/07/Fig-7.23.jpg
Copyright Dr. Nate Porcher
How to reach me: Nate Porcher DC ART DNS FMS
Email:
[email protected] Office: (847) 342-3000 Web: www.foundationsportspine.com Location: 115 N. Arlington Heights Road Suite 104 Arlington Heights, IL 60004 Copyright Dr. Nate Porcher
