Strong Girls: ACL Injury Prevention for Girls

Strong Girls Fall 2016

Strong Girls Comprehensive Class
This comprehensive small group or individual training program will give athletes the skills they need to decrease their risk of tearing an ACL while learning movement efficiency to increase their performance on the field or court.

Register here for any of our fall classes!

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Proper Technique of Ergometer Rowing

By: Shannon Brown, LPTA

The ergometer, “Erg”, is commonly referred to as an indoor rowing machine. It is used for training with crew athletes and it is also gaining popularity with fitness enthusiasts, especially CrossFit and Orangetheory Fitness, to name a few. Erg training allows an athlete to get a low impact total body and cardio workout.

Erg RowerThere are 4 main components of the stroke:

  1. Catch: Keep arms straight and shoulders relaxed; Shoulders should be ahead of the hips putting the trunk in the 1 o’clock position; Keep shins vertical and feet in full contact of the foot plate.
  2. Drive: Keep arms straight and push through the legs tightening the core bringing trunk to the 11 o’clock position.
  3. Finish: Squeeze the shoulder blades and drive the elbows past the trunk.
  4. Recovery: First extend the arms, then the trunk leans forward as the knees bend toward the 1 o’clock position and, finally, the shins return to a vertical position.

Erg Rowing TechniqueCommon Mistakes:

  • Using only arms/upper body.
  • Engaging your arms and legs at the same time.
  • Not engaging core and allowing your back to arch or hunch.
  • Attempting to row too fast and not engaging your muscles in the proper sequence.
  • Allowing your wrists to come out of a neutral position.

References:

  1. Steer RR, McGregor AH, Bull A. A Comparison of Kinematics and Performance Measures of Two Rowing Ergometers. Journal of Sports Science and Medicine (2006) 5, 52-59.
  2. Tabata Times. How to improve your Rowing Technique. http://www.tabatatimes.com/row-better-now/ Accessed 07/01/16.
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Rehabilitation and Prevention Exercises for Traumatic Lower Extremity Injuries Common in Adolescent Dancers

By: Ashley deLalla, DPT, PMA®-CPT

DancerIn previous posts we have discussed overuse injuries in the adolescent dancer. Today the focus will be on traumatic injuries and what to do if the dancer experiences one prior to a competition or recital. A good strengthening program involving all the muscle groups is the best method to prevent muscle imbalances and weaknesses preventing injuries. Activities like yoga, Pilates, and whole body conditioning keep the dancers in top shape, but when injuries occur, it is important to know the steps to take to get you back on the floor. With any traumatic injury it is important to seek medical attention, especially if your signs and symptoms worsen.

Dancer 2The most common traumatic injury in the adolescent dancer is a lateral ankle sprain. Most dancers experience these injuries when on Pointe, demi-Pointe, or a missed landing from a jump. The mechanism of injury is often rolling over the lateral border of the foot. When on Pointe, the most common ligament involved is the ATFL (Anterior Talofibular Ligament). When the foot is dorsiflexed or inverted (toe in), the CFL (Calcaneofibular Ligament) is most likely involved. The greatest risk factor of an ankle sprain is a previous sprain thus, injury prevention is key! Once a ligament is stretched or torn, it never returns to its 100% strength. Signs and symptoms of a lateral ankle sprain include tenderness to palpation Inversion Ankle Sprainon the outside of the ankle, swelling, and bruising. Treatment includes RICE (rest, ice, compression, elevation), bracing in an ankle air-stirrup brace in athletic shoes outside of dance class, limited dance, dynamic postural control/balance/stability, and ankle strengthening. Prior to return to dance it is important that the dancer continue with Pilates and core strengthening in non-weight bearing to start as well as progress from floor barre class prior to full return to class to prevent re-injury.

Flexor Hallicus Longus.jpgFlexor Hallucis Longus (FHL) Tendinitis (also known as “Dancer’s Tendinitis”) is another common ankle injury seen in the dancer. More commonly an overuse injury, the result of repetitive Pointe work can also lead to a traumatic injury if the dancer “falls” out of Pointe. One biomechanical study demonstrated that the muscles crossing the Metatarsophalangeal joint (which includes the FHL) work 2.5-3x harder than those muscles that just cross the ankle joints in dancers rising on to a full pointe position. The FHL tendon becomes inflamed with repeated changes in foot position (from full PF on Pointe to Plie with ankle flexed) if it is being compressed in its fibroosseous tunnel along the posteriormedial talus under the sustentaculum tali (basically the tendon and its covering gets “caught” on ridges/bony prominences in the foot resulting in rubbing and pain). One risk factor for developing Dancer’s tendinitis is posterior ankle impingement and/or os trigonum which puts the FHL tendon at risk for compression. Signs and symptoms of Dancer’s tendinitis include posteriomedial ankle pain, swelling, and/or popping in the ankle joint. Occasionally dancers get triggering or locking of the big toe. Treatment includes rest from Pointe work and jumps, physical therapy, and anti-imflammatory medication (including Iontophoresis). If severe, surgery may be required to decrease the triggering of the hallux and/or any nodules on the tendon.

ANKLE EXERCISE IDEAS FOR THE DANCER:

  1. Resisted Ankle 4 way + Ankle Plantarflexion with Toe Flexion
    Perform these exercises to work the muscles concentrically and eccentrically. Perform 2 sets of 15 repetitions, once a day.Ankle PF with Toe Flex
  2. Heel/Toe Raises
    Place tennis ball between the heels. Maintain neutral posture throughout exercise. Begin to relevé, keeping pressure against the ball. Hold for 4-5 counts before returning to ground with control. Perform 3 sets of 10 repetitions, once a day.Heel_Toe Raises
  3. Airplanes
    Stand on one leg in a parallel position. The other leg is in parallel arabesque. Bring your arms to your side and maintain a flat back position. Balance: Add a small demi-plié. Hold balance for 10-30 seconds. Perform 1 set of 3 repetitions, once a day on both sides.Airplanes 2

Most knee injuries involve overuse injuries and poor functional mechanics with dance activities; however, one example of a traumatic dance injury to the knee/hip is a hamstring muscle strain. With forceful battement, for example, dancers put their muscles Pulled Hamstringat risk for injury if they are not properly warmed up and/or lack the tissue extensibility with movements. By forcing the movement, injury can occur at the muscle or more commonly with Hamstrings strains the musculotendon junction. The most common Hamstring muscle involved is the Biceps Femoris (the action of the muscle is to extend the hip and flex the knee). The closer the injury is to the ischial tuberosity attachment the longer the time for return to dance. Risk factors for muscle strains include previous injury, decreased quad flexibility, muscle imbalances in knee/hip muscles, and fatigue. Signs and symptoms of hamstring muscle strains include pain, high speed contraction with excessive stretching or quick change in direction as the mechanism of injury, decreased active and passive range of motion with pain, tenderness to palpation, and decreased knee flexion/hip extension strength. Treatment includes RICE, eccentric strengthening (controlling the lengthening of the muscle with exercises like Nordic Hamstrings), lumbopelvic stability, and dynamic warm-ups. Focusing on core strength and hip muscle weakness (including hip external rotators) are important while allowing the hamstring muscle to rest.

HIP/KNEE EXERCISE IDEAS FOR DANCER:

  1. Nordic Hamstring
    Begin in tall kneel with a partner holding your ankles. Slowly begin to lower trunk to the mat maintaining tall upright posture. Use your hands to catch yourself and help lower yourself to the ground. Perform 2 sets of 10 repetitions, once a day.Nordic Hamstring
  2. Resisted Side Step in Relevé
    Stand in First Position with the Theraloop around your ankles. Begin to relevé, and maintain position. Side step one direction maintaining axial elongation, then side step to the opposite direction. Perform 1 set of 3 repetitions, once a day.Resisted Side Step in Releve
  3. Clams
    Lie on your side with knees bent and elastic looped around thighs just about knees. Keep heels together and lift top knee upward. Lower and repeat. Repeat series lying on opposite side. Perform 2 sets of 15 repetitions, once a dayClamshells

CORE EXERCISES FOR THE DANCER:

  1. Femur Arcs/Toe Touches
    Begin lying with a foam roll vertically along the middle of your back, knees bent, and feet resting on the ground. Tighten your abdominals and lift each leg off the ground, keeping your knees bent. Slowly lower one leg to touch your toe to the ground, then bring it back up and repeat with your other leg. Make sure your head is resting on the foam roll and do not arch your low back during the exercise. Perform 8-10 repetitions, once a day.Foam Roll Toe Taps
  2. Bridge on Foam Roll
    Begin lying on your back with your knees bent, feet resting on a foam roll, and arms on the floor by your sides. Tighten your abdominals and slowly lift your hips off the ground into a bridge position, keeping your back straight. Hold briefly, then lower yourself back down to the ground and repeat. Make sure to keep your abdominals tight throughout the exercise and your arms flat on the floor. Perform 2 sets of 10 repetitions, once a day.Foam Roll Bridge

CHKD offers great resources for dancers including Pointe Readiness Assessments and Pilates Mat Classes for conditioning.  Check the Sports Performance Academy page and this blog for upcoming classes. The Dance Program will also be hosting an Injury Prevention lecture with break-out exercise sessions in the Fall for parents/dance students. Be on the lookout for more information coming your way soon!

References:

  1. Kadel N, Donaldson-Fletcher, Segal A, and Ordendurff M. Kinematic, Kinetic and Electromyographic (EMG) Analysis of Muscle Activity During Rise to the “Pointe” Position.  2006 Orthopaedic Research Report.  8-12.
  2. Potter K, et al. Screening for Improved Dance Function.  International Association for Dance Medicine and Science. 2011; 3(1): 14-17.
  3. Leanderson C, et al. Musculoskeletal Injuries in Young Ballet Dancers.  Knee Surgery, Sports Traumatology, Arthroscopy.  2011; 19: 1531-1535.
  4. Kadel N. Foot and Ankle Problems in Dancers.  Physical Medicine and Rehabilitation Clinics of North America.  2014: 829-844.
  5. Schmitt B, Tyler T, and McHugh M. Hamstring Injury Rehabilitation and Prevention of Reinjury Using Lengthening State Eccentric Training: A New Concept.  International Journal of Sports Physical Therapy.  2012; 7(3): 333-341.
  6. Heiderscheit BC, et al. Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation and Injury Prevention.  Journal of Orthopedic and Sports Physical Therapy.  2010; 40(2): 67-81.
  7. Sherry MA, et al. Hamstring Strains: Basic Science and Clinical Research Applications for Preventing the Recurrent Injury.  Strength and Conditioning Journal.  2011; 33(3): 56-71.
  8. Haas JG. (2010) Dance Anatomy. Champaign, IL: Human Kinetics.
  9. Weiss DS and Zlatkowski M. Rehabilitation of Dance Injuries to the Shoulder, Lumbar Spine, Pelvis, and Hip.  Orthopaedic Physical Therapy Clinics of North America: Physical Therapy for the Performing Artist, Part 1: Dance.  1996; 5(4): 477-495.
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Water Safety

By: Lexi Gambrell MEd, ATC, LAT

Child Life JacketNow that we are in the hottest part of the year, many children and adolescents will be looking to partake in one of America’s favorite summer activities: spending time in the water. The Hampton Roads area has a variety of bodies of water to enjoy; from the local swimming pool to the Atlantic Ocean. However, with drowning being the leading cause of unintentional death worldwide, there are some important things to consider this summer to keep kids safe in the water.

How big of a problem is this really?

According to the Center for Disease Control, from the years 2005-2014, there were approximately 10 deaths a day from drowning, that’s an average of 3,536 per year. Of those deaths, one in five was a child under the age of 14. Drowning is the second leading cause of death for children 1-4 years old, behind birth defects.

What increases the risk?

Factors that increase the risk of drowning include lack of swimming ability, lack of supervision, failure to wear life jackets, and seizure disorders. Alcohol use is also a factor. While not commonly an issue with children, alcohol can affect the quality of the adult supervision.

Basic Safety Tips

Some basic safety tips can keep you and your loved ones happy and healthy in all types of water:

  1. Know your limits:

Be honest with yourself about you and/or your child’s swimming ability, while I have mostly focused on water safety for children, if the person supervising is uncomfortable in the water, they have limited ability to save a child in trouble.  If you have a child or adolescent who is not a strong swimmer, consider lessons. If not, avoid deep water and encourage the use of a properly fitting life jacket.

  1. Know the water:

Being familiar with the location for your water activities is ideal. How deep the water is, whether there are rocks or tree roots along the bottom, and how fast the current is can all be important to everyone’s safety. Never dive into shallow water or water that you are unsure of the depth. The temperature of the water may also be a factor, as cold water can cause hypothermia after prolonged exposure, regardless of how warm the day is. Knowing if there is a lifeguard around, and where they are located is also helpful in case of emergency.

  1. Provide Supervision:

No child should be swimming alone. Regardless of their swimming ability, no safety measure can replace adequate supervision. The supervising adult should be comfortable in the water and able to swim. Toys filled with air or made of foam should not be used as a substitute for inadequate swimming skills. While these toys may provide buoyancy to children, unlike life jackets, they are not regulated or designed to keep a swimmer safe.

  1. Know what drowning looks like:

Drowning in real life does not look like what is commonly depicted on TV shows or in movies. The victim is often unable to make any noise or create large splashes as is commonly depicted. Often drowning is silent. However, if someone in the water is indicating distress, it is wise to assume something is wrong and help them. Here is a news report illustrating what drowning looks like:

  1. Know what to do in an emergency:

If someone in the group is missing, the FIRST place to check is the water. If you notice someone drowning in deep water, throw them a flotation device or reach for them from a stable spot on land, to avoid them reaching for you in a panic and pulling you under with them.  If the water is shallow and you have stable footing, pull them out of the water with you. If a lifeguard is present, alert them. Regardless, CALL 911, even if the victim is rescued, they will likely need medical care.  Knowing CPR can also be a huge help in an emergency situation. If you don’t know CPR, the 911 dispatcher will be able to guide you.

  1. Life Jackets :

There is a wonderful list of guidelines from the US Coast Guard Boating Safety and Resource Center that illustrates proper fit and type of lifejacket for each activity (US Coast Guard Recommendations for Choosing the Right Life Jacket ).  The most important point is that for a life jacket to work correctly it must fit and be worn properly.

Pool Safety

Children from ages 1-4 are most likely to drown in home swimming pools. Ways of preventing this include having a fence with a gate that swings outward surrounding the pool and making sure all toys are put away so a child doesn’t attempt to retrieve them from the water.

Natural Water Safety

Most drownings in natural water (lakes, rivers and oceans) involve people age 15 and older.  With older children, constant supervision may not be realistic, so the buddy system is a must. Most importantly, pay attention to any posted warnings.  These are displayed for your benefit and can warn about anything from surf conditions to dangerous wildlife. Knowing what the weather is going to be like throughout the day can also help protect you and your loved ones.  Rip currents are a risk at the beach in particular. Even the strongest swimmers are susceptible to their effects. If caught in a current, be sure to swim parallel to the shore until free, and then swim diagonally toward the shore.

Now that you know how to keep everyone safe in the water, go out there and make a splash!

References:

  1. http://www.who.int/violence_injury_prevention/global_report_drowning/Final_report_full_web.pdf
  2. https://www.edgarsnyder.com/swimming-pool/swimming-pool-statistics.html
  3. http://www.seattlechildrens.org/classes-community/community-programs/drowning-prevention/teen-campaign/tips/
  4. http://www.nbcwashington.com/news/local/Drowning-Swimming-Drown-Water-Pool-Beach-15-Things-You-Need-to-Know-This-Summer-about-the-Fifth-Leading-Cause-of-Death–263491391.html
  5. http://www.cdc.gov/homeandrecreationalsafety/water-safety/pubs.html
  6. https://www.cdc.gov/safechild/drowning/
  7. http://www.cdc.gov/homeandrecreationalsafety/water-safety/
  8. http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/child-safety/art-20044744
  9. http://kidshealth.org/en/parents/safety-drowning.html
  10. http://www.cdc.gov/safechild/pdf/cdc-childhoodinjury.pdf
  11. http://www.cdc.gov/homeandrecreationalsafety/pdf/water-safety/lifeguardreport-a.pdf
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We moved!

We are pleased to announce the opening of our Sports Medicine Physical Therapy and Sports Performance gym in Newport News, Virginia.  The gym is located at 680 Oyster Point Road, Newport News, 23602.  Our clinic features state of the art equipment that makes physical therapy fun!  The new sports medicine gym includes a pitching lane, a Biodex dynamometer, AlterG anti-gravity treadmill, a state of the art lifting platform complete with CHKD Sports Medicine logo, and additional cardiovascular and resistance training equipment.  In addition, we offer Dartfish® video motion analysis to analyze pitching, jumping and landing, and running mechanics.  For appointments in Newport News, please call 757-668-6235 or fax 757-668-4858.

Tech Center 1Tech Center 2Tech Center 3

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