soccer

"What's the best stretch for..."

This has honestly become one of my LEAST favorite questions.  As soon as people hear what I do, they'll start telling me about all their ailments and then will usually ask me, "What is the best stretch for *insert joint problem here*?"

The answer- it depends.

There is no assigned stretch for each pain.  Now that answer varies from the other junk that it is online.  I see it every day on Facebook and Instagram- 7 stretches for should pain, 3 stretches you should do every day, relieve back pain with these stretches.  But it's not that easy.  All pains are not made equal, so all "stretches" are not the same either.

All that being said, I do assign stretches to almost all of my patients! Now I seem like a hypocrite... but here at Victory, we try to assign appropriate stretches according to the diagnosis and the type of pain.  So let's discuss all of the different types of stretching:

  1. Static stretching- this is the one that everyone is familiar with.  You take a joint, stretch it, and hold.  However, I usually see just about everyone doing this wrong.  For the most part, a stretch should not be painful, so stretching beyond what is tolerable is not necessarily better.  Once you feel a stretch in a muscle/tissue/etc, then you should stop there and hold.  Also, most people do not hold a stretch long enough.  10 seconds does not change anything.  If you want to actually stretch something, you need to hold it somewhere around 2 minutes.  Now, that doesn't have to be 2 minutes straight, but a total of 2 minutes of stretch. So if you hold for 30 seconds, you should repeat that 4 times.
  2. PAILs- this stands for Progressive Angular Isometric Loading and is a foundational component of the FR and FRC system.  I teach this a lot to my patients due to it's therapeutic benefit.  The idea behind this is to really enhance a static stretch, but also increase strength in a lengthened position.  If you take a joint, stretch it, then start contracting the muscle (or stuff) into the opposite direction with about 10-20% max effort, you are adding extra signal to the stuff you are trying to stretch.
  3. PNF- proprioceptive neuromuscular facilitation is a popular stretch for athletes.  A similar idea to PAILs, but using a lot more effort against someone or something.  You push the joint against a resistance for 10-15 seconds then relax and your joint magically gets more range.  Except it's not magic, it's science.  You are taking advantage of the nervous system and telling certain tissues to temporarily relax.  While this is a moderately good warmup, it does not lead to any permanent change and the tightness will come back in a few minutes to hours.
  4. Dynamic stretching- this is what is involved during a typical warmup.  Spending time moving a joint through a range of "motion to get the blood flowing".  While this does help circulation, it is actually more of a primer for the nervous system.  Increasing signal to the joints you are going to use helps prepare the brain to utilize the joints you want to be using for whatever activity you are doing.  At Victory, we highly utilize CARs, another element to the FRC system.  This slowly take your joint through it's full range of motion to both increase the efficiency of the nervous system to that particular joint, help increase range of motion or keep it, help keep joints healthy, and decrease pain or inflammation.

So when people ask me "whats the best stretch...", my answer is "depends".  Assigning stretches to random body parts can be beneficial but also detrimental and make the problem worse.  If you want to learn more about you can take care of your body, schedule an appointment to figure out what your problem is or come join one of KINSTRETCH classes, where you take your body through full ranges of motion and teach really great exercises to do at home for your joints.

Looking into the crystal ball of ACL injuries

Sometimes I wish I had the ability to just look at an athlete and tell them exactly when and how they will injure themselves, and then be able to prevent it (of course).  Not only could I prevent  a TON of injuries, but I could probably make a TON of money!  Imagine getting hired by all the professional teams and just pointing and telling them who they need to work with, who they need to cut, or who needs to play more.

But unfortunately I can't tell the future.  It's not as easy to look at someone and predict an injury.  There is good news though- I do have statistics on my side!  That sounded cooler in my head, but I'm also a huge nerd.  What I mean by that was that I have data that people a lot smart than me have compiled over the years that can statistically show who is MORE LIKELY to be injured and how we can possibly prevent them.  The big injury we are gonna talk about today is the big A- ACL tears.  It is one of the most common injuries, especially in athletes, so let's break down what it is, how common it happens, and can we prevent it.

all-knee-ligaments.jpg

The ACL (anterior cruciate ligament) is an important ligament within the knee capsule.  It begins on the posterior aspect of the intercondylar notch on the femur and attaches onto the anterior tibial plateau.  There are actually two parts that arise from the femur and come together to attach into the anterior aspect of the knee capsule and medial meniscus.  Like the image to the left shows, many texts and images will show the ACL is separate from the meniscus, but this is a fairly inaccurate representation, as there are very few structures within the musculoskeletal system that are completely isolated.

The primary function of the ACL is to provide stability within the sagittal plane (think front to back) and helps keep the tibia from sliding forward.  It works with the PCL (posterior cruciate ligament) to provide complete stability of the knee joint within the sagittal plane.  Without these ligaments, your knee would just slide forward and backward (see our Instagram post from March 22nd, 2018 to see what it looks like when your ACL is torn).

There are approximately 200,000 ACL injuries per year in the US, with 95,000 of those being complete tears.  100,000 ACL reconstruction surgeries are performed annually with an average cost of $5,000-$17,000 per patient (out of pocket cost), and some research actually puts the societal cost at $38,000 per ACL surgery.

I'm going to put those numbers together... the number of ACL surgeries within the US costs somewhere between $500 million to $1.7 billion, and that doesn't include what the insurance companies pay!  Ok, so we've established there are a lot of ACL injuries and they're expensive... but who's at risk of getting them?

Allan et al performed an epidemiological study on high school ACL tears from the 07/08 year to 11/12.  I could literally spend 2-3 hours breaking down this study (because that's what I did to write this blog... and enjoyed every minute of it), but I'm just going to throw out the highlights-

  • ACL surgeries account for 60% of sports related surgeries among high school athletes
  • ACL injuries account for more than 50% of all knee injuries
  • Across 9 sports surveyed (Football, boy's and girl's soccer, volleyball, boy's and girl's basketball, wrestling, baseball, softball), girl's soccer accounted for 14.9% of all ACL injuries, with football coming in second and 11.5%
  • The rate of ACL injuries in high school is 6.5 per 100,000 athletic exposures (this includes every practice and game)
  • 42.8% of ACL injuries were during an athlete/athlete contact, 37.9% were non-contact

This is important information to digest.  We can talk about each point of these, but the main thing to focus on is that if you play a sport, you have a higher chance of an ACL injury.  I focus on high school athletics because roughly 50% of all high school aged adolescents play sports, but this does not include club sports, which probably increases that number fairly significantly.

One thing I observed during this study though was the ratio of contact vs. non-contact.  I've read some studies where the ratio is 30/70 (contact vs. non-contact), and the definition of contact to me is not well defined.  I don't believe the contact is defined as contact directly to the knee, just contact with another individual of any means, which I believe changes these numbers.  Also, the numbers from football really skew the numbers in favor of contact, as 61.2% are contact related.  Almost every other sport had a higher rate of non-contact ACL injuries than contact.

Why are we talking about this?  Well, summer is approaching shortly, and despite the doom and gloom I just presented, there is hope!  The National Athletic Training Association released a position paper on ACL prevention programs in January, showing some of the efficacy of these programs.  While we are limited on the information of what actually causes ACL tears, programs that include strength, plyometrics, agility, balance, and flexibility seem to help reduce the risk of ACL tears, especially in females.

All that being said, Victory will be introducing it's first ACL Prevention program this summer!  While most people know us for helping recover from injuries, we want to make sure we offer programs to help prevent injuries in the first place.  This is important to help athletes stay on the field, but also reduce health costs, as a prevention program will be much cheaper than an ACL injury.  We will be releasing the finalized program within the next week, so keep your eyes peeled on when, where, and how much.  Don't let the summer fly by without making you or your athlete a better, healthier athlete.