sports medicine

More than just injuries.

Sometimes I've really thought about the name Victory Sports Rehab and if it does me a disservice or not.  While my training is as a chiropractic practitioner and a sports medicine doctor, what we are able to do at Victory is so much more than just waiting till you have pain or an injury.  But why would you come to a rehab facility if you weren't injured?

1. Injury Mitigation

This one is probably the most obvious.  Many times, injuries can be mitigated through prevention programs, exercises, and stretches by going through an appropriate screening.  Obviously there is no way to prevent all injuries, but compounded injuries through bad motions, muscles, joints, etc, can hopefully be at a minimum mitigated to not be as severe (or even subclinical).

The problem we find though is there are so many programs and people claim that they can prevent injuries, so which one is correct? If you've read my blog posts before, then you probably know my answer is about to be vague.

The answer? It depends.

I promise I'm not trying to cop out, but it really is case dependent.  There are a lot of general things that we can do (ACL prevention programs have done a good job of that) due to knowledge of the most common mechanisms of injuries.  I can run a baseball pitcher through an arm care program and probably make them better, but the only way to truly know if what we are doing is helping is by doing a complete assessment that includes active movements, passive range of motion, and coordinated movements.  In fact, coordination is a big factor I see in athletic injuries in children and adolescents.  I love what Eric Cressey has to say on this-

Don't take mechanics solutions to athleticism problems. Before tinkering with mechanics, make sure a pitcher can jog to the mound without tripping.

You have to be an athlete first before you can be a "sports player".  Fundamental athleticism is extremely important to every single athlete, no matter the sport.  In fact, the NFHS and University of Wisconsin conducted a study that showed athletes that played 1 sport were 70% more likely to suffer an injury than an athlete that plays more than 1 sport.  Why is that the case?  Single sport athletes tend to overuse the same joints by playing that sport 8, 9, 10 months out of the year (in some cases all year round), which causes compound damage to joints.  If you are only playing one sport, then injury mitigation and joint health has to be a priority, regardless of "pain".

2. Strength and Conditioning

A proper strength and conditioning program is VITAL to every single athlete, no matter the sport. Once again, it's not a one-size-fits-all approach.  How I would train a football player is different than a baseball player and is different than a soccer player.  Even within that, how I would train a lineman is different than a defensive back, different than a quarterback, etc.  Finding a qualified S&C trainer is one of the two most important off season investments you can make.  While your school or team may have a good coach, taking the time and investment to have someone actually look at your own movements, exercises, and mobility cannot be overstated.

The other important investment is your joint health.  I just talked about injury mitigation, and that goes hand in hand with the S&C.  Reinforcing proper joint motion is crucial to joint health and coordination (the athleticism I mentioned earlier).  The more good input you create in your joints, the better coordinated output you will create (garbage in, garbage out model).  I love how Dewey Nielson, one of the master instructors for Functional Range Conditioning and Kinstretch, describes mobility training.  He basically says that having optimal mobility is like having the cheat codes to movement, and let me tell you, he is spot on!

Personal story- I recently just started rock climbing again after 3 years.  I had a membership in 2015, before I started my own mobility training, and had a hard time figuring out the moves to bouldering.  When I picked it back up this summer, I can tell you that even without climbing for 3 years, it seemed so much easier with having good control over my range of motion.

It is imperative for everyone, but especially for athletes, to make sure your joints are functioning at their highest potential, and one of the best ways I have found is through Functional Range Conditioning. There's no fluff, it is just science and the application of proper stress.  


Honestly, you don't want to wait to see me until you have an injury. As my patients' know, I am gonna make you work, and it's usually easier to work with me when you're healthy than on your injury.  My love is helping athletes who are injured get back to playing, so don't let this post fool you into thinking I don't like injuries, but all of our goals, from the athlete to the coach to the parent to the practitioner, should be to create healthy athletes at all costs.  And I promise, investing into your health is less expensive than treating injuries...

Is Crossfit a good workout?

I wish I had a dollar for every time someone asks me this question.  It's right up there with "what stretches should I do?"  And my answer is going to be the exact same-

It depends.

Yeah, that means you're going to have to read more into this blog post to get all of my thoughts! But that's because there's not much about health that is just black and white (other than eat well and exercise, but that's just so general...)

First things first, there is nothing inherently wrong or bad about Crossfit.  The idea that you are more likely to be injured because of a Crossfit workout is just not true.  If anything, there are many benefits to the movements and variations in a Crossfit WOD (workout of the day).  You have very complex movements that involve the entire body, demand lots of core strength and stability, and incorporates cardio elements within a strength workout.  Many programs I see at gyms usually focus on strength or cardio (the idea of weight loss vs. toning, which is not really true), but Crossfit does a phenomenal job of hitting both at the same time.

Incorporating lifting weights and high intensity cardio is a great way to create energy consumption confusion within the body, which is why many people see such great weight loss and body mass changes within a relatively short amount of time doing Crossfit.  One day you may have a heavy lifting day, the next is a ton of box jumps or rope climbs or odd object carrying, so you have to be ready for something new, and this keeps your body constantly trying to figure out what is going on.

The community aspect of Crossfit is one of my favorite things about each box.  I have never really seen a group of people supporting one another outside of a sports team like I do within Crossfit.  When you have a group of people that motivate and encourage you on a daily basis, you can really only see good results versus just working out by yourself or in a negative environment.  You also can make incredible friends for life and have a support group outside of just working out.

As I kind of mentioned before, the idea that cardio is for losing weight and weight lifting is for adding muscle mass is not entirely true.  In fact, you can lose a lot of weight doing a weights only program.  I also get asked by a lot of females if doing Crossfit will make them bulky and again, it just depends.  Everyone's body is different, so how our hormones react to exercise can create vastly different results.  If you run a little higher on testosterone, then yes you may have more muscle mass, but that doesn't mean you will "look like a man".  That takes intense training and a strict diet.

Which brings me to the next point and where I do see some problems within Crossfit.  Now before anyone gets upset at me, I am speaking on an individual level, not Crossfit as a whole.  I do see some people who have poor diets and try to do Crossfit but then get upset when they don't see results.  Diet and exercise go hand in hand, you have to have control of both to see true health expression and changes.  Also understanding how your own body responds to certain macronutrients is extremely important.  As for myself, I know I need carbs after a hard workout with my insulin spike.  If I don't ingest carbs within 30-60 minutes after a workout, I crash hard.

I also see people not eating enough calories.  Crossfit burns a lot of calories in a short amount of time, and you should not be reducing calories significantly if you are increasing your exercise routine.  Eating clean does not necessarily mean calorie reduction.  On the contrary, I've recommended patients actually increase their caloric intake by 500-1000 daily and we see MUCH BETTER results.  Again, everyone is different, so it is important to talk food with a healthcare professional or registered dietician.

My biggest beef with people doing Crossfit is not even about Crossfit itself, but the people who participate.  Let me explain- if you are a desk jockey (someone who sits at a desk/chair for 8 hours a day) and haven't been working out, stretching, whatever for years, and then you want to go do full cleans, heavy front squats, and box jump, you are asking for an injury!  Now, the majority of boxes I know make new members go through an on-ramp class to review movements, which is a great start, but rarely can you make true mobility changes within a month from years of joint abuse.

Like I said, that's not a Crossfit problem, that's a people problem and it is true for any type of workout.  You can hurt yourself doing basic cross training at your local gym.  You can hurt yourself doing yoga.  You can hurt yourself playing softball (men over 40, I'm talking to you... warm up and stretch!!).  The only reason we think it happens more in Crossfit is due to the complex movements and use of heavier weights.  Without properly working your joints, those problems were probably going to come out regardless of what type of workout.  Obviously if you can barely flex your arm over your head, then you really have no business doing weighted snatches and presses.  Does that mean you shouldn't do Crossfit?  Of course not, there are tons of modifications that you can do while you work on mobility.  Good boxes with good coaches know what limitations their members have and can always program a modification to the movements that you have restrictions in.

So if I had to some up and give you an answer, Crossfit is a fine workout, if that's the type of workout you want to do.  The important aspects of any exercise outlets is finding something you enjoy doing, make sure you have a solid diet, and if you have the joint mobility to do what you want to do.  If Crossfit is what you want to do, then I highly encourage it!  Is it for everybody? Of course not; but there is nothing inherently wrong with doing Crossfit.  

 

Maybe it's not your arm.

I'm back talking about baseball again... I would apologize, but it's definitely going to happen more!

Spring and summer baseball is in full swing.  Now that the cold has finally left us, baseball tournaments are pretty much every weekend around here.  It's pretty common for youth leagues to have 3-5 games in a weekend (which is crazy, in my opinion), and so with more baseball comes the risk of more injury, especially for the pitchers.

But what if I told you that arm fatigue may not be from the arm?

It's fairly well known and documented that player fatigue is correlated with a higher rate of injuries, and youth players are more likely to pitch in multiple games in a day and rest less.  This is a big reason USA Baseball started the PitchSmart program, a guideline to how many pitches a player should throw dependent on their age.

So we know too much pitching can lead to injury, but it is arm fatigue that is leading to these injuries?  Some studies may show otherwise...

A study done in 2016 by Chalmers et al showed that fatigue and a drop in velocity is normal within a game situation.  What they found, however, that the loss of velocity is not due to arm speed, but actually to leg muscle fatigue first.  This study demonstrates that velocity may be directly more correlated with leg strength than arm speed!  But if you look up all these programs online, every coach promises you more arm speed or strength.  Maintaining shoulder-hip separation, proper thoracic flexion and rotation, landing leg knee flexion, and total shoulder range of motion are also important factors into pitching injuries.

We talk a lot about arm injuries when speaking of pitchers because it is the most common injury to happen! If you look at our blog from March 28th, you can see what the chances of being injured and what that injury is.  It's important to discuss because we are seeing a significant increase in youth and adolescent injuries and surgeries.  While we may not know EXACTLY what's causing this rise, we have an educated guess as to multiple reasons why and try to hit all of the factors involved.

Remember when I said leg fatigue leads to lower velocity?  To me, this is one of the EASIEST fixes in sports!  Although it's not glorified like football, strength training is incredibly important for a baseball player.  All of the power for a baseball player comes from the legs, whether it's pitching, throwing, running, or hitting.  Without properly strengthening the body, you are losing out on power potential!  Now I know that strength training isn't fun, nor does it make for good stats and Instagram posts.  I get it, chicks dig the long ball.  But in order to hit home runs, throw a nasty fastball or breaking ball, or throw out the runner at home, you have to prepare your body.  And that preparation is a combination of skill work, strength training, mobility and body care, and just general maturity.

It's easy to focus on what hurts- it's much more difficult to focus on what is causing the pain to begin with.

"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.