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.

Managing Concussions: An ever-changing science

The NFL Draft is this week, which means my favorite part of the NFL season is about to happen- everyone booing Roger Goodell!  Should I be so excited about that? Probably not, I just have not been a fan of many of the choices he has made as the NFL Commissioner, especially when it comes down to his involvement of hiding research about traumatic brain injuries and football.  But that's a whole different topic...

We do have some interesting research coming out about concussions though.  Now with the eyes of the world watching the NFL and other sports on how they handle head injuries, it's really important that we pass on this information to the collegiate, high school, and adolescent sporting communities.  I want to spend some time talking about how to manage a concussion and some of the misconceptions about head injuries.

1. Not every doctor or athletic trainer is qualified to diagnose or manage a concussion.

This is both from a training and legal standpoint.  First, let's discuss training.  Medical doctors (MDs), regardless of their speciality or training, are allowed to diagnose and sign off on return to play.  That means your general physician, who probably has not had a neurology course since med school, can dictate how a concussion is treated.  Not I am not saying that you should not go to your GP for a head injury, but it is important to know if you medical professional knows what the latest consensus says about head injuries (FYI, it is the 2016 Berlin Consensus, we should be expecting another one this year in 2018).

Last year, the consensus released the SCAT5, which should be the guideline for sideline assessments at a sporting event.  If your trainer is using a SCAT3, I would kindly suggest asking them to updated their repertoire.

2. You have to be hit in the head to have a concussion

This is EXTREMELY false.  Many concussions happen from blows to the neck or upper body.  Direct head contact is not required to be considered a head injury.  The force of the neck whipping can send the brain into an acceleration-deceleration vector and cause concussion-like symptoms.  

3. I didn't lose consciousness, so I didn't have a concussion

Another gross misconception.  Loss of consciousness (LOC) is not a requirement to be diagnosed with a concussion.  In fact, a majority of concussions do not have LOC as one of the symptoms; however, LOC is a very important symptom of a possible traumatic brain injury and should be treated very seriously.  Parents, you can go to our Forms Page and download the Concussion Recognition Tool version 5 to have available and if your child has any of those symptoms during or after a sporting event, get them checked out by a medical professional.

4. There is nothing that can be done about a concussion except time

Not exactly true.  While we don't have any definitive research to support an exact treatment on concussions, there is a lot of evidence showing the efficacy of multiple different types of treatment.  New research actually shows that returning to aerobic activity sooner can have a positive outcome on returning to sport/school/work.  There is a consensus on the timeline of when to introduce different activities and levels, but the treatments during this time can be varied, from vestibulo/oculo motor training to low level laser to hyperbaric chambers and so on.  Not one treatment is the only one that can work for concussions, but each treatment can be successful in it's own right.

Concussions are near and dear to me because I had a bad experience with a concussion when I was in high school.  Head injuries are very serious and can have long term consequences if not treated appropriately.  We do manage concussions here at Victory* and would love to be a part of helping you or an athlete you know return back to activity and soon and safely as possible.

*in the state of Texas, Dr. Blake cannot diagnose a concussion, due to scope of practice laws.  We can manage and treat concussions with co-current treatment with your medical doctor.  We can work with your medical doctor on creating a treatment plan that is beneficial for you or your child to allow a more integrated and successful treatment.  Give us a call if you have any questions on how this can work.

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.


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.


Over the last couple of months, I have really started to take some interest in CBD oil.  I was always kind of skeptical and unaware of what it was, but the more I dug, the more I have started to fall in love with what CBD can do! So I am going to pose a few questions I had and questions different people have asked me, so hopefully you can learn more about it and how it can help you or someone you know.

Q: What is CBD?

A: CBD is the shorthand for cannibidiol.  It is a non-intoxicant compound found in the cannabis sativa plant with many therapeutic benefits, with case reports of helping people with chronic pain, cancer, Crohn’s, diabetes, rheumatoid arthritis, PTSD, cardiovascular disease, anxiety, antibiotic-resistant infections, multiple sclerosis, schizophrenia, and more.

Q: Is CBD legal?

A: This is a common question and concern.  Currently CBD is legal for consumption in 45 states, and legal to purchase in 32 without a prescription.  In Texas, it is legal to purchase as long as there is less than 1% of THC in the oil.  What makes the legality of CBD confusing is that any cannabis plant is technically illegal under federal law, but many states have legalized marijuana and/or hemp.  The majority of CBD oils sold within the US are derived from hemp, which has no psychoactive properties.  Currently this a federal vs. state issue, but as long as CBD oil does not cross state lines, it is not a problem in the states where it is legal.

Q: What is the difference between CBD and THC?

A: Both CBD and THC are found in cannabis plants.  They are very similar in their chemical makeup, but CBD has no psychoactive properties (aka it cannot get you high).  Both have clinically proven benefits and work well together, but many people want the benefit without the high, which is what makes CBD so appealing.


Q: What is CBD good for?

A: Clinical research has shown that CBD has powerful anti-oxidant, anti-inflammatory, anticonvulsant, anti-depressant, anti-psychotic, anti-tumoral, and neuroprotective qualities.  If you suffer from inflammatory diseases, anxiety, headaches, joint issues, and much more, it probably could be beneficial.  There are some small side effects, especially if you on other medication, so always make sure you talk with your health-care provider if you are on medication.  You can read more about medication interactions here.

The neuro-generative and neuroprotective properties of CBD have also shown to be a good therapy for concussions and TBI, both as preventative and rehabilitative.

Q: Can I pass a drug test while taking CBD?

A: If the company is a reputable source that takes care of their product, in theory yes.  However, there can be trace amount of THC within CBD oil that, over a long period of time, may trigger a positive drug test.  Reports show you usually have to be taking 1,000 to 2,000 mg daily to have that much (whereas the recommended dosages are usually in the 15-35mg), but it is still a possibility.  Topical CBD analgesics do not enter the bloodstream, so if you just use a cream, you are not at risk of failing a drug test. 

WADA has just recently moved CBD to an accepted substance, and the NCAA is following suit and is reported to be lifting the ban on CBD.  NFL and NBA still have a ban, whereas the MLB and NHL do not test for cannabis.

If you play a sport with a governing body or are drug tested for your sport or work, contact your governing board prior to beginning an ingested CBD regiment.  You can also read more about the chemistry behind CBD oils and drug testing here.

Q: How is CBD consumed?

A: There are a few different applications of CBD oil.  The first is orally--taking the oil straight.  Some people put a few drops under their tongue or you can buy it in capsules (or make your own capsules).  You can apply it topically--many are mixed with other types of oils that are good for your skin or analgesics (such as menthol and camphor).  Some people also use the oil in a vape pen, especially for problems such as anxiety, although I personally do not recommend inhaling any foreign substance that is not prescribed.

Q: Where can I purchase CBD products? Do I need a medical exemption?

A: Within the state of Texas, as long as the THC content is <1%, you can purchase CBD products without a prescription.  Certain brands only sell directly to healthcare providers, such as CBD Clinics.  We will begin selling specific CBD products within our office this week, and some are products that the general public cannot directly order.  It is important to know where you are buying your CBD products from--both from the producer and the seller.  We will be selling products derived from hemp and primarily using companies such as CBD Clinics and Charlotte's Web.

Feel free to ask myself or our clinic any questions you may have on CBD oil and products!

Is posture really important?

Just reading that title, you probably shifted in your seat.  But more than likely you're reading this on your phone with your head down, so let's quickly reset as you raise your arms and stop giving yourself a headache.

Now, even after that, I'm still going to pose a question to you- is posture important?

Before I answer that question, let's talk about what posture actually is.  Posture is a static representation of the demands you place on your body.  I think a common misconception is that posture is how you should maintain your body during activities, but our bodies are designed to move! For example, if your back was supposed to remain at "neutral", we wouldn't have joints in between the 24 individual vertebrae.

So like I said before, posture is the result of the demands you place on your body.  Whatever you do on a normal basis will lead to how your body "sits" when you're not moving.  This is why I don't believe it's important to place emphasis on "maintaining good posture", because good posture for you may not be good posture for me.

Now before the other chiropractors and therapists who are reading this get upset and tune me out, I want to clarify some things.  By saying that there is not an ideal posture does not mean that there aren't bad postures.  Absolutely.  Things like forward head posture (FHP) is detrimental to health.  The Journal of Physical Therapy Science published a paper this year showing the negative effects of FHP on lung capacity.  FHP also has a correlation to a decrease in EMG activity to the serratus muscles (however, we are unaware which causes the other).  As a sports practitioner, both of those are HUGE for my patients, because lung capacity and shoulder function play major roles in sports performance and health.  So I am not suggesting that we sit back and ignore the signs of bad posture.

What we need to be better at though is start creating better posture outcomes for different populations.  My swimmer is going to have a different posture than my pitcher, and my soccer player will have a different posture than my IT worker.  And that's ok.  They should not look the same IF they are expressing proper function.  That's where we need to draw the line.  We shouldn't be happy with dysfunction, and posture can give us an insight as to what is going on with our patients on a daily basis.

There is a misconception I do want to clarify about chiropractic though- getting an adjustment does NOT realign your spine or your hips.  Over a treatment course, it is an important aspect of creating good function, but just simply receiving an adjustment cannot and does not change your static postural alignment.  What the adjustment does it create better movement within the joints to allow you to express more mobility within the spinal segments, which in course increases endorphin and enkephalin production, which makes you feel better.  But how many times have you received an adjustment, then an hour later you feel the same?  That's like going to the gym once and expecting to be in shape.  It takes time and effort to change your function, and once you have repeatedly put in good function into your body, you can then have proper expression, which is your posture.

So is posture important? Yes. But realize that good posture should not be the end goal, but more of a means by expressing your best function.