February 13th, 2014
Cross Country skiing is a strenuous sport that stresses the body in many ways and exposes the athletes to numerous cold injuries. Cold injuries can affect skiers in ways that can makeor break the outcome of the race for the individual. This article will go over some of the injuries that a skier may encounter during the sport, and can serve as a guideline of how these injuries can be prevented by the athlete.
The first injury we will discuss is hypothermia, which can occur due to a decrease in the core temperature of the body and is classified as mild, moderate or severe. Mild hypothermia occurs when the bodies’ core temperature is between 95°F – 98.6°F, moderate hypothermia occurs at 90°F – 94°F, and severe hypothermia occurs at core temperatures of below 90°F. Some signs and symptoms of hypothermia include: vigorous shivering, decreased blood pressure, bradycardia, decreased motor control, cardiac arrhythmias, depressed respiration, loss of consciousness.
Frostbite can be defined as the freezing of the body tissues, and is a localized response to a dry and cold environment. Some signs and symptoms of frostbite include: dry/waxy skin, edema, tingling or burning, hard skin, white/grey/black/purplish skin, decreased circulation, throbbing pain and limited movement of the affected area.
Chilblain occurs from extended exposure to wet, cold conditions that skiers are exposed to regularly. Chilblain is an inflammatory response to the cold exposure causing restriction of the blood vessels leading to vessel inflammation, as well as edema in the dermis. Some signs and symptoms of chilblain include: red lesions, tenderness, itching, numbness, tingling and swelling.
Immersion foot occurs from prolonged exposure in cold, wet conditions typically around 12 hours or longer. Immersion foot affects the soft tissues including nerves and blood vessels, which are the results of an inflammatory response that causes high levels of extracellular fluid in the tissues. Prolonged wearing of wet socks or footwear most commonly causes immersion foot. Some of the signs and symptoms of immersion foot include: burning or tingling, loss of sensation, skin blotches, swelling, pain and blisters.
Cold urticaria is an allergic reaction to cold temperatures due to cold exposure. Signs and symptoms of cold urticaria are redness, itching, swelling and hives on the skin that is exposed to cold.
Raynaud’s disease is a condition that causes some areas of the body to feel numb and cold in response to cold stresses it is under. Raynaud’s causes the smaller arteries that are responsible for supplying blood to the skin to become narrow, which leads to a limited blood circulation to the affected areas. Signs and symptoms of Raynaud’s include skin discoloration, tingling, numbness, pain to affected areas and in rare cares ulceration of the affected area.
These injuries can be avoided if the skier takes the proper precautions to avoid them from happening. Always ensure you are staying as dry as possible and as warm as possible when exposing yourself to cold climates. If you ever find yourself affected by one these conditions, consult your medical provider to find out if you require any treatment before it is to late. Happy skiing! Stay warm!5 comments
December 4th, 2013
The gluteal muscles (buttocks) are one of the most important areas of muscle that often gets overlooked. They consist of the gluteus maximus, gluteus medius, and the gluteus minimus. These muscles help with movement of the hip and thigh, specifically extension and stabilization. Glut exercises can be very beneficial in addition to normal workouts since many workouts do not target the gluts. Here are a few glut exercises that can be added to any workout 3-4 times a week. In order to increase the intensity, add another set or add reps to 2×12 starting recommendation.
1) Start on hands and knees. Extend one leg to the side and bend knee to 90°. Raise knee and leg up to 90° to the “fire hydrant: position. Switch legs and repeat 2×12.
2) Start on hands and knees. Extend one leg straight back. Hold 1 inch above the ground. Slowly raise and lower leg 1 foot. Do not raise the leg higher than the straight line across the back. Switch legs and repeat 2×12.
4) Start on hands and knees. Extend one leg straight out in a line with the spine. Bend leg at the knee (like a door hinge) then straighten leg back out. Switch legs and repeat 2×12.
5) Start on hands and knees. Raise one leg into the fire hydrant position and extend leg up and out towards the corner of the ceiling. Return leg to starting fire hydrant position and repeat. Switch legs and repeat 2×12.
6) Start on hands and knees. Extend leg straight to side at a 90° angle. Raise straight leg up and down while keeping foot parallel to the floor. Switch legs and repeat 2×12.
7) Start on hands and knees. Bring one knee to chest and kick leg straight back into full extension. Keeping the straight line of the spine while kicking back. Switch legs and repeat 2×12.
8) Start on hands and knees. Extend leg straight to side at a 90° angle. Raise leg up into the “fire hydrant” position. Kick the leg out remaining in a 90° angle. The leg should only move at the knee like a door on a hinge. Move the leg from “fire hydrant” to straight leg. Switch legs and repeat 2×12.1 comment
September 3rd, 2013
By now, we all have tried some form of “energy” supplement out on our long skis, runs, races, etc. It can be rather confusing and difficult now that brands are expanding their variety. A multitude of flavors, caffeinated, sugar free, and densities can really seem like a lot to sort through when selecting what works for you. Below is a break down of the most popular forms of energy supplementation for endurance athletes, complete with pros and cons. See what works best for you!
Gummies: These small sports energy gummies can be found in single or bulk packet. Popular brands include Sharkies and Energy Blasts. Gummies can also come in organic flavors.
Pros: Energy chews are comparable to the chewy candy gummy bears as well as infused with energy-boosting ingredients such as those found in other energy enhancing products like energy drinks and bars. The sports energy gummies feature natural caffeine from guarana extract. They come in 60-calorie packs and hold the energy equivalence to a single energy drink; yet, without the excess of sugar and caffeine.
Cons: Since they are similar to the popular chewy gummy bear, they are often eaten as a candy instead of being used for the fuel reenergizing qualities needed for a prolonged workout.
Beans: Beans are relatively new on the market. Jelly Belly is the most popular brand to find your sports beans in an assortment of flavors.
Pros: Beans contain a mix of vitamin B, vitamin C, electrolytes, and carbohydrates. They help boost sugar levels and fuel muscles in order to provide maximum power output during exercise. There are also caffeine-infused beans for more extreme endurance needs. The single serving packets can also fit comfortably in shorts or jacket pockets without the bulkiness.
Cons: Sugar is the number one ingredient, so while the beans may do their job, they are not the healthiest choice. Evaporated cane juice is listed first in most products, which is basically sugar but cane juice is combinations of sugar such as glucose and fructose. The next ingredient is glucose syrup, which is a common sweetener in foods.
Gels: Gels are quickly being a popular staple in endurance sports. Some of the common brands you may see include: Accel Gel, Cliff Bar, GU Company, Honey Stinger, Hammer Nutrition, Power Bar, PacificHealth Labs, Vitalyte, and Carb Boom. Below are the pros/cons for the use of gels during endurance activities.
Pros: Gels are a way to provide energy to your body during endurance events. Gels are not made up of the carbohydrates that can trigger an insulin production reaction resulting in a feeling of energy loss. However, they are mostly consisted of maltodextrin or some other form of carbohydrate, which easily breaks down in the body and does not cause a sugar overload. Gels also contain trace minerals in your body (such as magnesium and potassium) that are needed by your body for muscle function.
Cons: Gels can lead to a mental dependency that you cannot finish the race unless you take one or two gels. Some people have trouble with gels if their stomachs do not handle them well. You many also experience the feeling of having too much sugar in your body.
It is always important to not take the gels too quickly and to wash them down with a few mouthfuls of water. It is also advised not to consume too many gels in a short amount of time. Two per hour or one gel every 45 min have been seen as the recommended time span between gels. This all depends on your metabolism, so another great reason to test out the gels before using them in a race.
Gum: The popular sports gum includes brands such as Gator Gum (from Gatorade) and Quench Sports Gum.
Pros: The gum is easy to transport as it comes in chunk or stick form; yet, the thirst quenching abilities of the gum have not been fully established. The process of chewing gum triggers the saliva production, which can prevent the dry “cotton mouth” feeling during long periods of activity.
Cons: Sports gum has been promoted by the ability to eliminate the sensation of thirst. However, this gum does not actually prevent dehydration. There have even been reviews of the gum actually making them more thirsty.
Since many of these products can cause stomach problems, it is also smart to train with and practice the usage of these products before an event or race.
Pills/Tablets: Electrolyte tablets are usually found in capsules (powder encased) or in tablet form. They are a concentrated substance containing electrolytes lost during exercise. Usage across the board usually recommends drinking water after consuming. Different brands include Hammer, Gu, Nuun, and others.
Pros: You can carry multiple pills or tablets in a small container, and makes easy for transportation, as long as the product stays dry. If you don’t like the taste of fluid replacement drinks, swallowing a pill and carrying water with you is a good alternative. Also, pills and tablets usually don’t contain as much sugar as a normal Gatorade/Powerade, so if sugar upsets your stomach while exercising, a pill/tablet could be a good alternative.
Cons: If you purchase tablets, you can chew them and then drink water, or drop into a bottle and dissolve for a electrolyte drink. If chewing a powder tablet or swallowing pills is hard for you on a normal basis, move towards a more liquid replenishment or a bar.
It’s important to note that if you are carrying a fluid replacement drink, those often have enough sodium and electrolyte replacement, so doubling up might not be necessary. If you select the tablet/pill route, check the sodium dosage and make sure you know how many you need to take per hour because it can vary per product.
Liquids: Liquids are premade fluid replacement beverages made to replace electrolytes, fluid and carbohydrates lost during exercise. Many different brands exist, but some include Gatorade, Powerade, Accelerade, and Lucozade.
Pros: Gatorade has a wide variety of flavors, and has established itself as a powerhouse for rehydration. This has led to many other generic brands and competitors developing products. Carrying a fluid replacement beverage can knock out the electrolyte replacement and fluid needs if digesting solid foods can upset you stomach.
Cons: If using an “original” formula of a fluid replacement beverage, often times the sugar can be higher than 20 grams for one serving. Again, if you know you have a sensitive stomach to sugar, experiment with the reduced sugar or sugar free options.
Since fluid replacement beverages can be appealing, it often times is substituted as a drink during the day when not exercising. This can be detrimental to an athlete because of all the excess carbohydrates found in a bottle.
Bars: Brands include Clif Bar, Power Bar, Luna Bar, Snickers Marathon Bar, HOOAH!, and many others.
Pros: Bars are often great for recovery AFTER exercise since they are high density foods with a decent ratio between protein and carbohydrates. A Clif bar can be beneficial however during a very long bout of exercise when large amounts of calories are being lost, just be careful to experiment before competitions to see how your body reacts.
Cons: Consuming bars during exercise, especially without liquid, can cause distress in the athlete. Plus some bars contain high amounts of fiber, which can lead to gastrointestinal distress. Also, competing in cold weather activities (such as cross country skiing!) these bars freeze and become nearly impossible to consume.
Good luck finding what works best for your body!!3 comments
July 15th, 2013
Asthma is a condition in which breathing becomes very difficult. Symptoms common to experience include coughing, wheezing, and chest tightness. Asthma severity can range from person to person. Symptoms often arise when exercising, which is called exercise-induced asthma. This can occur when air is cold and dry such as when one may experience while out skiing.
Allergy-induced asthma can cause symptoms triggered by particular allergens such as pollen, pet dander, and cockroaches. Other triggers include allergic reactions, respiratory infections (common cold), certain medications (beta blockers, aspirin, ibuprofen), strong emotions and stress, gastroesophageal reflux, or the menstrual cycle in some women.
Risk factors for asthma include having a blood relative with asthma, having an allergic reaction, being overweight, being a smoker, exposure to secondhand smoke, having a mother who smoked while pregnant, exposure to exhaust fumes or other pollution, exposure to chemicals, or low birth weight.
One must seek emergency medical attention if rapid worsening or shortness of breath or wheezing occurs, if no improvement after use of a quick-relief inhaler, or shortness of breath after only minimal physical activity.
A few home remedies or changes to your daily life to help keep asthma in check: avoid your triggers, use your air conditioner, decontaminate your decor, maintain optimal humidity, prevent mold spores, reduce pet dander, clean regularly, and cover your nose and mouth if it’s cold outside. Another good way to keep asthma at bay is to continue skiing regularly, maintain a healthy weight, eat fruits and vegetables, and control heartburn.
Prevention of asthma can occur by following an asthma action plan, getting immunizations for influenza and pneumonia, identifying and avoiding asthma triggers, monitoring breathing, identifying and treating attacks early, taking medications as prescribed, and paying attention to increasing quick-relief inhaler use.
If you are alone and experiencing an asthma attack or with an individual having an asthma attack, maintaining calm is the best tool. Simple breathing exercises can help by taking slow, shallow breathes through the nose. Ordinarily, asthma attacks occur when the individual panics and breathes as quickly and deeply as possible.
Breathing rate is controlled by the amount of carbon dioxide (the gas that regulates the acid-base level of the blood), not the amount of oxygen in the blood. Therefore, a method to treat an asthma attack is to have the person with the attack breath into a paper bag (such as a brown paper lunch bag) of some sort to increase the amount of carbon dioxide in the body. This old trick in the movies really works!
If the person has an inhaler, help them find it, instruct them to use it, and continue to have them remain calm and control their breathing until breathing has returned to normal. If breathing cannot be controlled or returned to normal, even after the use of an inhaler, it becomes an emergency situation and one must seek medical attention. One must seek emergency medical attention if rapid worsening or shortness of breath or wheezing occurs, if no improvement after use of a quick-relief inhaler, or shortness of breath after only minimal physical activity.
May 8th, 2013
Concussions can occur at any time and any place. A concussion is a traumatic brain injury that is caused by a blow to the head or body, fall, or another injury that jars or shakes the brain inside the skull. In some cases, a concussion can even occur without any impact to the head itself (whiplash from a car crash, or crashing on roller skis). If an injury occurs the results in cuts or bruises on the head or face, there may be no visible signs of a brain injury. Concussions are often overseen, since many people believe there must be loss of consciousness to have a concussion.
With rest, most people recover fully from a concussion. Recover can take a few hours, days, or weeks. In some rare cases, repeated concussions or a severe concussion may require surgery of lead to long-lasting problems related to movement, learning, or speech. Due to the possibility of long term problems, it is important to be able to diagnose a concussion immediately and seek medical assistance.
Symptoms of a concussion can be mild to severe and for hours, days, or weeks depending on the severity of the injury. The categories symptoms fall into are thinking and remembering, physical, emotional and mood, and sleep. The thinking and remembering symptoms include: not thinking clearly, feeling slowed down, not being able to concentrate, and not being able to remember new information. The physical symptoms include: headache, blurred vision, nausea and vomiting, dizziness, sensitivity to light or noise, balance problems, and feeling tired or having decreased energy. Emotional and mood symptoms include: being easily upset or angered, sadness, nervousness or anxiousness, and being more emotional. The sleep symptoms include: sleeping more than usual, sleeping less than usual, and having a hard time falling asleep.
There is neurological testing and a cognitive assessment that can be performed if a concussion is suspected. The neurological portion consists of testing cranial nerves. I have mentioned these nerves and how to test them in a previous post, but here they are again. Cranial nerves are labeled 1-12: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal. Each nerve tests a different sensory, motor, or mixed function. Depending on the nerve or function that is damages, the area of injury to the brain can be more focally localized.
1 – Olfactory: tests smell – test smell with smelling salts, smelly socks, or a strong food
2 – Optic: tests vision – can you see the tree down the mountain or the tree right in front of you
3 – Oculomotor: tests reaction to light and eye movement – look at pupils while passing a light in front of the eyes and following a finger down and in (from lower corner to center of sight) with just the eyes, test both eyes
4 – Trochlear: eye movement – follow a finger up and out (from center of sight to upper corner) with just the eyes: test both eyes
5 – Trigeminal: tests jaw clench and facial sensation: clench jaw tightly and try to separate, feel for sensation on the face
6 –Abducens: tests lateral eye movement: watch pupil movement as eyes move from side to side (fast and slow)
7 – Facial: tests taste and facial movements: raise eyebrows, smile/frown, taste (eat a mint or taste the sap from a tree)
8 – Vestibulocochlear: tests hearing: can check hearing by tapping a ski against the other; snap fingers near the eyes to check for peripheral hearing
9 – Glossopharyngeal: tests swallowing and taste: make swallowing motion; eat a mint or taste the sap from a tree
10 – Vagus: testing swallowing, and uvula: making swallowing motion; say ‘ahhh’ and watch the uvula (the conic projection at the back of the throat)
11 – Accessory: tests neck range of motion and strength: shrug shoulders and apply downward pressure to shoulder shrug
12 – Hypoglossal: tests tongue movement, stick out tongue
The cognitive assessment includes red flags such as unusual communication, inappropriate behavior, irrational thinking, mental disability, or personality changes. Recall and memory can be tested for retrograde (prior to event) or anterograde (since event occurred) amnesia. Amnesia is a deficiet in memory caused by brain damage or trauma. Retrograde testing can include asking the time (what time of the day is it?), place (where are you?), person (who are you? what is your full name?), and purpose (what are you doing here?). Anterograde is usually only affected by more severe head injuries. Anterograde is checked by telling the person 3 words in the beginning of the assessment (such as apple, snow, bubble). Have the person repeat the words back after the neurological and retrograde testing. The affected person can also test analytical skills by counting down by 7’s from 100; spelling the word ‘world’ forward and backward; and saying the months of the year backwards.
Treatment of concussions is very conservative. While symptoms persist, the indivdual should avoid all brain stimulation. Stimulation includes homework, reading, watching tv, and looking at a computer. There must be no symptoms before light aerobic activity can take place. Progression daily from light to moderate to heavy activity must take place. Each day the activity level increases as long as symptoms do not return. It is better to be cautious when it comes to the brain. When in doubt, seek medical assistance
December 1st, 2012
Athletic Trainers can be a little narrow minded in respect to how stretching should be performed. Often times the focus is on the concentric action (a simple static stretch) we learn initially and focus on this movement to strengthen and stretch during rehabilitation programs. However, this focus on the concentric movement limits the athlete in several ways. For that reason, we need to realize what degrees of motion our muscles have.
The muscles in our body all perform concentric (shortening the muscle), eccentric (lengthening the muscle), and isometric (contraction but no movement) movements. These movements can also differ in respect to whether the athlete is in a weight bearing or a non-weight bearing position. In most cases, the athlete will need to be weight bearing to function in their respective sport. With this in mind, three-dimensional stretching has been developed to be an aid in rehabilitation and training.
Have you ever thought about why you do certain types of stretches? Maybe it is to just increase flexibility, but stretching can do many more things than that. “3D” stretching can be used to ‘turn on’ your muscles before exercise or even to treat the cause of injuries. Multiplanar or ‘3D’ stretching is beneficial for all pre and post workout routines.
It is essential that we utilize the knowledge that each muscle in the body performs three movements over three planes of motion. They can move in the frontal, sagittal, and transverse or rotational planes. Here’s an example, as many of you know, muscles move in more than one plane of motion. When you simply go to wave to a person, you pick your arm up at the shoulder in the frontal plane, you raise the distal part of your arm in the sagittal plane, and (if you are the queen of England) you do a dainty wave in the transverse plane. This is proof that you move in way more planes of motion than you thought you did.
From here, it is rather simple to put together a 3D stretch that pertains to the functions our athletes need to complete to perform optimally. For this post, videos and written descriptions will be demonstrated for various areas of the body. It is important to note that each stretch should be performed doing 3 sets with 10-15 slow pulses (1 pulse= 1 movement to each side) per movement. In the videos, I have my subjects doing 4-5 pulses to allow you to see the movement solely for demonstration.
CHEST (Pectoralis Major/Minor)
A traditional stretch for the chest is to lean forward with one hand on a wall corner and then lean forward. We can use this as our starting point for maximizing the effectiveness on this stretch three-dimensionally. Position yourself as mentioned before, but now you lean forward and come backward, then rotate side-side, and then lastly rotate all while keeping your hand on the wall. This covers all three planes of motion and once you give this stretch a try, you will feel the effectiveness of the stretch in all aspects of range of motion. Another great aspect to this perspective on stretching is that we can tailor it to your individual needs. See Michael demonstrate below.
SHOULDER (Deltoids, Pectoralis Major & Minor, Supraspinatus, Infraspinatus, Subscapularis, Latissimus Dorsi, Rhomboid, and Teres Major & Minor)
To start, find a doorway, and put your arms up in the position where you extend the furthest. From here, push your elbows or forearms up against the door with your body in the doorway. Extend your body through the doorway as far as possible to feel a stretch (use this as your starting body position for each plane of stretch). To add in the 3D component, push your body front to back through the doorway to get the first stretch, move your entire body side to side to get the second stretch, and rotate your body around the edge of the door that your arm is on to get the final stretch. See Mario demonstrate below.
The way you stretch this is as follows: 1. Hold onto the edge of a doorway with your hand and move away from the door until you feel a stretch in the shoulder. 2. Keep your arm in at least slight amount of flexion (elbow bent) so that you simulate poling motion. Last, move your body front to back (remember not to move out of the point of feeling a stretch), side to side, and rotate your body all around your arm that stays fixed on the door frame. See video below.
GROIN (Adductors, Sartorius, Gracilis, etc)
For the groin, the starting position will be to step your left foot out sideways about 5 feet from your body while keeping your right foot in the same spot. Slowly bend your right knee until you feel tension in your left groin. This should feel similar to if you were performing sideways lunge. For the first movement, put your hands on your hips, gently rock your hips back and forth sideways (you should feel the stretch when rocking away from your left leg). The second movement, put your hands on your hips, gently rock your hips forwards and backwards. Finally, hold your arms out in front of you for balance, rotate your upper body left and right keeping your feet firmly planted. (You should feel the stretch when rotating to the right) See Matthew demonstrate below.
HAMSTRING (Biceps Femoris, Semimembranosus, Semitendinosus)
Before you begin, select a foot. The foot that is in the front will be the one you will be stretching. To start, you will simply lean forward, touch your toes and rock forward and backward slowly. The second action, you will remain bent over, but you will have your hands to your sides and you would rock from side-to-side. Last motion, you will twist to your right and then twist to your left, or if it is easier you can walk your hands to your left and then walk your hands to your right. See Gonzo demonstrate below.
HIP FLEXOR STRETCH (Iliopsoas)
Begin by kneeling down on a knee, making sure you have some sort of padding under that knee. Then, place the other leg in front, bent at a 90 degree angle and lean back with your torso. Place your hands on your hips and rock back and forth. The next motion will be to rock side to side and finally, twist your torso to reach for your other foot. Some variations would be to point your toe in or out to feel a different stretch. See Amanda demonstrate below
QUADRICEPS (Rectus Femoris, Vastus Medialis, Vastus Lateralis)
These stretches can be done either kneeling or standing. To perform it standing, place the top of your foot on a nearby table or use the back of a chair. For this demonstration, we will show kneeling. Begin by kneeling on the ground, keeping one knee on the ground and stepping the other leg out in front of your body, placing that foot on the ground. Reach behind you and grab the ankle of the leg with the knee on the ground and slightly extend your hips. From this position, lean side to side, bending from your waist while continuing to look straight ahead. Returning back to the starting position, lean forward and backward, again bending at your waist, over your knee, pulling back on the foot in your hand. In the starting position, rotate your body over your knee, rotating at the waist and looking over your shoulder at the end of the motion. See Anna demonstrate below.
CALF (Gastrocnemius, Soleus, Plantaris)
A few examples of calf stretches include bringing one foot forward and forcing your foot into dorsiflexion against a wall or flat surface. (Dorsiflexion is bringing your foot toward your lower leg.) To begin, slowly rock your body forward and back, in the sagittal plane. Then slowly rock side to side, in the frontal plane. Finally slowly rotate your body from side to side, in the transverse plane. See the video below
Another stretch includes posing in a lunge-like position with one leg more forward than the other while keeping the back foot flat on the ground. Only separate your legs as far as tolerable. Any painful movements will not be beneficial. While holding this lunge position bring your arms out and press them into a wall or flat surface and rock your body forward and back, in the sagittal plane. Then slowly rock from side to side, in the frontal plane, and finally slowly rotate your body from side to side, in the transverse plane. See Kristi demonstrate below
3D stretching lengthens out the entire muscle group that you are targeting. This lengthening is what increasing an individual’s flexibility. Increased flexibility, or in other words the increased ability to lengthen a muscle, allows for an individual to load up their muscle, which is an eccentric contraction, in order to explode, which is the concentric contraction. This load-to-explode concept is what gives athletes their power. An example would be, the calf is used to push off with running. The heel is the first body part to strike the ground when running (unless you are a forefoot runner). The position of the heel on the ground and the toes still up in the air is dorsiflexion, a lengthened position for the calf.
Multiplanar, or three dimensional stretching is still a new concept, and something really cool for athletes and skiers to try out. To be afraid, it helps mix up the boring routine of static stretching, give it a try! A huge thank you to all the students at Concordia for helping out with this!1 comment
October 13th, 2012
It’s not too often skiers are diagnosed with Achilles tendinitis, but it can happen, especially during running intensity the athlete isn’t accustomed to, tight calf muscles (gastrocnemius and soleus), improper form, or ill fitting ski boots and shoes. Ideally any exercises performed should be pain free, so adjust accordingly.
Before taking on a rehabilitation program, first try to control the pain in your Achilles tendon. Depending on the stage of your injury, a multitude of options are available. Lots of heel stretching (See previous post, Part 1 of “Am I Imbalanced?”), icing after workouts, NSAIDs (ibuprofen), and massaging are good options to start with to control pain. Compression socks are also very popular to wear if activity isn’t too aggravating.
Through my experiences, I have found that eccentric exercises usually produce success in getting athletes back to full strength. Eccentric means an athlete is working on strengthening the muscle in an elongated position. Think of it this way, you are bench pressing and push the bar up quickly in a 2 second count, but you lower it to your chest slowly in a 4-6 second count. These types of exercises are often referred to as “negatives”. Another common example is when female athletes are unable to perform large numbers of pull ups, they can start with a negative pullup (getting a boost to hold themselves at the top of the bar, then lowering their bodies down in a 10 second count). Below are some great eccentric Achilles exercises to perform.
Exercise 1, “Heel Drops”: Find a box, or anything high enough and sturdy enough to stand on. This exercise is pretty basic, and is essentially taking calf raises and reversing them. Start by placing your heels off the back of the box, make sure to have a wall or something to hold onto so you don’t lose your balance. Drop your heels into the starting position, do a calf raise up in a 2 second count, and then lower yourself down slowly in a 6 second count back to the starting position. Repeat this at least 15 times, if possible perform 20.
Video here: http://www.youtube.com/watch?v=epgJdM2muzI
Exercise 2, “Single Leg Board Squats”: Find a slanted board if possible, and set against a wall so it doesn’t slide around as you move. Plus, holding to the wall for support will help with balance and safety. Stand about midway on the board on just your toes, pick which leg you want to start with. In an upright position, lower your body in a 6 second count to the bottom of your range of motion, then push up on your toes in a 2 second count. If you can perform this in front of a mirror, that will be helpful to make sure your knee is staying in a straight line, and not moving all over. The key to this is to not let your heel touch the board. Do 10 repetitions on each leg, add another set if you feel able.
Video here: http://www.youtube.com/watch?v=P2Cbr_SvdJo
Exercise 3, “3 Dimensional Lunges”: This exercise is not as focused on the eccentric aspect, but proper form and hitting all ranges of motion. Focusing on the three dimensions the body operates in is sometimes overlooked in rehab, and can be a secret to success. To start, go forward into a lunge position. On the return push back, really focus on using that calf in the behind leg to bring yourself back. Perform these squats slowly, it’s not meant to be explosive in anyway. After going forward with the lunge, step into the next lunge but aiming to the left. At a 45 degree angle. Return to the center, and the lunge to the right at a 45 degree angle. Going the three ways counts as one set, repeat 10 sets on each leg.
See video below for how to perform, just do it without the rotation.
Variation on Exercise 3: While performing the three different motions, a rotational aspect at the hips can occur as well. We do this because it turns the hip into internal rotation, which translates the tibia (shin bone) creating a different pull on the muscle. Hitting all these dimensions of the Achilles will properly ensure even strengthening throughout.
Video of the variation can be seen here: http://www.youtube.com/watch?v=W7R7VmBSy-c
These exercises can be done as preventative as well as rehabilitation. Part 2 of “Am I Imbalanced” will be out soon! Thanks to the athletes who helped me.2 comments
August 7th, 2012
Per request of a comment I received from the last post, I tried to tackle the topic of identifying imbalances on the body. We all aren’t physical therapists and athletic trainers, so sometimes knowing the basics can help you recognize when you are at risk for an injury, or how you can make an easy fix for a nagging problem. My thought process was to break it up into upper extremity and lower extremity and identify “hot spots” or common areas that lead to multiple problems for endurance athletes. I will start from the ground up literally, with part one being Lower Extremity.
Common Injury: Plantar fasciitis, Achilles tendinitis, bursitis, calf cramps
Am I imbalanced?: Checking for calf (gastrocnemius and soleus muscles) tightness is difficult. A quick test to try and see is to simply extend your leg in front of you, (so you need to be sitting or laying down.) Try and bring your foot to your body, if you can see a reflection of your foot, even better. If the angle of your foot to your shin (tibia) is over 90 degrees, you are not in the “normal” flexibility range.
The first stretch is a basic stretch. First obtain a towel and wrap around your toes. Pull the towel and your toes towards your body. Hold for 30 seconds and repeat 3 times.
The next stretch is probably one we all have learned from elementary school, but if you can look in a mirror, see how good your flexibility is. The key is to keep your heel in contact with the floor at all times.
This next stretch helps to stretch the other part of your calf, the soleus muscle. The soleus lies directly underneath your gastrocnemius. Keeping your heel in constant contact with the ground and the bending your knee slightly, you will feel a different stretch.
Strength test: This is a test that as an athletic trainer I will use on someone if they present any symptoms of weakness. It’s quite simple, if you can’t perform this, you’ve got some work ahead of you or you have a nerve issue. Simple see if you can do 25 calf raises with a straight knee in a row without any issue. Next, bend at the knees slightly to test the solues muscle. (Assume the same position as the stretch above, only doing calf raises).
Area: VMO (Vastus Medialis Oblique)
Common injury: Patellar tendinitis, patellar tracking issues, ITBFS, general knee pain, condromalacia patella, etc
Am I imbalanced?: To start, the vastus medialus oblique is one of the three major quadriceps muscles. It is seen most predominantly on athletes right on the inside part of the knee. I used my own leg as an example, and it’s not the greatest, but I will use Marit and Therese to really show a good example.
When you flex your quad you should have a “tennis ball” shape appear by your knee. If you touch right by your knee and only feel some squishy skin, you’re in trouble. This muscle supports the patella in all its motions, so if the VMO is weak, the patella likes to run all over like a loose train cabin. A good way to test this is to get a small hand towel, roll it up, and place underneath your knee. Next flex your quad as hard as you can, imagining you are trying to crush the towel into the table/ground/etc. Look at the inside of your knee, do you see a bulge form? Push there, can you feel a muscle flexing? It’s more common in women to see a deficit in this muscle than men.
How can I fix this? Using the towel test as an exercise is a great way to strengthen the VMO as well. Try to “crush the towel” for a long 5 second hold, and then relax. Repeat this 10 to 15 times. If you still feel like you aren’t tired, find an ankle weight and hang your ankle off the table to add some more resistance, or hold for longer than 5 seconds.
Area: Gluteus Medius
Common injury: ITBFS, General pain in back, hips, knees, many more. This muscle is a very important stabilizer in the repetition of running and skiing.
Am I imbalanced? In the athletic training realm, the test for checking for gluteus medius weakness is called Trendelenburg’s Test. The best way to try and check yourself is to perform this in front of a mirror. Start by putting your hands right on your hips. Then, trying to keep your hips level, lift your foot off the floor and flex your knee behind you to 90 degrees. Watch your hands on your hips, do they move? Can you feel yourself wanting to shift all your weight to one side? If you can’t keep your hips level while balancing on one leg, you definitely have a weakness. See if you can keep your hips completely level for 30 seconds to a minute.
How can I fix this? Two great exercises are Hip Hikes and Fire Hydrants. You can’t target the muscle properly unless you do these correctly. To perform a hip hike, find something to stand on that is at least 8 inches tall or so. Start by standing with one foot on the surface, and on foot hanging off the side. Start in a position with your hips level, just holding your foot over the edge. Using ONLY your hips, try to drop your foot down to the floor. Do not bend your knees in any way. You should only feel your hip muscles trying to lift you. Repeat at least 20 times on each side, repeat 3 times.
The second exercise is called Fire Hydrant because it simulates they position dogs assume when nature calls. The key to this exercise is to not use your back and rotate all over the place. Start by balancing on your knees and hands on the floor. Then, lift one leg up to the side, going until you feel yourself begin to rotate. Repeat 20 times each side, repeat 3 times to really feel the burn.
Area: Weak or Tight Hamstrings
Common injury: Low back pain, Chronic hamstring strains, Hip alignment issues, knee injuries, etc
Am I imbalanced? The easiest way to tell if you are imbalanced is to find a wall in your home or gym, and lie down facing it. Try to place your feet on the wall and scoot yourself as close to the wall as you can. If you can get your butt to touch the wall without a problem, you have at least 90 degrees on hamstring flexibility which is a good start. If you can’t get to 90 degrees, you have very tight hamstrings. Another test is simply to see how close you can touch your toes. Also, if your quadriceps are a lot stronger than your hamstrings you can be predisposing yourself to problems down the line.
How can I fix this? A few different hamstring strengthening exercises are available, and creativity can make them enjoyable. The first, which is one of my favorites to use on athletes who are rehabbing from ACL surgery, is stool racing. Find an office stool or chair on wheels. Find a nice long clear space to either do laps, or straight lines and using only your heels, pull yourself across the space. Make sure to be pulling yourself forward for at least a minute at a time. Repeating at least 3 times.
The second exercise, which can help with double poling even since you will be getting your hips forward, is a hip fall. Find a heavy enough couch/chair, and put your feet underneath it. (I didn’t have anything that could hold me in the picture, so just imagine I did) Then, fall forward and try to hold your upper body as long as you can before gravity takes over and you drop. The key to this is keeping your back as straight as possible, if you bend at the hips, you can cheat on this exercise all day.
Keeping these muscle groups flexible is important too, see my previous post about Hamstring Flexibility.
Area: IT Band
Common injuries: ITBFS, patellar tracking issues, bursitis, hip pain, low flexibility in stride length
Am I imbalanced? The IT band is difficult to “test” on yourself necessarily, you need to think back of any symptoms you’ve had. Is there pain directly on the outside of your knee? Do you feel like someone is pushing your knees together when you’re running? If you touch the outside of your leg, does it feel extremely tight? Can you not foam roll the outside of your leg without wanting to cry?
How can I fix this? If you haven’t invested in a foam roller, do so as soon as you can. It can do wonders for many injuries. Typically what I have seen is that athletes suffering from ITBFS (IT Band Friction Syndrome) usually has a weak gluteus medius, so doing this exercises are a smart idea. Otherwise another good exercise is to take a theraband (if you have one) and wrap on your ankles for resistance. If you don’t have a band, you can use ankle weights. Be creative, but find some sort of resistance at your ankles that you can tolerate. Lie on your side, and lift your leg up. The motion you will make is a scissor kick, or a “Jane Fonda” style leg lift. Make sure your body stays straight, and you don’t roll forward or backward. Do 20, repeat 2 times.
There is a lot to process on this post, if any reader is interested in one particular aspect, I can dedicate a single post to it in the future. Stay tuned for the next post, Part 2, which will address upper extremity deficiencies such as the core, pectoralis muscles, shoulder strength, and others.2 comments
June 22nd, 2012
Excuse me for my temporary hiatus since April, I recently graduated college, became a certified Athletic Trainer, and moved to Milwaukee to start my new job! Exciting times. While in my last few weeks at Gustavus Adolphus College, I had time to film some hamstring stretches. As skiers we know that we use virtually every muscle in our bodies, and some days we wake up with soreness and we’re not sure why. The hamstrings are such a big muscle group and usually are neglected by endurance athletes. Keeping hamstring flexibility and strength in your mind can help to alleviate other problems, like low back pain for one example. Below are 6 videos or hamstring stretches. Ideally, they would all be done together, so the overall stretch time is about 3-5 minutes. You will need a stretching rope, or any type of rope or cloth that is long enough and sturdy enough. Check them out!
The first stretch is pretty easy. Make a U shape around the bottom of your shoe. Pull your leg up, keeping the knee STRAIGHT to get the best stretch. Don’t let your butt come off the table. Ideally you want to get the leg to 90 degrees or further. Go to the point of a good stretch and stop, hold that stretch for a long 3 second count, relax and bring the leg back down. Repeat 10 times.
This stretch is the same except for the position of the rope. After making the U shape around the base of your shoe, wrap the cords clockwise around your ankle and over your calf. Grab the rope and pull the leg straight again, 3 long second hold, relax, repeat 10 times.
Same as stretch 2, except for now bring the rope counterclockwise around your ankle and calf.
This stretch is the same as stretch 1, just start with your knee and hip bent at 90 degrees. Hold for 3 seconds, relax, repeat 10 times.
Same starting position, except wrap the cords clockwise.
Same starting position, except wrap the cords counterclockwise.
The hamstrings are actually a grouping of three different muscles. The wrapping of the cord around your ankle and leg helps stretch those three muscles: biceps femoris, semimembranosus, semitendinosus. Enjoy the stretches, and stay flexible!3 comments
April 6th, 2012
Well, the ski season is over for most of us and spring is coming out. Now is the time to find those other extra curricular activities to spend time with. This post is inspired by a fellow ski friend of mine that displayed some odd behavior the other day. Picture this scenario, you’re roller skiing and your buddy decides he is too cool for his helmet, and takes it off. One pot hole later, and he’s laying in the street seeing stars and is losing sensation in his face. In the realm of athletic training, there are functional tests we ask athletes to perform to make sure all twelve cranial nerves are working optimally. Usually these are damaged with blows to the head, but crazier things have happened. Here are the twelves nerves, and how to test them
I. Olfactory- Sense of smell, to test: take a swab of rubbing alochol, a sweaty ski boot, something pungent, etc
II. Optic- Vision, to test: Pick words at a distance for them to read
III. Occulomotor- Vision, to test: Remove the Rudys, cover one of their eyes, move hand and see if the pupil returns to normal
IV. Trochlear- Vision, to test: Take your finger and move it from side to side and watch their eye tracking
V. Trigeminal- Facial sensation, chewing, to test: Have them clench their jaw, or try to open their water belt with their teeth
VI. Abducens- Vision, to test: Take your finger and move it diagonally watching eye tracking again
VII. Facial- Facial expressions, to test: Tell them to smile and scrunch their face up, frown, etc
VIII. Vestibulocochlear- Hearing/Balance, to test: rub your fingers together next to their ears to see if they can hear, have them stand up and balance on one foot
IX. Glossopharyngeal- Swallowing/Gag reflex, to test: give them some water to swallow
X. Vagus- Swallowing/Gag reflex, to test: tell them to stick their finger in their throat until they gag…don’t induce vomiting here now, just a small gag reflex
XI. Accessory- Swallowing, Innervation of neck, to test: tell them to shrug shoulders
XII. Hypoglossal- Tongue movement, to test: Tell them to stick their tongue out
Hopefully your friend has learned that wearing a helmet is a necessity, and that losing cranial nerve function can be slightly embarrassing! Protect your heads out there