|
|
Predicting injury potential
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Predicting injury potential - June 1, 2005 8:08:00 AM
|
|
|
coreconcepts
Posts: 68
Joined: April 13, 2005
From: Vancouver, BC
Status: offline
|
A particular area of interest for me in physical therapy, is the ability of practitioners to predict the potential for injury in patients. Are there any particular "postures" or "pathomechanics" that you have found to predict certain injuries? I realize that this is a somewhat vague question, but I am curious as to some patterns and correlations physios notice between movement, tight/weak muscles, other environmental factors and suceptibility to injury. A local physio here told me that he makes all of his money on the TFL and levator scapulae, explaining that the dominant nature of these muscles causes "all h*ll to break lose". He also mentioned that ex-dancers and gymnasts who are "too flexible" are often injured later in life.
Any thoughts?
|
|
|
|
|
Re: Predicting injury potential - June 1, 2005 9:42:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Some things I think are useful. There is some evidence to support the mechanics of jumping/landing as predictive of knee injury, and the effect of training on improving mechanics.
I am speaking particularly of the adduction/internal rotation at the femur, seen more frequently in females.
I definitely think there's enough evidence to support that as something worthwhile to look at and try to change if we find it.
Also, in injury surviellance, we do notice more injuries among the most flexible and the least flexibile, so I think there is something to your local PTs description of ex-ballet dancers and gymnasts. I have found the same anecdotally, but then again the dancers and gymnasts without pain don't see anyone, so it's hard to say.
I think that both the levator scapulae and the TFL can be problematic, though to what degree I'm not sure. I do not know about hell breaking loose, but those muscles can be overreactive and chronically painful for some.
Whether that is the cause of their problem is yet another issue entirely...
:)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: Predicting injury potential - June 1, 2005 4:23:00 PM
|
|
|
jma
Posts: 2414
Joined: August 24, 2000
From: NY
Status: offline
|
Hmmm, I have seen a few people with less than 90 degrees SLR, who tried various sports, i.e soccer, football and track, who eventually came with HS pulls, just as one example. It would be interesting if there are studies correlating this with HS injuries.
|
|
|
|
|
Re: Predicting injury potential - June 2, 2005 1:30:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
It is my experience that HS strains are associated with failure to adequately warmup before activity, and not with length or stretching.
I wonder if there is any data out there about this...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: Predicting injury potential - June 2, 2005 7:44:00 AM
|
|
|
coreconcepts
Posts: 68
Joined: April 13, 2005
From: Vancouver, BC
Status: offline
|
Great insight everyone - thanks for the feedback.
Jason - the jump/land is interesting - I never thought to have a client perform this. I usually look for the same things (internal rotation/adduction) while observing a contolled squat, but I can see how a jump test would be more telling.
jma - yeah, I notice clients who have tight hammies are more likely to strain them. I also find that those who test tight in the Thomas test, usually feel "stiffer" and "sore" or "achey". Not very scientific, I realize, but I have seen it enough to suspect that it is not a coincidence. To the issue of proper warm-up, as brought up by Jason, I have to agree that a dynamic warm-up is recommended prior to activity, and can prevent injury. That Physician and Sports Med. article on stretching that Barrett posted a few weeks back gave me some good insight on that topic.
USAPT - thanks for the links, look forward to reading them.
I'm still trying to get a grasp on certain concepts of flexibility such as; relative flexibility, stiffness vs. tightness (and discerning one from the other) and facilitated muscle. How do you know whether a stiffness is muscular or capsular (such as with the shoulder as an example).
Do any of you find the degree of lubar curve to influence injury risk or pain? Are those with extreme curves more at risk of injury? How much of an issue may it be if one were to have too much curve at a certain segment (ie. T/L junction) vs. L4/L5? How do you go about retraining this?
So many questions! My brain hurts right now - I think I'll go take a nap.
|
|
|
|
|
Re: Predicting injury potential - June 2, 2005 9:20:00 AM
|
|
|
USAPT
Posts: 278
Joined: January 14, 2004
Status: offline
|
as far as distinguishing muscle tightness from capsular restrictions, for ex. I compare passive ER at 45 deg and 90deg. At 45, the capsule is not that much of a factor until 90 deg. If restricted at 45, not 90-->more muscular and do STM to subscapularis and pec minor. I have seen up to a 30 deg improvement just doing that. If tight at both and you visualize scapular mov't--> obviously it is more capsular.
I'm rambling...must get back to work!!
_____________________________
Jason, PT
|
|
|
|
|
Re: Predicting injury potential - June 2, 2005 11:52:00 AM
|
|
|
coreconcepts
Posts: 68
Joined: April 13, 2005
From: Vancouver, BC
Status: offline
|
That was helpful, USAPT - much appreciated.
|
|
|
|
|
Re: Predicting injury potential - June 2, 2005 8:36:00 PM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
Core,
There doesn't seem to be any correlation between lumbar curves and LBP. I realize this is slightly different than injury but the burden of proof has shifted to the proponents of lumbar curve as an predictor. Spinalconcepts.com makes an argument for it and in fact a whole business of it, but no real research that I have found.
On the other hand somethings like ACL/patellofemoral injury may be predictable by even static posture analyis. (I"ll find the reference if needed), and I believe there is some evidence for shoulder impingement and TMJ being somewhat predictable also.
Hamstring tightness hasn't been shown to be a factor in hamstring pulls, at least, last time I did a good search about 5 years ago I didn't find any. Warming up, like Jason suggested, did have some influence.
|
|
|
|
|
Re: Predicting injury potential - June 2, 2005 10:57:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
I think one of the most important things I can do with my soldiers is hip flexor work. I believe tightness here can predispose someone to injury. In the Army soldiers do a lot of sit ups and sagital plane activities (running and road marching). Add all that on top of military jobs that require a lot of desk work i.e. sitting all day and there you have it, wicked tight hip flexors. I see my fair share of PFPS and lumbar spine pain and I feel tight iliopsoas may be a contributing factor. Almost all my guys get this type of stretching with their programs.
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: Predicting injury potential - June 3, 2005 1:51:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1207
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
I agree that the link between increased lumbar curve and injury risk is so far only a theoretical one. After many years of treating x-c skiers, gymnasts, figure skaters and dancers - all with increased lumbar curves in standing - I can say that in my experience, "kissing spine" syndrome is the more common one here vs. spine problems in rugby, football, soccer. But predictability? No, I do not think so. A very big (number of participants) and long (time-line) research study will have to take place to either confirm or deny the link....
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: Predicting injury potential - June 8, 2005 10:08:00 AM
|
|
|
certMDT
Posts: 154
Joined: April 5, 2004
From: Durham, NC
Status: offline
|
Shirley Sahrmann wrote an interesting editorial a year or so ago regarding the lack of information derived from lumbar spine curves. She made the excellent point that while there may not be an effect if the curve is relatively close to normal, a stronger correlation may be found looking at those 1 or 2 standard deviations outside of the norm (the "kissing spines" Sebastian alluded to).
I still think that it would be a challenge to find a consistent statistical correlation with static postures, because our bodies are so great at adapting to any deviations from "ideal" alignment, and keeping us out of pain.
I was always amused by the doctors and PT's that I work with talking about how much the distance runners we see need to stretch their hamstrings, no matter what the ailment. I run 70 miles a week, and my hamstrings never even approach a stretched position. Tight hamstrings seem to come with the repetition of performing millions of mid-range repetitions. I think they may even have a performance-enhancing effect due to improved recoil, but I can't remember the reference. If I were a hurdler, it would be another story...
Charlie
_____________________________
Charles Sheets PT OCS Dip MDT
|
|
|
|
|
Re: Predicting injury potential - June 9, 2005 9:54:00 AM
|
|
|
Nicole Matoushek PT MPH CSHE CEES
Posts: 727
Joined: January 15, 2005
From: St. Petersburg, FL
Status: offline
|
I think as clinicians, we are always looking for the science behind the theory..... I happen to have chosen to specialize in ergonomics and work-related injuries for that reason, there appears to be alot more science supporting the cause of injury, the risk for injury and the prevention measures or exposure limits that are considered acceptable, in order to reduce injury. In ergonomics and work-injuries (which are very similar to sports injuries, as they relate to muscle length/tension relationships, joint forces, joint positions, exertion/strain, repetition and muscle overload) there is a lot more science to support injury risk potential.
Hope this is helpful.
Nicole Matoushek, MPH, PT, CEES, CSHE, CEAS
[URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL]
_____________________________
Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com
http://www.ErgoRehabBlog.com
http://www.ComputerAccessoriesOnlineStore.com
|
|
|
|
|
Re: Predicting injury potential - June 9, 2005 12:12:00 PM
|
|
|
coreconcepts
Posts: 68
Joined: April 13, 2005
From: Vancouver, BC
Status: offline
|
Thanks for the food-for-thought everyone.
Chuck - good point on the Sahrmann reference regarding our inherent ability to adapt to positions that avert pain.
Seb - is "kissing spine syndrome" simply jammed facet joints?
Alex - I have always felt that tight psoas muscles contributed (at least indirectly) to LBP. Recently, I was told by a PT that hip flexor tightness is actually not as commonplace as people think, and that a dominant TFL and tight quads are actually more common. Are you aware of any studies that correlate HF tightness and LBP?
Nicole - Yes, very helpful indeed. Do you have any specific links to articles or studies that outline the specifcs of your post? I am particularly interested in the length/tension relationships as they relate to injury risk.
Again, thanks for the awesome feedback.
|
|
|
|
|
Re: Predicting injury potential - June 10, 2005 2:28:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1207
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
"Kissing spine" refers to the spinous processes being compressed into eachother when spine extends - associated with local palpable inflammation, very localized pain on full flexion and extension (of course) and gentle touch. If only treated by the athlete with many months of ibuprofen (many do 8-12 a day), x-ray evidence can develop at the superior and inferior aspects of the spinous processes involved. Obviously mostly in lumbar spine, but can occur in thoracic as well (see flat t-spines of gymnasts, dancers, etc).
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: Predicting injury potential - June 10, 2005 9:18:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Core-
I think on the website [URL=http://www.girlscanjump.com]www.girlscanjump.com[/URL] there are some videos of correct/incorrect mechanics. There is a PT/ATC who runs this site and does injury prevention stuff for young women in sports, emphasizing jumping/landing skills.
Hope that helps.
I would agree with that PT who noted that a tight TFL and quads are probably more commonplace. I think there is a lot of actual iliopsoas weakness out there that is misinterpreted, anecdotally speaking.
I have read some interesting biomechanics theories on tight iliopsoas and rectus fem contributing to inhibition of the lower abdominals/TrAbd as well.... I find my chronic LBP people who have difficulty in prologed standing or walking never seem to get better until we get those addressed...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: Predicting injury potential - June 10, 2005 9:43:00 AM
|
|
|
coreconcepts
Posts: 68
Joined: April 13, 2005
From: Vancouver, BC
Status: offline
|
Sebastian - thanks for the detailed description of "kissing spine" - very helpful.
Jason - thanks for that website, I will check it out today. Very interesting, the theories on tight psoas/rectus and inhibition of lower abs and transversus. I value your knowledge and clinical acumen.
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.094
|
Printable Version
