UCL Injury

The damaged ulnar collateral ligament (UCL) can be a setback for any individual. With varying degrees of injury to the ligament, an individual may be out for a few days to over a year if there is a complete rupture to the UCL. The most minor of these sprains means a person could return relatively quickly to activity, usually within a few days. I remember when I sprained my UCL. I was out for about a week, and then was taping my elbow with the help of my co-workers so I could return to Jiu-Jitsu.

Bursitis

If you have ever hit your elbow hard enough, especially on the edge, then you may have noticed major swelling, also known as bursitis. This can be rather painful and may need a physician. Usually you can take care of this yourself by icing and compressing the area. However, in more extreme cases, the physician may need to drain it. If that is done, and you return to activity, you may consider using an elbow pad for the first week or so.

Tennis Elbow

Another irritating elbow issue is best known as “tennis elbow.” In the medical arena it is known as lateral epicondylitis. This can happen to anyone from the grappler to the powerlifter and results from overuse of the extensor muscles in the forearm. The onset of pain is gradual and as it worsens the person is unable to perform his/her activity at the highest level. If caught early enough, it is best treated with rest, ice, compression, and elevation (RICE). For those who may wait a bit longer, the use of other therapeutic aides may be necessary. These aides can range from anti-inflammatory/pain medications to a brace. This is all dependent upon what instructions you are given from a medical professional.

Muscle Strains

Muscle strains can occur anywhere, lower leg to back to shoulder to anywhere there are muscles in the body. Around the elbow, the biceps, triceps, forearm flexors, and extensors are the most commonly injured. The worst of these can be a torn biceps. When this happens the muscle “balls” up in the upper arm. From here there are two options: let it heal as it is or have surgery to have it reattached. In most cases, surgery is the best option. This choice all depends on age, activity level, the individual involved, and the physician. A less severe biceps injury means you have strained the muscle without a complete tear. These can be slow healing because of the amount the arm is used and the fact this muscle serves two purposes: elbow flexion and assisting with shoulder flexion. The best and worst case scenario is a few days to a few months for recovery. It all depends on healing and how well it is taken care of.

Rehabilitating the Elbow

Taking care of and rehabilitating the elbow is a rather different process. Most of the time, it’s all about strengthening the injured muscle. Well, being a joint, it needs strengthening both above and below the joint. For the sprained elbow, once inflammation is down and range of motion has been restored, strengthening can proceed. The best thing to do is strengthen the forearm by doing gripping exercises, such as scrunching up a towel, squeezing putty, or performing flexion and extension exercises using a dumbbell. For the upper arm, any form of biceps curls or triceps extensions will help to strengthen this area. Remember, if there is pain, back off and consult a health professional as needed. None of these exercises should cause pain; well, outside of the normal muscle soreness.

The elbow, although a fairly stable looking joint, can be susceptible to many injuries. They can range from relatively minor to something major that requires surgery. As an athlete, it is good for you to have a basic idea of injuries and how to handle them.

Recovering From Elbow Injury

1. Always begin with RICE.
2. Move to range of motion exercises, regaining flexion and extension as needed.
3. Incorporate exercises that will help build strength and stability to the joint.

If ever in doubt about the injury, check with your physician. Activity should last a lifetime. Better to take care of something early than wait until it becomes a problem. Injuries are a part of life; how the injury is handled, determines how well a successful recovery will occur.

You might also like:

• Got A Cranky Elbow? How To Train Smart And Prevent Pain
• How To Heal Tennis Elbow And Golfer’s Elbow
• How To Treat Kettlebell Lifter’s Elbow
• Tennis Elbow: What Is It, Do You Have It, And How Do You Treat It?

The post Common Elbow Injuries and What to Do About Them appeared first on Breaking Muscle.

Most people do not like going to a physician unless it is absolutely necessary. Athletes, especially, really dread going to the physician and hearing those deathly words “surgery,” “rest,” “physical therapy,” and “avoid your sport.” Hopefully, a few of these questions I am providing may help to ease the stress, strain, and anxiety of discussing a shoulder injury for the first time and help you get back to your active life.

Rotator Cuff Strain

One of the most common injuries is going to be the rotator cuff strain, which if left untreated, can turn into a complete tear. Just look at professional baseball players and the number who have had surgery.

Once a physician has said rotator cuff, begin to think of questions that affect that particular activity. For example, “What is the recommended treatment?” From there, questions that can be asked include “What type of physical therapy will be needed?” and “How long will I be in therapy?”

The scary part for many is approaching the subject of imaging and further diagnostic testing. My suggestion is, if the physician doesn’t recommend it right away ask why. Ask “How long do I try therapy before we do more testing?” Sometimes, physicians are hesitant to begin with imaging and try to take a more conservative approach. If you are that concerned, you can push the issue or ask for another opinion. Personally, I think pushing the issue may be the best initial approach.

Dislocation/Subluxation of the Shoulder

Another injury that happens quite frequently is the dislocation or subluxation of the shoulder. Here is where it gets tricky. A shoulder dislocation can cause damage to so many structures within the shoulder that the treatment is widely variable. Structures that can be injured range from the musculature to the ligaments to the labrum. All of these structures incorporate similar yet different physical therapy components.

This is when it is important to ask the appropriate questions. First and foremost, ask about immobilization. How long will the shoulder need to be immobilized before physical therapy can begin? What are the short-term effects of being immobilized? What activities can I do while in the sling? Will there be additional imagining, such as an MRI? What are my limitations at work and/or in regards to activity? The fear people have is hearing the worst – that you can’t do anything. In most cases, physicians are willing to work with you on certain limitations, especially when it comes to work.

Remember, a dislocation will take some time to recover. Be patient, but be proactive at the same time. If you don’t understand what is being said, ask the physician to slow down and explain in terms that you understand. The worst feeling is leaving the office and not knowing what was said.

Shoulder Surgery

A dislocation or subluxation can lead to a worse scenario – surgery. That is most likely the worst word any person wants to hear. Believe me, I know. I have had four knee surgeries, one hand surgery, and one ankle surgery. Yes, the orthopedist likes to see me walk into the office.

When there is the chance the topic of surgery will be approached, go prepared with questions. Most importantly, find out what type of procedure will be used. Ask the physician to explain it. Then, find out what the risks are that are involved with surgery. What is the success rate of the procedure? A key question for people today is, “How much work am I going to have to miss?” The younger athlete may ask, “How long I am going to be out of my sport? Will this affect my chances of a scholarship?” These are all valid questions to consider when deciding on the course of action.

It even comes down to whether or not you want to do surgery with that physician. You have the right to a second opinion. Get it. If surgery is something that may affect your career, ask for a second opinion. You never know, maybe the other physician has a better procedure or has other options. It never hurts to check it out, especially when it can affect your livelihood.

Listen Carefully

The last bit of advice I can give is to listen carefully to what the physician is saying. Why? As the physician explains the injury, surgical procedure, or physical therapy, you may come up with additional questions that I didn’t include. If the questions are open-ended and require more than a yes/no answer, you should be able to go through a whole series of questions that will help you to ultimately get the answer for which you are looking.

Always ask, even if you think it is not important, if you are thinking about it then it is important to you. It’s your shoulder. It’s your health.

You might also like How To Self-Diagnose Your Shoulder Pain and this list of articles how to prevent and treat shoulder injuries.

The post The Best Method for Talking to Your Doctor About Shoulder Injury appeared first on Breaking Muscle.

I’ve been using MFD in my practice for over a year now. I’ve used it therapeutically to treat almost any injury, from plantar fasciitis to hamstring strains to myofascial restrictions unrelated to injury. I’m surprisingly pleased with how many of the athletes are asking for repeat treatments. Although they all complain about how sore it makes them, they are pleased and excited with the outcomes: increased flexibility, fewer restrictions, and an overall feeling of being better.

Those key words from the athletes are what keep me using and expanding my knowledge of MFD. I’ve even done a before and after with several of them. I assess their range of motion before the treatment, especially hamstrings, and compare it with post-treatment results. I have found three techniques that are most helpful. Two of the three require active movement from the athlete after the cups have been placed:

1. The first is an active flexion/extension movement. Although painful at the start, most of the athletes indicate more movement. After treatment the range of motion increases by ten to fifteen degrees.
2. The more aggressive technique has that athlete prone, leg off the table, hip flexed, and knee flexed. The goal is to get the heel down and extend the knee. If they can get the heel to touch the ground then that is excellent progress. For runners, this mimics more the motion required to propel forward. Again, this is painful when the person move, but the gains are invaluable.

Swimmers have also inquired about MFD and there are two clients in particular I’ve worked with. Both were having “reach and pull” issues on their strokes. The focus was placed on the latissimus dorsi and teres major. After the cups were placed, they were asked to extend and slightly pull down with the arm. Motion increased in both. One of them even had the fastest swim of his career! He is so happy with the results he plans on doing another treatment before conference. It’s wonderfully exciting to see the success achieved by the athletes.

MFD has its benefits for everyone. I tend to focus on athletes and their return to play or improved performance enhancement. I cannot say if it is the right treatment for everyone. It depends on what you are trying to achieve. My focus is on active motion with MFD. Other professionals prefer to use MFD as a way of relaxation.

The traditional way of using MFD is following the meridian lines of the body. The cups are placed along these particular lines to elicit change within the body. I’ve even seen someone cry after being treated because it fell along one of the emotional lines. It was surprising to see, but I knew to expect it. I have also known people who had it done to help with general back pain and soreness. Funny thing is, they fell asleep with the cups on them. When it’s being used in this manner, anything is possible.

Two completely different methods, using the same equipment, can elicit such different results. It’s really interesting to see the old methods intertwined with new concepts and theories. As we move forward with research and literature, we continue to see so many amazing changes to traditional theories, with MFD being a good example. From the early years, where it was solely used for medicinal and relaxation to purposes to the current trend of using movement patterns with MFD, the treatment practice has grown immensely. Now, it’s the en vogue treatment for athletes and weekend warriors.

Anyone who is interested in experiencing either form of this treatment needs to seek out a practitioner qualified in MFD. If you want a relaxing experience with MFD, then it is recommended to seek out a licensed acupuncturist. Most will generally have knowledge and skill in the use of MFD. If you are seeking the more aggressive MFD utilizing movement, that will be more difficult to locate. In the athletic realm, some physical therapists and athletic trainers have taken coursework in incorporating MFD and movement. More professionals on the West Coast may have exposure to such techniques. As with anything, please make sure to ask questions before jumping into something new. Make sure it’s what is right for you.

Have you tried MFD or cupping? What was your experience?

Photos courtesy of Shutterstock.

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Now, there is so much more we know in terms of balance, stability and strength as it relates to an ankle injury. Now, a more global approach is taken to make sure an athlete gets the most out of his/her rehabilitation or preventative program. (Please note: If you are beginning a rehabilitation program for an injury, make sure there are no other underlying conditions, such as a hairline fracture, by seeking the appropriate medical care.)

What do I mean when I say global approach to rehabilitation? In this case, I mean looking away from the ankle and incorporating the entire body as part of the rehabilitation or preventative program. It is not only the ankle that helps to stabilize itself, but it is aided by the knee, the hip and the core.

The core is best described as the “lumbo-pelvic-hip girdle.” This area helps to stabilize our body in so many ways – posture, walking, running, sitting, etc. How has this affected the way I treat an athlete? Good question. The answer – I look to this area to see how it reacts as an athlete stands on a single leg.

The ankle, when injured, loses its sense of proprioception quickly. The recovery can be tricky. Originally, I used to only look at how the ankle was reacting as the person stood on the single leg. Now, I look to see if the knee is turning inward, the hip is rotating, or if the hip drops out. What does this mean if these things happen? Simply put, it means that other muscles within the kinetic chain are not capable of handling a functional load after an injury, or maybe the musculature was weak to begin with.

A key focus area in this whole picture is the gluteus medius. The gluteus medius is a smaller muscle within the posterior chain, responsible for hip abduction as well as hip stabilization. If this muscle is weak, the hip will drop out, the knee will turn inward, and the ankle will not be able to stabilize properly. As a result of this, the rehabilitation program for the ankle injury may need to include strengthening for the hip. This is how the global approach to care becomes a part of overall rehabilitation program.

I know, you’re thinking it’s only an ankle injury. Well, have you ever noticed while working with an athlete that he/she is not progressing as planned? Weakness in another part of the body may be part of it. How can this be helped? Simply put, add additional exercises for the gluteus medius or any other muscle imbalances that may be noted.

The gluteus medius, albeit a smaller muscle, plays an integral part in the process of hip stabilization. The simplest way to work on strengthening this area is side-lying leg raises. I instruct the athlete to line his/her toes and heel together and lift from there. This causes activation of the gluteus medius.

Another simple way to improve strength to this muscle is to do clamshells. Here, the athlete has his/her knee bent and externally rotates the thigh while the feet remain in contact with each other. If properly done, this will cause some major ‘burning’ in the muscle. As strength becomes more apparent, more functional strengthening can begin. This incorporates balance with slight knee bend and focusing on getting the gluteus medius to “fire.”

I like having the athlete do two different types of exercise depending on his/her strength levels. During this whole process, the focus shifts to what the knee and hips are doing compared to what the ankle is doing. To start the athlete stands in front of a mirror and uses self-feedback to correct any positional errors that may occur. For example, while the athlete works on a step-up and step-down motion, he/she focuses on making sure the knee does not fall inward and the hips remain level. After a few repetitions of this, the athlete will usually comment on how they feel the muscle working. This is a good way to get more functional work/strengthening done to help with the ankle proprioception.

Another highly useful exercise is having the athlete balance on a single leg with a band around the opposite one. One the athlete has engaged the abs, gluteus medius and ankle stabilizers, the athlete is then asked to move the opposite leg causing the center of balance to shift based on band tension and direction. The athlete is asked to move forward, backward, sideways, and inward with the leg. Here, focus is on the lumbo-pelvic-hip girdle, knee position, and ankle stability. By incorporating multiple facets, the idea is to improve overall stability, performance, and reduce the chance of further injury.

It’s amazing how over the years as we gain more knowledge through research, experimentation, and good old trial and error, we find how important it is to involve the body in rehabilitation. In this case, a more global approach to the lower limb injury can help to correct not only the major problem at hand, but also to help begin the process of correcting other biomechanical issues that may be affected by the kinetic chain.

Today, it’s not about only treating the site of injury, but about treating the whole individual. When I say treating the whole individual, I mean looking at their movement, functional tests, and special tests that relate to the injury. If anything is noted as being abnormal, I try to educate the athlete about the importance of adding such exercises to his/her program to help enhance rehabilitation and ultimately performance.

In the end, the ultimate goal is to get an athlete back to playing as quickly and safely as possible. If, through simple education like this, I can get a person to realize the importance of strengthening our entire global and local systems, then I hope I have accomplished something good for that person.

The post Ankle Injuries: The Secret to Preventing and Healing Them appeared first on Breaking Muscle.

I was first exposed to this over a year ago. At the time, I didn’t fully understand it nor did I see it benefiting any athletes. This past summer a colleague took a course and was actually shown how to properly set up and use myofascial decompression (MFD). I was rather impressed with the results. So, naturally, I took the course in December. Since then, I have seen fairly good results with getting athletes to return to the playing field after other ‘traditional’ methods did not seem to work.

Cupping has origins dating as far back as Egyptian hieroglyphic writing around 1500 B.C.¹. However, the earliest recorded methods may have been between 281-341 A. D.². Cupping, also known as jiaofa, continued to be part of both eastern and western practices. By the mid to late 1800’s, criticism surrounded the method and western practitioners began to decline. Western science and medicine was looking to discredit eastern practices because there was no scientific backing to what was being performed¹. Chinese Medicine and other eastern medicinal therapies continued to progress in other parts of the world.

Cupping began to return to western practices in the mid to late 20^th Century with the development of both glass and plastic cups². Although there is still no concrete scientific evidence to the effectiveness of cupping, there seems to be a positive outcome in most cases. I can say this from experience: after having taken the course, I have been applying the procedures to various athletes and I’m still amazed and shocked at the results I have been getting.

I have been using myofascial decompression on a wide variety of athletes over the past two months. The results have been rather interesting. Yes, I was skeptical as to how this would work. I still can’t explain all of it, but I do know that subjectively, athletes have been responding to the effects of MFD. I am happy to say that the use of MFD on plantar fasciitis has had some of the most favorable responses.

The first athlete on whom I used MFD was caught in the early stages of the plantar fasciitis. He had just begun to notice pain in his foot with waking in the mornings then continues a few more days when he started to notice it with running. He was open to trying the technique. After the first treatment, he notice marked improvement and decreased pain with waking. Approximately five days later, a second treatment was done. Since then, he has been pain-free and running without incident. As you can see, here is a prime example of how early use of MFD can be beneficial in care.

The second athlete, also with plantar fasciitis, has had similar but different results from the first case. Here, the athlete has been treated with conventional means (excluding a night splint) for nearly four months with little to no improvement. MFD was suggested to her. The first treatment resulted in decreased muscular tightness in her calf and foot. However, the pain was still present. A second treatment was done with similar results. Pain diminished slightly but not to expectations. A third treatment was schedule but she did not return. She was seen by a podiatrist who injected her with cortisone. To this day, there still has been little change since the injection.

Most recently, another athlete has been added to the list of plantar fasciitis cases. She was treated bilaterally with MFD. Upon her first treatment, she noticed good improvement with both pain and muscle tightness. Both had decreased and she was walking normally. She was also able to walk on her toes with little to no discomfort. Due to the team’s travel schedule, she has not been able to do an additional treatment. However, she seems to be doing fairly well and uses night splints to aid in her treatments.

Another athlete was having issues with this iliotibial band (ITB) and hamstring. His chief complaint was tightness and mild pain on the outside of his knee. He was also four months post-ACL reconstruction at that time. He had four cups placed along his ITB. Upon removal, he immediately noticed that his ITB was looser. He has had no further treatments on his ITB and continues to progress in his rehabilitation without incident. The cups were also used on this hamstring due to some flexibility issues. After two treatments, he has gained more flexibility and now continues to improve his strength and stability. 

The next athlete is a more unique situation in comparison to the other athletes. This athlete presented with a calf strain. He was treated with initial conservative treatment to control pain and swelling. After the first three days, I opted to incorporate the use of one cup. This cup was used to almost flush the area. As I ran the cup over the affected area, I felt grit. It was like driving over a bad gravel road. Actually, he had so many adhesions, I could hear the grit. It was very audible. After the first treatment, he reported pain was gone and noticed that he had more flexibility and motion on the injured side. He was treated again two days later with the same procedure. Within a week, he was able to return to limited practice. He continues to move forward and should be 100% in the near future.

I’m still amazed at what I have seen with MFD. Every time I use it, I ask for feedback from the athletes. So far, almost all results have been favorable. It’s good to see an ancient therapeutic method still has value today. If you have the chance to have this done to you, try it. You will be surprised at what happens. I can’t explain it scientifically, but I can say it has been an eye-opener.

Will this work for everything? I can’t say that. I mean not everything works for everyone. It’s trial and error. As long as I see positive results, I will incorporate that into an athlete’s rehabilitation program. If I don’t see results, then I will move forward into another area of treatment. All I can say is, be open and willing to try a new method. You never know what might happen.

References:

1. Bentley, Bruce. A Brief History of Cupping. February 2008.

2. Dharmananda, Subhuti, PhD. Cupping. March 1999.

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