Sports Injuries

Knee injuries can present in physically active individuals that lift weights. Can understanding the types of weightlifting knee injuries help in prevention?

Weightlifting Knee Injuries

Weight training is very safe for the knees as regular weight training can improve knee strength and prevent injury as long as the correct form is followed. For Individuals with knee injuries from other activities, incorrect weight-training exercises could worsen the injury. (Ulrika Aasa et al., 2017) As well as, sudden twisting movements, poor alignment, and pre-existing injuries can increase the risk of worsening or creating further injuries. (Hagen Hartmann et al, 2013) The body and the knees are designed to support vertical forces on the joints.

Common Injuries

Weightlifting knee injuries occur as the knee joints endure a wide range of stresses and strains. In weight training, the ligaments that attach to the complex bone system of the knee joint can be damaged by incorrect movements, overloading the weight, and increasing the weight too soon. These injuries can result in pain, swelling, and immobility that can range from minor to severe, from a sprain or a slight tear to a complete tear in serious cases.

Anterior Cruciate Ligament - ACL - Injury

This ligament attaches the thigh's femur bone to the lower leg's shin bone/tibia and controls excessive rotation or extension of the knee joint. (American Academy of Family Physicians. 2024)

• Anterior means front.
• ACL injuries are seen mostly in athletes but can happen to anybody.
• Severe damage to the ACL usually means surgical reconstruction and up to 12 months of rehabilitation.
• When weightlifting, try to avoid twisting knee movements, intentionally or accidentally, under excessive load.

Posterior Cruciate Ligament - PCL - Injury

• The PCL connects the femur and tibia at different points to the ACL.
• It controls any backward motion of the tibia at the joint.
• Injuries occur most with high-impact forces as a result of accidents and sometimes in activities where forceful trauma to the knee occurs.

Medial Collateral Ligament - MCL - Injury

• This ligament maintains the knee from bending too far to the inside/medially.
• Injuries mostly occur from impact to the outside of the knee or from accidental bodyweight force on the leg that bends at an unusual angle.

Lateral Collateral Ligament - LCL - Injury

• This ligament connects the smaller bone of the lower leg/fibula to the femur.
• It is opposite to the MCL.
• It maintains excessive outward movement.
• LCL injuries occur when a force pushes the knee out.

Cartilage Injury

• Cartilage prevents bones from rubbing together and cushions impact forces.
• Knee menisci are cartilage that cushions the knee joints inside and outside.
• Other types of cartilage protect the thigh and shin bones.
• When cartilage gets torn or damaged, surgery may be required.

Tendonitis

• Aggravated and overused knee tendons can lead to weightlifting knee injuries.
• A related injury known as iliotibial band syndrome/ITB causes pain to the outside of the knee, usually in runners, but it can occur from overuse.
• Rest, stretching, physical therapy, and anti-inflammatory medication are a common treatment plan.
• Individuals should consult a physical therapist for pain lasting longer than two weeks. (Simeon Mellinger, Grace Anne Neurohr 2019)

Osteoarthritis

• As the body ages, normal wear and tear can cause the development of osteoarthritis of the knee joints. (Jeffrey B. Driban et al., 2017)
• The condition causes the cartilage to deteriorate and bones to rub together, resulting in pain and stiffness.

Prevention

• Individuals can minimize their risk of weightlifting knee injuries and pain by following their doctor's and personal trainers' recommendations.
• Individuals with an existing knee injury should follow their doctor's or physical therapist's recommendations.
• A knee sleeve can keep the muscles and joints secure, providing protection and support.
• Stretching the leg and knee muscles can maintain joint flexibility.
• Avoid sudden lateral movements.
• Possible recommendations can include:

Avoiding Certain Exercises

• Isolation exercises like leg curls, standing, or on a bench, as well as using the leg extension machine, can stress the knee.

Deep Squat Training

Research shows that the deep squat can protect against lower leg injury if the knee is healthy. However, this is when done with proper technique, under expert supervision, and with a gradual progressive load. (Hagen Hartmann et al, 2013)

Individuals should talk to their doctor before beginning a new exercise routine. A personal trainer can provide training in learning the proper technique and weightlifting form.

How I Tore my ACL Part 2

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Aasa, U., Svartholm, I., Andersson, F., & Berglund, L. (2017). Injuries among weightlifters and powerlifters: a systematic review. British journal of sports medicine, 51(4), 211–219. https://doi.org/10.1136/bjsports-2016-096037

Hartmann, H., Wirth, K., & Klusemann, M. (2013). Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports medicine (Auckland, N.Z.), 43(10), 993–1008. https://doi.org/10.1007/s40279-013-0073-6

American Academy of Family Physicians. ACL injury. (2024). ACL injury (Diseases and Conditions, Issue. https://familydoctor.org/condition/acl-injuries/

Mellinger, S., & Neurohr, G. A. (2019). Evidence based treatment options for common knee injuries in runners. Annals of translational medicine, 7(Suppl 7), S249. https://doi.org/10.21037/atm.2019.04.08

Driban, J. B., Hootman, J. M., Sitler, M. R., Harris, K. P., & Cattano, N. M. (2017). Is Participation in Certain Sports Associated With Knee Osteoarthritis? A Systematic Review. Journal of athletic training, 52(6), 497–506. https://doi.org/10.4085/1062-6050-50.2.08

Percussive massage guns have become a standard tool in osteopathy, physical and massage therapy, and chiropractic care. They provide rapid bursts of force into muscle tissues to quickly loosen and relax the muscles to alleviate soreness, stiffness and increase circulation. Percussive massager therapy devices can be a healthy part of an exercise and recovery routine. They allow individuals to give themselves quick, powerful massages anytime and anywhere. But they need to be used correctly to reap the benefits.

Percussive Massager

These devices can be found in stores and online. Many are on the market, making it tough to separate high-quality massagers from low-quality ones. With a little research and advice from a physical therapist or chiropractic professional, they can help the individual get the right one and training on how to use them to maintain a healthy musculoskeletal system.

Percussive Therapy

Massage guns utilize percussive therapy or vibration therapy, sometimes simultaneously. Percussion and vibration therapy are slightly different. They are soft tissue manipulation, which reduces muscle soreness and post-physical activity, and workout fatigue.

• Vibration therapy uses vibration movements to relax the body, alleviate stress and improve circulation.
• Vibration therapy applies force to targeted areas but with less intensity.
• This type of soft tissue therapy is generally defined as reaching eight to 10 millimeters into the soft tissues.
• Vibration therapy is often recommended for individuals with chronic pain conditions, overly sensitive muscles, or a medical condition that prevents them from using percussive therapy.
• Percussive therapy involves the application of force to muscles and fascia to break up adhesions and increase circulation to sore and sensitive areas.
• Percussive therapy extends deeper into the muscles and reaches deep into soft tissue, estimated to be about 60% deeper.

Using It Properly

It's important to know how to use the machine to get the most out of a percussive massager. Using the massager incorrectly can lead to further injury or the development of new injuries.

Before Workouts

A pre-workout massage session can help warm up the body by increasing circulation and improving the range of motion of the muscles that will be engaged during the workout. Spend one to two minutes massaging each muscle group that will be worked out, plus 30 seconds on supporting muscle groups. For example, here is a pre-workout massage for a leg workout.

• Sixty seconds on each quadricep.
• Sixty seconds on each hamstring.
• Thirty seconds on the lower back.
• Thirty seconds on each calf.

Circulation increases in less than five minutes, and the muscles are ready for exercise. However, this does not replace proper warming-up like dynamic stretching and light cardio to increase heart rate.

After Workouts

After working out, a percussive massage can be part of the cool-down.

• Post-workout percussive therapy can help return the body from a heightened state to a resting state.
• Percussive therapy helps reduce inflammation, which helps reduce post-workout muscle soreness is thought to occur due to microscopic tears in muscle fibers and inflammation in the tissues.
• Percussive therapy maintains increased circulation after a workout, providing oxygen and nutrients to tired muscles.
• The massage helps relax the nervous system by reducing soreness and pain signals, similar to a TENS unit.

Sore Muscles

The muscles may still be sore a day or two after working out. This is called delayed-onset muscle soreness/DOMS.

• A percussive massage can help but may not completely alleviate DOMS but it will provide temporary relief.
• The massager's speed and depth settings should be adjusted to where they don't cause pain.
• Sore muscles tend to remain sensitive, and it is recommended to use the lower settings.
• Once a setting feels good, use the massager for one to two minutes on each sore area.

How Not to Use

Individuals are recommended to consult a doctor if not sure of percussive massage therapy and should avoid using a percussive massager on:

• Musculoskeletal injuries - sprains and strains.
• Bony areas.
• Areas of severe or unexplained pain.
• Sensitive areas.
• Bruises or open wounds.
• Individuals with arthritis, osteoporosis, fibromyalgia, or other musculoskeletal conditions.

Percussive massage devices are safe to use for muscle soreness and as a tool to improve fitness. Individuals can safely use a percussive massager every day as long as they use proper techniques and don’t exceed the recommended usage time, usually provided with instructions on how long to use the device during a session. And some massagers have an automatic shut-off so the individual doesn't exceed the recommended time.

Revitalize and Rebuild with Chiropractic

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Cheatham, Scott W et al. “Mechanical Percussion Devices: A Survey of Practice Patterns Among Healthcare Professionals.” International journal of sports physical therapy vol. 16,3 766-777. 2 Jun. 2021, doi:10.26603/001c.23530

Dupuy, Olivier, et al. “An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis.” Frontiers in physiology vol. 9 403. 26 Apr. 2018, doi:10.3389/fphys.2018.00403

García-Sillero, Manuel et al. “Acute Effects of a Percussive Massage Treatment on Movement Velocity during Resistance Training.” International journal of environmental research and public health vol. 18,15 7726. 21 Jul. 2021, doi:10.3390/ijerph18157726

Hotfiel, Thilo, et al. “Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics.” “Delayed Onset Muscle Soreness – Teil I: Pathogenese und Diagnostik.” Sportverletzung Sportschaden : Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin vol. 32,4 (2018): 243-250. doi:10.1055/a-0753-1884

Imtiyaz, Shagufta, et al. “To Compare the Effect of Vibration Therapy and Massage in Prevention of Delayed Onset Muscle Soreness (DOMS).” Journal of Clinical and diagnostic research: JCDR vol. 8,1 (2014): 133-6. doi:10.7860/JCDR/2014/7294.3971

Konrad, Andreas, et al. “The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles' Range of Motion and Performance.” Journal of sports science & Medicine vol. 19,4 690-694. 19 Nov. 2020

Nerves control muscle fibers. Muscle twitching is an involuntary contraction of the muscle fibers. When individuals play sports/work out vigorously or for a long time, they may experience muscle twitching and can often see and/or feel the twitches happening. The most worked-out muscles are likely to twitch, which includes the biceps, thighs, and calves, but twitches can occur in any muscle. Chiropractic care, massage therapy, and functional medicine can help relax the muscles, improve circulation, restore function, and train individuals to prevent future episodes.

Muscle Twitching

A muscle twitch often occurs after intense physical activity or a hard workout because the muscle or muscles have been overworked, and there is hyper-excitability of the nerve/s that makes the muscle/s continue to contract.

• A muscle twitch that can be seen is called fasciculation.
• A muscle twitch that cannot be seen is called fibrillation.
• If there is pain or the twitching is prolonged, it is a muscle spasm.

Causes

The most common causes include the following:

• Intense exercise and rigorous physical activity build up lactic acid in the muscles.
• Dehydration is a very common factor for shaky muscles.
• Vitamin D and calcium deficiencies could cause muscle spasms in the hand, calves, and eyelids.
• Using caffeinated products to increase physical performance.
• Not enough or a lack of healthy sleep.
• Anxiety or stress.
• Certain medications like estrogen and corticosteroids.
• Nicotine and tobacco use.

Physical Activity/Exercise

• Intense exercise and physical activity can cause muscle fatigue.
• Muscle fatigue triggers twitching and cramping in overworked muscle fibers.
• Electrolytes play a role in muscle contraction.
• Electrolyte loss and imbalances within muscle fibers through sweating can lead to twitching.

Dehydration

• Muscle mass comprises 75% water.
• Water carries nutrients and minerals to muscles to support function.
• Not being properly hydrated can cause twitching and cramping.

Vitamin D Deficiency

• Nerves need vitamin D to relay messages to and from the brain to the body's muscles.
• A vitamin D deficiency can cause muscle weakness and twitching.

Magnesium Deficiency

• Magnesium deficiency is known as hypomagnesemia.
• Magnesium plays a role in maintaining nerve and muscle health.
• Magnesium helps transport calcium across cell membranes to support nerve and muscle function.
• A magnesium deficiency can cause twitching anywhere in the body, including the face.

Causes of magnesium deficiency include:

• Poor diet
• Diarrhea
• Drinking too much alcohol
• Not addressing magnesium deficiency can increase the risk of cardiovascular disease.

Caffeine

• Caffeine is a stimulant.
• Drinking too much coffee, tea, or energy drinks can cause fasciculation.

Not Enough Sleep

• Brain chemicals or neurotransmitters transmit information from the brain to the nerves that control muscle contraction.
• Sleep deprivation can affect how neurotransmitter receptors work.
• This means excess neurotransmitters can build up in the brain.
• Lack of sleep can affect neurotransmitter function.
• A common site of fasciculation tiredness occurs in the eyelids.

Anxiety and Stress 

• Experiencing psychological stress or high anxiety levels can cause excess muscle tension.
• This can lead to muscle twitching.
• Muscle fasciculation caused by stress can occur anywhere in the body.

Certain Medications

• Certain medications can lead to involuntary muscle twitching.
• The reaction can be a side effect due to interactions with other medications.
• Individuals should discuss side effects and medication interactions with their doctor when taking a new medication.

Chiropractic Care

Chiropractors are experts on the musculoskeletal system and have many techniques to treat muscle fasciculation and spasms. It often depends on the cause/s, and specific treatment varies on a case-by-case basis. Common chiropractic treatments include:

• Massage therapy
• Heat and ice therapy
• Manual manipulation
• Joint adjustments
• Ultrasound
• Stretches to keep the muscles flexible
• Exercises to strengthen the muscles
• Nutritional recommendations

Fasciculation

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Bergeron, Michael F.. Muscle Cramps during Exercise-Is It Fatigue or Electrolyte Deficit?. Current Sports Medicine Reports July 2008 - Volume 7 - Issue 4 - p S50-S55 doi: 10.1249/JSR.0b013e31817f476a

Gragossian A, Bashir K, Friede R. Hypomagnesemia. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (F.L.): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500003/

Küçükali, Cem Ismail, et al. "Peripheral nerve hyperexcitability syndromes." Reviews in the neurosciences vol. 26,2 (2015): 239-51. doi:10.1515/revneuro-2014-0066

Maughan, Ronald J, and Susan M Shirreffs. "Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining." Sports medicine (Auckland, N.Z.) vol. 49, Suppl 2 (2019): 115-124. doi:10.1007/s40279-019-01162-1

Miller, Kevin C et al. "Exercise-associated muscle cramps: causes, treatment, and prevention." Sports health vol. 2,4 (2010): 279-83. doi:10.1177/1941738109357299

Riebl, Shaun K, and Brenda M Davy. "The Hydration Equation: Update on Water Balance and Cognitive Performance." ACSM's health & fitness journal vol. 17,6 (2013): 21-28. doi:10.1249/FIT.0b013e3182a9570f

Squat exercises are highly effective, as they strengthen the back and core muscles, helping the prevention of injury. They can be done anywhere with or without equipment like weights and resistance bands and can be part of an aerobic workout. Squatting requires following proper form and posture. Using the improper form, adding too much weight too soon, overdoing it without enough recovery time can cause soreness, back pain, and injury. Having muscle soreness after performing squats is expected; however, if symptoms like chronic soreness, tingling, numbness, or sharp aches that come and go, begin to appear, it is recommended to consult a medical trainer, chiropractor, doctor, or spine specialist to evaluate the symptoms, and if necessary develop a treatment plan, as well as a prevention plan to continue exercising safely.

Squat Exercises

Squatting is a highly beneficial form of exercise. Athletes, trainers, coaches, and individuals just staying healthy use the technique as a part of their training and workouts. This is because squatting increases core muscle strength, increasing body power. Squat exercises benefits include:

Increased Flexibility

• Improved strength and a range of motion allow the body to move flawlessly in various directions with minimal effort.

Increased Core Strength

• All major muscles work together during a squat.
• This increases muscle stabilization, maintains body balance, increasing core strength.

Injury Prevention

• Squats work all leg muscles simultaneously, synchronizing the body.
• This increases body stability decreasing the risk of injury.

Back Pain and Potential Injury

The spine is exposed and unprotected during a squat. This is where back pain and injury can happen. Potential causes include:

• Not warming up/priming muscles properly.
• Tight muscles and a limited range of motion.
• Improper form and squatting technique.
• Adding weight or loading too soon.
• Weak core muscles.
• Incorrect or improper footwear with inadequate arch support.
• Weak ankle muscles are not used to the weight and shift, causing misalignment and awkward positioning.
• Previous injuries to the lower back can cause a flare-up to the area and potentially worsen.

Prevention

Ways to troubleshoot and prevent back pain during squat exercises.

Warmup

• Using a proper and effective warmup will ensure that the body is ready for the workout stress.
• Priming each muscle is recommended. This could be:
• Starting with glute work.
• Then planks to activate the core.
• Finish off with stretching and range of motion exercises.
• A personal trainer can assist in creating a customized workout routine.

Starting Position

• The feet should always face forward to protect the hips and knees when beginning a squat.
• If the feet face at an angle, the form can be impacted, leading to back pain or collapsing arches.

Spinal Alignment

• Maintaining a straight-ahead or upward gaze, which increases center awareness during squat exercises, can prevent the body from leaning forward and placing stress on the spine.
• Only squat as far as possible, making sure to feel in control and maintain the form.
• Squatting too deep can cause muscle strain leading to pain.
• Focus on form, as it is more important than depth.

Joint mobility

• Ankle mobility and stability are essential to balance and control.
• If the ankle is compromised, the feet could lift off the floor, forcing the body to compensate, leading to strain and potential injuries.
• Only squat as far as ankle stability allows.
• Ankle flexibility exercises will help improve squat form.

Variations

• Choose the correct squat variation.
• Goblet or front squats can be easier for beginners.
• Barbell back squats are more advanced and, if done incorrectly, can cause injury.

A chiropractor or physical therapist will be able to evaluate spinal health, exercise form, and advise if there is an issue.

Body Composition

Achieve Health and Fitness Goals By Doing What You Enjoy

Don't engage in workouts or fitness programs that make you miserable. Do workouts/activities that you enjoy and have fun doing. Exercise for the love of the body, keeping it healthy and in shape, not because there is a feeling of obligation.

• Try and experiment with different workouts/physical activities to see and feel what works for you.
• Individuals who don't like lifting weights try using resistance bands or bodyweight exercises.
• The same goes for nutrition. Don't base diet and supplement choices on misperceptions about health.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Calatayud, Joaquín et al. "Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-back Pain." International journal of environmental research and public health vol. 16,19 3509. 20 Sep. 2019, doi:10.3390/ijerph16193509

Clark, Dave R et al. "Muscle activation in the loaded free barbell squat: a brief review." Journal of strength and conditioning research vol. 26,4 (2012): 1169-78. doi:10.1519/JSC.0b013e31822d533d

Cortell-Tormo, Juan M et al. "Effects of functional resistance training on fitness and quality of life in females with chronic nonspecific low-back pain." Journal of back and musculoskeletal rehabilitation vol. 31,1 (2018): 95-105. doi:10.3233/BMR-169684

Donnelly, David V et al. "The effect of the direction of gaze on the kinematics of the squat exercise." Journal of strength and conditioning research vol. 20,1 (2006): 145-50. doi:10.1519/R-16434.1

Zawadka, Magdalena et al. "Altered squat movement pattern in patients with chronic low back pain." Annals of agricultural and environmental medicine: AAEM vol. 28,1 (2021): 158-162. doi:10.26444/aaem/117708

Chiropractic medicine is used as a standard musculoskeletal injury/strain treatment and for rehabilitation. Chiropractic helps with:

• Different types of back pain
• Headaches
• Neck pain
• Shoulder pain
• Arm pain
• Hand pain
• Leg pain
• Foot pain

Spine and nervous system health are essential for a properly functioning body and overall health. There are significant benefits of chiropractic care that can improve an individual's overall quality of life and health. Chiropractic treatment can help:

Relieve Stress

Stress is natural in life, and it's too much or poor management techniques that can cause pain and or injury. Chiropractic can improve how the body responds to stress. The nervous system is responsible for adapting the body to its environment, especially a stressful environment. Around 90% of the central nervous system travels down and through the spinal column. Spinal vertebral subluxations/misalignments can interfere with proper nerve flow disrupting body functions. Vertebral subluxation decreases the body's ability to adapt to the environment. When this happens, stress can have a high adverse impact on the body's health. An aligned spine along with an optimally operating nervous system helps the body to manage stress easier.

Improve Posture

Posture shifts affect spinal alignment and nerve function. The most common is Forward Head Posture/FHP. This is where the head shifts forward and down on the shoulders. This affects the natural curve in the neck, causing tension to form in the spinal cord. Improper ergonomics and overuse of electronic devices play a role in FHP. Chiropractic treatment helps and restores proper spinal alignment, significantly improving the body's posture.

Elevate Mental Mood

Individuals in pain are often in a bad, sad, low mood reflecting their pain level. Balancing the body’s nervous system restores the balance of chemical flow in the body. Conditions like depression and ADHD have shown improvement with regular chiropractic care.

Strengthen Immune System Function

Spinal misalignment adversely affects the nervous system. The nervous system sends all the necessary information to different areas of the body. If the spine has been compromised, specific sites will not receive the vital signals required to function at full potential. This can affect any or all the systems in the body, especially the immune system. Chiropractic improves nerve flow to the organs of the immune system.

Enhance Thorough Sleep

Lack of sleep leads to all kinds of health issues. Lack of proper sleep can be from a nervous system that does not shut down, add pain, stress, and nightly symptoms do not allow the body to rest. Optimal spinal alignment relaxes the nervous system decreasing pain. Sleep improves over time, with individuals reporting reduced pain and an increase in health and wellness.

Body Composition

Gluten Effects

Gluten causes digestive issues/problems for individuals that have celiac disease or autoimmune thyroid disease. Individuals with these conditions that eat gluten foods can present with uncomfortable and painful effects. Symptoms can vary and have different classifications.

Classical Celiac Disease - CD

Classical celiac disease presents with symptoms that include:

• Diarrhea
• Discolored stools
• Constipation
• Abdominal bloating
• Pain
• Weight loss

However, these symptoms are more common in children with CD than adults. In adults, symptoms are more similar to those in non-classical celiac disease.

Non-Classical Celiac Disease

Non-classical celiac disease symptoms may not present with severe digestive symptoms as in classical CD but suffer from other symptoms. These include:

• Abdominal distension
• Pain
• Iron deficiency anemia
• Fatigue
• Migraines
• Weak bones
• Depression

Silent Celiac Disease

Silent CD is less visible. There might not be any symptoms, but damage to the intestines is still occurring.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Khodakarami, Nima. “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation.” Healthcare (Basel, Switzerland) vol. 8,1 44. 24 Feb. 2020, doi:10.3390/healthcare8010044

Rubinstein, Sidney M et al. “Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomized controlled trials.” BMJ (Clinical research ed.) vol. 364 l689. 13 Mar. 2019, doi:10.1136/bmj.l689

Urits, Ivan et al. “A Comprehensive Review of Alternative Therapies for the Management of Chronic Pain Patients: Acupuncture, Tai Chi, Osteopathic Manipulative Medicine, and Chiropractic Care.” Advances in therapy vol. 38,1 (2021): 76-89. doi:10.1007/s12325-020-01554-0

Strength training: The Centers for Disease Control have estimated that around 16% of six to nineteen-year-olds in the US are overweight or obese. This comes from inactivity, no movement, exercise, and poor diet. On the other end, young athletes search for ways to gain an edge, often falling victim to steroids, and all of the negative effects they have.

This is where strength training comes in. This could be an answer to getting kids off the couch, moving, and offers a healthy alternative to the young athletes looking for that competitive edge. Fitness experts, doctors, health coaches, and parents say absolutely.

Strength Training

Kids' strength training is very different than strength training for adults. This exercise program focuses on:

• Controlled movements
• Proper technique
• Correct form
• Uses more repetitions
• Uses lighter weights.

This type of workout program can be done with:

• Free weights
• Weight machines
• Resistance bands
• A child's own body weight

The focus for children in strength training is not to bulk up, as this is not weightlifting, powerlifting, or bodybuilding. Fitness experts agree that these types of training regiments are not healthy or safe for children. The goal is to:

• Build strength
• Improve muscle coordination
• Enhance long-term health
• Rehabilitate injuries
• Prevent injuries

Added benefits of strength training can help young athletes improve performance through increased endurance.

Training Guidelines

It is fundamental to find a program that is safe and successful for children. Parents want a program that is designed specifically for kids, is supervised by a fitness professional with child experience, and most of all that it is fun. For strength training there is not a minimum age, however, the kids should be able to understand and follow directions.

Before starting a child on any new fitness program check with their doctor or healthcare provider.

A training program should include:

• A session should start with a 5-10 minute warm-up exercise/s like stretching and light aerobics.
• Every session should end with a cool-down combined with stretching and relaxation.
• Kids should not immediately be using weights until proper form and technique are learned.
• Kids should start with their own body weight, bands, or a bar with no weight.
• Using 6-8 different exercises that address all the muscle groups, begin with 8-15 repetitions.
• Each exercise should be done with a complete follow-through of the full range of motion.
• If the repetitions are too much with a specific weight, reduce the weight.
• Repetitions and sets should gradually increase over time to maintain the intensity of the training.
• Add more weight only when the child displays the proper form and can easily do at least 10 reps.
• Workouts should be 20 to 30 minutes long, 2 to 3 times per week to get the most benefit.
• Make sure to rest a day between each workout day.

Safety

Strength training was not always considered appropriate exercise for kids. Doctors and fitness professionals believed that it was unsafe for a child's growing body because of the added pressure on growth plates or the cartilage that has not fully turned into solid bone. Experts now know that with proper technique and supervision, kids can safely participate in a strength training program.

As with any type of exercise/fitness regiment, safety measures need to be in place along with heightened supervision. Most injuries happen when kids are not supervised, not using proper techniques, or from trying to lift too much weight. Here are some safety precautions to remember:

• Learning new exercises should be done under the supervision of a trainer/instructor making sure proper technique and form are used
• Smooth controlled motions should be the goal
• Controlled breathing and not holding their breath needs to be taught
• Proper technique will help avoid injuries
• The kids' progress should be monitored
• Have the children keep a record of the exercises they have done, how many reps, and the amount of weight/resistance.
• If enrolled in a strength training class, a good ratio is one instructor per 10 students. With this ratio, the kids can receive proper instruction and supervision.
• Kids should train in a hazard-free, well-lit, and properly ventilated facility.
• Make sure the kids drink plenty of water during and after the workout
• Fitness trainers/instructors will see to it that there are frequent rest and rehydration breaks

Keep in mind

In a strength training program for children, there should be no competitive drive. The focus should be on participation, learning the movements, and positive reinforcement. Set realistic goals and expectations for the child, so that they understand that it will take time to learn these new skills.

Remember that kids do not increase muscle size until after puberty. Make sure the kids enjoy the strength training sessions and that they are having fun. Keep in mind that kids can become easily bored. Therefore use a variety of exercises and routines keeping them excited and wanting to learn and do more.

Healthy Habits

Getting kids interested in fitness early on can help establish a life-long habit of wanting to be and stay healthy. This includes a balanced diet, plenty of rest, and regular exercise. When done correctly strength training can be a fun and highly beneficial activity.

PUSH Fitness

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico

As we age, staying active keeps us healthy,  our lives are lengthened and we feel great! Older individuals are discovering that exercise, sports and being physically fit does not mean having to do hardcore workouts and hard-to-maintain exercise/s and schedules.

Many of these individuals get their exercise from active pastimes like biking, Crossfit, and tennis. Others participate in less active recreational activities like walking, gardening or golf. Regardless of which activity they get into, they are all getting relaxation and fun while securing a healthy future.

Exercise helps us feel better because it improves our health.

Spending just a little time each day doing some type of physical activity, will bring these benefits:

• Longer
• Healthier life
• Stronger bones
• Reduced joint
• Reduced muscle pain
• Improved mobility
• Improved balance
• Lower risk of falls
• Lower risk of serious injuries e.g. hip fractures
• Slower loss of muscle mass

Fortunately, individuals are living longer but their quality of life means staying healthy and active to remain independent.

Staying active will lower the risk of many common diseases, relieve arthritis pain and help you recover faster when illness hits.

Activity and Safety

Keeping active means that it's also important to be safe during these activities/exercises. With more older individuals participating in physical activities, there is an equal increase in sports-related injuries. This is true for bicyclists, skiers, weight lifters and those that use exercise machines.

A recent study by the U.S. Consumer Product Safety Commission (CPSC),  showed an estimated 53,000 people ages 65 and up were treated in U.S. emergency rooms for sports, physical activity-related injuries. Additional injuries were treated in doctor's clinics/offices.

The increase comes from more older individuals engaging in active sports. However, most of these injuries were not severe but more importantly, they could've been prevented. An example was cyclists treated in emergency rooms for head injuries were not wearing helmets. Wearing a helmet reduces the risk of serious head injury up to 85 percent. Regular exercise along with doing it safely means you can enjoy yourself a lot more.

Activity log

Medium physical activity for 30 minutes a day is beneficial for everyone but especially those with chronic bone/joint conditions.

The 30 minutes of activity can be broken up into shorter periods of different activities, like 15 minutes of gardening and 15 minutes of stretching exercises. This can help not getting bored with a routine by mixing it up.

Activity log to keep track of the time you spend on each.

Injury Prevention Tips

When exercise/participating in an activity, doctors recommend following these tips:

• Wear the proper safety gear for whichever activity/sport you choose.
• Wear the right shoes for each sport/activity.
• Warm-up before engaging in physical activity. This could be moderate walking at your normal pace with an emphasis on arm movements.
• Exercise at least 30 minutes a day. Break the activities into shorter periods of 10 or 15 minutes throughout the day.
• Follow the 10 percent rule, which means never increasing the program like walking/running distance or weight-lifting more than 10 percent a week.
• Try not to do the same routine two days in a row.
• Mix it up so as not to sprain/strain the same muscles and allow the other muscles to get a workout. So walk, swim, tennis or lift weights, as this keeps the exercise more interesting.
• Read instructions carefully when working with exercise equipment, and if needed, ask a qualified professional to help you.
• Check exercise equipment making sure it's in proper working order.
• If weight training interests you but you have never done it, make sure to get professional consultation before starting.
• Stop exercising if there is severe pain or swelling and get checked by your doctor.

There are plenty of ways to enhance our lives as we age, and staying fit and active along with the proper diet are a few of the most important.

Our clinical focus and personal goals are to help your body heal itself naturally quickly and effectively.  At times, it may seem like a long path; nevertheless, with our commitment to you, it’s sure to be an exciting journey. The commitment to you in health is to, never lose our deep connection to each one of our patients on this journey.

When your body is truly healthy, you will arrive at your optimal fitness level proper physiological fitness state.  We want to help you live a new and improved lifestyle. Over the last two decades, while researching and testing methods with thousands of patients, we have learned what works effectively at decreasing pain while increasing human vitality.

El Paso, TX Chiropractor Lower Back Pain Treatment

Two surgeons discuss the diagnosis and treatment of acromioclavicular injuries in athletes. El Paso, TX. Chiropractor, Dr. Alexander Jimenez follows the discussion.

Acromioclavicular (AC) joint injuries most often occur in athletic young adults involved in collision sports, throwing sports, along with overhead activities like upper-extremity strength training. They account for 3% of all shoulder injuries and 40% of shoulder sports injuries. Athletes in their second and third decade of life are more often affected(1), and men are injured more commonly than women (5:1 to 10:1)(1,2).

Acromioclavicular dislocation was known as early as 400 BC by Hippocrates(3). He cautioned against mistaking it for glenohumeral (shoulder joint) dislocation and advocated treating with a compressive bandage in an attempt to hold the distal (outer) end of the clavicle in a diminished position. Almost 600 decades later Galen (129 AD) recognized his own acromioclavicular dislocation, which he sustained while wrestling(3). He left the tight bandage holding the clavicle down as it was too uneasy. In today's era this injury is better known, but its treatment remains a source of fantastic controversy.

Anatomy

The acromioclavicular joint combines the collarbone to the shoulder blade and therefore links the arm to the axial skeleton. The articular surfaces are originally hyaline cartilage, which affects to fibrocartilage toward the end of adolescence. The average joint size is 9mm by 19mm(4). The acromioclavicular joint contains an intra-articular, fibrocartilaginous disc which may be complete or partial (meniscoid). This helps absorb forces in compression. There is marked variability in the plane of the joint.

Stabilizers

There is little inherent bony stability in the AC joint. Stability is provided by the dynamic stabilizers -- namely, the anterior deltoid muscle arising from the clavicle and the trapezius muscle arising from the acromion.

Additionally, there are ligamentous stabilizers. The AC ligaments are divided into four -- superior, inferior, anterior and posterior. The superior is most powerful and blends with muscles. The acromioclavicular ligaments contribute around two- thirds of the constraining force to superior and posterior displacement; however, with greater displacement the coracoclavicular ligaments contribute the major share of the resistance. The coracoclavicular ligament consists of the conoid and trapezoid. The conoid ligament is fan-shaped and resists forwards motion of the scapula, while the more powerful trapezoid ligament is level and resists backward movement. The coracoclavicular ligament helps bunch scapular and glenohumeral (shoulder joint) motion and the interspace averages 1.3 cm.

Mechanism Of Injury

The athlete who sustains an acromioclavicular injury commonly reports either one of two mechanisms of harm: direct or indirect.

Direct force: This is when the athlete falls onto the point of the shoulder, with the arm usually at the side and adducted. The force drives the acromion downwards and medially. Nielsen(5) found that 70 percent of acromioclavicular joint injuries are caused by an direct injury.

Indirect force: This is when the athlete falls onto an outstretched arm. The pressure is transmitted via the humeral head into the acromion, therefore the acromioclavicular ligament is disrupted and the coracoclavicular ligament is stretched.

On Examination

The athlete presents soon after the severe injury with his arm splinted to his side. The patient may state that the arm feels better using superiorly directed support on the arm. Most motions are limited secondary to pain near the top of the shoulder; the degree varies with the grade of sprain. The hallmark finding is localized swelling and tenderness over the acromioclavicular joint.

In dislocations, the outer part of the collarbone will appear superiorly displaced using a noticeable step deformity (in fact, it is the shoulder which sags beneath the clavicle). Occasionally, the deformity may only be apparent later, if first muscle spasm reduces acromioclavicular separation. Forced cross-body adduction (yanking the affected arm across the opposite shoulder) provokes discomfort. The clavicle can frequently be moved relative to the acromion.

Acromioclavicular Visualisation

The typical joint width measures 1-3mm. It's regarded as abnormal if it is more than 7mm in men, and 6mm in women. Routine anteroposterior views of the shoulder reveal the glenohumeral jointnonetheless, that the acromioclavicular joint is over penetrated and so dark to interpret. Reduced exposure enhances visualization.

The individual stands with both arms hanging unsupported, both acromioclavicular joints on one film. Weighted viewpoints (stress X-rays) are obtained with 10-15 lb weights not held but suspended from the individual's wrists. They help differentiate type II-III injuries, but are of little clinical significance and therefore are no longer recommended in our practice.

Classification Of AC Separation

The importance of identifying the injury kind can't be over emphasized because the treatment and prognosis hinge on an accurate diagnosis. The injuries are graded on the basis of that ligaments are injured and how badly they're torn.

Allman (6) classified acromioclavicular sprains as grades I, II and III, representing respectively, no involvement, partial tearing, and total disruption of the coracoclavicular ligaments. More recently, Rockwood (1) has further classified the more severe injuries as standard III-VI.

The injuries are classified into six categories:

Treatment

The treatment of acromioclavicular joint injuries varies based on the seriousness or grade of the injury.

Initial treatment: These can be quite painful injuries. Ice packs, anti-inflammatories plus a sling are utilized to immobilize the shoulder and then take the weight of the arm. As pain starts to subside, it is important to start moving the fingers, wrist and elbow to prevent shoulder stiffness. Next, it's important to begin shoulder motion in order to stop shoulder stiffness.

Un-displaced injuries only require rest, ice, and then a slow return to activity over two to six weeks. Major dislocations require surgical stabilization in athletes if their dominant arm is involved, and if they participate in upper-limb sports

What's more, the patients treated non-operatively returned to full activity (work or athletics) earlier than surgically treated groups(10, 11). The exceptions to this recommendation include people who perform repetitive, heavy lifting, people who operate with their arms above 90 degrees, and thin patients who have prominent lateral ends of the clavicles. These patients may benefit from surgical repair(12).

Any discussion about the management of acute injuries to the AC joint must deal with which of the many methods of surgical therapy described is the best for their situation, but whether surgery should be considered at all. Surgery is generally avoided in athletes participating in contact sports since they will often re-injure the shoulder later on.

Surgery

Surgical repair can be divided into anatomical or non- anatomical, or historically into four types:

For the individual with a chronic AC joint dislocation or subluxation that remains painful after three to six months of closed treatment and rehabilitation, surgery is indicated to improve functioning and comfort.

Postoperatively, the arm is supported in a sling for up to six weeks. Following the first two weeks, the patient is permitted to use the arm for daily activities at waist level. After six weeks, the sling or orthosis is discontinued, overhead actions are allowed, formal passive stretching is instituted, and light stretching using elastic straps is initiated. Stretching and strengthening are begun slowly and gradually. The athlete shouldn't return to their sport without restriction until full strength and range of motion has been recovered. This usually occurs four to six months following operation.

Conclusion

AC joint injuries are an important source of pain at the shoulder area and have to be assessed carefully. The management of these injuries is nonoperative in the majority of cases. Type I and II injuries are treated symptomatically. The present trend in uncomplicated type III injuries are a non operative strategy. In the event the athlete develops following problems, a delayed reconstruction might be undertaken. In athletes involved in heavy lifting or prolonged overhead activities, surgery may be considered acutely. Type IV-VI injuries are generally treated operatively.

No matter what kind of treatment is chosen, the ultimate purpose is to restore painless function to the wounded AC joint so as to reunite the athlete safely and as quickly as possible back to their sport. It is possible in the vast majority of acromioclavicular joint injuries.

References

Reza Jenabzadeh and Fares Haddad

1. Rockwood CA Jr, Williams GR, Young CD. Injuries of the Acromioclavicular Joint. In CA Rockwood Jr, et al (eds), Fractures in Adults. Philadelphia: Lippincott-Raven, 1996; 1341-1431.

2. Dias JJ, Greg PJ. Acromioclavicular Joint Injuries in Sport: Recommendations for Treatment. Sports Medicine 1991; 11: 125-32.
3. Adams FL. The Genuine Works of Hippocrates (Vols 1,2). New York, William Wood 1886.
4. Bosworth BM. Complete Acromioclavicular Dislocation. N Eng J Med 2 41: 221-225,1949.
5. Nielsen WB. Injury to the Acromioclavicular Joint. J Bone Joint Surg 1963; 45B:434-9.
6. Allman FL Jr. Fractures and Ligamentous Injuries of the Clavicle and its Articulation. J Bone Joint Surg Am 1967;
49:774- 784.
7. Powers JA, Bach PJ: Acromioclavicular Separations: Closed or Open Treatment? Clin Orthop 1974; 104 (Oct): 213-223
8. Cox JS: Current Methods of Treatment of Acromioclavicular Joint Dislocations. Orthopaedics 1992; 15(9): 1041-1044
9. Clarke HD, Mc Cann PD: Acromioclavicular Joint Injuries. Orthop Clin North Am 2000; 31(2): 177-187
10. Press J, Zuckerman JD, Gallagher M, et al: Treatment of Grade III Acromioclavicular Separations: Operative versus
Nonoperative Management. Bull Hosp Jt Dis 1997;56(2):77-83
11. Galpin RD, Hawkins RJ, Grainger RW: A Comparative Analysis of Operative versus Nonoperative Treatment of Grade III Acromioclavicular Separations. Clin Orthop 1985; 193 (Mar): 150-155
12. Larsen E, Bjerg-Nielsen A, Christensen P: Conservative or Surgical Treatment of AC Dislocation: A Prospective, Controlled, Randomized Study. J Bone Joint Surg Am 1986;68(4):552-555
13. Bosworth BM. Complete Acromioclavicular Dislocation. N Engl. J. Med. 241: 221-225,1949.

An orthopedic surgeon explains why shoulders go wrong and what can be done to repair them. Shoulder chiropractor, Dr. Alexander Jimenez gets into the discussion.

The shoulder joint is frequently injured in the throwing athlete since it has a greater range of movement than any other joint in the body, and because its stability is dependent upon complete muscles and ligaments rather than supporting bone structures.

Phases Of Throwing

The five phases of throwing are wind-up, cocking, acceleration, deceleration and follow-through. The forces generated during those phases are significant and the subsequent pressures generated around the shoulder joint make it more likely to severe and chronic inflammatory conditions and injuries. A poor throwing technique will exacerbate the possibility of chronic inflammatory shoulder conditions.

A fantastic throwing technique requires the athlete to use his body weight as well as the big muscle groups of the legs, back and trunk to generate kinetic energy across the shoulder in the path of the thrown object. After the object is thrown, then the retained energy in the throwing arm has to be dissipated back to the large muscles which then absorb it. Poor mechanics throughout the wind-up and cocking stages require the shoulder muscles to generate extra energy to propel the object being thrown. This also contributes to exhaustion of the shoulder muscles, and can ultimately result in injuries.

When the object is thrown, a poor follow-through will lead to excess energy being retained in the delicate tissues of the shoulder, rather than returning to be consumed by the large muscles described previously, causing local tissue damage. Dynamic electromyographic analysis has substantiated a lot of the theory(2,3,4).

Simple Anatomy & Biomechanics

The shoulder (glenohumeral) joint is a ball (the humeral head) and socket (the glenoid fossa of the scapula) joint that's supported by the glenohumeral ligaments and labrum. The glenohumeral ligaments (inferior, middle and superior) are different capsular thickenings that restrict excessive rotation and translation of the humeral head. From the overhead throwing athlete, the more inferior glenohumeral ligament is the key anterior stabilizer when the arm is abducted beyond 90 degrees and externally rotated. The labrum is a thickening surrounding the glenoid which functions to deepen the glenoid cavity (the socket).

The shoulder is stabilized by both static and dynamic restraints. Static restraints include the articular anatomy, the labrum, the glenohumeral ligaments as well as also the negative pressure inside the joint. Dynamic restraints incorporate joint compression and also the steering effect of the rotator-cuff muscles (the very important small muscles around the shoulder).

The rotator-cuff muscles include the supraspinatus, infraspinatus, teres minor and subscapularis. The subscapularis is an internal rotator of the glenohumeral joint, whereas the infraspinatus and teres minor muscles are outside rotators. The rotator cuff as a whole functions to center the humeral head in the glenoid for stability and to allow maximal leverage during shoulder movements.

Shoulder Injuries In The Throwing Athlete

One of those dynamic or static restraint mechanisms could possibly be ruined by the throwing actions of this athlete, and there's a considerable overlap of injuries. Furthermore, an untreated or unrecognized injury may progress to additional injuries within the shoulder.

Common acute overuse injuries include rotator-cuff tendinitis and biceps tendinitis. Common chronic accidents include impingement syndrome, rotator-cuff tears, glenoid- labrum tears and shoulder instability.

The athlete will usually complain of anterior shoulder pain that is worst when trying to increase the speed or power of their throw.

Primary Instability & Secondary Impingement

Most athletes with anterior shoulder pain have favorable impingement signs and before a couple of years ago it was considered that they all had primary impingement. They subsequently underwent anterior acromioplasty (removal of the anterior part of the acromion process -- the acromion is a bony plate which juts up from the shoulder blade to supply a sort of protective roof over the shoulder joint) using rotator-cuff repair as necessary and the results of surgery proved to be inconsistent(5). It's currently known that symptomatic throwing athletes frequently have a primary instability of the shoulder with secondary impingement(6,7). Anterior acromioplasty with excision of the coracoacromial ligament in these people may actually raise shoulder instability and magnify symptoms.

Anterior instability can develop after a high-energy injury but in the throwing athlete it starts as an overuse injury. Chronic overuse can stretch the static stabilizers of the shoulder, resulting in instability. The scapular and rotator-cuff muscles act out of synchrony with each other placing an increased strain on the rotator cuff to maintain the head of the humerus at the center of the glenoid. As the rotator-cuff muscles weaken, the head subluxes anteriorly (moves forward) when the arm is abducted and externally rotated. This lateral subluxation causes a secondary impingement (compressing against) of the rotator cuff on the acromion and the coracoacromial ligaments, causing pain.

Clinical Examination

Active and passive array of motion, shoulder strength and regions of tenderness ought to be elicited. Most athletes with shoulder pain have favorable impingement signs. Pain during forward flexion while the examiner stabilizes the scapula is the principal impingement sign. Pain during active abduction of this internally rotated arm is your secondary impingement sign.

Examination of shoulder stability is significant and also the signals may be subtle. The apprehension test may be utilized to detect anterior instability and entails abduction of the shoulder to approximately 90 degrees followed by external rotation. As the outside rotation is increased, the athlete with anterior instability will feel as though the shoulder will 'pop out' or sublux forward. He/she will attempt to guard against further external rotation and eventually become very apprehensive.

The movement evaluation is done in a similar manner with the patient lying supine (on his/her back) and applying lateral pressure into the posterior aspect of the humeral head when abducting and externally rotating the arm. When there's anterior instability, this may be painful, but by employing a posteriorly directed force into the humeral head, the pain will ease because the humeral head is put in the anatomic position.

The existence of posterior capsular stimulation may be modulated by the presence of decreased internal rotation of the shoulder.

Imaging

Recent studies suggest that MRI is superior to ultrasound and CT scanning in assessing shoulder pain caused by rotator-cuff tears, subacromial impingement and osteoarthritis of the glenohumeral and acromioclavicular joints(8,9,10). Ultrasound evaluation in the hands of a good musculoskeletal radiologist is much cheaper, however, and allows dynamic evaluation. With a good history and evaluation, however, such imaging might not be required from the great majority of instances.

Plain radiographs should be taken to exclude bony pathology such as fractures, calcific tendinitis, metastatic disease and osteoarthritis. Axillary views may demonstrate signs of instability, namely spurring or erosion of the anterior glenoid or even a Hill-Sachs lesion (osteochondral depression on the anterior humeral head brought on by impaction of the dislocated humeral head on the glenoid rim).

Other Diagnostic Tools

Selective local anesthetic shots can help pinpoint the painful area in the shoulder.

Diagnostic arthroscopy allows excellent visualization of the glenohumeral joint and the subacromial space with little soft- tissue destruction and brief rehab period. Whilst the individual is anesthetised, the existence, level and management of this shoulder instability might be evaluated(11). Of course, it is likely to proceed to fix or fix many of the pathological conditions in the shoulder arthroscopically.

Non-Operative Treatment

The mainstay of initial treatment for primary instability and secondary impingement is non-operative(12). A huge analysis of non-operative management for subacromial impingement syndrome demonstrated that non steroidal anti inflammatory drugs with specific rehabilitation programs gave sufficient results in 67% from 616 patients and that just 28% needed a subacromial decompression(13). There ought to be a period of 'comparative remainder' where overhead activity is avoided(14).

An individualized chiropractic program should then be initiated. Stretching of tight muscle groups whilst avoiding stretching the anterior muscles and capsule in a patient with anterior instability should be followed by strengthening exercises for the scapular rotators and rotator-cuff muscles. This should last for six to 12 months under supervision. If now it's still not possible due to pain, a surgical procedure to address the problem with the anterior capsule and labrum should be sought. Athletes with recorded rotator-cuff tears, labral lesions or loose bodies should have these lesions repaired or debrided.

Operative Treatment

The athlete with chronic shoulder instability whose ligaments are excruciating, resulting in capsular laxity, must have a surgical alteration to the ligament tension in order to restore ligament equilibrium if non-operative measures have failed. Such processes are termed capsulorrhaphies or capsular changes (that they efficiently demand a tightening of the capsule to stop unwanted movement). The adjustment is made medially, inferiorly or laterally in the capsule(15,16). Other processes are described but are contentious as they work by limiting the selection of motion so that the end-range laxity isn't challenged. That is obviously not ideal for the athlete. Recent work has been printed on laser-assisted capsulorrhaphy(17) andthermal-assisted capsular shrinkage (18) --that the jury is still out on those techniques.

Primary or secondary impingement could be surgically treated by open or arthroscopic acromioplasty. Care has to be taken to avoid elimination of the lateral acromion, to stop deltoid detachment and to eliminate just enough bone. The aim is that by removing the source of mechanical abrasion of the supraspinatus tendon of the rotator cuff, progression of impingement to partial and full thickness tears will probably be ceased. But, inadequate vasculature, tendon nutrition, established fibrosis and makeup changes in the tendon imply that the practice of degenerative disease and cuff tearing continues despite relief of painful symptoms(19).

The anticipated outcome after acromioplasty for impingement syndrome, whether performed within an open or arthroscopic procedure, is comparable(20). Roughly 80% of individuals will experience sufficient pain relief(21,22). There are, however, a lack of some standardized tests, so an accurate comparison between studies is not actually possible.

Post-operative rehabilitation originally requires the recovery of a pain-free passive array of motion and then the growth of active strength. The results of surgery frequently seem poor for the first three months but tend to improve over the first year.

The principal benefits of arthroscopic surgery include the shorter hospital stay, less anesthetic morbidity and reaching rehabilitation landmarks quicker(23). Sadly, some studies suggest poorer results where patients have been involved in compensation claims(24).

Referred neck pain pathology should always be excluded. Repetitive pressure may also injure the acromioclavicular and sternoclavicular joints. Finally, bear in mind the less common causes of shoulder pain in the throwing athlete. These include quadrilateral space syndrome, suprascapular nerve entrapment, axillary artery occlusion, axillary vein thrombosis, lateral capsule laxity and glenoid spurs. These investigations lie in the domain of the professional shoulder surgeon.

References
1. Review of Sports Medicine and Arthroscopy, Philadelphia, pp123, 1995
2. Annals of Cases on Information Technology, Vol 70(20, pp220-226, 1998
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Dr. Alexander Jimenez, shoulder injury specialist and sports injuries explains how overhead athletes may prevent chronic shoulder pain.

Does your shoulder ache after overhead activity? Is it getting worse and now restricting that action? Has a span of rest apparently resolved the issue just for the pain to recur when you return to the game? Chronic shoulder pain is unfortunately an all-too-common consequence of repetitive 'overhead activity', such as serving and smashing in tennis, freestyle or butterfly swimming, bowling in cricket, javelin, or baseball throwing and above-shoulder weight-training exercises. Chronic pain in the 'overhead' athlete is normally the consequence of damage to the rotator-cuff muscles of the shoulder (a group of four, small, deeply located, strap-like muscles). This article will look at how such repetitive damage is caused and how the athlete could have the ability to prevent it happening in the first place.

Structure Of The Shoulder

The shoulder joint complex is in fact made up by four joints: the glenohumeral joint (the ‘ball-and socket’ joint between the upper arm or humerus and the shoulder blade or scapula, which most non-experts consider to be the shoulder joint), the acromioclavicular joint (the joint between the lateral end of the collar bone or clavicle and the scapula), the sternoclavicular joint (the joint between the medial end of the clavicle and the breast bone or sternum) and the scapulothoracic joint (the ‘virtual’ joint between the undersurface of the scapula and the chest wall). Problems at any of these four joints may result in ineffective function of the shoulder-joint complex and consequently pain.

There is more movement possible in the shoulder joint than at any other joint in the human body. Over 1,600 places in 3- dimensional space can be assumed from the shoulder. The price to be paid for this extreme selection of movement is an inherent lack of stability.

To attain peak performance during overhead activity, there has to be optimum balance between mobility and stability. It is well-known that swimmers who over-stretch their shoulders in an effort to boost the range of their stroke, without improving their functional stability, are at heightened risk of injury to the rotator cuff.Tennis players and throwing athletes, actions which are essentially asymmetrical, often develop greater shoulder external rotation in their dominant shoulder and this is often associated with functional instability. Shoulder-injury prevention strategies need to concentrate on improving shoulder stability.

Impingement & The Rotator Cuff

The bony anatomy of the glenohumeral joint includes a large chunk (the head of the humerus) and also small socket (the glenoid of the scapula) together with all the muscles of the rotator cuff and scapular rotating (stabilizing) muscles acting as the most important dynamic stabilizers of this joint. The muscles of the rotator cuff envelop the glenohumeral joint itself, and include the supraspinatus, infraspinatus, teres minor and subscapularis muscles. Supraspinatus abducts the arm (moves it laterally away from the face of the body), infraspinatus and teres minor externally rotate the shoulder, and subscapularis is chiefly an inner portion of the shoulder. Sitting above the cuff is that the coracoacromial arch, composed of the coracoid and acromion bony processes of the scapula and a ligament connecting the two processes. Since the arm is abducted away from the human body or flexed (brought forward), 'impingement' or squeezing of the rotator cuff involving the head of the humerus below along with the coracoacromial arch above can happen. The healthy, conditioned rotator cuff functions effectively as an integrated component to stabilize and depress the head of the humerus, opposing the activity of the big deltoid muscle and thus preventing impingement.

Any overhead activity that includes the arm being taken regularly enough from below the shoulder level to over shoulder level has the capacity to damage the rotator cuff. With recurrent impingement, a badly ventilated cuff may get damaged, along with a cycle of cuff damage, diminished function, additional impingement and worsening cuff harm is initiated.

This form of primary impingement is most commonly found in weight coaches who overemphasize the development of the 'prime moving muscles' (pectoralis major, latissimus dorsi and deltoid) in the expense of their rotator cuff. It looks increasingly prevalent in athletes as they reach their thirties. Primary impingement is preventable and, even if the cuff is suitably conditioned, exercises like behind-the-neck press, incline bench press and also prolonged front laterals, won't lead to pain.

Secondary impingement refers to impingement secondary to underlying glenohumeral instability, when the rotator cuff is fatigued by its own attempts to maintain the humerus centered on the glenoid and thus allows the head of the humerus to ride up, reducing the subacromial space. This is possibly the most common mechanism of cuff injury found in younger athletes, especially those with increased joint laxity, and is observed frequently in swimmers and throwers. The principal difficulty here is instability and, unless that is treated, pain will probably be ongoing and progressive.

Scapular Stability

A strong and healthy rotator cuff is essential to the overhead athlete. In recent decades, the function of the scapula-stabilizing muscles in positioning the glenohumeral joint for optimum rotator-cuff work has been increasingly highlighted. Coordinated action of the set of muscles is needed to supply a stable base for pain-free overhead activity. The excessively simplistic 'ball and socket' model of the shoulder joint has been superseded by a model similar to the acting seal that could balance a ball on its nose. The seal equates into the scapula, and constant little adjustments by the seal (scapula) are required to avoid the ball dropping off its nose (glenoid). Overhead athletes must be able to effectively control the position of their scapula for optimum cuff function.

Injury Prevention Plans

Most cuff injuries can be prevented relatively simply. The crucial point is not to overwork the rotator cuff by increasing shoulder work too quickly. Keeping increases in workload to less than 10 percent per week will significantly reduce the risk of injury.

The key balance between stability and variety of shoulder movement has already been emphasized. Athletes with access to sports medicine support will benefit from an official evaluation of dynamic shoulder function. This should encompass an extensive overview of static and dynamic anatomy, range of movement at all four joints of the shoulder joint complex, muscle strength and balance (particularly of the rotator cuff and scapular stabilizers) and an assessment of inherent glenohumeral stability in all three planes. Significant abnormalities detected should be addressed and fixed. Such screening is becoming more and more regular for the more elite overhead athlete and validated evaluation and treatment protocols have been defined.

Strategy should be evaluated by the trainer and appropriate technical changes incorporated into the rehab program.

The Function Of The Kinetic Chain

More importantly, the use of force generation by other body parts has been assessed. For instance, the power generated by the shoulder at the tennis serve was preceded by power generated by the legs, trunk and back. The muscular mass of this shoulder is comparatively modest, and if insufficient power is generated by the previous connections in the kinetic chain the shoulder has to perform 'catch-up' and generate power rather than acting as a power regulator. Improving the server's leg activity, spinal strength and trunk rotation during the function will reduce the prevalence of rotator-cuff injury. Such biomechanical evaluation is difficult however, in skilled hands, is a crucial and effective component in injury prevention.

How Can An Athlete Prevent Injury?

Though shoulder rehab protocols after injury need to deal with subtle muscle imbalances and joint restrictions, and so require oversight, isolated rotator-cuff strengthening exercises can be very effective as part of a pre-participation conditioning program and can be performed using the next three simple exercises. The key is to strengthen the inner ozone (subscapularis), external rotators (infraspinatus and teres minor) and abductor (supraspinatus) muscles of the shoulder. This is most easily and safely performed using the varying resistance of a cliniband -- a length of flat rubber available from large chemists in varying resistances. You'll need about two meters; begin with the lowest resistance and workout!

To strengthen the right scapularis muscle, begin by holding your right arm from the side of your body with your elbow bent/ flexed at 90 degrees (the forearm will be at right angles to the upper arm and the line of the forearm points forward). Attach or loop one end of this cliniband above a door handle to the right of your own body and hold the other on your right hand. Internally rotate your humerus against the resistance of this cliniband (seen from above, the forearm moves in anti-clockwise direction towards the left) while maintaining your elbow bent at 90 degrees and at the side of your body. Let your forearm return to its starting place by the pull of the cliniband in a controlled manner.

The external rotators are strengthened from the opposite actions. From the same starting place but using the cliniband looped over a door handle to a left, externally rotate your right humerus from the immunity of the cliniband (viewed from above, the forearm moves in a clockwise direction to the right) while the elbow is again retained to the side of your system in 90 degrees. The forearm is again allowed to come back to the beginning position in a controlled fashion. Single sets include a minute of either internal or external rotation exercises and can be replicated three to five times a day. The cliniband needs to follow you around during the day! To strengthen the internal and external rotators of the left shoulder demands similar but mirror-image maneuvers.

Supraspinatus conditioning requires abduction work and initially should be carried out under shoulder level. The beginning position is quite different from the previous two exercises. To strengthen your proper supraspinatus, put one end of this cliniband beneath your left foot and then extend (keep straight) your right elbow. Hold the other end of the band on your hand and then internally rotate your right arm so that your right thumb points towards the floor and the back of your right hand faces forwards. Then, keeping your elbow extended, move your right arm away from your body (keeping the elbow straight) against resistance to just below shoulder level, and then let it go back to the beginning place in a controlled manner. An easy refinement is to unite pure abduction with just a little flexion so that you bring the arm forwards as you move it away from your side.

Pinch Your Scapulae Together

Pain shouldn't be felt through any of the three exercises. Three- to-five minute sets over the course of a day will generate a conditioning effect. By shortening the length of the band you will have the ability to progressively increase resistance. There are a massive number of variants on the exercises clarified that attain similar conditioning gains, and I make no claims for the superiority of their chosen three. But they have functioned well in my medical practice and infrequently cause unanticipated issues. Similar exercises could be performed using the pulley systems found in most gyms and with further adaptations can be done with free weights. Maintaining scapular retraction (the scapulae are 'pinched together' towards the middle of your spine and 'pushed down') while carrying out these exercises enables you to develop your scapular stabilizing muscles at the same time.

Strengthening the scapular stabilizers without specialist supervision is more difficult, but there is benefit from integrating wall leans (standing push-ups against a wall), knee push-ups and regular push-ups in any conditioning program. Seated rowing will strengthen the latissimus dorsi and should be undertaken while trying to keep scapular retraction.

Core chiropractor, Dr. Alexander Jimenez continues from part I through the core stability routines.

Menu 6: Pulley, Standing

This menu challenges pelvic stability during unilateral standing upper body movements. The kinds of arm movements undertaken in many sports create strong rotational forces that have to be controlled by the trunk and pelvic muscles. The aim of these exercises, therefore, is to develop co-ordination and control of the pelvis.

Research has shown that unilateral exercises increase the recruitment of the core musculature. The core and pelvic muscles will all be using static contractions to hold the required postures, while the upper body muscles will be producing the limb movements. The resistance load on the arm is secondary to the stability challenge of the core. Overall this menu is intermediate.

Rear Sling

Overview: The challenge of this exercise and its pair (see opposite) is to establish perfect pelvic alignment, while standing on one leg, against a rotational force from the upper body.

Level: Intermediate

Muscles targeted: Abdominal wall Adductors, Gluteus medius, (Deltoid and rotator cuff)

Technique: Stand on one leg to the side of the pulley column. Handle is attached at below-hip height. Grasp the handle with the hand on the opposite side (opposite to standing leg). Set perfect posture and pelvic alignment.

Brace the core and then pull the weight up and around the body, keeping the elbow straight, so that the arm rotates up and out. Finish with hand above your head and out to the side slightly. The aim is to maintain perfect balance and pelvic alignment as you raise and lower the arm diagonally. Reposition to repeat exercise for opposite leg/arm.

Perform 10 reps each side increasing to 20 reps; 2 to 3 sets.

Progression: Increase the weight.

Front Sling

Overview: This is the natural opposite of the rear sling exercise. It involves a forward arm rotation, which must be controlled.

Level: Intermediate

Muscles targeted: Abdominal wall Adductors, Gluteus medius, (Pectorals and rotator cuff)

Technique: Stand on one leg to the side of pulley column. Handle is attached at above shoulder height. Grasp the handle with the arm nearest the column (opposite side to standing leg). Set perfect posture and pelvic alignment.

Brace your core; pull the weight down and around the body, keeping the elbow straight so that the arm rotates down and round. Finish with hand next to your hip across your body. The aim is to maintain perfect balance and pelvic alignment as you lower and raise the arm. Reposition to repeat with opposite leg/arm.

Perform 10 reps each side, increasing to 20 reps; 2 to 3 sets.

Progression: Increase the weight.

One Leg, One Arm Rowing

Overview: The challenge of this exercise is to maintain stability while standing on one leg and controlling against a pulling force from the upper body. The pelvis must stay fixed when the upper back and shoulder are pulling backwards.

Level: Intermediate

Muscles targeted: Abdominal wall, Adductors, Gluteus medius, (Rear deltoid, rhomboids, latissimus dorsi)

Technique: Stand on one leg, facing the pulley column. Handle is attached at waist height. Grasp the handle with the opposite arm (same side as lifted leg). Your hand will be out directly in front of you in the start position. Set perfect posture and pelvic alignment, standing tall with shoulders back.

Brace your core; pull on the cable, leading with the elbow in a rowing movement Finish with hand by your side and elbow behind you. The aim is to maintain perfect balance and pelvic alignment as you perform the rowing movement. Reposition to repeat with opposite leg/arm.

Perform 10 reps each side; 2 to 3 sets.

Progression: Increase the weight.

Menu 7: Medicine Ball, Floor

The four exercises in this menu all involve throwing and catching the medicine ball while performing a trunk flexion or rotation movement. The action of throwing the ball during the muscle-shortening phase of each of the exercises increases the force production of the trunk muscles. The action of catching the ball at the start or during the muscle-lengthening phase of each exercise not only increases the force production but also the overall stability challenge.

The impact that the catch has on the upper limb has to be controlled by the trunk. You should be aiming to maintain good spine alignment and correct movement while making the catch. Only use a weight of medicine ball that will allow you to perform the exercises with good technique. If the ball is too heavy, you will sacrifice core stability, irrespective of your arm strength.

Overall these exercises are advanced. However they are also safe and effective for young athletes using light medicine balls to develop dynamic trunk movement and control.

Sit Up & Throw

Overview: An advanced version of a sit-up exercise, in which the throwing action makes the crunch phase faster and the catching action adds load to the return phase.

Level: Advanced

Muscles targeted: Abdominals (Plus upper body)

Technique: You will need a partner to receive and pass the ball. Alternatively perform the exercise in front of a wall and use a medicine ball that will bounce back.

Start in the sit-up position (knees bent) with hands up ready to receive the ball. Catch the ball and begin to lower back down. Do not collapse back down, control it with the abs and keep hands above the head as you lower down.

Once shoulders are touching the floor (keeping head up and eyes forward), reverse the movement. Throw the ball forward and crunch up at the same time. Follow the throwing action and complete the sit-up as fast as possible. Make sure you crunch as you throw so that the abs contribute to the force of the throw and help you sit up faster. Men should start with a 5kg ball; women with a 3kg ball.

Perform 10 to 20 reps; 2 to 3 sets

Progression: Progress to heavier ball once 3 sets of 20 reps is comfortable

45-degree Sit, Catch and Pass

Overview: A very tough stability exercise that requires massive trunk musculature co-contraction to hold a good spine alignment against the impact of making the catch.

Level: Advanced

Muscles targeted: Erector spinae, Abdominals, Obliques

Technique: Sit up with knees bent and lean back at 45 degrees. Aim to hold a ‘lengthened’ spine, with lumbar spine in neutral, shoulders back and neck long and relaxed. It takes a fair amount of control and strength endurance simply to hold this posture perfectly. Aim to get this right before progressing on to the catch and pass.

Raise hands in front of your face and receive a pass from a partner, around this height. As you catch the ball you must hold the long spine position. Do not flex the low back, or become round-shouldered. Gently throw the ball back. Men should start with a 3kg ball; women with a 2kg ball.

Complete a few passes, holding the position for 30 seconds. Perform 2 to 3 sets.

Progression: Raising the hands to above head height makes the stability challenge of the catch significantly harder. Catches made to either side of the head are also more challenging.

Sit & Twist Pass

Overview: A trunk rotation exercise involving catching and passing the medicine ball, which provides a challenge to the obliques to produce powerful rotation, but also pelvic stability, so that the sitting position is stable throughout the movement.

Level: Advanced

Muscles targeted: Abdominals, Obliques

Technique: Sit up with knees bent and lean back at 45 degrees. Aim to hold a ‘lengthened’ spine, with lumbar spine in neutral, shoulders back and neck long and relaxed. Your feet, knees and hips should remain reasonably still throughout this exercise, the rotation coming from your waist and not your hips.

Hold hands to one side ready to receive the ball. Catch the ball to one side and absorb the catch by turning your shoulders further to that side. Reverse the rotation, turning back to the middle and release the ball. Continue rotating to the other side; receive the ball the other side and continue. Ensure you can hold good posture throughout the movement, with a long spine and wide shoulders. Men should start with a 4 to 5kg ball; women with a 2 to 3kg ball.

Perform 10 to 20 reps.

Progression: Increase the weight of the ball once you can perform a set of 20 reps comfortably with perfect technique.

Kneeling Twist Pass

Overview: To perform the rotation movement in this position demands a greater range of motion, helping to develop strength through the full range of trunk rotation. It may also help to develop trunk rotation range of movement.

Level: Intermediate to advanced

Muscles targeted: Obliques

Technique: Kneel upright with good posture (lumbar spine in neutral, chest out, shoulders low). Start with the ball in hands and twist shoulders and head round as far as you can. Then, under control, twist around to the other side as far as possible, and hand the ball to partner. Turn back to the start position, receive the ball again and continue.

The aim of the movement is to rotate through the biggest shoulder turn you have. You can allow the hips to rotate a little with the shoulders, but not too much. You should feel a stretch in the side at the end of each twist.

As you gain greater flexibility and stability you will be able to fix your pelvis square to the front and rotate through an increasingly full range of motion. Men should start with a 5 to 6kg ball; women with a 3 to 4kg ball.

Perform 10 reps then take the ball to the opposite side and repeat.

Menu 8: Medicine Ball, Standing

The aim of this menu is to perform trunk movements while standing on one leg. This is functional training for balance in sports and daily living activities. These exercises are advanced because of the requirements for lower limb balance and body movement awareness, which makes controlled performance of these trunk movements quite difficult. These moves also use the hip rotator and abductor muscles for control and stability.

One-leg Twist Pass

Overview: A trunk rotation exercise performed on one leg. This requires good pelvic stability at the hip of the standing leg, for the trunk rotation to be dissociated from the pelvis.

Level: Advanced

Muscles targeted: Gluteus medius, Piriformis, Abdominal wall, Obliques

Technique: Stand on one leg with hips facing square to the front. Hold medicine ball slightly out in front. Slowly twist from side to side. The rotation comes from the waist only, head turning with the shoulders. Keep pelvis fixed square and knee in line with second toe throughout. Men should start with a 5 to 6 kg ball; women with a 3 to 4 kg ball.

Perform 10 slow reps; 2 to 3 sets. Repeat on other leg.

Progression: Swap the ball for a pulley machine and add resistance, once you have mastered the controlled balance on one leg.

One-leg Deadlifts with Rotation

Overview: An advanced exercise for the posterior chain of muscles, which includes rotation to challenge control of pelvis.

Level: Advanced

Muscles targeted: Erector spinae, Gluteals (max and med) Hamstrings, Piriformis

Technique: Stand on one leg. Flex the free leg a little at the knee to lift it off the floor, but do not flex or extend the hip of the free leg throughout the movement, in order to keep pelvis in control. Hold the ball in front of you.

Bend down, flexing at the knee and the hip. Lower down until the ball touches the floor by your foot, all the time keeping your arms straight and without reaching excessively with your upper back (ie, maintain a reasonably flat back). Stand back up, pushing down through the foot to use your gluteals correctly to extend the hips.

Alternate between touching the ball down on the inside and then the outside of the standing foot. This means you are internally or externally rotating the hip on alternate repetitions, challenging control of hip rotation. Keep the knee in line with second toe as much as possible throughout. Men should use a 5kg ball; women use a 3kg ball.

Start with 5 slow controlled reps, 2 to 3 sets. Build up to 10 reps. Repeat on the opposite leg.

Progression: Increase the weight of the ball or use a dumb-bell as you get stronger.

One-leg Catch & Pass

Overview: The main aim of this exercise is to control the impact of the catch without losing balance or rotating excessively at the hips. It’s all about how effectively you can anticipate the impact and produce the required stiffness throughout the body to retain good posture and control. This is a very useful ‘reaction’-type stability exercise.

Level: Advanced

Muscles targeted: Everything

Technique: Stand on one leg with good posture (lumbar spine neutral, chest out, shoulders wide) and with hips square to the front. Hold hands up ready to catch. Receive catches anywhere within arm’s reach. Make sure the passes are varied in their placement. Aim to restrict movement to arms and/or turning your shoulders, keeping the pelvis and lower limb stable. Use a 2 to 3kg ball that is not too big, so it is easy to catch.

Start with 30 sec bouts of catch and pass on each leg; 2 to 3 sets.

Progression: Receive more forceful passes so the impact of the catch is greater.

Menu 9: Resistance-Based

Menu rationale

The aim of these three exercises is to progress the loading in order to build high-level trunk muscle strength. These exercises can be performed in the 5- to 10-repetition range with a suitably high weight for this number of reps. As you get stronger, you should prioritize an increase in weight rather than an increase in the number of reps. Overall, these exercises are very advanced.

Crunch with Weight

Overview: The standard isolated abdominal exercise with increased load.

Level: Advanced

Muscles targeted: Abdominals

Technique: Perform the crunch in the usual way: knees bent, low back flat, head up and looking forward. Curl the shoulders up and down using just the abdominals. The weight (medicine ball, dumb-bell or barbell weight plate) should be held above or behind the head. Arms are fixed, all they do is hold the weight in place. Do not use arms to move the weight relative to head as the crunch is performed. Keeping the elbows out helps to achieve this.

Perform 5 to10 reps; 2 to 3 sets.

Progression: Increase weight, maintaining the range of 5 to 10 reps per set.

Reverse Hypers

Overview: An excellent hip and back extension exercise to which it is very simple to add load.

Level: Advanced

Muscles targeted: Erector spinae, Gluteals

Technique: Lie on your front on a horizontal bench, with hips just off the end of the bench. Grasp bench legs firmly for support. Your legs should be straight with a dumb-bell between the ankles for resistance. Squeezing the gluteals, extend hips and lift legs and the dumb-bell off the floor. Stop when your back is slightly hyper-extended and hips are fully extended. Lower slowly until feet are just off the floor and continue.

Perform 8 to 10 reps; 2 to 3 sets.

Progression: Increase weight, maintaining the range of 8 to 10 reps per set.

Reverse Crunch with Weight

Overview: This is a great exercise, as it requires good coordination and strength. Research shows that the obliques as well as the abdominals work very hard during this exercise, making it excellent value.

Level: Advanced

Muscles targeted: Abdominals, Obliques

Technique: Lie on back with hands behind head and elbows out to the sides. Knees should be bent and heels close to bum. Hold weight between your legs. Initiate the movement by curling the pelvis upwards (flattening the back into the floor) and then continue to use the abs to pull the low back and pelvis off the floor. This is the bit that requires good co- ordination, as the temptation is to kick with the legs and pull the hips up with the hip flexors. Learn to focus on the abs before you add weight, as if you do this strictly it is very tough, especially for women (whose pelvises are relatively heavier).

Perform 5 to 10 reps; 2 to 3 sets.

Progression: Increase weight, maintaining the range of 5 to 10 reps per set.

Menu 10: Hanging Bar

Menu rationale

The aim of these three exercises is to work the abdominals as hard as possible with very advanced, gymnastic-style movements. Reasonable upper body strength is required for these exercises.

Hanging Leg Lifts

Overview: This exercise requires you to lift the full weight of your legs and (if possible) your pelvis, while hanging from a bar. Anyone who can perform these movements well through a good range of motion has achieved good strength.

Level: Advanced

Muscles targeted: Abdominals, Obliques, Hip flexors

Technique: Hang from a bar with arms straight. Lift knees, bringing them up as high as possible. At the top of the movement the knees should be near the chest and pelvis should be curled upwards (low back flexed). This extra curl of the pelvis ensures that the abdominals are working maximally. Do not kick legs up or swing the body excessively. Simply draw up knees, crunching as you lift. It is important to feel that the abdominals are doing the lion’s share of the work rather than the hip flexors or front of thigh muscles.

Perform 5 to 10 reps;, 2 to 3 sets.

Progression: Perform the same exercise with straight legs, lifting them up to 90 degrees in front of you, curling the pelvis at the top of the movement.

Windscreen Wipers

Overview: The ultimate ab-buster. Anyone who can do 10 reps of this exercise with good technique has a very strong core!

Level: Super advanced

Muscles targeted: Abdominals, Obliques, Hip flexors

Technique: Hang from bar with arms straight. Lift legs up in the air until feet are at approx head height. Maintaining the height of the lift, take the legs from side to side in an arc. The movement will look like a windscreen wiper, moving from side to side. Aim for at least 45 degrees of movement to each side.

Perform 5 to10 reps; 2 to 3 sets.

Progression: The straighter the legs, the harder the exercise. Increasing the range of movement to each side also makes it tougher.

Candlesticks

Overview: Another beauty! Lots of strength required to control this movement; only for the very strong.

Level: Super advanced

Muscles targeted: Abdominals, Obliques, Hip flexors

Technique: Lie flat and raise yourself up to a shoulder stand position, holding on to a bench/table leg/partner's leg with your hands above your head. Establish a fully extended hip and leg position and then begin to lower your body down slowly to the floor. The body should move in an arc as a single unit (no sagging in the back, or bending at the hips or knees). Lower under control from vertical to just above horizontal.

Gripping firmly for stability, lift your body back up into shoulder stand, again keeping everything straight and aligned in a single unit.

Slow and controlled movement on the way down will help, and a maximal contraction of everything will get you back up.

Perform 3 to 5 reps; 2 to 3 sets.

Progression: There it is.

Sourced From:

Chiropractor, Dr. Alexander Jimenez examines the ankle sprain treatment options presented in this case.

The treatment plan I outline below has been utilized in professional sports for years but hasn't entered into mainstream injury management protocols. I suspect the reason is simple: it is very uncomfortable! Nonetheless, it works: I have seen athletes on crutches after sustaining diagnosed Grade 2 2+ ankle sprains who could walk without crutches with only a minimal limp following their first session of this treatment, and who had been back training after three to four days (obviously with a great deal of tape support).

Readers will probably be familiar with what occurs after an ankle sprain: internal bleeding, inflammatory processes, pain and swelling. The brain also gets involved, producing muscle inhibition and a decrease in proprioception, which usually compels the injured athlete to limp in an effort to reduce pain.

By numbing the toe and tricking the brain into allowing the ankle to move through a normal range of motion without pain, I believe we can minimize the detrimental effects of ankle sprains.

25-Minute Cryo-Kinetic Ice Bath

By icing the ankle in an ice tub, just following the protocol outlined below, I think you will be able to:

Precaution!

Perform this regime every two to three hours for the first two days following the injury. In professional sports, injured athletes may also set their alarms and ice a few days, late at night and early morning (eg, 12pm and 3am) to minimize swelling and optimize recovery speed. For your averagely active individual who also has a day job, I'd get them to perform this program as soon as possible following the accident and after that, for the initial two to three days, once a day towards the end of the day once they're back from work and have settled down to the evening. I have even had success using this technique on chronic swollen ankles that was sprained four to six weeks previously. After one to two sessions in the bucket, the swelling was minimal and the range of movement improved dramatically.

Caution!

There are a few basic principles which the patient should be informed of:

Part II

6. Types Of Stretching

The reason that flexibility and stretching are confusing issues is partially because there are so many diverse kinds of stretching and exercisers are just at a loss about what type of moves to do and when. With this in mind, this chapter is devoted to setting the record straight so that you understand what kind of stretching is best for your personal circumstances.

Don't feel you've got to perform them all -- that's definitely not what is intended. Rather, read the descriptions and then use the methods that are specific for your training and workout goals. Use the right sort of extending at the ideal time and you're much more likely to find benefits from your flexibility training.

Static Stretches - Active Vs. Passive

Static stretches are the most identifiable form of flexibility training and also what most people today think about when you mention extending. For several decades, static stretching was how we all stretched -- before, during and a er exercise.

Ere are two major types of static stretches -- active and passive. A passive stretch uses an outside object or power to take you in stretch, for example employing a door frame or partner to elongate your pecs. In a busy stretch, you are using your muscles to maneuver you into a stretched position, e.g. clasping your hands behind your back and pushing your elbows to the rear to stretch your torso.

It really doesn't matter too much if you perform passive or active static stretches as the result is the same. It's worth noting, however, that if you are likely to hold a stretch for an extended time period, passive stretches are o en more comfy. Using the above cases, holding a doorway chest stretch for 60 seconds or more will be much simpler and much more comfortable than holding the hands clasped behind the back at a chest stretch for the exact same period.

1. Static Maintenance

In case your flexibility is already great and you simply want to be certain you don't lose it, for example after a work out to o set adaptive shortening, maintenance stretching is right for you. A maintenance stretch is not meant to enhance your flexibility and, as such, is not held for very long.

Maintenance stretches are normally held for between 10 and 15 seconds with no attempt to move deeper than is initially comfortable.

Commonly used as a member of a cool down, static stretches help reduce muscle strain and return your muscles for their pre-exercise length. However, the downside, static stretches have a tendency to cause your heartbeat to drop and reduce muscle contractility which may lead to a reduction in force production possible. In other words, static stretching can make you temporally weaker. For all these reasons, static stretches are normally omitted from setups.

2. Static Developmental

If you would like to enhance your flexibility, developmental static stretching is a good choice. Developmental stretches are held for between 30 to 60 minutes or longer and, as the name suggests, you should attempt to increase the thickness of this stretch as time passes.

If you stretch a muscle, you reach the natural end point of your muscle's elasticity -- known as the point of bind, or POB for short.

Should you stay in the POB for 15 minutes or so, you may feel your muscles relax slightly and you should then have the ability to move into a deeper stretch. Is happens more readily for those who a) unwind and b) do not hold your breath. Continue extending the POB as many days as possible till you get to your true conclusion of scope. Once you are there, continue for a further 15 to 30 minutes to actually maximize your flexibility training.

To recap:

• Move into POB and hold for 10-15 seconds
• As you feel your muscles relax, move a little deeper to new POB
• Keep your body relaxed and breath steadily
• Repeat steps one to three a couple more times before you reach your true flexibility limitation
• Hold this final place for 15 to 30 minutes
• Slowly ease out of this stretch

As you may see, developmental static stretching can be rather time consuming thus is best reserved for muscles that are really tight. Developmental stretching is best used as part of the cool down or, even if you're serious about improving your flexibility, during committed stretching sessions a er a light warm-up.

Just like all types of stretching, don't force either variety of static stretch. If you feel any burning or shaking immediately back off and use a less extreme POB.

An Exception To The Rule

While static stretches are normally reserved for cool downs, tactical use of a select number of static stretches can be used at a warm-up under specific circumstances.

As an example, when you've got tight chest muscles you might find it rather difficult to pull a barbell into your sternum when performing barbell bent over rows. In this instance, stretching the pecs before performing an upper/mid-back exercise could be beneficial.

Another example: if you've got tight hip flexors, then you may discover that, when squatting, you have a propensity to lean too much forwards which could put an inordinate quantity of stress in your lower spine. Statically extending your hip flexors may help eliminate this issue.

Finally, and again using the squat as an example, if you find your heels lift off the ground when squatting, this may suggest tight calf muscles. Stretching your calves before and between sets of squats may stop this potentially dangerous problem.

3. Dynamic

Where static stretches are generally best used in down the cool, dynamic stretches are much better suited to warming up. Dynamic stretches are stretches performed on the move and into the uninitiated do not actually look like stretches at all!

The beauty of dynamic moves is that they prepare your body for the activities you're going to perform without allowing you to get cold or diminishing the contractility of your own muscles. They also offer an excellent chance to rehearse the motions you are about to perform on your upcoming workout.

Dynamic stretches are also quite time efficient and it is possible to have a synergistic impact on most of your major muscles in as few as three exercises although chances are you're going to want to perform more like five or six so that you feel properly warmed up. You'll discover a lot of dynamic stretches in the stretching library in chapter seven.

Dynamic stretching uses a happening called reciprocal inhibition -- the exact same thing mentioned back in chapter two. Fundamentally, when one muscle contracts, its opposite number, called the antagonist, should unwind and this allows you to stretch it. For instance, if you bend your elbow, your knee contract and your triceps, located on the back of your upper arm, then should unwind and receive a gentle stretch as your arm reaches full flexion. Is is the very essence of dynamic stretching.

By performing specific movements like leg swings, overhead reaches and standing waist spins, you stretch none but two muscles -- you, as you move in one way, which muscle's antagonist as possible return. Is two-for-one stretch is what makes dynamic stretching so time-effective.

Unlike stationary stretching, dynamic stretching does little for the resting length of your muscles. It simply takes your muscles into the POB so that they are adequately prepared for your coming workout.

When performing dynamic stretches, it is very important you increase your assortment of movement slowly over a collection of 10 to 20 repetitions. Start o by being really careful and conservative and then increase the range of movement as you believe that you're prepared.

Also, be sure that every stretch is done rhythmically and with controller. Do not ing your limbs around with complete abandon! Each motion should take a couple of moments to finish and at no point should you feel as though you're bouncing out of the end point of the stretch. Decide on a steady tempo and stick to it for the duration of your set.

Make sure you don't do so many repetitions that your dynamic stretches turn into a test of muscle endurance! Is is particularly true of exercises such as lunges and squats -- Both good examples of dynamic moves for the more advanced exerciser. Do as many reps as you need to feel comfortable but no more. Save your energy for your workout!

Precede your dynamic moves using a couple of minutes of cardio to ensure your joints and muscles are warm and nice though, again, only do as much as you want to prepare your body to the coming workout.

4. Ballistic

Ballistic stretching is a lot like dynamic stretching, just faster and more volatile. Is increase in motion velocity includes a heightened probability of harm which is why ballistic stretching isn't suggested for beginners or those who don't actually need it.

In sports such as kickboxing, sprinting, gymnastics and even fencing, motions are performed a) very quickly and b) via a large selection of movement -- that the very definition of ballistic. Is way that participants in such and similar sports may consist of ballistic stretching as part of the training. Not to do so would invite harm when they practice their preferred sport.

For the rest of us, where rapid and large movements aren't the norm, the chance of ballistic stretching far outweighs any possible benefits. Dynamic stretches are fine for the majority of even the most ardent exercisers and provide many of the advantages related to ballistic stretching without the dangers.

If you're a sportsman or women who needs to add ballistic stretching in your training, be sure that you always warm up thoroughly before commencing. Increase the range of movement slowly to prepare your muscles to what's to come, start o with dynamic stretches and then, ultimately, advancement to ballistic moves (and even then advance your speed). Exercise some control at the end range of movement to minimize the risk of injury and make sure the motion is coming out of the ideal part of your body -- i.e. do not round your back when doing high front leads as the strain is being taken o your hamstrings and also being placed in your delicate passive lower back ligaments and discs.

Ballistic stretching bottom line? Only satisfactorily prepared sportsmen and sportswomen should utilize this advanced kind of flexibility training and then with caution.

5. PNF

PNF, short for proprioceptive neuromuscular facilitation, is an effective form of extending that may result in very rapid improvements in flexibility -- almost instantaneous. While the advancements that result from PNF are very rapid and noticeable, they're not permanent so PNF is not a one-shot x for inferior flexibility. But if you need some immediate gratification from your stretching, PNF is for you! PNF functions on the grounds that once a muscle was contracted, it goes to a place- contraction relaxed condition and is much more amenable to being stretched.

Basically, by using PNF, you "trick" your muscles into relaxing more quickly than they would normally so you can progress the point of bind or POB into a greater degree and in significantly less time.

PNF stretches are best done with a knowledgeable training partner since they may be complicated to do independently but, saying that, many can be performed alone if you're ready to think a little outside the box and also utilize external props like webbing straps to achieve the desired results.

Because PNF stretching takes time, it is generally best left for your cool-down and reserved for those muscles that are really tight. PNF is also a great form of stretching to add in standalone flexibility sessions at which time is less of a problem.

It is vital that there's good communication between the 'stretch-er' and 'stretch-ee' because overenthusiastic limb misuse could lead to serious injury. If in doubt or if you feel any discomfort, back o immediately.

6. CRAC

Standing for Contract Relax Antagonist Contract, CRAC is a variation of PNF and for all intents and purposes, synonymous. Using exactly the same contract/relax happening as PNF to encourage a deeper stretch, CRAC adds an extra component to progress the POB farther and potentially faster.

As you know, when one muscle contracts, its opposite number must relax to allow motion. CRAC utilizes this mechanism to allow you to move to a deeper post- contraction stretch. CRAC is also an efficient way to develop isometric power and is a helpful strengthening instrument o en used in post-injury rehabilitation. (Isometric contractions are the most powerful of all muscular contractions and result in no Motion as a single muscle group operates against the other.)

To illustrate how you can do PNF and CRAC moves independently, this stretching Example uses the doorway chest stretch, which is a excellent way to fix a round- shoulder position while, strengthening the muscles of the mid-upper spine (center trapezius and rhomboids)

● Position yourself in an open doorway. Raise your arms and rest your elbows and forearms against the vertical sides. Your elbows should be roughly level with your shoulders.

● Adopt a staggered stance for stability.

● Keeping your elbows and forearms pressed against the door frame, lean your body between your arms until you feel a stretch across your chest.

● Hold this position for 10-15 seconds until you feel your pecs relax.

● Contract your chest muscles by pressing your elbows and forearms forcefully against the door frame. Do not allow your arms to move. Use between 30-50% of your maximal perceived strength and hold the contraction for 10 to 15 seconds.

● Relax your chest and then use your upper back muscles to pull your elbows further back to increase the stretch in your chest. Lean forwards again so that your arms are resting on the door frame.

● Repeat steps four to six a couple more times until you fail to see any noticeable increases in the range of movement.

Like PNF, CRAC is a fairly lengthy process so is best retained to your tighter muscles and utilized in your cool-down or standalone flexibility sessions. It is quite effective for developing your flexibility but, if performed too aggressively or with a spouse who lacks the necessary experience, could lead to injury. While mild distress is acceptable and may even be desired, pain isn't, so make sure you back o if you're feeling anything untoward.

7. Library Of Stretches By Muscle Group

There are literally hundreds of ways to stretch - some very simple and some really convoluted. The primary point to keep in mind when assessing the worth of every stretch is that, to be effective, you must pull off the ends of the muscle away from each other and do this in a way that puts minimal stress on your joints along with the remainder of the body. By applying these standards, the great number of moves which are possible can easily be whittled down to 50 or so stretches.

In this section, you'll find instructions on how best to perform Various great stretches for every one of your major muscle groups. Ere are inactive stretches, dynamic stretches and, where relevant, some which can be performed using PNF and/or CRAC protocol.

Out of your personal flexibility evaluation, you must now know what areas of your body are tight and what regions are normal concerning flexibility. Pick developmental static stretches or PNF/CRAC on the tight muscles and utilize maintenance static stretches to your muscles that are more flexible. Perform these stretches as part of your cool down or through standalone flexibility sessions. Remember, however, to maintain dynamic stretches to your setups.

If, when performing any of these exercises, then you fail to sense much of a stretch a) test that your limbs are aligned correctly, b) try another stretch for the same muscle and then c) don't worry! It might well be that you're adequately flexible in the muscle in question and then you do not feel a lot of stretch.

As mentioned before, all stretches should be preceded by a few minutes of mild cardio to increase core temperature and enhance blood ow though your muscles.

Gastrocnemius

Is is the larger/upper calf muscle and can be among the most powerful by dimension muscles at the body. As they are so powerful, the gastrocnemius can take a fair bit to stretch, however if it Becomes tight can have an adverse effect on knee health. Its basic function is to stretch your ankle.

Prone cobra

●  Lie on your front with your hands under your shoulders

Pectoralis Major

Standing upper trap stretch

●  Stand with your feet hip-width apart and your knees slightly bent

Overly tight forearms can result in hand, wrist and elbow pain. If you hands naturally gravitate to a clenched position when you relax, chances are you have tight forearms. If you spend a lot of time typing, make sure you stretch these muscles o en to avoid developing a repetitive strain injury (RSI) or carpal tunnel syndrome.

Sourced From:

Individuals can become overly passionate about exercising. However, constantly training the body without taking enough time to rest and recover can impact athletes and fitness enthusiasts physically and mentally and lead to overtraining syndrome. Excessive training can cause decreases in athletic physical performance that can be long-lasting, sometimes taking several weeks or months to recover. Individuals who don't learn to manage overtraining can have injuries and more frequent illnesses and infections. And the psychological effects can also lead to negative mood changes. Learn the signs and how to cut back to prevent injury and/or burnout.

Overtraining Syndrome

Athletes and fitness lovers often exercise longer and harder than average to reach peak performance. Even individuals just getting started with exercise can push their limits as they try to figure out what works for them. This means taking into consideration the following:

• The mental side of training.
• How to get and stay motivated.
• How to set up a safe and effective program with balanced cardio and strength training.
• How to avoid skipping workouts when things get in the way.
• Exercising too much is a mistake many beginners make, putting themselves at risk for injury.

Overtraining syndrome is when the body goes through and feels:

• Extreme fatigue.
• Physical performance problems.
• Mood changes.
• Sleep disturbances.
• Other issues due to working out or training too much and/or too hard without giving the body enough time to rest.

Overtraining is common among athletes who train beyond their body's ability to recover, usually when preparing for a competition or event. Conditioning for athletes and enthusiasts requires a balance between work and recovery.

Signs and Symptoms

There are several signs to look for, with the more common symptoms being:

• Mild muscle or joint soreness, general aches, and pains.
• Decreased training capacity, intensity, or performance.
• Lack of energy, constantly tired, and/or drained.
• Brain fog.
• Insomnia.
• Decreased appetite or weight loss.
• Loss of enthusiasm for the sport or exercise.
• Irregular heart rate or heart rhythm.
• Increased injuries.
• Increased headaches.
• Feeling depressed, anxious, or irritable.
• Sexual dysfunction or decreased sex drive.
• Lower immunity with an increase in colds and sore throats.

Prevent Overtraining

• Predicting whether there is a risk of overtraining can be tricky because every person responds differently to various training routines.
• Individuals have to vary their training throughout and schedule adequate time for rest.
• Individuals who believe they may be training too hard should try the following strategies to prevent overtraining syndrome.

Take Note of Mental and Mood Changes

Methods exist to test for overtraining objectively.

• One is taking note of psychological signs and symptoms associated with changes in an individual's mental state can be an indicator.
• Decreased positive feelings for exercise, physical activities, and sports.
• Increased negative emotions, like depression, anger, fatigue, and irritability, can appear after a few days of intense training.
• If these feelings and emotions begin to present, it is time to rest or dial the intensity down.

Training Log

• A training log that notes how the body feels daily.
• It can help individuals notice downward trends and decreased enthusiasm.
• This can help individuals learn to listen to their body's signals and rest when necessary.

Monitor Heart Rate

• Another option is to track changes in heart rate over time.
• Monitor heart rate at rest and specific exercise intensities while training, and record it.
• If the heart rate increases at rest or a given intensity, this could be a risk indicator, especially if symptoms develop.
• Track resting heart rate each morning.
• Individuals can manually take a pulse for 60 seconds immediately after waking up.
• Individuals can also use a heart rate monitor or fitness band.
• Any marked increase from the norm may indicate that the body has not fully recovered.

Treatment

Rest and Recovery

• Reduce or stop the exercise and allow the mind and body a few rest days.
• Research on overtraining shows that complete rest is the primary treatment.

Take Extra Rest Days

• Starting anything new will usually make the body sore.
• Be prepared for the aches and take extra rest days when needed.
• The body won't have the same energy levels from day to day or even from week to week.

Consult A Trainer

• Not sure where to start or how to approach working out safely.
• This is the time to meet with a professional who can look at physical and medical history, fitness level, and goals.
• They can develop a customized program to meet specific needs.

Nutrition and Hydration

• Maintain optimal body hydration with plenty of H2O/water and rehydrating drinks, vegetables, and fruits.
• Staying properly hydrated is key to both recovery and prevention.
• Getting enough protein and carbohydrates supports muscle recovery.
• Carbs are important for endurance, and protein is important for muscular strength and power.

Sports Chiropractic Massage

• Research shows that sports massage benefits muscle recovery and can improve delayed onset muscle soreness/DOMS.
• Massage keeps muscles loose and flexible and increases blood circulation for expedited recovery.

Relaxation Techniques

• Stress-reduction techniques such as deep breathing and progressive muscle relaxation exercises can improve rest and recovery.

Total recovery from overtraining syndrome can take a few weeks or longer, depending on the individual's health status and how long the excessive training has gone on. A physician can refer individuals to a physical therapist or sports chiropractor, who can develop a personalized recovery plan to get the body back to top form.

Military Training and Chiropractic

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Bell, G W. "Aquatic sports massage therapy." Clinics in sports medicine vol. 18,2 (1999): 427-35, ix. doi:10.1016/s0278-5919(05)70156-3

Carrard, Justin, et al. "Diagnosing Overtraining Syndrome: A Scoping Review." Sports Health vol. 14,5 (2022): 665-673. doi:10.1177/19417381211044739

Davis, Holly Louisa, et al. "Effect of sports massage on performance and recovery: a systematic review and meta-analysis." BMJ open sport & exercise medicine vol. 6,1 e000614. 7 May. 2020, doi:10.1136/bmjsem-2019-000614

Grandou, Clementine, et al. "Symptoms of Overtraining in Resistance Exercise: International Cross-Sectional Survey." International Journal of sports physiology and Performance vol. 16,1 (2021): 80-89. doi:10.1123/ijspp.2019-0825

Meeusen, Romain, et al. "Brain neurotransmitters in fatigue and overtraining." Applied physiology, nutrition, and metabolism = Physiologie applique, nutrition et metabolisme vol. 32,5 (2007): 857-64. doi:10.1139/H07-080

Peluso, Marco Aurélio Monteiro, and Laura Helena Silveira Guerra de Andrade. "Physical activity and mental health: the association between exercise and mood." Clinics (Sao Paulo, Brazil) vol. 60,1 (2005): 61-70. doi:10.1590/s1807-59322005000100012

Weerapong, Pornratshanee, et al. "The mechanisms of massage and effects on performance, muscle recovery, and injury prevention." Sports medicine (Auckland, N.Z.) vol. 35,3 (2005): 235-56. doi:10.2165/00007256-200535030-00004

Any form of physical sports activity puts the body at risk for injury. Chiropractic care can prevent injury for all athletes, weekend warriors, and fitness enthusiasts. Regular massaging, stretching, adjusting, and decompressing enhances strength and stability, maintaining the body's readiness for physical activity. A chiropractor assists in sports injury prevention through analysis of the body's musculoskeletal system addressing any abnormalities from the natural frame and adjusts the body back into proper alignment. Injury Medical Chiropractic and Functional Medicine Clinic provides various sports injury prevention therapies and treatment plans personalized to the athlete's needs and requirements.

Sports Injury Prevention

Individuals involved in sports activities push themselves through rigorous training and play sessions to new levels. Pushing the body will cause musculoskeletal wear and tear despite meticulous care and training. Chiropractic addresses potential injuries by proactively correcting the problematic areas within the musculoskeletal system to improve body functionality. It ensures that all system structures, spine, joints, muscles, tendons, and nerves are working correctly and at their healthiest, most natural state.

Performance

When muscles are restricted from moving how they are designed to, other areas over-compensate and over-stretch to make the movement possible, increasing the risk of injury as they overwork. This is how the vicious cycle starts. Regular professional chiropractic:

• Regularly assesses the alignment of the body.
• Keeps the muscles, tendons, and ligaments loose.
• Spots any imbalances and weaknesses.
• Treats and strengthens the imbalances and deficiencies.
• Advises on maintaining alignment.

Treatment Schedule

Consecutive treatments are recommended to allow the musculoskeletal system to adapt to regular treatments. This allows the therapists to get used to how the body looks, feels, and is aligned. The chiropractic team gets used to the body’s strengths and weaknesses and learns the areas that need attention during each treatment. Initial treatment could be every week or two, allowing the chiropractor to spot any discrepancies in movement patterns and giving the body a chance to acclimate to the therapy. Then regular treatment every four to five weeks depending on the sport, training, games, recovery schedule, etc., helps maintain a relaxed, balanced, and symmetrically aligned body.

Pre-Workouts

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Hemenway, David, et al. “Injury prevention and control research and training in accredited schools of public health: a CDC/ASPH assessment.” Public health reports (Washington, D.C.: 1974) vol. 121,3 (2006): 349-51. doi:10.1177/003335490612100321

Nguyen, Jie C et al. “Sports and the Growing Musculoskeletal System: Sports Imaging Series.” Radiology vol. 284,1 (2017): 25-42. doi:10.1148/radiol.2017161175

Van Mechelen, W et al. “Incidence, severity, etiology and prevention of sports injuries. A review of concepts.” Sports medicine (Auckland, N.Z.) vol. 14,2 (1992): 82-99. doi:10.2165/00007256-199214020-00002

Weerapong, Pornratshanee et al. “The mechanisms of massage and effects on performance, muscle recovery, and injury prevention.” Sports medicine (Auckland, N.Z.) vol. 35,3 (2005): 235-56. doi:10.2165/00007256-200535030-00004

Wojtys, Edward M. “Sports Injury Prevention.” Sports health vol. 9,2 (2017): 106-107. doi:10.1177/1941738117692555

Woods, Krista et al. “Warm-up and stretching in the prevention of muscular injury.” Sports medicine (Auckland, N.Z.) vol. 37,12 (2007): 1089-99. doi:10.2165/00007256-200737120-00006

Delayed Onset Muscle Soreness - DOMS is when muscle pain or stiffness develops a day or two after playing sports, weight lifting, exercise, or work that involves concentrated physical activity like lifting and carrying objects. DOMS is considered a normal response to extended exertion and is part of the adaptation process that the recovering muscles experience as they undergo hypertrophy or an increase in muscle size. It is common in individuals who have just started exercising, increased the duration or intensity of their workouts, or just beginning a physically demanding job.

DOMS

When muscle contracts as it lengthens is known as eccentric muscle contractions, which is most associated with DOMS. It is related to increased stress in muscle fibers as they are exerted excessively. This also happens when engaging in movements the muscles are not used to, like a new exercise or helping a friend move heavy boxes, furniture, etc. Examples include:

• New exercise or unusual physical task.
• Descending stairs.
• Lifting/Lowering weights or heavy objects.
• Running downhill.
• Deep squats.

Symptoms

Individuals will not feel DOMS during the workout or physical activity. Delayed symptoms include:

• Swelling in the affected muscles.
• Muscles feel tender to the touch.
• Muscle fatigue.
• Reduced range of motion and movement.
• Pain and stiffness when moving.
• Decreased muscle strength.

Treatment Options

Time and waiting for the muscles to repair themselves is the natural healing process, but steps can be taken to ease the soreness, stiffness, and pain. This includes:

• Stretching.
• Hot or cold bath/massage shower.
• Ice/heat therapy.
• Topical analgesics.
• Percussive massage therapy.

It is different for everybody; personal experience will determine which works best for the individual.

Active Recovery

• Active recovery is a technique that uses low-impact aerobic exercise right after a workout to increase blood flow to the muscles.
• The increased blood supply can help relieve the inflammation.

RICE

This technique is used for acute injuries but can be applied to delayed onset muscle soreness. It stands for:

• Rest
• Ice
• Compression
• Elevation

Chiropractic

A chiropractic massage is for healing sore muscles, tendons, ligaments after an intense game, workout, etc. Chiropractic increases the blood and nerve circulation around the muscles delivering added oxygen and nutrients. This type of massage helps loosen the muscles/connecting tissues allowing the body to recover and heal quicker.

Body Composition

When Muscles Are Not Rested

Not taking time to recover because of overtraining/working can have consequences on the body. Inflammation that is not given the time to heal can lead to:

• Injuries.
• Weakened immune system.
• Muscle mass loss.
• Mental health issues.

The body’s immune system cannot function at total capacity during intense physical stress. This causes difficulty when trying to fight off germs and viruses. Studies have found preventing inflammation and injury requires prioritizing rest. Constantly being on the go and under intense physical stress can take a toll not only on the body but the brain as well. This can lead to irritability, frustration, anger, which leads to other health problems generating a vicious cycle.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Cheung, Karoline et al. “Delayed onset muscle soreness: treatment strategies and performance factors.” Sports medicine (Auckland, N.Z.) vol. 33,2 (2003): 145-64. doi:10.2165/00007256-200333020-00005

Guo, Jianmin et al. “Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis.” Frontiers in physiology vol. 8 747. 27 Sep. 2017, doi:10.3389/fphys.2017.00747

Reinke, Simon et al. “The influence of recovery and training phases on body composition, peripheral vascular function and immune system of professional soccer players.” PloS one vol. 4,3 (2009): e4910. doi:10.1371/journal.pone.0004910

Leg spasms and cramps are common conditions where the muscles in the leg suddenly become tight and painful. They present with no warning and can cause excruciating and debilitating pain. They usually occur in the calf muscles but can affect any area of the leg, including the feet and thighs. After the cramping has passed, pain and tenderness can remain in the leg for several hours. Although many leg spasm episodes go away by themselves, they can disrupt normal activities, exercise regimens, and sleep if they continue and are left untreated.

Leg Spasms and Symptoms

A leg spasm is a sudden, sharp contraction or tightening of a muscle in the leg. This can last a few seconds to a few minutes. Muscle cramps anywhere in the body cause sudden contraction of the muscle. This is an involuntary function and can include the following symptoms:

• Soreness and discomfort can be mild to extreme.
• Muscle tightening.
• Hardening of the muscle.
• Twitching of the muscle.
• Pain.

Leg spasms are typically brief and go away on their own, but individuals are recommended to seek treatment if they are frequently experienced or last for extended periods.

Causes

Dehydration

• Dehydration is a common cause of leg spasms and pain.
• Lack of fluids can cause the nerve endings to become sensitized, triggering muscle contractions.

Peripheral Artery Disease

• Peripheral artery disease affects how the body circulates electrolytes, causing cramping.

Mineral Deficiency

• When the body sweats, it loses water and electrolytes.
• When the body is low on electrolytes
• Imbalances in:
• Sodium
• Calcium
• Magnesium
• Potassium
• It can affect nerve transduction and lead to muscle spasms.

Hypothyroidism

• If the body does not produce sufficient thyroid hormone, this is known as hypothyroidism.
• Over time, this deficiency can damage the nerves that send signals from the brain and spine to the legs.
• Tingling, numbness, and frequent cramping can result.

Spinal Misalignment

• Spinal misalignment can compress nerve roots that run down the leg.
• This can cause radiating leg pain and spasms, specifically in the back of the thigh.

Muscle and Connective Tissue Injuries

• Injuries like tears, strains, and sprains can lead to leg spasms and frequent cramping.

Pregnancy

• In the second and third trimesters of pregnancy, calcium and magnesium deficiency are common and can lead to leg spasms and cramps.

Treatment

The proper course of treatment for leg spasms depends on the severity and underlying cause/s. A chiropractor can identify the cause and develop a personalized treatment plan to relieve and eliminate leg cramps.

Chiropractic

• Misalignments can compress the nerve roots radiating from the spine to the legs.
• This can lead to radiating leg pain and/or leg spasms.
• Realignment through chiropractic can relieve the pressure on compressed nerve roots, alleviating leg discomfort and pain.
• A chiropractor will also recommend exercises and stretches to strengthen the legs and core muscles.

Physical Therapeutic Massage

• A physical therapist will use various massage techniques to relax the leg muscles to prevent and reduce the severity of spasms.
• Massage therapy will relieve any inflammation that accompanies leg spasms, decreasing pain and swelling in the area.

Health Coaching

• Leg spasms can be caused by nutritional deficiency.
• As a part of the treatment plan, a health coach will evaluate the individual's diet and suggest changes that will help address any nutritional deficiencies contributing to leg spasms and cramps.

Body Composition

Track Inflammation and Fluid Imbalances From Injury or Surgery

Inflammation can occur with little to no visible symptoms following surgery or injury. Precision measurement of body water can detect water retention and inflammation to aid rehabilitation treatment. InBody effectively distinguishes water in the following compartments that comprise total body water.

• Intracellular-ICW-within the tissues.
• Extracellular-ECW-within the blood and interstitial fluids.
• The Edema Index can be used to detect fluid imbalances resulting from inflammation from injury or recovery after surgery.

Assessing fluid balance in the body and specific segments can help identify inflammation and guide treatment to reduce the risk of re-injury or post-surgery complications. These measurements are provided for the whole body and can determine where fluid imbalances may be occurring for more precise analysis.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Araújo, Carla Adriane Leal de et al. "Oral magnesium supplementation for leg cramps in pregnancy. An observational controlled trial." PloS one vol. 15,1 e0227497. 10 Jan. 2020, doi:10.1371/journal.pone.0227497

Garrison, Scott R et al. "Magnesium for skeletal muscle cramps." The Cochrane database of systematic reviews vol. 2012,9 CD009402. 12 Sep. 2012, doi:10.1002/14651858.CD009402.pub2

Kang, Seok Hui et al. "Clinical Significance of the Edema Index in Incident Peritoneal Dialysis Patients." PloS one vol. 11,1 e0147070. 19 Jan. 2016, doi:10.1371/journal.pone.0147070

Luo, Li et al. "Interventions for leg cramps in pregnancy." The Cochrane database of systematic reviews vol. 12,12 CD010655. 4 Dec. 2020, doi:10.1002/14651858.CD010655.pub3

Mekhail, Nagy et al. "Long-term safety and efficacy of closed-loop spinal cord stimulation to treat chronic back and leg pain (Evoke): a double-blind, randomized, controlled trial." The Lancet. Neurology vol. 19,2 (2020): 123-134. doi:10.1016/S1474-4422(19)30414-4

Young, Gavin. "Leg cramps." BMJ clinical evidence vol. 2015 1113. 13 May. 2015

Belly dancing has been found to be an effective way to help individuals managing low back pain. It could be utilized as a part of a chiropractic treatment plan. The dancing is beneficial for improving posture and allows an individual to improve their fitness with a light form of aerobic exercise.

Regular physical activity/exercise and a healthy lifestyle go hand in hand. For individuals with spinal issues, the right stretches and exercises can make a difference in their quality of life. It increases:

• Strength
• Flexibility
• Helps with pain management
• Improves posture
• Maintains spinal alignment

Belly dancing can help with injury recovery, as well as overall health. For most the trouble with exercising regularly is that it becomes routine and boring. Individuals want to live healthily, but it can be a challenge to maintain interest and motivation. An alternative form of physical activity that qualifies as exercise could be the answer.

Dancing has grown in popularity because of its fitness, flexibility, and spinal benefits. This form of belly dancing exercise does not require any special outfit or plenty of space. This utilizes the movements as a form of stretching and keeping the body moving in an aerobic fashion. They can be done at home with video instruction or an online class. Although the majority are women, men can and do belly dance.

Belly Dance

Information on the history of belly dancing. The dance has gone through various transformations since its inception. It was once considered burlesque entertainment, is now recognized as an important cultural expression, and today has been found to be a respected form of dance exercise.

Exercise

Belly dancing as physical exercise involves:

• Isometrics
• Dance posture
• Muscle control

Isometric exercises are contract specific muscles or groups of muscles. These types of exercise help with strength and stability enhancement. Both are vital for individuals recovering from back injuries or back pain management.

Posture

Dance posture is different than normal standing or sitting posture. Dance posture refers to the way an individual prepares/maintains their body to perform specific movements so that the motions are fluid, graceful, and with no presentation of pain. Belly dance posture maintains proper spinal alignment, which encourages reduced stress/pressure on the joints. This is beneficial for individuals managing back problems. The keys to spinal success are:

• Maintaining proper position/posture
• Keeping joints in alignment
• Pelvis stays straight in a neutral position
• The knees should be slightly bent and not stiff so as not to pull/strain the lower back muscles

When the abdominal and back muscles maintain/support a straight spine, this alleviates stress on the low back. Lower back issues have shown a positive response to a belly dance exercise therapy program. A study looked at the effects of belly dancing on pain and function in women with chronic lower back pain. The study found that belly dancing made movements of the trunk and pelvis that are known to influence low back pain much easier.

A belly dance program in conjunction with a chiropractic or physical therapy treatment plan can help alleviate pain and improve function. A 45-minute belly dance routine/session promotes aerobic benefits, improves flexibility and core strength.

Core Strength

These are movements that train the muscles in the:

• Pelvis
• Abdomen
• Hips
• Low back

They help build strength, generate stability, protect against back pain, poor posture, and muscle injuries. Having core strength is crucial for individuals with back issues, as it increases the stabilization of the spine. Core strengthening is highly recommended and often prescribed for individuals recovering from lumbar issues.

Depression/Anxiety Improvement

Individuals with back pain also tend to experience psychological issues like depression and anxiety. Back pain can affect:

• Mood
• Tiredness
• Sleep problems
• Self-esteem problems

Belly dancing as part of a treatment/therapy program can help an individual experience benefits that improve mental health and well-being. These include:

• Regaining mobility
• Having a positive body image
• Social interaction is enhanced

For All Ages

Belly dancing is a fantastic creative outlet and a great way to exercise. Anyone that is able can participate. Children, seniors, and everyone in between can get into belly dancing. It enhances health and strengthens the body and mind. When the body is in the proper position/posture there are no joint issues or pain. In-person classes, at home with online instruction, DVDs, or video meeting apps can benefit the body and especially the spine.

Eliminate Back Pain 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Being physically fit does not mean training for a triathlon. Regular light exercise/activity is all that is needed. Just going for a 30-minute walk around the neighborhood or playing a 20-minute game regularly is highly beneficial to your health. And the more active you are the better for your health.

• Skating
• Bicycling
• Jogging
• Swimming
• Walking
• Playing

Regular Activity

Whatever the activity, so long as you get at least 20 minutes of exercise a day will go along way in the future. Regular activity/exercise can help prevent diseases and injuries, which include osteoporosis.

Nothing crazy, just begin to work some activity little by little into a routine. One way is after some sitting work/schoolwork once the brain has had enough is the perfect time to go outside and move around. Do some chores that require physical movement, like vacuuming, sweeping, hanging laundry, etc and turn it into a workout.  A daily routine of light to moderate physical activity strengthens and maintains the body by helping to:

• Build healthy bones, muscles, and joints
• Control weight
• Build lean muscle
• Reduce overall body fat
• Prevent the development of high blood pressure hypertension  

Here are a few suggestions on how to get 20-30 minutes of daily exercise/activity.

• Try an online fitness class.
• Check out your local gym for online to see what classes are available.
• Family time can become a fun activity/exercise time.
• Take a walk with the family, as many are already doing, play basketball, soccer, or other favorite sport together.
• Invite friends to be physically active online, maybe playing a workout video game and workout together.

If regular physical activity is difficult or you have a medical condition, consult your doctor to recommend the appropriate amount of physical activity and exercises that are safe to perform. But if you are a healthy person, but have not exercised for a while then try for 30 minutes of physical activity a day to keep you healthy and strong.

Core Exercises That Help With Back Pain

Here are some examples of abdominal exercises that can help develop strong abs and help with back pain prevention. These exercises and the number of repetitions are only suggestions. Talk to your doctor before trying these exercises, and remember to listen to your body. If it doesn't feel right, stop right away.

Elbow Planks

1. Lie down on your stomach with your body straight.
2. Elbows should be at 90-degrees and close to the body's sides.
3. Rest the forearms on the floor and interlace the fingers.
4. Gently push your body up using the forearms.
5. Don't' let the back fall/drop.
6. Stay straight.
7. Engage the core muscles during the entire movement.
8. Hold this position for 30 seconds, release, and repeat 3 times.
9. Do this once a day.

Crunches

1. Lie on your back with the knees bent and the feet flat on the floor, about hip-distance.
2. Interlace the fingers of your hands behind your head with the elbows out wide.
3. Inhale and then as you exhale, use the abdominal muscles and not the neck muscles to slowly raise the head, neck, and back off the floor.
4. Inhale and slowly lower the upper body back to the floor, and repeat.
5. Try for 3 sets of 10 crunches every day.

Push-ups

1. Lie down on the stomach so your body is straight.
2. Place the hands on the floor a little higher/further than the shoulders.
3. The hands should be wider than the shoulders.
4. Lift your body so that you're balanced on the hands and toes.
5. Maintain a straight back, lower your body to the floor, and slowly bend your elbows until at 90 degrees.
6. Push back up using arm strength, upper back, and chest muscles, and repeat.
7. Try for 3 sets of 10 every day.
8. Once the body becomes stronger, you can go for more reps.

Doing these along with other core exercises you will notice your core strength leading to overall and optimal body strength. Other exercise forms that can help develop core strength while keeping the spine safe are yoga and Pilates. A good idea is to work with a physical therapist/chiropractor that can create a specifically targeted exercise plan that involves core strengthening and flexibility exercises to keep the spine healthy and help maintain proper posture.

Correct Bad Posture with Custom Foot Orthotics

Shoulder chiropractor, Dr. Alexander Jimenez examines the latest research into shoulder problems and gives practical advice on achieving balanced upper-body development.

Chronic shoulder injury is a common issue, and not only for athletes. Among the people at large, day-to-day activities such as DIY or gardening can produce chronic pain, as may resistance work at the gym, when weightlifters pile on the weight without paying attention to the demand for balanced strengthening. Adults beyond age 50 are more vulnerable to general to rotator-cuff tears, the incidence increasing with age(1).

One large group, known as 'overhead athletes', are at increased risk of chronic shoulder injuries. The overhead group covers a broad array of sports such as swimming, tennis, cricket, javelin and baseball, all of which include variations on the standard throwing activity where the arm moves over the head (see below).

The throwing movement recruits a large number of muscles and unites a massive assortment of arm motion with high forces or levels at the shoulder joint. All overhead athletes often perform many repetitions of the movement, typically with the dominant arm only, as part of their sports training.

For the shoulder and arm to maneuver efficiently requires coordinated movement of the scapula and humerus, called scapulo-humeral rhythm. By way of instance, arm abduction is accompanied by some upward rotation of the scapula, allowing the deltoid muscle to maintain a good length-tension relationship throughout the whole 180 degrees of abduction.

Scapular and humeral coordination also involves the stabilizing muscles of the scapula working in concert with the rotator-cuff stabilizing muscles of the glenohumeral joint. If the scapula retains its position correctly, the rotator cuff is going to do its job more effectively. Or, to put it another way, active stability is necessary to prevent excessive stress on the shoulder joint.

Get The Balance Right

The importance of rotator-cuff muscle strength in throwing was examined by a researcher from the West Point Army Hospital at the US(2). Scoville et al looked at the strength of ordinary subjects without any shoulder injury symptoms, comparing strength ratios of the end range of lateral and medial rotation. Subjects were assessed on an isokinetic dynamometer (which measures joint strength). Full range of motion (ROM) was defined as 90 degrees of lateral rotation (forearm vertical) to 20 degrees of medial rotation (forearm 20 degrees below the horizontal). The average force produced in the last 30 degrees of each direction was assessed as end ROM.

The group average strength ratios outcomes are as follows:

The concentric lateral rotation to eccentric medial rotation ratio of 1:2.4 indicates the lateral rotators have readily enough strength to decelerate the arm as it moves back into the cock position. The eccentric lateral turning to concentric medial rotation ratio of 1.05:1 suggests that the lateral (external) rotators are capable of decelerating the forward motion, but only just.

The results of Scoville's study suggest that ordinary adults without a shoulder problems possess adequately balanced strength for effective biomechanics of throwing. But it also shows how significant it really is for overhead athletes to keep that equilibrium of muscle strength, otherwise the lateral rotators might not have the ability to manage the more powerful lateral spinning force, compromising the shoulder joint.

Problems often arise when athletes concentrate on their training solely on the prime mover muscles, such as pectorals and deltoids, resulting in a relative weakness of the rotator-cuff and scapular stabilizer muscles. It is common practice now for overhead athletes to pay additional focus on lateral rotator strengthening. The same information will apply to all those that do resistance training: be certain to include exercises for the rotator-cuff and scapular stabilizers in order to create balanced strength in the upper body.

While the Scoville study analyzed rotation strength alone, we have already noted above that throwing combines spinning with flat extension and flexion movements. The rear deltoid muscles should also therefore act eccentrically to decelerate the arm throughout the end range when the pectorals and anterior deltoid are working concentrically. So strengthening applications must also look closely at back shoulder strength, including pulling and rowing movements to equilibrium pressing movements.

Here, again, gym-goers have a tendency to be most unaware of the need for balanced development, typically focusing on the 'mirror muscles' (pectorals, deltoids and biceps) and neglecting the back. The ideal program is going to be one that boosts strength in all muscle groups and also develops a balanced physique, front and back.

What Goes Wrong

Recent research from Kibler and McMullen (3) utilizes the idea of 'scapular dyskinesis': a change in the normal position or motion of the scapula during combined scapulo-humeral moves. They suggest that a wide variety of symptoms reveal exactly the same biomechanical fault, the inhibition or disorganization of activation patterns in scapular stabilizing muscles, resulting in altered scapular function.

This idea is supported by research from a team from Belgium(4). Cools et al investigated the time of trapezius muscle activity during a sudden downward decreasing motion of the arm, comparing the operation of both 39 overhead athletes with shoulder impingement against the of 30 overhead athletes with no impingement. The trapezius operates on the scapula in 3 sections: the lower portion depresses, the centre portion retracts, and the upper portion raises it.

Cools measured the time that the muscles took to change on in all three parts of the trapezius and at the middle deltoid, and discovered significant differences between both groups. Those with impingement showed a delay in muscle activation of the middle and lower trapezius the muscles which are important for preserving good shoulder positioning.

Another study from Cools and his group(5) researched if 19 overhead athletes with impingement symptoms had differences in their scapular muscle power (measured by isokinetic dynamometer) and electromyographic activity on the affected and uninjured sides. They found that the injured side revealed significantly lower peak force during protraction, a significantly lower ratio of protraction to retraction force and significantly lower electromyographic activity in the lower trapezius through retraction.

Collectively these findings support the idea of scapular dyskinesis involving abnormal recruitment timing and strength of the trapezius muscle, specifically the middle and lower portions. These results indicate the importance for harm prevention of good scapular stability in the depression and retraction movements.

Research in Germany highlighted changes in flexibility at the shoulders of overhead athletes(6). Using ultrasound-based measurement, Schmidt-Wiethoff et al found that the dominant arm at a group of pro tennis players had a considerably greater range of external rotation compared to the non-dominant arm, even while their internal rotation showed a substantial deficit relative to the non-dominant arm. Furthermore, the total rotational assortment of motion of the dominant arm was significantly less than that of the non-dominant arm or of a management group. Among the control group (not included in any overhead sports), there were no important differences in flexibility between their own shoulders.

How To Protect Your Shoulders

It would appear in the study that incorrect muscle function (developed through sport-specific demands or injury) is most evident at the lower and middle trapezius and lateral rotator-cuff muscles. From a practical viewpoint this means overhead athletes and people involved with weight training need to spend time on specific strengthening exercises to encourage injury prevention and ensure balanced strength and good posture.

Step 1: Equalize Front & Rear Strength

The beginning point is a balanced program for front and back shoulder muscle growth. Opposing muscle groups have to be trained equally. While exercises for the anterior shoulder and pectorals create power, to train just those muscles will unbalance the shoulder. The better approach is to plan exercise pairs that work opposing muscles (see Table 1). Coaches and therapists must check that equivalent quantities of sets from each column are written into strength programs.

Step 2: Develop Good Pulling Form

It's crucial to do row or pull exercises with proper technique so as to ensure that the middle trapezius, rhomboids and lower trapezius muscles are properly recruited.

As an example, the lat pulldown is a popular exercise for the upper-back and rear-shoulder muscles, involving adduction of the arm. The workout begins with the arms above the head. Throughout the pulldown motion the exerciser must focus on utilizing the lower trapezius muscles to depress the scapula while the massive latissimus dorsi muscles pull on the elbows downwards. And throughout the return motion, it's important to make the lower trapezius muscle 'keep hold' of the scapula as the arms rise with the weight.

This recruiting creates the proper scapulo-humeral rhythm. Without correct use of these lower traps, the lat pulldown is performed in a hunched shoulder position, which promotes poor mechanics.

Exactly the same coaching principle applies to rowing exercises. These involve horizontal expansion of their arm, utilizing the powerful latissimus dorsi muscles, and require concurrent scapular retraction in the middle trapezius and rhomboids. Exercisers should concentrate on retracting the scapula at the same time as the elbow is pulled straight back and maintaining the scapula retracted as the arm goes forward with the weight on the return motion. If the scapula is not stabilized the athlete will perform the practice in round-shouldered (kyphotic) posture, which again leads to bad shoulder joint mechanics.

Measure 3: Isolate The Rotator Cuff

The small but essential muscles of the rotator cuff should be targeted alongside the lower traps to prevent developing weakness or dysfunction. In the following four exercises, look closely at the coaching points.

A club golfer was cured of a nagging consistent shoulder pain. Shoulder injury chiropractor, Dr. Alexander Jimenez evaluates the case study.

Here’s a pertinent quote from the late lamented author of Letter From America, Alistair Cooke: ‘To get an elementary grasp of the game of golf, you must learn, by endless practice, a continuous and subtle series of highly unnatural movements, involving about 64 muscles, that result in a seemingly “natural” swing, taking all of two seconds from beginning to end.’

An avid club golfer with a handicap of 4 and a right-handed stroke asked for assistance with his nagging L shoulder pain that had recently become markedly worse and finally was threatening to stop him playing. He explained he knew he must have asked for help sooner, but he believed it would just go away (one of the most commonly heard statements by treating practitioners!) and it had now been hanging around for about six months in total, despite routine training.

He explained that initially it only used to damage when he caught his chipper from the grass and disrupted his follow-through, but now if he used an iron he'd feel a sharp pain unless he happened to stroke the ball flawlessly. It would also ache when he slept on the side, and after playing a full round it ached for some days. He had tried a million stretches and even appeared quite flexible with specific movements around the shoulder. In addition, for some years he had battled with R low- back pain and anterior hip pain which, when really bad, would render him limping a couple of days after an 18-hole round.

Assessment

Evaluation showed all the signs of rotator-cuff tendinitis (inflammation and microscopic breakdown of tendon), together with accompanying weakness of the muscle itself, leading, over time, to excessive anterior translation of the head of his humerus (extra shearing of the ball in his socket joint) on follow-through. This would likely cause an impingement of his already thickened tendon beneath the rectal acromial arch of the shoulder, giving him the sharp stabs of pain he complained of more lately.

His standing posture gave us the most clear clues as to why this had evolved, without ever needing to video his stroke biomechanics: rounded shoulders and a very noticeable low- rear arch (lumbar lordosis) are classic signs of poor postural control resulting in wrong movement patterns within his stroke. Gradually over time something needed to give often it's the non-dominant arm.

Had he had been middle-aged, we may have X-rayed his shoulder to search for any calcification of his tendon (he'd just turned 30), and only if progress wasn't going well would we believe doing an ultrasound scan to find out the size of scarring and limb breakdown.

Treatment

Rehabilitation could have a month or two if all went according to plan the key unknown factor is how well he'd take on the challenge of holding his shoulders and pelvis differently; this re-education procedure is frequently the most difficult. The general treatment procedure will first entail improving flexibility so that appropriate posture positions can be held most of us get stiffness in a number of our joints because of gravity wrecking our great posture.

Recent improvements in sports physiotherapy have enhanced the speed of the process significantly. Aside from a systematic stretching regime from the patient, we 'release' muscle tightness by deep-tissue massage and trigger-point treatment, heat, a home program of self-pressure massage with a tennis ball, and mobilizing of the tight parts of the capsule of the shoulder with seat-belts. Tightness in the posterior rotator-cuff muscles of this specific patient took a lot of effort to workout, and lat dorsi and pec major/minor were also big players.

Additionally, he had considerable stiffness in his thoracic spine, particularly with L rotation, which was worked loose, as were certain gluteal and hip-flexor muscles.

The Next Two Phases

Secondly, postural muscles needed to be 'turned on', ie recruited correctly, and a schedule of gradual strengthening of their ability to restrain the joints to which they're responsible began. In this instance the crucial ones were the lower and mid trapezius and transversus abdominus muscles we also taped up them sometimes to help him remember to continue using them, until it became more habitual.

Around this time, pain has gotten less and less of a problem along with his postural control was growing nicely. He was able to come back to his coach and start utilizing the positional changes in his stroke, slowly increasing the stroke distance and frequency and all the while maintaining his flexibility with the tennis ball. This third phase, which entails integrating the right posture into the stroke, has to do with the coach, and requires substantial discipline on the part of the athlete to ensure he remains inside the realms of what his brand new system can tolerate without being overloaded. Because he can still overdo it!

All went well, with all the golfer reaching one of his best-ever scores in the Queensland Open Tournament three months later. However, two weeks after that he dived badly in a game of rugby and twisted the exact same L shoulder and ripped the exact same rotator-cuff tendon he'd worked so hard to fix. Back to the chiropractor.

Sports fitness & injury chiropractor, Dr. Alexander Jimenez suggests additional exercises that will assist you avoid shoulder pain.

The functional anatomy of the shoulder an the way the weakness at the rotator cuff and an inability of the scapula to stabilize the shoulder are the significant contributors to shoulder impingement injuries. Three important exercises for strengthening the rotator cuff and approaches to boost scapula stabilization. This article provides more exercise suggestions and provides further practical tips to help athletes prevent shoulder pain.

1. Balance Your Upper-Body Workouts

A good way to prevent shoulder injuries is to ensure that your upper-body strength sessions are more balanced. This means that every push or press exercise must be balanced using a pull or row exercise. Too many athletes and weight trainers focus on creating the 'mirror muscles', the upper trapezius, anterior deltoid and pectorals. As a result, the 'non mirror- muscles', lower trapezius, rhomboids, latissimus dorsi and rear deltoid, are underdeveloped. This also contributes to a muscle imbalance in the shoulder, which results in poor scapular stabilization because the non-mirror muscles are those that function to stabilize the scapula. Moreover, over developed mirror muscles may lead to some round-shouldered position, which wrongly places the scapula up and forward. Redressing this imbalance is quite vital for the prevention and rehabilitation of shoulder impingement injuries.

The following is a good illustration of a balanced upper-body workout which I would recommend.

Note the 1:1 ratio between push/press and pull/row exercises.

For those who are more prone to shoulder pain or are recovering from a shoulder injury, then I would advise changing the ratio to 2:1 in favor of the non-mirror muscles. Remember, it is the push/press exercises which cause the problems, so you need to change your accent before the imbalances have been redressed. Additional pull/row exercises include: bent-over row, single-arm dumbbell rows, single-arm cable pulls, bent-over rear fly, pull-ups (wide or narrow), stiff-arm pull-downs with cable/flexaband.

2. Limit Your Range Of Movement, & Take It Easy

Rehabilitation from a shoulder impingement injury should focus on rotator-cuff strengthening. But it is important to remember that when it comes to re-introducing your own weight-training exercises, you must progress slowly. Frequently this implies avoiding specific ranges of movement where the shoulder joint sub-acromial space is compressed the most. The impingement zone to avoid is between 70 and 120 degrees of shoulder abduction (when you move the arm laterally away from the side of the body).

To start training the non-mirror muscles, start with the seated row, since the shoulder joint is not abducted in this workout. Once the pain is totally gone, then introduce the overhead exercises for example pull-ups and lat pull-downs. You ought to be even more careful when it comes to the mirror-muscle exercises. I'd avoid lateral raises, upright rows and shoulder presses completely for a while. But, incline bench press with arm abducted to 45 degrees are a great place to begin again. Slowly build up to the normal bench-press range as strength improves.

It is also crucial that you don't increase your weights too soon. Bear in mind that the tendons and ligaments need to accommodate to exercise as well as the muscles, and they may take longer to do so. I'd suggest staying in the 12-20 rep scope for a while before pushing up the weights, particularly with the mirror- muscle exercises. While I realize that it is important for many athletes to be powerful at exercises such as the seat and shoulder press, I would advise that you develop gradually to maximum advantage. Reducing your reps by two every 2 weeks is a fantastic guideline. During heavy workouts, ensure that you warm up the shoulder joint and rotator cuff thoroughly prior to lifting.

3. Correct Scapula Positioning When Performing Exercises

The appropriate position for the scapula (shoulder blade) is back and rotated down. Essentially, this means maintaining a great 'military posture', together with shoulders back and chest out. A round- shouldered or hunched posture is to be avoided at all times.To achieve the right position, you need to use your rhomboids, mid and lower trapezius muscles to retract the shoulder and pull the scapula down.

When you do any upper-body weight-training exercise, always get into the habit of starting with good upper-body posture and pinching the shoulder blades together. You need to feel that the scapula is a good platform which keeps the shoulder properly positioned as you do the exercise. As mentioned by Dr Kemp, a fantastic way to learn the correct position is through the seated row exercise by keeping your scapula down and back while you move your arms. Throughout the exercise, you should believe that the rhomboids and trapezius muscles have been statically contracting to maintain the scapula set up, and the latissimus is working to carry out the movement. After you have the feel for maintained scapula stability during the seated row, try to achieve it during all upper-body exercises. What you may find is that exercises such as the press-up or front raise, in which the shoulder may become impinged, won't be painful if you stabilize your scapula correctly. In effect, by using the scapular muscles you can achieve better shoulder mechanisms and avoid injury.

Correct scapular stability is hard to learn and demands a lot of concentration and practice during your training sessions. First you need to understand what the correct position is, and frequently this needs a trainer/physio to guide you. Then, during training sessions, instruction and observation from a trainer can help you reach and maintain the right shoulder position.

4. Sports-Specific Exercises Plyometrics For The Shoulder

Just as rehabilitation training for leg injuries needs a functional progression from simply strength exercises to sports- specific exercises, so does rehab for your shoulder. This means that for the athlete, eg a thrower or tennis player, conventional resistance exercises at the gym might not be enough to allow a full return to competition. Often what is needed to bridge the gap would be plyometric exercises for the shoulder that mimic sports- specific movements. Plyometrics for the shoulder usually involve medicine balls of different weights.

Plyometric exercises have two advantages. First, they're performed fast, and second, they demand stretch-shortening- cycle movement patterns. This means that they are much more sports-specific than traditional resistance exercises. Specifically, plyometric exercises for the rear-shoulder and external rotator muscles are extremely useful since they provide eccentric training for these muscles. This enhances their ability to control the shoulder through the potent concentric actions of the pectorals and anterior deltoid involved in throwing or serving. Thus it's important to ensure that your plyometric workouts are balanced between the prime movers (pectorals, latissimus, anterior deltoid) as well as also the rear-shoulder and upper-back muscles. I would recommend incorporating shoulder plyometrics through general conditioning exercises to prevent injuries and in the later phases of shoulder rehab to guarantee a functional progression back to competition.

Here are two suggestions. The key to both these exercises is that the medicine ball is caught, the impact quickly absorbed (fast eccentric phase) and then thrown back explosively (powerful concentric phase).

For athletes who rely on their shoulders, here are the five major guidelines for maintaining them injury-free. Shoulder chiropractor, Dr. Alexander Jimenez assesses the data.

There is not any joint in the human body as complicated, intriguing, or bothersome as the shoulder. It can leave clinicians scratching their heads, wondering why a problem they've solved several times before is this time so stubborn. And shoulder problems can surely be stubborn! That's why, in every case, prevention is indeed much better than cure. Rarely is a pain which has surfaced a very simple matter of applying some ice -- it is more likely to be the tip of an iceberg!

An athlete's shoulder is either a joint that he/she hasn't given a second thought to, or it's ever-present in their minds -- it is either no problem, or an issue they cannot dismiss. It has been stated that the design elements which compose the shoulder are either close to perfection, or close to disaster! Now, of course, this greatly depends on the sport you're in: cross-country runners are unlikely to possess the shoulder difficulties that javelin throwers or swimmers may encounter. But it is uncommon for athletes using their shoulders as part of the main routine to not take at least a little pain, while others possess a background of a substantial shoulder problem.

This report takes a good look at the big picture of shoulder injury management, and tries to empower and instruct athletes with a few DIY home injury prevention and performance enhancement techniques. It presents, some complex concepts, and is therefore in no way an exhaustive explanation or listing of exercises.

Preliminary Precautions

If you have a shoulder injury and would like to try and treat yourself, please bear in mind:

Treatment, Prevention & Performance Enhancement

The information that follows describes the prevention and treatment for overuse injuries of the shoulder, not the management of traumatic or acute accidents such as glenohumeral dislocation, clavicular fractures, or tears of the labrum ('cartilage').

However, the broader principles of rehabilitating a shoulder that has been surgically repaired, or been stuck in a sling for four weeks, are not any different, although there could be limitations and time constraints imposed by orthopedic surgeons.

The most important principle of shoulder management is: start working on it now. Don't wait until your shoulder starts to hurt!

However, moreover, the preventative steps outlined below are sure to improve performanc they will really improve the way your shoulder operates, and consequently it will be more powerful, more coordinated, and reach farther and last longer befpre fatigue sets in. All the experts say it: injury prevention equals performance enhancement.

Some Simple Anatomy Of The Shoulder Complex

The shoulder joint really comprises four joints -- see If You're able to feel them on your own:

The Rotator-Cuff Muscles

Without learned muscle control, any overhead action, let alone just lifting the arm, could be hopeless -- that the GH joint could dislocate or the HOH would jam under the arch of the acromion. The muscle group we all rely on for this control is your rotator-cuff (RC) muscles -- the infraspinatus, supraspinatus, teres minor, and subscapularis muscles (a body book will reveal where they lie). All of them arise in the scapula and are coordinated together to keep the HOH spinning/rotating as near the centre of the glenoid as possible with movement. The long head of biceps tendon running over the front of the GH joint also has a stability role to perform together with the RC, especially with the throwing action.

The muscles primarily designed to place the scapula for overhead motion are the trapezius (notably lower trapezius), and serratus anterior -- called therefore the 'scapular stabilizers' -- with counter forces being produced by levator scapulae, rhomboids and pec little muscles.

The larger and more powerful muscles that create motions of the arm are the deltoids, latissimus dorsi, and pectoralis major. So whereas the RC muscles organize the proper positioning of their HOH by acting near the centre of the joint (the 'inner core'), then the larger muscles with long lever arms move the arm with speed and force (the 'outer core').

The Five Guidelines: Balance Through Control

Let's sew what might be considered the five most essential ingredients for an athlete whose main weapon is the shoulder:

1. Sports-specific technique.

2. Flexibility.

3. Core stability.

4. Rotator-cuff control.

5. General strength.

The primary objective of these five regions of intervention is, in a word, balance. And the way to achieve it? Control. The higher your levels of functionality, the larger the control required to maintain equilibrium -- just as a Formula 1 car needs much higher levels of balance and control than does a standard road car. A deficit in any one area will ultimately trigger muscle imbalances to grow, which lead to soft-tissue breakdown and after even joint degenerative change. Picture a bike wheel in which one spoke in the wheel has been bent out of shape: a slow warping happens using use which creates an imbalance which further damages other spokes before the whole system comes to a grinding halt.

The more elite the athlete, the more committed he/she needs to be to getting expert help in satisfying and keeping these fundamentals. You'll also save yourself much time and distress should you seek experienced assistance as a preventative measure, rather than only requesting treatment once the issue has surfaced. Having a regular tune up/service can be done in the form of screening, where a sports-experienced physiotherapist can conduct you through a set of tests to find out if some of the areas below are not being adequately dealt with.

1. Sports-Specific Technique

Inadequate performance and shoulder pain very commonly originate in bad habits of technique. Often they're only clearly noticed when muscle fatigue sets in. But a fantastic coach will be able to pick up if this is occurring and recognize it is time for rest and recovery.

As a general rule, technique work ought to be performed after a thorough warm-up (or even as part of a warm-up), even whereas the muscles along with the brain-connections are still fresh and strong. On the flip side, when fatigue sets in can sometimes be a great time to do specific drills that don't load the shoulder, nevertheless will fortify good movement patterns. The only proviso is that one has to be extra diligent to observe when compensation strategies are setting in, and call a halt immediately.

Without wanting to state the obvious, practice is the key! Once you have mastered a new aspect of technique it must be repeated about 10,000 times before it will become an engraved on your mind, in other words, the point where the motion pattern becomes subconscious and feels 'natural'.

There are many methods to discover if your technique is faulty, however one of the greatest is video recording in order to slow down the action and break it into smaller components. The better the technology, the greater the outcome, but for actual worth it comes down to the experience of the person evaluating the picture. Using a mirror is seldom effective because the position of the mind focusing on the mirror may greatly affect the shoulder posture. The two main sources of opinions in this respect are your mentor and a bio-mechanist, and often a sports physiotherapist who has had a great deal of expertise in your sport.

What Faults To Look For

The assortment of overhead motions necessary for every sport gives rise to quite subtle and unique technique flaws. The following are some examples of things to look out for:

Tennis serve/smash: inadequate trunk twisting to open up torso in cocking position, ball toss too close to human anatomy or too far behind body, cutting follow-through short by whipping racquet.

Javelin/water polo/baseball throw: side-arm activity, elbow behind the shoulder through follow-through, inadequate trunk rotation at late cocking stage to open up the torso and at conclusion of follow-through to dissipate forces following release of the object. The nearer the surface of the upper arm may follow the point of the front part of the chest, the less strain there will be about the shoulder joint, and also the longer rotation which may be harnessed from the shoulder, the less the strain on the elbow joint.

Freestyle swimming: insufficient body roll, just ever breathing to one side, catching the water too close to the midline, not keeping the shoulder blade scraped on the back during pull stage, not keeping the elbow high enough during recovery stage (a indication of insufficient flexibility).

2. Flexibility

The objective of flexibility varies for the different muscles around the shoulder. For the major power muscles, it is necessary that flexibility allows freedom of motion for your pelvis, trunk, scapula, and humerus. For your rotator cuff, the critical issue is that the balance of forces centering the mind of humerus, and to a lesser degree, liberty of motion. It's more critical that the internal and external rotators are equally elastic, rather than how flexible they may be.

A warning: to have an excessive amount of flexibility at the expense of control and strength could be dangerous due to the excessive shear forces causing wear and tear in the joint. This is very true of the glenohumeral joint at which the primary source of equilibrium are the rotator-cuff muscles functioning in conjunction with additional soft-tissue structures like the torso, ligaments and cartilage. Too much flexibility at the cost of muscle control puts strains on the soft tissues and causes injuries like rotator-cuff tendinitis and degeneration, labral tears, subluxations and possibly even a dislocation.

Do not start a flexibility program until you've seen a sports physician or physiotherapist if:

Stretching

Stretching to increase flexibility should not be done prior to competition or training, but rather done during 'down' times in the week. This is because of the suppression of the 'stretch reflex' that occurs during sustained passive stretching of muscle tissue (ie repeated holds of 20-30 minutes). If you were to perform rapid forceful movements like throwing straight after such passive stretching, there could be an increased chance of muscle and tendon tears. For flexibility every muscle has to be stretched a few times in 20-30 seconds each, and repeated three to four times per week.

The most important areas for regular flexibility sessions are:

● Infraspinatus/teres minor (posterior rotator cuff and capsule).

● Pectoralis major/minor.

● Latissimus dorsi.

● Biceps/triceps.

● Thoracic spine (between shoulder blades).

● Upper trapezius/scalenes/levator scapulae.

● Gentle nerve extending (oscillations).

The perfect way to understand how to stretch the above areas is to be taught by a sports physiotherapist, sports conditionist or private coach.

It is important not to stretch the ligaments of the shoulder, which in due time may lead to laxity of the joint and potential instability. The most common case I see? Athletes stretching their pec muscles and ending up with their arm supporting them against the wall, but with their shoulder rolled forward, feeling the stretch onto the front of the point of the shoulder.

What is being stretched here are the anterior ligaments ('capsule'), not the muscle, which can be better stretched by pulling the scapula back and twisting from the trunk away from the shoulder (hands still on the wall). One then feels the stretch far more down to the chest area where it ought to be.

Warm-Up Practice & Theory

The shoulder ought to be warmed up thoroughly with gradually increasing movements -- large circles, across-body movements, back twists, shoulder-blade rolls and forward and backward squeezes. The objective of this is to increase blood circulation and temperature, thus increasing the elasticity and 'contribute' from the soft tissues. A streak of short-duration stretches (ie five to ten seconds) of all the major muscle groups should follow and then eventually a session of more sports-specific drills. These are utilized to heat up the brain's connection to the muscle, ie to fortify correct motor patterns, and also to place the right neural reflexes from the muscle.

Massage

One of the most essential features of massage is to decrease the build-up of 'trigger points' -- regions in the muscle which literally grab up due to excessive loading. This might make a muscle imbalance or be the result of one -- either way it must be 'published' via massage. Each of the muscles described above which are necessary to stretch are vulnerable to activate points and may become tight and/or feeble because of them. It is not unusual for a trigger point to develop in the muscle as the initial structure to start breaking down, gradually dragging different muscles, nerves, and the glenohumeral joint down into a cycle of inflammation and pain.

The best way to begin is to get a hard tennis ball to perform your massage with, then try these two ideas:

Pectoralis minor/ major 'release': This is a important muscle to keep loose since if becomes too tight, it binds the scapula forward, leading to the head of the humerus being thrown off centre, especially in overhead positions. Hold on the tennis ball into the soft muscle overlying the chest directly at the front part of the shoulder. Lean towards a door frame and allow the tennis ball to press against it, with the same side arm halfway up the wall, palm facing towards the wall. Look for the tender trigger points, and when you find you, stay with the pressure on to it until it softens and the pain eases.

Rotator cuff 'release': Often accompanying the above condition is tightness and overactivity of the infraspinatus and teres minor, the net impact of that can also be to push the head of the humerus forward from the centre of rotation. Hold a tennis ball into the rear of the shoulder on the scapula, and press the back and side of the scapula onto the wall. The arm that is being worked on should be cradled in the opposite hand. Let it dig deep!

3. Core Stability

Core stability has come to be a whole science in itself in the last decade since all manner of sports professionals have realized just how crucial it is for the inner core of the human body, particularly those joints nearer to the backbone, to be encouraged from the postural muscles designed to achieve that. For your shoulder, the essential areas are the lumbar and cervical spine, and the scapulothoracic joint. If these areas aren't secure, then significant extra loading and strain will be passed on into the shoulder joint.

The stability of the lumbar spine is achieved by the combined effects of transversus abdominis and multifidus acting on the thoracolumbar fascia. Pulling in the lower navel area when tensing the lower-back muscles slightly activates the 'corset'. The cervical spine is stabilized by the upper cervical flexors in conjunction with the lower cervical extensors, to attain a 'tall' neck posture with the eyebrow slight drawn into the neck. Keep in mind that this can be easier for some than others, based on how your system has been trained -- for example, ballet dancers will come across the stable position of the neck comes naturally, rugby players may not. Activating the muscles is the first stage of the learning process; training the position till you are prepared to integrate it into simple movements that are relevant to your sport.

The scapulothoracic joint is the most important 'joint' for the shoulder, because the glenohumeral joint is formed by the glenoid (the socket) of the scapula and the humerus (the ball). The muscles most directly accountable for its stability would be the trapezius muscle (especially its own middle and lower fibres) behaving together with the serratus anterior muscle -- together they act to hold the scapula at a neutral position whether the arm is from the side or over the head. The neutral position is where the glenoid socket is most ideally orientated for the rotator cuff to control the HOH .

Imitate The Action Of The Seal

Bear in mind the earlier picture of a seal with a ball on its nose? The seal is the scapula trying to balance the ball of the humeral head using the rotator-cuff muscles. How amazing it is to think that these high levels of balance are being utilized when we perform overhead activity!

Deficiencies of core stability are always found with chronic shoulder injuries, or after surgery or injury, because pain will inhibit the postural muscles so they cannot do their job correctly.

The way to activate the lower trapezius/serratus anterior muscles would be to sit at a relaxed tall position, arms relaxed across your thighs. Gently pull the inner boundaries of your scapula together and down with the minimum of work, and hold it there for 10 minutes. Do not pull too far back or you may over- activate other muscles which are not meant to be the primary core stability muscles -- it is always a delicate and relaxed activity using a 10-second hold. When you have practiced this for a couple of days as frequently as you can, experiment with 'setting' your scapula into the neutral position with your arms out to the side, along with your arms on your hips, up behind your mind, etc..

Once you have mastered the 'setting', add small movements of your arm when holding the established position, and slowly over a few weeks you can increase the sophistication, speed and loading of your arm. Finally you're doing the setting in precisely the exact same time as you are carrying out the rotator-cuff strength and control exercises explained below.

4. Rotator-Cuff Strength & Control

The rotator-cuff muscles are all determined by the great positioning of the scapula for successful management. If the scapula is angled too far forward or downward, for example, while the tennis player reaches overhead to smash, the RC muscles are biomechanically disadvantaged and may neglect to maintain the HOH centered. The role of the RC muscles therefore is to keep the position of this HOH whereas the prime mover muscles create power.

As you enhance your scapular management, the RC muscles can act more effectively and independently of the scapular control muscles. That's to say that you should have the ability to hold the scapula quite still in the neutral position while you individually move your arm. This ability is known as 'glenohumeral dissociation'.

Thus with each of the exercises following, it's presumed that the scapula is being held as close as possible to neutral:

5. General Muscle Strength

When the foundational issues of technique, flexibility, core stability, and rotator-cuff controller are being executed, we have to take a look at the larger picture of this 'outer core'. What is the rest of your body like -- does it help or hinder the functioning of your shoulder?

In every sport that relies heavily on the shoulder, it is vital to view it as merely one link in a 'kinetic chain' -- all the other connections must also be adequately developed to aid in the growth of rotary torque or the shoulder will be overloaded. There is a 'winding up' and an 'unwinding' which takes place at a quick speed starting from the legs, progressing through the hips, pelvis, lumbar spine, thoracic spine, shoulder, elbow, and wrist. And each must be educated to absorb its fair share. Golf is your classic game to use as a very clear case of this transfer of rotary power -- a succession of wind-ups finally being unwound since the stable base of this hips whips back into the opposite direction.

To this end there is a whole segment that may be written on the value of plyometrics, the exercise science involved in harnessing the eccentric strength of muscles to get increased power. The rotary energy of the human body is greatly strengthened by developing the eccentric contraction power involving the kinetic connections described earlier -- and this is where medicine balls, harnesses, and other strength and conditioning equipment come in.

Avoid This Imbalance

It is clear to most athletes that a gym routine needs to include strengthening function for the deltoids (three heads), latissimus dorsi, pec major, upper trapezius, and the rectus abdominis since they are the prime movers of the shoulder. Frequently what is critically overlooked, however, is the imbalance which could develop between the front part of the shoulder and the back.

In those athletes which are carrying an overuse injury at the shoulder, nine times out of ten they have overdeveloped pecs and lats comparative to their trapezius, rhomboids, posterior deltoids, and posterior rotator cuff. In these scenarios, flexibility must frequently be enhanced, scapular setting must be taught, and also the focus of gym exercises changed in the direction of the back. Seated and vertical row, barbell flies to the back, seat pull, and lat pull-downs with the bar behind the head are all exercises that must take higher priority.

Throughout all gym work it must be stressed that scapular setting along with the activation of core stability muscles to get good posture are vital for injury prevention.

Summary

So there we have it -- that the big picture of injury prevention and performance enhancement for athletes who rely on their own shoulders for playing their sport. Decide today which among these issues you may need some more work on, try some of the house exercises, and possibly seek out expert assistance to maximize the results of your efforts.

Weak buttocks destroy the runner. Discover just how, by firming up your buttocks, you can improve your performance. Science based core chiropractor, Dr. Alexander Jimenez evaluates the case.

How many routine runners would suspect that the upper buttock muscle (gluteus medius) is the offender in very many running overuse injuries? This fact is less surprising once you understand that through running you're always either completely in the air or dynamically balanced on one leg -- and in both conditions the gluteus medius is a key muscle.

Situated on the upper edge of the hip (see below), gluteus medius is responsible for lifting the leg away from the body (abduction), enabling it to bend inwards and outwards, and crucially, keeping the pelvis stable in some certain situations, including the stance phase of running.

During right stance phase, for example, the muscle contracts to slow the downward movement of the left side of the pelvis so that the pelvis does not tilt heavily towards the ground. If the gluteus medius isn't working well enough to accomplish this control, the athlete is said to have a 'Trendelenburg gait'. Frequently, but not necessarily, the exact same weakness could be noticeable in walking, making a waddling motion or, in extreme cases, a limp.

Adaptations

Runners that have a weak or easily fatigued gluteus medius are very likely to make various adaptations to their technique, which can hide the true reason for a running injury. Table 1 lists the adaptations or cheating movements that happen through the stance phase of running.

Adaptations 3 and 2 obviously cannot occur simultaneously, however a runner's technique may demonstrate a combination of adaptations, such as a mild Trendelenburg, inwards knee drift and a same-sided trunk shift.

In my experience, runners using inferior lively pelvic stability, for which gluteus medius is vital, will decrease their stride length and embrace a much more shuffling pattern to decrease the ground reaction force at contact and consequently the muscle control necessary to keep pelvic posture.

Weakness at gluteus medius will have consequences all the way down the kinetic chain. With Adaptation 2, for example, the buttock weakness will create inward drifting and rotating throughout the leg while running, which will leave the runner at higher risk of any condition concerning excessive or prolonged pronation of the foot, such as shin splints (medial tibial stress syndrome) or Achilles tendinitis.

An extremely informative analysis by Fredericson et al (2000)1 upholds the thought that gluteus medius weakness is a contributing element in ITB friction syndrome; affirms that injured and uninjured sides can be compared to ascertain weakness; also endorses retraining for strength gains as an effective treatment.

Fredericson measured hip abductor power in a group of injured male and female subjects, and found an average deficit of 2 percent in gluteus medius power on the injured side compared to the uninjured. Following a six-week retraining program, typical hip abductor torque improved by 34.9 percent for females and 51.4 per cent for males; 22 of the 24 injured athletes could return to running pain free. Above all, at a six-month follow-up no injury recurrences were reported.

Reference
1. Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA, ‘Hip abductor weakness in distance runners with iliotibial band syndrome’. Clin J Sport Med. 2000 Jul;10(3):169-75.

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Running might appear the most natural thing in the world, but for many who try, it certainly does not come naturally, nor even easily. The awkward reality is that many people simply shouldn't be running at all if they would like to avoid ongoing injury. Among the rest of us, running styles differ so much that it is fair to say everybody's individual running style will be exceptional -- after all, we all differ slightly in our body position, our lower limb muscle recruitment and our foot placement when striking the floor. El Paso, TX. Chiropractor, Dr. Alexander Jimenez has a look.

For a lucky few, running does appear to come naturally. But most individuals who aspire to run well and injury-free will require work in their technique and overall postural control.

Chiropractors are just as likely as anybody else to be confused by the large amount of analysis available on the biomechanics of running; it's really hard to make sense of information like the subtalar joint axis or level of lumbar rotation whenever you are attempting to figure out what's gone wrong with the wounded client running on a treadmill in front of you.

I have previously written about the method of 'pose running' as one approach which I believe to be highly effective for training individuals to conduct while avoiding injury. This report focuses especially on the technique fault of poor lumbopelvic management, which I think is essential to injury-free running.

Some People Should Not Run

Not all of us are born athletes, and some folks are intrinsically not designed to run. Others will struggle because of a combination of physiology and lifestyle variables. Although the following list is probably not exhaustive, here are some of the main sorts of people that will be more prone than average to running-related injury, and will certainly struggle to sustain any longevity of running form.

Muscular Control Is the Secret

Nicholas Romanov, the leader of this pose running style, characterizes the differences between good and bad running this way:

'A proper technique has particular perception of lightness, brief support, no pressure on muscles, no feeling of loading On your joints... The opposite -- wrong technique -- goes together with muscle strain, loading on your joints, heaviness...' (www.posetech.com)

Over time that I've been involved with conducting athletes, I have come to consider that static stretching is likely Less important and less successful in warding off harm and recovering from it than sufficient muscular strength, endurance and control at crucial sites.

Like I have previously mentioned, the pose method is 1 method that runners can really work on muscular control and postural dynamics in activity-specific positions. Anyone who adheres to this technique should be ready for a great deal of practice in order to learn proper alignment and muscle recruitment.

Pose places plenty of focus on lumbopelvic and eccentric knee muscle management, particularly the way that knee and Hip muscles operate when the mid-foot strikes the floor.

I realized that the need for great lumbopelvic stability partially as a consequence of my own early experiences in practicing pose running. I Discovered I was getting a great deal of calf muscle soreness at the first phases, and really the pose method could lead to jet muscle sprains.

The method requires the runner to lean or 'fall' forwards and pick up their foot off the ground together with the hamstrings. This certainly develops a lot of speed but can place undue strain on the anterior musculature of the joints and leg of the lower back. The eccentric load around the calf will be enormous and often contributes to physical breakdown of this muscle.

The underlying cause of the calf strain, however, is that the pelvic place the runner has embraced so as to lean Forward to gain momentum. It is very easy to over-do the normal inclination to hinge forward from the hips while jogging, which places the shoulders a very long way before the buttocks, also leads the runner to rely in their erector spinae and hamstring muscles to take the strain of the running stride. It is actually not surprising that all these athletes create symptoms within their hamstrings and low backs.

Set your customer on a stepper machine and you'll probably have the ability to see exactly the same muscular imbalances in action. The patient will stick out their bum and push through their quadriceps, not utilizing much hip joint action at all. These people tend to hang on their erector spinae when leaning forwards with regular activities and might benefit from more low abdominal activation.

This understanding has made me to advocate that any running client who presents with calf muscle tears should be Researched for a loss of pelvic control, particularly in the sagittal plane (uncontrolled anterior-posterior motion). While sports support professionals are utilized to the connection between hamstring injuries and inferior pelvic control, in my experience calf tears tend to ship us looking downwards into the over-pronating foot, rather than upward in the over- extending pelvis.

Conclusion

Like any athletic activity, some people make running seem easy, but some have to work at it. The reward for those who do not find running simple initially is that they'll truly appreciate advances in their technique, as It removes pain, effort and risk of injury.