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Wrestling is a sport that requires speed, strength, and endurance that involves intense physical contact, pushing and pulling the muscles, tendons, ligaments, and joints to their limits. Wrestlers' are constantly contorting their bodies. Pushing the body to its limits increases the risk of developing wrestling injuries that include: Wrestling Injuries The most common injuries usually occur from forceful contact or twisting forces. And if a wrestler has been injured, there is an increase for re-injury. Wrestling tournaments typically take place over days, often with back-to-back matches, which significantly fatigues the body and increases injury risk. The most common wrestling injuries include: - Muscle strains of the lower extremities and/or the back.
- Chronic problems can result from hours in the forward stance posture and repetitive motions.
- Trigger points.
- Neck injuries.
- Ligament knee injuries - Meniscus and MCL tears.
- Pre-patellar bursitis/Osgood Schlatter's syndrome from consistently hitting the mat.
- Ankle injuries.
- Hand and finger dislocations and fractures.
- Dislocations and sprains of the elbow or shoulder from take-downs.
- Cauliflower ear - is a condition that can cause ear deformity and develops from friction or blunt trauma to the ears.
- Skin infections occur from constant contact, sweating, bleeding, and rolling on the mats. Infections include herpes gladitorium, impetigo, folliculitis, abscesses, and tinea/ringworm.
- Concussions are usually caused by hard falls/slams or violent collisions with the other wrestler.
Injuries can cause wrestlers to alter/change their technique, exacerbating the existing damage and potentially creating new injuries. Chiropractic Rehabilitation and Strengthening There can be a variety of pain generators/causes when it comes to wrestling injuries. Joints and muscles can get overstretched, muscles can spasm, and nerves can become compressed and/or irritated. For example, a neck muscle spasm could be caused by nerve irritation from a shifted vertebrae. To determine the specific cause or causes of the injury/pain, a detailed chiropractic examination will be performed that includes: - Range of motion testing
- Ligament tests
- Muscle palpation
- Gait testing
Injuries often relate to the proper weight, neuromuscular control, core strength, proper technique, hygiene, and hydration management. Successful treatment depends on identifying the root cause of the wrestling injury. Chiropractic restores proper alignment through massage, specific manual adjustments, decompression, and traction therapies. Adjustments can include the back, neck, shoulder, hips, elbows, knees, and feet. Once correct body alignment is achieved, rehabilitative exercises and stretches are implemented to correct and strengthen muscle function. We work with a network of regional medical doctors specializing in referral situations and strive to return the athlete to their sport as soon as possible. General Disclaimer * The information herein is not intended to replace a one-on-one relationship with a qualified health care 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 Boden, Barry P, and Christopher G Jarvis. "Spinal injuries in sports." Neurologic clinics vol. 26,1 (2008): 63-78; viii. doi:10.1016/j.ncl.2007.12.005 Halloran, Laurel. "Wrestling injuries." Orthopedic nursing vol. 27,3 (2008): 189-92; quiz 193-4. doi:10.1097/01.NOR.0000320548.20611.16 Hewett, Timothy E et al. "Wrestling injuries." Medicine and sport science vol. 48 (2005): 152-178. doi:10.1159/000084288 Mentes, Janet C, and Phyllis M Gaspar. "Hydration Management." Journal of gerontological nursing vol. 46,2 (2020): 19-30. doi:10.3928/00989134-20200108-03 Wilson, Eugene K et al. "Cutaneous infections in wrestlers." Sports health vol. 5,5 (2013): 423-37. doi:10.1177/1941738113481179
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. 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
In part I Chiropractor, Dr. Alexander Jimenez discussed the post-operative rehab requirements following a Ligament Advanced Reinforcement System (LARS) procedure. In part II he explains the specific staged ‘criteria’ driven rehabilitation process, with an emphasis on specific strength and conditioning principles that need to be considered throughout the reconditioning process. Returning an athlete following a ‘LARS- reconstructed knee’ back to competitive status requires much more than simply restoring muscle strength and range of movement. An integrated approach encompassing full kinetic chain function enhancement is required. Additionally, an in-depth knowledge of strength and conditioning principles and how these apply to the systematic rehabilitation process and the long-term reconditioning of a LARS reconstructed knee is essential. Furthermore, ensuring the athlete remains injury-free requires ongoing management and regular monitoring. Key ConsiderationsReturn to competition following a LARS procedure differs significantly compared to a standard graft repaired knee (see Tracy Ward’s article elsewhere in this issue). Due to the unique nature of the LARS reconstruction, time frames are compressed and accelerated. Table 1 below compares the ‘expected’ time frames for return to competition for a LARS reconstructed knee versus a traditional ACL reconstruction. This topic has received a significant amount of media attention in Australia, with some professional Australian Rules Football players returning as fast as 14 weeks post injury. The primary reason for the delayed return to competition in traditional ACL reconstructed knees with an autograft such as the hamstring or patella-bone-patella graft is the time it takes for the autograft to re-vascularize. Furthermore, the autograft has a harvested site that leads to donor site morbidity. Therefore the graft and the harvest site have to be protected until both have sufficient strength to be loaded. Conversely a LARS reconstructed knee is immediately protected by the nature of the artificial ligament matrix. The remaining ACL stump regrows through the matrix; however the knee is essentially stable during this process. Stages Of RehabilitationWhen planning and delivering the stages of rehabilitation programs, an understanding of the influence of load exposure, load attenuation and force generation is critical to provide clinicians with a clear understanding of the milestones that need to be achieved – and the rate at which they can pursued. The best way to approach the process, therefore, is to stage the approach to high performance and load resilience using a ‘phased’ or ‘milestone- based’ strategy, with each stage feeding into the next. In keeping with the exit-criteria approach, we do not move between stages according to the passage of time, but the accomplishment of functional goals. The four primary stages of knee rehabilitation following LARS reconstruction are: 1. Protection and healing 2. Restoring muscle strength and range of movement 3. Integrated functional adaptation 4. Sports-specific retraining The time frame in each stage will depend primarily on the pathology we are dealing with. A simple LARS reconstruction will progress faster than a LARS that has associated meniscal repair, or if the femoral condyles and/or tibial plateau have residual bone oedema. The key objectives for each are discussed in more detail below. Phase 1 – Protection & HealingA critical early intervention following a LARS reconstruction is to protect the joint from further damage and to allow a supportive environment in which healing can take place. Dependent on the injury, this may require bracing, taping or even use of crutches. As soon as possible however, we want to restore normal gait mechanics as this has positive effects on proprioception and muscle activation. An effective way of graduating this is through an altered weight-bearing environment such as a pool. The Importance Of Removing EffusionsDue to the nature of the arthroscopic surgery to repair a torn ACL with a LARS prosthetic, it is common for the patient to demonstrate a knee effusion post operatively. A knee joint effusion is an excessive amount of fluid within the synovial capsule of the knee indicating that the knee is inflamed or irritated (see Figure 1). The exact patho-physiological mechanisms for an effusion and the necessary medical interventions are genuine concerns for the rehabilitation practitioner. Even small volumes of fluid (20-30mls) can result in a 50-60% reduction in maximal voluntary muscular activation(1-4), a process commonly referred to as ‘arthrogenic inhibition’(5). Moreover, small increases in intra- articular fluid (as modest as 5mls) increases the pressure within the knee joint. This can be a source of discomfort and concern for the athlete. Furthermore, it has also been found that knee joint effusions will also alter the knee joint mechanics during landing tasks(6). Those individuals with a knee effusion tend to land with greater ground reaction forces and in greater knee extension, resulting in more force being transferred to the knee joint and its passive restraints. Removing the effusion does make a demonstrable difference to quadriceps function. This can be a frustratingly slow process, however, and so a number of interventions should be prioritized: - Regular assessment performed prior to loading the knee joint, and in the subsequent 24 hours – particularly if the load is new and more progressive.
- Remove the effusion if present.This can be done with conventional methods such as elevation, compression with donut felt, effusion massage and reduced weight bearing. There are also more medically directed interventions such as non-steroidal anti-inflammatory medication (NSAIDs) or direct needle aspiration if indicated. Removing the internal fluid will significantly reduce the internal pressure within the knee as well as improving quadriceps strength.
- Exercise selection – quadriceps setting exercises that are performed in positions of partial (20°) knee flexion or isometric squats in 20-30° flexion, will allow muscle recruitment without increasing the intra-articular pressure associated with full knee extension.
- Early pool work provides us with the opportunity to take advantage of hydrostatic pressure to aid with effusion drainage.
Reactivation Of Muscles In Early Phase RehabilitationSince effective muscle function helps absorb joint loads, a restoration of contractile activity must be seen as a priority, and so in the early stages of knee rehabilitation the focus is on: - Quadriceps setting exercises
- Quadriceps-hamstring co-contraction exercises
- Isolated hip muscle exercises (particularly gluteals and hip external rotators) in a non-weight bearing (lying down or sitting) or protected-weight bearing situation (altered gravity treadmills or pools if available).
It should be noted that the LARS reconstructed knee usually does not need a major period of protected weight-bearing, so in most cases, weight bearing quadriceps, hamstring and hip muscle strength work can be included very soon after surgery. There are many ways to accelerate the return of muscle bulk and gross muscle strength in the early rehabilitation setting. Occlusion training (see Figure 2) and electrical muscle stimulation can be very helpful in gaining muscle hypertrophy in the early stages of rehabilitation where high mechanical and joint compressive loads are inappropriate. For a thorough piece on occlusion training, refer to an article written by Luke Heath in Issue 157 of Sports Injury Bulletin. Restoring Range Of MotionLimitations in range of motion (ROM) are common following a LARS reconstructive procedure, particularly in terminal extension. The primary mechanisms that limit the final 5-10° of extension can be broken down into mechanical (intra- articular) and myogenic (muscle tone) reasons. Dependent on the cause, manual therapy aimed at restoring accessory joint motion, effusion aspiration, soft tissue massage, trigger point releases and dry needling / acupuncture may help correct ROM restrictions. Phase 2 – Strength & MotionThe second phase of rehabilitation is geared towards the introduction of strength work. This can be broken down simply into knee- dominant and hip-dominant movements. These are essentially exercises done in a sagittal plane and involve the combination movements of ankle dorsiflexion/ plantar flexion, knee flexion/extension and hip flexion/extension. In simple terms, examples of the following are: - Knee dominant: single leg squat, single leg lunge, leg press, Bulgarian (rear foot elevated) squat, Nordic hamstring curls
- Hip dominant: Romanian deadlift, glute-ham raise, hip thruster
These are initially performed using bodyweight only and with slow controlled tempo. Load/speed and complexity is added as the athlete progresses through the rehabilitation setting. The key feature in this stage is that the joints of the lower limb (knee joint included) are engaging in a co-ordinated manner that satisfies the kinetic chain requirements of the lower limb. The joints initially absorb force (slowly in the early stages of rehabilitation) through the eccentric component. They are then required to hold, stabilise and control a loaded position, before finally propelling away from the loaded position whilst maintaining kinetic chain alignment. The benefit of a LARS reconstructed knee is the fact that no donor site morbidity exists as would be present in a PTB or hamstring graft ACL reconstruction. Therefore, strength work is usually progressed much quicker in a LARS reconstruction. Some rules/guidelines to follow when considering the implementation of these traditional clinical/gym based movements are: 1. Propulsion/acceleration forces – The joints and movements involved in the propulsion phase of locomotion are ankle plantar flexion, knee extension and hip extension (triple extension phase). This capacity is generally the easiest and safest to develop early, involves concentric muscle force, and requires the least work capacity and the safest joint reaction forces. 2. Absorption/deceleration forces–The joints and movements involved are ankle dorsiflexion, knee flexion and hip flexion (triple flexion phase). This capacity requires the highest amount of force production as the muscles are working eccentrically and the downward effect of gravity and the resultant upward ground reaction force are greatest. Joint stress on the knee is maximized and thus is the hardest to develop. However because knee injuries usually occur in the landing/ cutting/deceleration type situations, it is these absorbing/decelerating forces that need to be trained to a high level prior to return to competition. 3. Early plyometrics – Introduction of higher intensity movements, with the aim of perfecting technique for latter stages (where load is increased). These can be added early in the rehabilitation setting via safe joint-sparing alternatives such as unloaded fast eccentric exercises and pool plyometrics. 4. Bilateral transfer – Training the contralateral limb can result in measurable strength and performance gains in the affected limb. Early strength work on the unaffected side will assist in earlier functional recovery in the affected side. Phase 3 – Return To FunctionThe third phase is an extension of the second. However, the emphasis is now on sport-specific movements that need to be retrained prior to return to full training and subsequent competition. This is the stage that is characterised by return-to-running protocols and the introduction of agility and cutting movements. There are a plethora of factors need to be considered and integrated into a return to running program. Developing The Capacity To DecelerateGetting the athlete to repeat box landings are helpful in training the ability to arrest body weight. The progression sequence for a LARS reconstruction would be; 1. Two legged jumps onto a box 2. Two legged jumps off the box 3. One legged hops onto box 4. One legged hops off the box 5. One legged hops with increasing height (maximum height 40cm) This progression should take place over the course of a month. Do not try to ‘tick all these boxes’ in too short a period, as the risk of developing patellar tendinopathy is high if there is a sudden spike in loading. Clinicians also need to be acutely aware of the importance of well-structured running/agility programs that incorporate the development of the deceleration forces such as cutting, turning, slowing down, landing and pivoting. Generally speaking, the athlete should be exposed to a number of weeks of increasing volumes of acceleration, deceleration and top-speed drilling before integration into open-skilled training is considered. To allow progression to phase 4 of rehabilitation, we suggest the following exit criteria are passed (this can be as fast as 9 weeks post operative): 1. Maintenance of an effusion-free joint 2. Full range of movement (may lack 10% flexion) 3. Good control of single leg landing from a 40cm box 4. More than 85% hamstring and quadriceps strength compared to contralateral side 5. Good control of 50-degree change of direction to either side 6. Return to more than 85% of pre-injury maximum running speed Phase 4 – Return To PerformanceIn the final stage of rehabilitation and reconditioning, the athlete progressively returns to sport-specific skill training. In this stage, high-level rehabilitation exercises that incorporate functional kinetic chain integration (ankle, knee, hip, pelvis, spine and upper limb) need to be implemented in a manner that challenges the athlete’s proprioceptive abilities and reactive abilities. The purpose is to condition the neuro-sensori-motor system to a wide spectrum of unpredictable stimuli so that maximal ‘CNS wiring’ can occur. The variables that can be manipulated to provide broad spectrum challenges are: 1. Surface – stable (floor) to unstable (sand, balance boards, trampoline, mats) 2. Body movement – stable on feet to unstable (rolls to stand, jump variations) 3. External load – eg cables, dumbbells, weight vests, asymmetrical weight barbells, kettle bells, suspension trainers, medicine balls 4. Sensory cues – variations in responding to sound, vision and touch 5. Speed–slow speed to fast movement 6. Environmental obstacles – other athletes, cones, hurdles etc.. There exists a plethora of different training modalities that an athlete may be subjected to in this stage of the rehabilitation/ reconditioning process. Two modalities that have been used to great effect are sand-based training and gymnastics – based training. Sand-Based TrainingA 5m x 10m sand pit can provide a fantastic and challenging rehabilitation environment for the knee-injured athlete. Simple drills that are also done in stable- base training (eg grass or gym) can also be used in the sandpit. The benefit of the sandpit is that due to the shifting surface, it provides a greater proprioceptive challenge. Furthermore, the sand absorbs much of the downward reaction force, which is a positive benefit to the load-compromised knee: 1. Running drills – all of the running drills used in ground-based running can be used in a sandpit. Furthermore, as well as forwards running the athlete can perform backwards running. Carioca drills, stepping and cutting drills and lateral movement drills can also be performed in the sandpit. 2. Jump, hop and landing drills – forward hops, sideways, lateral hops, two leg to one leg, single hops vs multiple hops are all variations that can be used. 3. Sand displacement drills – using the planted feet, the athlete can be encouraged to ‘move’ through the sand by using a twisting motion to displace sand away from the feet. This encourages the development of hip/knee rotation, ankle stability and foot stability. The athlete can move forwards by stepping/lunging into the sand and then twisting the foot prior to the next step. Alternatively they can keep the feet buried and twist side to side to move laterally through the sand. Trampoline DrillsFull-size trampolines also provide a difficult balance environment for the knee injured athlete: 1. Run and stop drills – have the athlete running on the spot and stop on an auditory or visual cue. This will not only develop reactive abilities to external stimuli, it will also create greater proprioceptive and balance integration due to the unstable surface the trampoline provides. 2. Hop and landing drills – single hops, double-leg jumps, forwards, sideways, backwards are all variations that can be used with hop drills. 3. Rolls to balance – forwards and backwards rolling to a squat stance or single leg stance provides an enormous strength, balance and range of movement challenge. Although not exactly specific in its application, the crossover effect of this type of balance training can provide immeasurable benefit to the knee injured athlete. Return To Contact TrainingStaging a knee-injured athlete back to a full competitive training situation requires a stepwise progression of drills and skills that resemble the demands of the competition, whilst still allowing appropriate protection of the knee at critical stages of recovery. A logical way to prepare the athlete to develop match readiness is to modify the training environment from safe and controlled situations initially, to more advanced game-specific events as they progress. For example, starting in kneeling positions and then progressing to standing, walking and running positions allows the athlete to confidently practice contact components without fear of further knee injury. Functional TestsThe highest risk for a knee injury is a previous knee injury(7). In order to do everything we can to reduce this risk to a minimum – and be confident that the athlete is not just fit to play but fit to perform – a series of functional sports-specific test should be employed. The test should be an objective, measurable and quantifiable test that includes an element of: - Strength
- Agility
- Power
- Balance
- Neuromuscular status
The above factors can be incorporated into functional tests such as hops and agility/ movement tests. The more common hop tests include (seeFigure3): 1. Single hop for distance 2. Triple hops 3. Crossover hop 4. 6-meter timed hop It is beyond the scope of this article to discuss these functional hop tests in detail. The Load Compromised AthleteUnfortunately for the athlete returning from a LARS reconstruction, the knee joint pathology needs to be respected for the remainder of the athlete’s career. This essentially makes the athlete ‘load Injury classification compromised’ against a similar athlete with no previous history of knee injury. From a knee perspective, the practical interventions that need to be considered once the athlete is back to competition are: - Regular assessment of effusion, particularly after a major change has been implemented such as a new skill, extra load, plyometric type training, frequent exposure to competition/ training etc.
- Regular assessment of functional tests to ensure the athlete stays within acceptable levels.
- Load monitoring – this can be direct volume and impact monitoring using GPS or, if unavailable, carefully selecting the training sessions the athlete will be involved in. Athletes may need to miss the occasional session to allow knee joint recovery.
- Regular soft tissue therapy (to ensure the myogenic elements of tissue are not reacting adversely to load).
- Education for both athlete and coaches. All interested parties need to be aware that the knee may require periods of de-loading to restore a healthy homeostasis.
SummaryA LARS reconstructed knee is a controversial topic and is still relatively new and unknown in the world of sports medicine. Further long-term studies are needed to evaluate the implications regarding re-injury rates and other complications following a LARS reconstruction. However, the limited available empirical research does show promise in returning an athlete back to full competition status much faster than traditional ACL reconstructions. References
1. The Journal of Bone and Joint Surgery, 1988. 70-B(4): p. 635 – 638.
2. Journal of Athletic Training, 2010. 45(1): p. 87-97. 3
3. Quarterly Journal of Experimental Physiology, 1988. 73: p. 305-314.
4. Clinical Physiology. 1990. 10(5): p. 489-500.
5. Annals of Rheumatic Diseases, 1993. 52: p. 829-834.
6. American Journal of Sports Medicine. 2007. 35(8): p. 1269-1275.
7. British Journal of Sports Medicine. 2006. 40(2): p. 158-162.
8. J Strength and Cond Research. 2002. 16(4); 617-622
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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: 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: 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. 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*
Simple twisting movements, performed correctly, can develop significant core power. Core chiropractor, Dr. Alexander Jimenez explores body care slings. Core stability training has come in several of guises over the years, according to whatever modality occurs to be the style of the moment. Most Swiss ball programs, Pilates and other core workouts deliver useful benefits in the physical preparation and injury management. They offer you a whole lot of variety -- and there are some things you can do to a Swiss ball or Pilates Reformer which you simply cannot do on any other apparatus. As the flow of new fads in equipment and training styles reveals no sign of slowing, it's helpful to return to fundamentals and gain a little education about how the low back (lumbo-sacral backbone) and its encouraging muscle system work. This article introduces some important research done lately that helps us gain a much clearer practical understanding of how the lower back and pelvis work, and therefore what types of training are most likely to have a positive impact on core stability and strength. This research introduces the anatomical concept of 'myofascial slings'. Myofascial SlingsThe idea of myofascial slings comes out of the work done by Andre Vleeming as well as many others on sacro-iliac joint (SIJ) stability. Unlike what rheumatologists will inform say, the sacro-iliac joints -- which link the fused section of the lower spine (the sacrum) to the pelvic/hip bones on each side -- do have to move during regular daily activities such as walking and running. It's both necessary and desirable that the sacro-iliac joints proceed, since they will need to act as shock absorbers between the lower limbs and spine, and also as a way of providing proprioceptive (body positioning awareness) feedback to get co- ordinated movement and control between the back and lower limbs. Since the SIJ is capable of movement, that movement has to be properly controlled, much like any of the body's joints. Some hands comes through the pure architecture of the low back and pelvis, but more is possible by employing the surrounding muscle, ligament and connective tissue system (myofascial slings) to provide compression on the joints. This is important since we can help influence the effectiveness of the compression through exercise and retraining following injury. The 3 muscle systems or 'slings' that help to stabilize the pelvic girdle are known as: - The posterior oblique sling;
- The anterior oblique sling; and
- The posterior longitudinal sling.
Key Training Principles1. Stay UprightMaintain the compression load vertical: as most athletic endeavors and functional daily activities are done upright, the majority of the 'core' training function also needs to be performed upright. It is likewise very important to stand, rather than sit, so that you have the ability to transmit load through the legs. Ground reaction force if standing is transferred up the upper leg bone (femur), into the hip along with the pelvic bones. This is fulfilled by the downward force of gravity acting on the trunk. This lets the SIJ to be held stable by using its natural structure when standing, as the sacrum sits nicely into the corresponding surface of the pelvis/hip in this position. Additional the shock-absorbing intervertebral discs of the lower (lumbar) spine favor the compression power that standing provides, rather than shear (sliding) force or tensile (pulling) force. Most damaging shear force occurs when the vertebrae slide against each other and shear the adjoining intervertebral disc -- as occurs when the body is horizontal (the position used for several Swiss ball exercises). Tensile force occurs when the lumbar spine is bent forwards or backward (flexed or extended). 2. Work In NeutralKeep the spine in neutral. The most frequent way to harm intervertebral discs would be to get the spine flexed, as you do when bent over. In this position the pressure within the disc increases significantly; with additional compression this place can cause discs to bulge. So it's important to keep the spine away from full flexion and extension positions, to avoid repeated micro injury to disks, vertebrae and ligaments. 3. Learn To Contract Stomach MusclesMaintain the upper abdominals (rectus abdominis) at static contraction. Many elite athletic endeavors require that the abdominals work statically (isometrically). This permits the stomach muscle to present a stable anchor for the potent side trunk (oblique) muscles to generate force. The rectus anchors the obliques via lateral tendons and this layout allows power to be transferred across to the oblique muscles. Training The Myofascial SlingsWith close attention to good strategy, the easy twisting exercise in the diagram (see below) is a good way of training the myofascial slings. The key principles are as follows: - The exercise is performed standing up.
- Bend slightly at knee and hip. This will pre-tense the buttocks (gluteus maximus) and front of thigh muscles (quadriceps), which in turn will help to create a chain of stability and tension through the posterior oblique sling.
- Adopt a slightly forward leaning position with a gentle forward pelvic tilt. This activates the deep short muscles of the lower back (part of the posterior longitudinal sling).
- There is trunk rotation against resistance. This activates the side stomach muscles (part of the anterior oblique sling). The upper stomach muscle must be statically contracted to provide a stable base for the obliques to work from. It is also important to activate the lower stomach muscle (the transversus abdominis) in a ‘hollowing’ action.
- The broomstick sits on the shoulders, and is pulled into the shoulders to help secure the stability of the posterior oblique sling.
How To Perform The ExerciseThis exercise was originally developed at the Australian Institute of Sport in Canberra. The diagram and points 1 to 5 above will guide you on correct form. Tape or otherwise fix the resistance bands firmly to the broomstick. An appropriate level of resistance (band strength and length) should allow you to perform 3 sets x 10 reps without great difficulty. Progress from there. Watch out for the following points to maintain good technique: - Keep the front of thigh and buttock muscles tight
- Keep lower stomach (transversus) hollow and tense the upper stomach (rectus abdominis)
- Don’t rotate the pelvis, just the trunk. If you have trouble achieving this, perch your buttocks on the back of a chair, which will help you to keep your hips stable while you get used to twisting through the trunk alone
- Maintain a slight arch in the lower back (neutral position)
- Keep looking straight ahead, do not allow your head to turn as your trunk rotates
- Keep the broomstick firm on your shoulders.
ProgrammingNote: one full repetition of this exercise involves rotating from X degrees backward trunk rotation to X degrees forward trunk rotation, and then returning to the backward start point. Beginners- Use a single band.
- Move through a small range of rotation 10 degrees to10 degrees each direction (total arc of 20 degrees).
- Perform 3 sets of 10 reps each direction (band at left, then band at right).
Intermediate- Use two bands, one either side of the broomstick.
- Rotate through 20 degrees to 20 degrees
- Perform 3 sets of 10 reps in each direction
Advanced- Can double up number of bands (or more, and/or use tougher bands etc), depending on your rotation strength
- Extend range of rotation up to 45 degrees to 45 degrees.
- Perform 3 sets of 10 reps in each direction.
Modifications- Place one foot on a step to increase the range of hip flexion. This is particularly effective for sports requiring stability in positions of hip flexion, eg: rowing and cycling.
- Decrease the width of the base of support by adopting a lunge stride position
Sourced From: Chris Mallac © Green Star Media Ltd 2014 Published by Green Star Media Ltd, Meadow View, Tannery Lane, Bramley, Guildford GU5 0AB, UK Publisher Jonathan A. Pye
Editor Jane Taylor
Designer The Flying Fish Studios Ltd The information contained in this publication is believed to be correct at the time of going to press. Whilst care has been taken to ensure that the information is accurate, the publisher can accept no responsibility for the consequences of actions based on the advice contained herein.
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Wrestling is a sport that involves intense physical contact, pushing and pulling the body, increasing the risk of wrestling injuries. For answers to any questions you may have, please call Dr. Jimenez at 915-850-0900 or 915-412-6677