Lateral Ankle Sprains

    

By Michael Joseph, DPT Student

Ankle sprains are a common injury; in the United States there is an incidence rate of 2.15 ankle sprains per 1000 people every year. Nearly half of all ankle sprains (49.3%) occurred during athletic activity, with basketball (41.1%), football (9.3%), and soccer (7.9%) being associated with the highest percentage of ankle sprains during athletics.

This article will focus on lateral ankle sprains, which occur as a result of excessive ankle inversion, when the foot rolls inwards under the leg. The three lateral ligaments that may be affected are the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. Ankle sprains are divided into three categories: Grade I, where the ligament is stretched and may have slight tears. Grade II where the ligament is partially torn. And Grade III where the ligament is completely torn.

Management:

The PRICE (Protection, Rest, Ice, Compression, Elevation) protocol is an important part of treatment during the acute phase, as it is an effective method for reducing pain and inflammation. However, combining PRICE with exercise may be more beneficial. A randomized controlled trial from Bleakley, et al. evaluated the effectiveness of accelerated rehab after an ankle sprain. One group of subjects followed the PRICE protocol for the first week after injury and then began exercise rehab during the following four weeks. The experimental group began the PRICE protocol and exercise rehab immediately, during the first week post injury, and then followed the same 4 week exercise rehab. The authors stated the early exercises were from a “general protocol” that included ankle range of motion and strengthening exercises. The study found short term outcomes (4 weeks) were significantly better in the group that began exercising immediately, but there was no significant difference in long term outcomes (16 weeks).

 Rehabilitation and Prevention:

There is some evidence to support that taping and/or bracing is effective at reducing the risk of recurrent ankle sprains in sports. However, the decision between tape or bracing depends on the individual and the requirements of the sport. There is no evidence that one is significantly more effective than the other.

Kerkhoffs et al, identified four intrinsic risk factors that predispose individuals to lateral ankle sprains: strength, proprioception, range of motion, and balance. A rehab exercise protocol should address all four of these risk factors in order to prepare the athlete to return to sport and to prevent recurring sprains. Proprioception exercises should be sport specific and should focus on the demands of the sport. For example, a basketball player’s program needs to include takeoff and landing ankle mechanics in an square stance (jump shot) and off of one leg (lay up).

Blog Post written by Michael Joseph, DPT Student at Mount Saint Mary’s University. Michael is currently in his final Clinical Rotation with me at Catz Physical Therapy Institute.

Sources:

1. Bleakley CM, O’connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010;340:c1964.
2. Kerkhoffs GM, Van den bekerom M, Elders LA, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012;46(12):854-60.
3. Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279-84.

Speed to Perform

    Chris Butler Sports PT

By Darelle Noel

Most people believe speed is something you’re born with and that you’re genetically inclined to be fast. But it has little to do with that – it’s a science. You can train your body to produce more force and the way you deliver force to the ground. And once that happens, it will completely change your perception of how fast or explosive you ever thought you could be.

Speed is an integral part of every sport and can be expressed as one of or a combination of Power(Elastic Strength) for acceleration, absolute speed and speed endurance. Speed is the quickness of movement of a limb generated by the athletes ability to apply force and generate it with great frequency.

(Force X Frequency=Speed)

Maximizing stride length and stride frequency is mainly influenced by the athletes stability, mobility, strength and technique. Having good hamstring flexibility and hip mobility improves stride frequency (the ability to strike and recover) and stride length is improved by developing muscular strength and explosive power i.e. olympic Lifts and Plyometrics.

Developing speed is a rather complex process that is controlled by the nervous system, learning the movements needed to develop speed and learning how to perform them are equally important. In order to move faster the muscles have to adapt and contract faster, The brain and the nervous system have to learn the motor skills to control these fast movements efficiently. Practicing the basic fundamentals of running will not only improve your running ability but also improve your brains ability to adapt and perform the movements quickly. Complex coordination and timing of the motor units and muscle groups must be performed beginning with slow speeds transitioning to high speeds to improve patterns. Maintaining some form of speed training on a consistent basis will ensure that your movement patterns and nervous system will stay in sync.

General Principles for speed development are:
•Work on your mobility to develop ROM, range of motion in your hips will drastically effect your speed and assist in preventing injuries.
•Improve flexibility to improve your turnover ability.
•Perform explosive and plyometrics movements such as jumping, hopping and bounding to develop explosive power that translate to running.
•Implement skill development for sports specific speed. IT HAS TO TRANSLATE TO THE SPORT!!
•Train Energy System specifically to maintain and maximize endurance and speed over time.

 Blog Post written by Darelle Noel, Athletic Gaines Performance Specialist.  I have had the good fortune to work with him at Catz Physical Therapy/Athletic Gaines Pasadena. You can find him on Instagram @dmn_1of1

Is Your Lack of Ankle Mobility Increasing Your Risk for Knee Injury?

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By Ashley Pena, DPT Student

 According to the NCAA Injury Surveillance system, knee internal derangements accounted for the highest percentage of more severe injuries sustained by college athletes (44.1% in games and 25.5% in practices) and approximately 70% of all game and practice injuries affected the lower extremities. As a result of these studies, much thought has gone into what factors contribute to this in an attempt to prevent, or rehabilitate these injuries while decreasing pain and improving performance. Although there are many factors which have been found to contribute such as muscle weakness, body type, training factors and others, little thought is given to the ankle joint unless it is giving the athlete pain.

When a person lacks dorsiflexion range of motion, often times compensations begin to manifest such as excessive pronation or “fallen arch”,  hip external rotation or “out-toeing” during walking, or lack of knee flexion with landing, all of which can increase the valgus forces on the knee and decrease shock absorption which can place a person more at risk for ACL injury, meniscus injury, or collateral ligament strains. In a systematic literature review done by Mason-McKay et. al, strong evidence was found that a restriction in DF ROM alters landing mechanics with specific studies reporting that altered frontal plane ankle motion (inversion and eversion), reduced sagittal knee excursion, and greater peak knee valgus.

 Blog Post written by Ashley Pena, DPT Student from Cal State Northridge.  Ashley is currently in her final clinical rotation with me at Catz PTI.

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❗️4th Student of the year❗️ Welcome Ashley, from my alma mater Cal State Northridge. Continuing with the BFR hazing. Stay tuned for some 💻blog posts from her soon. #CSUN @ashpena3r

A post shared by Chris Butler, MPT, CSCS (@cbutlersportspt) on Jun 13, 2017 at 12:18pm PDT

Sources:

1. Arendt E, Dick R. Knee Injury Patterns Among Men and Women in Collegiate Basketball and Soccer. The American Journal of Sports Medicine. 1995;23(6):694-701.
2. Dick RM, Putukian M. Descriptive Epidemiology of Collegiate Women’s Soccer Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 Through 2002–2003. Journal of Athletic Training. 2007;42(2):278-285.
3. Kerr ZY, Marshall SW. College Sports–Related Injuries — United States, 2009–10 Through 2013–14 Academic Years. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6448a2.htm. Published December 11, 2015. Accessed June 5, 2017.
4. Mason-Mackay A, Whatman C, Reid D. The effect of reduced ankle dorsiflexion on lower extremity mechanics during landing: A systematic review. Journal of Science and Medicine in Sport. 2017;20(5):451-458. doi:10.1016/j.jsams.2015.06.006.
5. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Llyod-Smith DF, Zumbo BD.  A retrospective case-control analysis of 2002 running injuries.  Br J Sports Med 2002; 36: 95-101.

What is Turf Toe?

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By Meggie Morley, DPT

During Game 3 of the Clipper’s series against the Utah Jazz, Blake Griffin suffered an injury to his toe that would rule him out for the remainder of the playoffs. He recently underwent surgery to treat his injury, which was reported as an injury to the plantar plate of his big toe. This injury is also known as turf toe, and even though it may seem like a small injury it can greatly affect the ability to participate in sports, recreational activities and even walking.

Toe Anatomy

Turf toe typically refers to an injury to the big toe. The big toe is comprised of two bones, known as the distal and proximal phalange. The proximal phalange attaches to the metatarsal bone in the foot, forming the metatarsal phalangeal joint (MTP). Underneath the MTP is the plantar plate, a small sesamoid bone, and various ligaments and muscle attachments.   

Mechanics of Injury

Turf toe typically occurs when the first toe is hyperextended. In other words, when the toes are planted on the ground and the rest of the foot is lifting off the ground. This position places strain on the bottom of the MTP joint, causing damage to the plantar plate and surrounding structures. This injury occurs commonly on turf due to the harder surface, which can cause the toes to be stuck in place. The symptoms of turf toe include pain, tenderness, bruising, stiffness and swelling at the joint.  Parents should watch for avoidance behaviors and painful gait patterns in their children.

Ligament Sprain Grade

Grade I: The ligament is stretched and there may be small tears

Grade II: Large tear, but the tear doesn’t completely go through the ligament

Grade III: Complete rupture of the ligament

Recovery time depends on the grade of the sprain, and in the case of complete tears surgery may be necessary. For any turf toe injury, rest is required in order to allow for healing.  Bracing, splinting and taping are often used for weight bearing tolerance so it is important to prevent adhesions in the injured structures. Passive ROM can be initiated within a few days of Grade I and II injuries along with non-impact activities. Grade III injuries require immobilization but even if surgery is needed, ROM can be performed at 5-7 days post op.  Make sure to see a PT and find out what you can be doing throughout all phases of recovery.

Blog Post written by Meggie Morley, DPT.  At the time of posting Meggie was in her final clinical rotation with me at Catz Physical Therapy Institute.

References

1. Stanley, Laura. Physical Therapist’s Guide to Turf Toe. Retrieved from http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=6db543a6-7a53-4dcd-8141-3137c4391f07

2. McCormick JJ, Anderson RB. Turf toe: anatomy, diagnosis, and treatment. Sports Health. 2010; 2(6):487–494.

3. Garguilo, C. (2015). Foot and Ankle Orthopedics (Power Point slides). Retrieved from https://courseworks.columbia.edu/access/content/group/PHYTM8610_081_2015_2/Lectures/Ankle/Camtasia%20Foot%20and%20Ankle%20Lectures/Camtasia%20Lecture%20Foot%20Ankle%20Disorders%20Handout%202015%20Section%203.pdf

Bike Fitting Basics: Keep Riding, Reduce Your Injury Risk

 Chris Butler Sports PT is Social

By Michael Joseph, DPT Student

In my three years working as a professional bicycle fitter I have done fits for every level of cyclist, from individuals who were purchasing their first road bike to professional level cyclists and national team members. A properly fit road bike is imperative to ensure the frame and components are the right size for the rider.  The purpose of professional fitting is to reduce pain, increase comfort and maximize speed and efficiency. The following article will cover basics of fit measurements, positioning, and reasons why riders may be experiencing pain or discomfort on the bike. The bulk of this content is based on my professional experience as a bicycle fitter and the training I received from GURU Cycling.

Saddle Height 

Saddle height is measured with the rider seated on the saddle with his or her foot at the 6 o’clock position. The rider’s pelvis should be level on the saddle and there should be 40 degrees of knee flexion (plus/minus 5 degrees). Measure both legs to ensure no there are no imbalances. Common symptoms of a saddle that is too high include IT band syndrome, posterior knee pain, and hip or low back pain. Common symptoms of a saddle that is too low is anterior knee pain from stress on the quadriceps and patellar tendons.

Saddle Setback

Saddle setback refers to the fore and aft position of the saddle. When the foot is in the 3 o’clock position, the front surface of the knee should be directly over the pedal spindle. This can be measured using a plumb bob or laser. The rider should feel like they are pushing the pedal straight down, not in front of them or behind them; the pedal stroke should feel powerful and efficient. If the saddle is set too far back, it can irritate the IT band and hamstrings tendons. If it is too far forward, it may put excessive pressure on the quadriceps and patellar tendons.

Type of saddle  

Saddle selection is highly subjective. Every manufacturer seems to develop their own way of fitting a saddle to a rider. This can include basing it on width of the pelvis, sit bone pressure points, or spinal flexibility. However, the best way to determine the which type of saddle to use is to test ride it. Saddle selection is all about finding the saddle that fits the rider’s body type.

Cleats  

Cleat fitting might warrant an entire article all on its own, but here are some basics.

The fore aft position of the cleat on the shoe should align the ball of the foot with the pedal spindle. The medial/lateral position of the cleat should position the knee directly over the foot. The rotational position of the cleat should position the foot so it is facing directly forward. Knee pain can be caused by improper foot and cleat positioning. If a rider has knee pain and the saddle height and setback are positioned correctly, cleat positioning may be the culprit.

Handlebar Reach

Handlebar reach is defined as the distance from the saddle to the handlebar and is measured from the front tip of the saddle to the center of the tubing of the handlebar. When fitting reach, the rider should place his or her hands on the brake hoods. The reach should be as long as possible, while still feeling comfortable. A longer reach allows for a longer stem, which makes the front of the bike more stable and makes steering more responsive. However, in this position the shoulder should not exceed 90 degrees of flexion. There should also be about 15 degrees of elbow flexion. If the reach is too long, the rider may experience elbow pain, tension in the neck and shoulders, and back pain.

Handlebar Drop

Handlebar drop is defined as the difference in height between the saddle and the handlebar. Increasing the drop makes the rider position more aggressive and aerodynamic. This may be ideal for a rider participating in stage or criterium racing. However, for a leisure rider, a more upright position will likely be more comfortable. If the drop is too low, the rider will experience symptoms in the hands and wrists, such as pain from too much weight on the hands. This can also cause nerve irritation; riders may experience numbness, tingling, and burning sensations in the hands.   

Blog Post written by Michael Joseph, DPT Student at Mount Saint Mary’s University. Michael is currently in his final Clinical Rotation with me at Catz Physical Therapy Institute.

Sources:

1. www.gurucycling.com
2. Asplund, Chad, St. Pierre, Patrick. Knee Pain and Bicycling: Fitting Concepts for Clinicians. The Physician and Sports Medicine. April 2004. 32(3).

What are Shin Splints?

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By Michael Joseph, DPT Student

Definition and Risk Factors:

Medial Tibial Stress Syndrome (MTSS), better known as shin splints, is a common athletic injury caused by repetitive stress to the tibia. MTSS is more prevalent in activities involving a great deal of running and jumping, like distance running, sprinting, basketball, tennis, gymnastics, and dancing; it is also common in military personnel. MTSS can be caused by many factors stressing the tibia, including: periostitis (inflammation of connective tissue surrounding bone), periosteal remodeling, tendinopathy, and dysfunction of muscles surrounding the tibia, like the tibialis posterior, tibialis anterior, flexor digitorum longus, and soleus muscles. Risk factors for MTSS include flat feet and/or over-pronation, repetitive running and jumping, excessive hip range of motion, smaller calf girth, and a body mass index above 20.2.

Symptoms:

Symptoms include pain of the middle and lower thirds of the medial shin. Individuals may experience pain during and/or after physical activity. During the early onset of MTSS, symptoms may be felt at the beginning of exercise, but may subside as activity continues. As MTSS progresses, pain may be felt throughout exercise and may linger afterwards.

Diagnosis:

A thorough physical therapy subjective and objective exam is usually sufficient to diagnose MTSS. However, patients may require further imaging or work up to rule out pathologies like stress fractures, exertional compartment syndrome, or peripheral vascular disease.

Management of Shin Splints:

Acute Phase:

The goal of physical therapy in the acute phase is to reduce pain and inflammation. This can be done through stretching, manual therapy of the injured tissue, taping, icing, and rest. For many athletes prolonged rest from their sport is not ideal. MTSS management may require “relative” rest, meaning their activity level may need to be adjusted but not stopped completely. This depends on the activity and severity of the pathology.

Subacute Phase:

The goal of physical therapy in the subacute phase is to modify training regimens and correct biomechanical abnormalities. According to Galbraith et al, reducing weekly training frequency and intensity by 50% will likely improve symptoms without completely stopping training. However, this depends on each patient’s case and may need to be adjusted. Training can also be augmented with low impact exercises, like swimming or cycling, to help maintain strength and cardiovascular endurance.

Create a Physical Change in Your Body and Movement

Another treatment of MTSS is to strengthen the arch of the foot and hip, and increase core stability; this will help to improve jumping and landing mechanics, as well as single leg stability. Specifically, strengthening the tibialis posterior and intrinsic foot musculature will help increase arch support and prevent excessive pronation. Improving hip extensor and abductor strength can help improve lower extremity mechanics. Stretching and eccentric strengthening of the calf has also been shown to be beneficial by decreasing muscle fatigue with running and jumping.

Changing running biomechanics may also be beneficial. A study from Leiberman et al, found that heel first strike during initial contact, when running, creates an impact transient equal to nearly three times the individual’s body weight. Not only is this incredibly inefficient, but this creates a large force traveling directly up through the tibia with each step. The impact transient with forefoot first strike during initial contact is seven times lower than with a heel strike. This evidence suggests forefoot running is more efficient and less injurious. 

Blog Post written by Michael Joseph, DPT Student at Mount Saint Mary’s University. Michael is currently in his final Clinical Rotation with me at Catz Physical Therapy Institute.

Sources:

1. Budde, Kari Brown. Physical Therapist’s Guide to Shin Splints (Medial Tibial Stress Syndrome). http://www.moveforwardpt.com. Accessed May 11, 2017.
2. Galbraith, R. Michael, Lavelle, Mark E. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009 Sep; 2(3):127-133.
3. Lieberman, Daniel E., Venkadesan, Madhusudhan, Werbel, William A., Daoud, Adam I., D’Andrea, Susan, Davis, Irene S., Mang’Eni, Robert Ojiambo, Pitsiladis, Yannis. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010 Jan; 463:531-535.
4. Moen, Maarten Hendrik, Holtslag, Lenoor, Bakker, Eric, Barten, Carl, Weir, Adam, Tol, Johannes L., Backx, Frank. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Med Arthrosc Rehabil Ther Technol. 2012 Mar; 4(12).

What is Platelet Rich Plasma?

 Chris Butler Sports PT is Social

By Meggie Morley, DPT Student

In recent years the use of platelet rich plasma has been on the rise as a means of promoting healing in soft tissue structures such as tendons, muscles, ligaments and joints. With professional athletes such as Tiger Woods and Steph Curry receiving the injections as a method to promote healing, it may be useful to take a closer look at the possible effects and uses of PRP injections.

How it Works

Platelets are a component of the blood with the main function of promoting blood clotting. They also release numerous growth factors, including Platelet Derived Growth Factor (PDGF), which is a protein that helps regulate cell growth and division. PRP is made by collecting a blood sample from the patient, then centrifuging the blood to separate out the platelets.  The platelet rich plasma is then treated and injected into the patient, often with the use of ultrasound to guide the placement of the injection. PRP is made from the patient’s own blood, so there are very few side effects associated with the injections, however it is recommended to stop taking anti inflammatory medications before and after the injection. 

Article Review

In an article by Pandey et al., the effects of PRP were examined in patients who underwent arthroscopic rotator cuff repairs compared to subjects that underwent the same procedure without PRP.  The effectiveness of the treatment was measured by four different clinical scores and by ultrasound to view if there was a re-tear and the general vascularity of the rotator cuff. The results found that three of the four clinical scores demonstrated significantly better outcomes in the PRP group versus the control group at various follow up times. The other score (The American Shoulder and Elbow Surgeons Score) was comparable between the PRP and the control group at all follow-up visits. The incidence of re-tears was significantly lower in the PRP group, but only for large tears. The ultrasound also showed that there was significant vascularity at the repair site three months post operatively.

While this article showed positive outcomes for patients who received PRP, overall the evidence for the use of PRP in human subjects is still lacking. As with any medical procedure it is important to be informed and discuss your options with your physician.

 Blog Post written by Meggie Morley, DPT.  At the time of posting Meggie was in her final clinical rotation with me at Catz Physical Therapy Institute.

References

Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012 Mar 31;28(3):429-39.

Kohen R, Warren R, Rodeo S. (2010, October 5). Platelet Rich Plasma (PRP) Treatment: An Overview. Retrieved from https://www.hss.edu/conditions_platelet-rich-plasma-prp.asp

Pandey V, Bandi A, Madi S, Agarwal L, Acharya KK, Maddukuri S, Sambhaji C, Willems WJ. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2016 Aug 31;25(8):1312-22.

Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indications. Knee Surgery, Sports Traumatology, Arthroscopy. 2016:1-6.

High Intensity Interval Training vs. Steady State Cardio

By Darelle Noel

Whether you use cardio workouts to improve your health or performance in sports, one common goal of cardio training is to improve the function and capacity of your energy system. Many people decide the intensity of their workouts based on what they’re looking to accomplish during training. Some prefer steady state cardio (Aerobic) while others prefer high intensity interval training (Anaerobic).  Both yield great cardiovascular results so neither is a wrong way to go.

Slow steady state cardio or aerobic activity is when an exercise is performed at one steady pace for an extended period of time, maintaining a relatively constant intensity level or heartrate.

High Intensity Interval Training or anaerobic training is a technique that alternates between short intense activity with a maximum recovery period. This technique varies the heartrate expeditiously improving your work to rest ratio (Energy System Capacity).

A blend of both could be an even better option. Instead of slow, plodding workouts, try a combination of utilizing both energy systems. This will have your muscle groups, nervous system, and hormones acting synergistically to help your body work as efficiently as possible. All these benefits result from time-efficient workouts that are much shorter than your average lower-intensity cardio session. The program you choose should reflect a balance of strengthening your weaknesses and challenging your strengths.

Begin by improving your overall aerobic threshold, some great exercises are:

◾Outdoors: Paced walking, walking up hills, biking, rowing

◾Indoors: Biking, treadmill climbing/walking, elliptical trainer

Using the aerobic zone will improve your cardiovascular system and prepare your muscles for the greater speeds.

Next try to move into a little more intensity levels, At this level you’ll ride, run, or climb as hard as possible for between 10-30 seconds with maximum levels of recovery.. In order to get the most out you’ll need to pack as much power and energy into these segments as possible.

Some of the best activities for this are:

◾Sprinting (flat or uphill)

◾Shuttle runs (5 yards and back, 10 yards and back, 15 yards and back)

◾Bicycle intervals

◾Tredmill Sprints

◾Rowing for speed. 

A balanced training program should use different combinations of these exercises and different intensity levels to create varied and personalized workout that will develop both energy thresholds. You can spend more time in aerobic level initially and progress to performing intervals in which you spend more time in higher-intensity zones to improve your overall endurance, strength, and power.

Blog Post written by Darelle Noel, Athletic Gaines Performance Specialist.  I have had the good fortune to work with him at Catz Physical Therapy/Athletic Gaines Pasadena.

Straight Bar Deadlifts vs. Hex Bar Deadlifts

By Michael Joseph, DPT Student

The deadlift is one of the most effective and widely used exercises to build raw strength. There are many variations of the deadlift, including conventional deadlifts, sumo deadlifts, stiff leg deadlifts, Romanian deadlifts, and the popular hex bar deadlift (HBD). As opposed to a straight bar deadlift (SBD), where the bar is sitting in front of the body, this bar allows the lifter to stand within a hexagon-shaped frame and lift the weight from the ground. But, what is the difference between a straight bar and a hex bar? And why would you use one instead of the other?

Research

In a study by Swinton et al, a group of competitive powerlifters were recruited to compare the biomechanical differences between the SBD and HDB. Subjects tested their 1 rep max and submaximal lifts on both bars. 3-D motion analysis was used to measure body position and velocity and acceleration of the bar. The study found the powerlifters were able to lift an average of 45 lbs. more using the hex bar, compared to the straight bar. In addition, across submaximal loads deadlifts using the hex bar produced greater peak force, peak velocity, and peak power compared to the straight bar. This suggests that the HBD is a more effective exercise due to the greater mechanical stimulus produced during submaximal loads. 

A follow up study was done by Camara et al, comparing electromyography, force, velocity, and power characteristics between the two bars. Surface EMGs were placed on the vastus lateralis (quadriceps), biceps femoris (hamstrings), and erector spinae (low back) muscles. Force, velocity, and power were measured by attaching a velocity transducer to the barbells. This study also measured subjects’ 1 rep max and submaximal loads. EMG results found greater quadriceps activation during the HBD, but greater hamstrings and low back activation during the SBD. However, there was not a significant difference in the 1 rep max lifts. This study also confirmed higher peak velocity, peak force, and peak power with the HBD than the straight bar deadlift.

Clinical Application

Both studies confirm the SBD puts greater stress on the hamstrings and low back, while the HBD distributes loads more equally, putting greater stress on the quads. For individuals with low back pain or who are rehabilitating a low back injury, using a hex bar to deadlift may be a safer alternative to using a straight bar. Similarly, for a patient who may not be ready to perform a loaded squat, the HBD may be used as an effective alternative to strengthen the quadriceps.  

Both studies also agree that the HBD produced greater peak force, velocity, acceleration, and power. This suggests the HBD is a better exercise for overall strength training. The HBD may be a more beneficial deadlift variation than the SBD for athletes because it is more effective for improving overall strength, while putting them at less risk of a low back injury. So when should the SBD be used for patients and athletes? If the goal is to strengthen hamstrings and low back extensors specifically, the SBD will be more effective. Similarly, if the SBD is specific to the athlete’s sport, (for example, powerlifting or CrossFit) training the SBD may be more beneficial.

Blog Post written by Michael Joseph, DPT Student at Mount Saint Mary’s University.  Michael is currently in his final Clinical Rotation with me at Catz Physical Therapy Institute.

References

1. Swinton PA, Stewart A, Agouris I, Keogh JW, Lloyd R. A biomechanical analysis of straight and hexagonal barbell deadlifts using submaximal loads. J Strength Cond Res. 2011;25(7):2000-9.
2. Camara KD, Coburn JW, Dunnick DD, Brown LE, Galpin AJ, Costa PB. An Examination of Muscle Activation and Power Characteristics While Performing the Deadlift Exercise With Straight and Hexagonal Barbells. J Strength Cond Res. 2016;30(5):1183-8.

5 Things to Do Before Going on a Run

By Meggie Morley, DPT Student

It is well known that exercise is crucial for living a long and healthy life, but recent studies have shown that running may actually be the most effective exercise for increasing life expectancy. In a recent study by Lee et al., it was found that running can increase a person’s life span by 3 years, and reduces the risk of premature death by 40%. The researchers also noted that the benefits are the same regardless of pace, mileage, drinking and smoking or being overweight.

Hopefully studies such as this one encourage people to take up running, so here are a few things to do before going on a run to boost performance and minimize the risk of injury. The idea behind these exercises are to warm up the muscles and joints before running as well as “turn on” the muscles we want to be active while running.

1. Warm Up

Start by simply walking for a few minutes to increase blood flow and prime the joints and muscles for motion.

2. Walking Lunges with Torso Twist-Works: Quads, gluts, hamstrings

Step forward with the right leg into a lunge. Place your right hand next to the right foot then twist your trunk to the left while reaching the left arm up towards the ceiling.

3. Planks with Knee Drive-Works: Abdominals, hip flexors

Hold a high plank with the shoulder directly over the wrists. Alternate driving the knees towards the chest ten times. Then perform ten knee drives toward the same side elbow and ten toward the opposite elbow in order to engage both the rectus abdominus and the obliques.

4. Bridges-Works: Abdominals, gluts, hamstrings

The gluteal muscles are crucial for generating power and maintaining proper biomechanics down the entire lower extremity while running. Do three sets of bridges with a focus on keeping the core engaged and lifting the hips with the gluts in order to prepare the muscles to be active during running.

5. Alternating Lunge with Medial Reach-Works: Quads, hamstrings, gluteus maximus, gluteus medius

Step forward with the right leg into a lunge and reach out to the left with the left arm. Perform ten lunges then switch sides. This places more demand on the gluteus medius, which is important for maintaining proper pelvis alignment during running.

 Blog Post written by Meggie Morley, DPT Student at Columbia University. Meggie is currently in her final Clinical Rotation with me at Catz Physical Therapy Institute.

References

1. Lee DC, Brellenthin AG, Thompson PD, Sui X, Lee IM, Lavie CJ. Running as a Key Lifestyle Medicine for Longevity. Progress in Cardiovascular Diseases. 2017 Mar 30.

2. https://www.nytimes.com/2017/04/12/well/move/an-hour-of-running-may-add-seven-hours-to-your-life.html

3. Yamaguchi T, Takizawa K, Shibata K. Acute effect of dynamic stretching on endurance running performance in well-trained male runners. The Journal of Strength & Conditioning Research. 2015 Nov 1;29(11):3045-52.