Back Clinic Sports Injuries Chiropractic and Physical Therapy Team. Athletes from all sports can benefit from chiropractic treatment. Adjustments can help treat injuries from high-impact sports i.e. wrestling, football, and hockey. Athletes that get routine adjustments may notice improved athletic performance, improved range of motion along with flexibility, and increased blood flow. Because spinal adjustments will reduce the irritation of the nerve roots between the vertebrae, the healing time from minor injuries can be shortened, which improves performance. Both high-impact and low-impact athletes can benefit from routine spinal adjustments.
For high-impact athletes, it increases performance and flexibility and lowers the risk for injury for low-impact athletes i.e. tennis players, bowlers, and golfers. Chiropractic is a natural way to treat and prevent different injuries and conditions that impact athletes. According to Dr. Jimenez, excessive training or improper gear, among other factors, are common causes of injury. Dr. Jimenez summarizes the various causes and effects of sports injuries on the athlete as well as explaining the types of treatments and rehabilitation methods that can help improve an athlete’s condition. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Stress fractures to the ribs occur in rowers, golfer, canoeists, lacrosse players and baseball pitchers. They are more common in sports involving an element of trunk rotation with scapula movement across the rib cage.
A stress fracture is described as an overload to the bone caused by repetitive loading due to a particular movement. Any load on the bone will create a stress in the bone. However, given enough recovery time the bone heals and ends up stronger. This is known as Wolfe�s law. But, if the bone load is too high or too frequent, then the bone does not repair quickly enough, a stress response occurs and a fracture follows.
In rowing, the repetitive loading is created by a number of factors. Muscles such as the serratus anterior and abdominals that directly attach to the ribs can lead to loading on the ribcage due to contraction. Bad rowing technique, perhaps caused by poor hip flexibility, which then requires an excessive compensatory thoracic rotation, may then lead to rib breakdown.
Other causes include equipment issues such as the oar type (lighter carbon oars increase rib loading), bigger boats with more drag and position in the boat (bow rowers have less incidence due to lower stroke rate and force). Rib cross section and density also influence the chance of stress fractures, and women have a higher chance due to greater likelihood of bone density issues. Finally, training variables such as volume, intensity, type of loading and off water training can also be factors in stress fracture development.
The signs and symptoms are usually straight forward. These include generalised rib pain with a focused spot of tenderness, pain rolling onto the ribs whilst sleeping and pain with deep breathing. They can be confirmed with bone scan (black spot) and/or MRI (white spot).
Unfortunately for the rower, the immediate management of the injury involves rest. Usually 4-6 weeks away from rowing will be enough to allow some bone healing and this is followed by a progressive increase in rowing load over another 4 weeks before the athlete is back to full training.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Chiropractic and Athletic Performance
Chiropractic care is a popular, alternative treatment option which focuses on the diagnosis, treatment and prevention of injuries and/or conditions associated to the musculoskeletal and nervous system, primarily the spine. Many athletes, and civilians alike, seek chiropractic care to restore their natural health and wellness, however, chiropractic has been demonstrated to benefit athletes by increasing their athletic performance.
The talk in soccer circles this week is the imminent return to action of Theo Walcott, the Arsenal and England star who damaged his knee back at the start of 2014. After 286 days of rehab, Walcott made a return to Arsenal’s Under 21 team last week. This has left journalists salivating at finding out when he will be returning to the main team.
For a young professional sports person, nine months is a long time out of the game. For Walcott, missing out on this Summer’s soccer World Cup in Brazil was perhaps more than just rubbing salt into the wound.
In issue 139 of Sports Injury Bulletin, I present a case study of a similar problem in a rugby player of identical age. This big lump of a kid ruptured his lateral meniscus in the knee — a bit different to Walcott’s ACL injury. However, this player also missed a big chunk of the season (17 weeks) and I had to live with his personal frustrations, and the yo-yo of daily emotions.
The piece shows the knee anatomy, details the types, clinical features and management of meniscus tears, and the required post-surgical rehabilitation.
On a recent Rehab Trainer course, one of the participants asked me what she should do about the small lateral meniscal tear in her knee. This is a bit like answering “how long is a piece of string?”, as it depends on so many things.
But to wrap it up in a nutshell, the surgeon will use a set of criteria to determine if a meniscal tear needs repairing, removing, or to be left well alone.
Criteria for Surgery
1. Age
The younger the patient, the more comfortable surgeons are about operating. Often the small degeneration tears in older patients are just a precursor to a knee that is about to become arthritic. With older patients, many surgeons will try for rehab first.
2. Function
This depends on what the knee has to do. If the patient does nothing but collect stamps all day and the knee does not bother them, then clearly the surgeon will want to leave it alone. But if the patient is an athlete with a repetitive catching and locking knee due to a meniscal tear, they will be more comfortable about operating.
3. Type of tear
Issue 139 of Sports Injury Bulletin details the types of tears we see in meniscus. In short, tears such as bucket handle tears do not do well without surgery, while small longitudinal tears can do well without surgery.
4. Location of tear
The outer portion of the meniscus has a nice, rich blood supply (hence, called the “red-red zone”). These areas can do well if left alone. Inner third zone tears (the “white zone”) with no blood supply don’t heal, so they need repairing or removing.
So, if the patient is lucky and fits the criteria for conservative management, or let’s say they simply don’t want surgery, then what options do we have to prevent the injury from getting worse?
Suggestions to Avoid Further Meniscus Injuries
Avoid positions that catch the meniscus. For example, full squatting may catch the posterior horn of the meniscus and flare it up, so the patient has to learn to avoid these positions if possible.
Keep the quadriceps working. If the quads remain strong and active then the shearing effect of the tibia moving across the femur is reduced. This will limit the stress to the meniscus.
Watch for swelling. Regular assessments for a knee effusion (called a “fluctuation test”) may need to be done a few times a week to make sure the knee stays dry. The knee’s biggest enemy is an effusion as it shuts off the quads straight away.
Intervene if the knee has an effusion. Donut felt compression, regular icing, NSAIDS if indicated, needle aspiration if indicated. Avoiding an effusion at all costs is pretty important for any knee injury.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Preventing Sports Injuries
Many athletes largely depend on chiropractic care to enhance their physical performance. New research studies have determined that aside from maintaining overall health and wellness, chiropractic can also help prevent sports injuries. Chiropractic is an alternative treatment option utilized by athletes to improve their strength, mobility and flexibility. Spinal adjustments and manual manipulations performed by a chiropractor can also help correct spinal issues, speeding up an athlete’s recovery process to help them return-to-play as soon as possible.
A common soccer move — bouncing the ball off of the head — may not be as harmless to the brain as has been thought, new research suggests.
A study of more than 200 adult amateur soccer players of both genders found that regularly “heading” the ball, as well as suffering accidental hits to the head, significantly boosted a player’s risk of concussion.”The prevailing wisdom is that routine heading in soccer is innocuous and we need only worry about players when they have unintentional head collisions,” study leader Dr. Michael Lipton, of the Albert Einstein College of Medicine in New York City, said in a college news release.”But our study suggests that you don’t need an overt collision to warrant this type of concern,” said Lipton. He is professor of radiology, psychiatry and behavioral sciences at Einstein.Another concussion expert who reviewed the findings agreed.Soccer Athletes at Risk
The study “seems to provide additional evidence that such practices within the game of soccer can put athletes at risk for traumatic brain injury,” said Dr. Jamie Ullman. She directs neurotrauma at North Shore University Hospital in Manhasset, N.Y.Much of the research into sports-related concussions has concentrated on high-impact sports, such as football or hockey. But head trauma experts have long known that other sports — including soccer and rugby — might carry risks, too.In prior studies, Lipton said his team found that “30 percent of soccer players who’d had more than 1,000 headings per year had a higher risk of microstructural changes in the brain’s white matter, typical of traumatic brain injury, and worse cognitive performance.”Exploring the issue further, the new study focused on online questionnaires answered by 222 adult amateur soccer club players in the New York City area, both male and female. All had played soccer at least six months during the prior year.Men averaged 44 headers in two weeks, the survey found, while women averaged 27. One or more accidental head impacts, such as a ball hitting the back of the head or a head colliding with another player’s knee, were reported by 43 percent of women and 37 percent of men.Players who regularly headed the ball were three times more likely to have concussion symptoms than those who didn’t head the ball often, Lipton’s team reported.Players who suffered accidental head impacts two or more times within a two-week span were six times more likely to have concussion symptoms than those without accidental head impacts, the findings showed.Of those who headed the ball or reported accidental head impacts, 20 percent had moderate to severe concussion symptoms, according to the report.Of the seven players with very severe symptoms, six had two or more unintentional head impacts over two weeks, four were among those who headed the ball the most, and three were in the group that headed the ball second-most.Lipton stressed that the findings cannot be generalized to child, teen or professional soccer players.Still, “our findings certainly indicate that heading is more than just a ‘sub-concussive’ impact, and that heading-related concussions are common,” Lipton said. “We need to give people who have these injuries proper care and make efforts to prevent multiple head impacts, which are particularly dangerous.”That means watching out for symptoms, he added.”Many players who head the ball frequently are experiencing classic concussion symptoms — such as headache, confusion and dizziness — during games and practice, even though they are not actually diagnosed with concussion,” Lipton explained.”Concussion sufferers should avoid additional collisions or head impacts during the following days or weeks, when their risk of incurring a second concussion is extremely high,” he said. “Because these injuries go unrecognized and unmanaged, there may be important clinical consequences for the short and long term.”Dr. Salman Azhar is a neurologist and director of stroke services at Lenox Hill Hospital in New York City. He said the new findings are in accordance with prior studies, and the odds for concussion appeared to rise along with the frequency of head impacts.”The chance of having moderate-to-severe symptoms increased when the unintentional heading went from just one per two-week period to two per two-week period,” Azhar noted.The study was initially published online Feb. 1 in the journal Neurology.
For more information, ask Dr. Jimenez or contact us at 915-850-0900
Presented By:
Dr. Alex Jimenez D.C.,C.C.S.T
Spinal Trauma Specialist
Concussions, or head injuries, are considered to be some of the most common sports injuries. Athletes can experience head trauma due to a variety of injuries and accidents related to their specific sport. While there are various symptoms which can characterize the presence of a concussion, recent research studies have found that certain markers in the blood can predict an athlete’s recovery from a head injury.
Researchers at the National Institutes of Health found that the blood protein tau could be an important new clinical biomarker to better identify athletes who need more recovery time before safely returning to play after a sports-related concussion. The research study, supported by the National Institute of Nursing Research or NINR, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, or NICHD, published online in the Jan. 6, 2017 issue of Neurology, the medical journal of the American Academy of Neurology.
How Blood Markers Can Help Athletes with Concussions
Despite the millions of sports-related concussions that occur annually in the United States, there is no reliable blood-based test to predict recovery and an athlete’s readiness to return to play. The new study shows that measuring tau levels could potentially be an unbiased tool to help prevent athletes from returning to action too soon and risking further neurological injury.
“Keeping athletes safer from long-term consequences of concussions is important to players, coaches, parents and fans. In the future, this research may help to develop a reliable and fast clinical lab test that can identify athletes at higher risk for chronic post-concussion symptoms,” said NINR Director Patricia A. Grady Ph.D., R.N.�
Athletes who return to play before full recovery are at high risk for long-term symptoms like headaches, dizziness, and cognitive deficits with subsequent concussions. About half of college athletes see their post-concussive symptoms resolve within 10 days, but in others, the symptoms become chronic.
Tau is also connected to development of Alzheimer’s and Parkinson’s diseases, and is a marker of neuronal injury following severe traumatic brain injuries.
In the study, led by Dr. Jessica Gill, NIH Lasker Clinical Research Scholar and chief of the NINR Division of Intramural Research’s Brain Injury Unit, researchers evaluated changes in tau following a sports-related concussion in male and female collegiate athletes to determine if higher levels of tau relate to longer recovery durations.
“Incorporating objective biomarkers like tau into return-to-play decisions could ultimately reduce the neurological risks related to multiple concussions in athletes,” said Gill.
To measure tau levels, a group of 632 soccer, football, basketball, hockey, and lacrosse athletes from the University of Rochester first underwent pre-season blood plasma sampling and cognitive testing to establish a baseline. They were then followed during the season for any diagnosis of a concussion, with 43 of them developing concussions during the study. For comparison, a control group of 37 teammate athletes without concussions was also included in the study, as well as a group of 21 healthy non-athletes.
Following a sports-related concussion, blood was sampled from both the concussed and control athletes at six hours, 24 hours, 72 hours, and seven days post-concussion.
Concussed athletes who needed a longer amount of recovery time before returning to play, (more than 10 days post-concussion) had higher tau concentrations overall at six, 24, and 72-hours post-concussion compared to athletes who were able to return to play in 10 days or less. These observed changes in tau levels occurred in both male and female athletes, as well as across the various sports studied.
Together, these findings indicate that changes in tau measured in as short a time as within six hours of a sports-related concussion may provide objective clinical information to better inform athletes, trainers, and team physicians’ decision-making about predicted recovery times and safe return to play.
Further research will test additional protein biomarkers and examine other post-concussion outcomes.
Preventing Sports Injuries with Chiropractic
Chiropractic care is frequently utilized by athletes to treat common sports injuries. Aside from treating the side effects associated with concussions, chiropractic can help relieve neck pain and back pain caused by an injury or accident. Chiropractic care can also help prevent sports injuries from occurring as the spinal adjustments and manual manipulations can help improve the strength, flexibility and mobility of the structures surrounding the spine, particularly improving the health and wellness of the neck and head.
Organization Information
About the National Institute of Nursing Research (NINR): NINR supports basic and clinical research that develops the knowledge to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care. For more information about NINR, visit the website at www.ninr.nih.gov.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit NICHD’s website.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
For more information, ask Dr. Jimenez or contact us at 915-850-0900�. �
By Dr. Alex Jimenez D.C.,C.C.S.T
Spinal Trauma Specialist
Additional Topics: Neck Pain and Auto Injury
Neck pain is characterized as the most prevalent symptom after being involved in an automobile accident. During an auto collision, the body is exposed to a sheer amount of force due to the high speed impact, causing the head and neck to jolt abruptly back-and-forth as the rest of the body remains in place. This often results in the damage or injury of the cervical spine and its surrounding tissues, leading to neck pain and other common symptoms associated with whiplash-related disorders.
As a team physician for the St Louis Cardinals during their 2011 World Series Championship season, I learned a lot about the importance of players taking care of themselves firsthand. I would see players preparing themselves both mentally and physically for the game ahead. Kids look up to these players and emulate them. Major League Baseball (MLB) recognizes this and wants their youth players to be healthy and play as safely as possible. This is why MLB took time, energy, and resources, to determine what would be best for today�s young pitchers. Below is a snapshot of what the MLB and the American Sports Medicine Institute (ASMI) found as risk factors for the young pitcher. It�s recommended that these guidelines be followed by coaches, parents, and players.
The MLB Pitch Smart guidelines provide practical, age-appropriate parameters to help parents, players, and coaches avoid overuse injuries and encourage longevity in the careers of young pitchers.
It was found that specific risk factors were seen as creating a higher incidence of injuries. According to the ASMI, youth pitchers that had elbow or shoulder surgery were 36 times more likely to regularly have pitched with arm fatigue. Coaches and parents are encouraged to watch for signs of pitching while fatigued during their game, in the overall season, and during the course of the entire year.
The ASMI also found that players that pitched more than 100 innings over the course of a year were 3.5 times more likely to be injured than those who did not exceed the 100 innings pitched mark. It�s important to note that every inning counts. Games and showcase events should count toward that total number of 100.
Rest is key. Overuse on a daily, weekly, and annual basis is the greatest risk to a young pitcher�s health. Numerous studies have shown that pitchers that throw a greater number of pitches per game, as well as those who don�t get enough rest between outings, are at a greater risk of injury. In fact, in little league baseball, pitch count programs have shown a reduction in shoulder injuries by as much as 50% (Little League, 2011). Setting limits for pitchers throughout the season is vitally important to their health and longevity in the game.
Pitching with injuries to other areas of the body will also affect a player�s biomechanics and change the way he delivers his pitch. An ankle, knee, hip, or spinal injury can cause changes in the biomechanics of how a player throws and will put more stress on his arm. Be cautious with these injuries, because at times the changes in the mechanics of the player can be very subtle; however, they can cause a significant amount of strain on a player�s pitching arm.
For best results for your youth baseball player�s longevity in the sport and keeping a healthy arm for seasons to come follow the MLB�s pitch count and required rest guide.
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3 Common Shoulder Sports Injuries
The shoulder is the most mobile joint in the body, which also makes it prone to injury. If you�re an athlete, taxing your shoulder over time with repetitive, overhead movements or participating in contact sports may put your shoulder at risk for injury.
There are several nonsurgical and surgical options available to treat labrum tears in the shoulder.
These are three common shoulder injuries caused by sports participation:
1. SLAP Tear
This is a tear to the ring of cartilage (labrum) that surrounds your shoulder’s socket. A SLAP tear tends to develop over time from repetitive, overhead motions, such as throwing a baseball, playing tennis or volleyball, or swimming.
Athletic performance decreases. You have less power in your shoulder, and your shoulder feels like it could �pop out.�
Certain movements cause pain. You notice that pain occurs with certain movements, like throwing a baseball or lifting an object overhead.
Range of motion decreases. You may not throw or lift an object overhead like you used to, as your range of motion decreases. You may also find reaching movements difficult.
Shoulder pain you can�t pinpoint. You have deep, achy pain in your shoulder, but you can’t pinpoint the exact location.
It�s common to experience shoulder instability if you�re an athlete. This injury can occur if you�re participating in contact sports, including football or hockey, or ones that require repetitive movements, like baseball.
Shoulder instability happens when your ligaments, muscles, and tendons no longer secure your shoulder joint. As a result, the round, top part of your upper arm bone (humeral head) dislocates (the bone pops out of the shoulder socket completely), or subluxates (the bone partially comes out of the socket).
Dislocation is characterized by severe, sudden onset of pain; subluxation (partial dislocation) may be accompanied by short bursts of pain. Other symptoms include arm weakness and lack of movement. Swelling and bruising on your arm are visible changes you may also notice.
This is another injury commonly seen in athletes participating in repetitive, overhead sports, including swimming and tennis. Rotator cuff injuries are typically characterized by weakness in the shoulder, reduced range of motion, and stiffness.
Being aware of these injuries and knowing their symptoms may encourage you to seek medical treatment sooner; early treatment intervention could result in a better outcome and earlier return to sports.
There�s nothing more frustrating for an athlete than sitting injured on the sidelines watching others compete. Although there�s not one foolproof way to stop shoulder pain from occurring, there are several tips that may help prevent it from starting or getting worse.
If you notice shoulder pain during certain activities, say while throwing a baseball or swimming, stop that activity for a period of time and find an alternative exercise, such as riding a stationary bike. Doing so can give your shoulder some time to rest and heal, while maintaining your cardiovascular fitness.
At the same time, don�t eliminate all shoulder movement. This is because you don�t want to develop a stiff shoulder from infrequent use. Consider doing some mild stretches to keep your arm moving.
2. Change Your Sleeping Position
If you notice pain in your right shoulder, don�t sleep on your right side. Try sleeping on your left side or back instead. If sleeping on your back irritates your shoulder, try propping your arm up with a pillow.
3. Warm Up
Exercising cold muscles is never a good idea. Before practicing your volleyball serve or baseball pitch, warm up your body with mild exercise. For example, start walking for a few minutes and gradually build up to a jog. Doing so raises your heart rate and body temperature and activates the synovial fluid (lubricant) in your joints.1 In other words, a mild warm up gets your body ready for the intense workout that follows.
4. Build Up Your Endurance
It�s a good idea to increase your endurance over time. If it�s been a few weeks or months since you�ve hit the tennis court, consider playing for a short period of time�maybe just 20 minutes to start�and build up to a longer period of playing time. Don�t fall into the trap of doing too much too soon, especially when your body is not used to it.
Strengthening your shoulder muscles can help provide support and stabilization to your shoulder joint. This, in turn, may prevent painful injuries like a shoulder dislocation, which is when the ball of your shoulder comes out of its socket.
Speak to your doctor before starting a strengthening program. They can suggest exercises to perform or may recommend working with a physical therapist.
6. Cross-Train
Some sports are particularly taxing on the shoulder due to repetitive, overhead movements. So you may want think about cross-training. If you�re a swimmer, for example, alternate some of your swimming workouts with a running or biking workout to reduce the stress on your shoulder, while still staying physically fit.
Alternatively, if you�re a painter or construction worker�two occupations commonly associated with repetitive, overhead movements�talk to your boss and ask if there are other non-repetitive tasks you can take on.
Above all, listen to your body and be proactive. You may need to make some adjustments to workout or daily routine to help prevent further damage down the road. It may also be worth getting your doctor�s input, even if you think you�ve got a minor injury. Catching injuries or discomfort early may help keep you in the game and prevent painful injuries down the road.
Being aware of sports�injuries and knowing their symptoms may encourage you to seek medical treatment sooner as early treatment intervention could result in a better outcome and earlier return to sports.�For Answers to any questions you may have please call Dr. Jimenez at
Exercise is an important part of a healthy lifestyle, and sports are one approach many people choose to use to get their exercise.
For people with back pain, sports can still be a viable option if they pay attention to their back.
For others who participate in sports, knowing the type of strain various sports place on the back may help prevent a back injury.
This article gives specific information about sports injuries and back pain from bicycling, weight lifting, running, swimming, skiing, golf, and tennis.
Types of Sports-Related Back Injuries
In any sport, injuries to any part of the spine are possible, as well as injuries to the soft tissue and fascia that help comprise the makeup of the body. Up to 20% of all injuries that occur in sports involve an injury to the lower back or neck.
Lower Back Injury
The lower back is subject to a great deal of strain in many sports. Sports that use repetitive impact (e.g., running), a twisting motion (e.g. golf), or weight loading at the end of a range-of-motion (e.g., weightlifting) commonly cause damage to the lower back.
Neck Injury
The neck is most commonly injured in sports that involve contact (e.g., football), which place the cervical spine (neck) at risk of injury.
Upper Back Injury
The thoracic spine (mid portion of the spine at the level of the rib cage) is less likely to be injured because it is relatively immobile and has extra support. Injuries seen here can involve rib fracture and intercostal neuralgia as well as intercostal muscle strains in sports that involve rotation of the torso (e.g. weight training with rotation), swimming, golf, tennis, and even skiing.
Stretching and Warm-Up Prior to Exercise
While static stretching prior to any type of exercise used to be recommended, a number of studies in recent years have shown that stretching the muscles prior to exercise is not needed. A number of studies have shown that it does not help prevent injury, and likely does no harm either.1,2,3
For every sport, a thorough warm-up should be completed before starting to play. The warm-up will target the muscles used in that sport, but it should also prepare the back for the stresses to come.
The warm-up used should be specific to the sport to be played. A typical warm-up should include:
Increase circulation gradually by doing some easy movement (such as walking) to increase blood circulation to the muscles and ligaments of the back
Stretch the lower and upper back and related muscles, including hamstrings and quadriceps
Start slowly with the sport movements (e.g. swing the golf club, serve the ball)
Work with a Professional to Prevent or Manage Back Injury
There are professionals or instructors in almost every sport who are willing to share their expertise. Ideally, someone with this type of expertise can teach the correct form for a new sport or help develop and keep the proper technique for a current sport.
Before starting to work with any sports or exercise professional, it is advisable to inquire about his or her credentials. In general, if the individual is certified by the National Strength and Conditioning Association (NSCA), he or she should be up to date on the latest evidence related to stretching, exercise routines for specific sports, and additional information designed to benefit your personal routine.
Mets’ Infield, Chiropractor Is The Most Important Position
There are many ways to describe the Mets� projected starting infield of David Wright, Asdrubal Cabrera, Neil Walker and Lucas Duda. But two weeks ago, as Mets Manager Terry Collins discussed how he would handle their playing time, he provided a telling answer while rattling off the positions.
�We�ve got a bad back, bad back, bad knee and a bad back,� Collins said, referring to Wright, Walker, Cabrera and Duda.
The 2017 Mets, for all of their potential and talent, cannot ignore a significant question mark: health. Aside from the arm-related injuries of the pitching staff, the condition of the spines of three key infielders will hover over the team all season.
Wright, the long-tenured third baseman, has played only 75 games during the past two seasons; part of the reason was neck surgery in June, but mostly it is because of spinal stenosis, a chronic condition. Walker, the second baseman, had surgery to repair a herniated disk in his lower back in September. And Duda, the power-hitting first baseman, missed four months last season because of a stress fracture in his lower back.
All three reported to spring training relatively healthy; in Wright�s case, fusion surgery on a herniated disk in his neck had healed. But only two days into the exhibition schedule, the Mets have suffered a setback.
After experiencing what he said was a pain-free off-season, Duda reported feeling spasms in his back late last week. The pressure had an adverse effect on his hips, and he received a cortisone shot on each side Friday.
�So we�ll take a few days now instead of two weeks down the road,� Duda said. �Just being cautious.�
That should be the Mets� motto all year.
Although baseball players put repeated strain on their core when pitching or swinging, they do not suffer more back injuries than athletes in sports that entail more forceful impact, such as football or hockey, said Dr. Andrew C. Hecht, the chief of spine surgery for Mount Sinai Health System, who wrote a soon-to-be-released book on spine injuries in athletes.
�What happens when you have a few on one particular team is that it highlights it,� Hecht said.
Walker�s injury was the simplest. He first felt discomfort in his lower back and tingling in his leg late during the 2012 season, which he thought was caused by the sport�s day-to-day rigors. Some back pain recurred in the years that followed, but never to the degree that it did last season, when he said he also experienced numbness in his leg and foot.
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Hecht, who is not involved in the treatment of these Mets players, said lumbar disk herniation like Walker�s is �as common as common can be.� Surgery to repair the injury involves removing only the part of the herniated disk that is pinching the nerve and causing the pain, Hecht said.
Walker, 31, said he completed his physical therapy in less than three months and went through normal off-season workouts. Although he is healthy now, Walker said that he has a regimen of daily exercises and stretches to keep his back in good shape.
Despite the back ailment last season, Walker still hit .282, with 23 home runs and a career-high .823 on-base-plus-slugging percentage. The Mets felt confident enough in his recovery that they gave him a one-year, $17.2 million qualifying offer. Walker accepted, and the sides have talked about a contract extension.
Duda�s injury, a vertebral crack, is another common back ailment in athletes, Hecht said. The usual treatment is rest and rehabilitation.
Before his recent flare-up of back spasms, Duda, 31, said he, too, was regularly doing exercises to support his back. Until last week, there was reason to be optimistic about Duda�s outlook because, after missing 107 games last season, he returned in September to play eight games.
Still, as a precaution, right fielder Jay Bruce took ground balls at first base during workouts on Sunday. Jose Reyes and Wilmer Flores are options to back up Walker; Cabrera, the infielder with the balky knee last season; and Wright.
Wright�s stenosis, a narrowing of the canal in the spinal cord that can lead to chronic stiffness and pain, is the most complicated ailment. Hecht said the condition was rare among younger athletes, and while Wright is only 34, he is entering his 14th major league season.
Wright said doctors have told him his condition was the �perfect storm� of three factors. He was born with a narrow spinal canal, Wright said, explaining, �Ideally, you�d want a little more space so that those nerves don�t get pinched.� Wright also sustained a vertebral fracture years ago, which, along with the wear and tear of playing so much baseball, has contributed to his injury.
Wright had neck surgery in June, for an injury that he said was unrelated to his spinal stenosis, which was diagnosed in May 2015. After rest and rehabilitation, he returned to the field in August 2015, but he often required hours of stretching and preparation to play. That kind of maintenance is expected to continue for the rest of his career.
While expectations of how much Wright can play will be tempered again this season, he can try to limit the effects of spinal stenosis. Compared with last year, Wright said, he has a better idea of how to manage his back in spring training, even though he is still building up his arm strength after his neck surgery.
�I know the routine and the process,� he said. �I understand my body a little bit better.�
In any sport, injuries to any part of the spine are possible, as well as injuries to the soft tissue and fascia that help comprise the makeup of the body. Up to 20% of all injuries that occur in sports involve an injury to the lower back or neck.�For Answers to any questions you may have please call Dr. Jimenez at
For running athletes as well as a variety of other sport professionals, proper muscle strength, flexibility and mobility is fundamental towards the best, overall performance. When an injury or a condition develops, the damage can lead to issues and complications for the athlete. Many muscles surrounding the lower spine, buttocks and thighs are ultimately essential for the athlete and following various methods and techniques can help.
The gluteus medius is a muscle that has peaked a considerable amount of interest among those who actively engage in sports and physical activity as well as healthcare professionals alike.
This muscle plays an important role in stabilizing the pelvis during the stance phase of gait and for controlling the sagittal, frontal and coronal planes of movement of the lower extremities during stance phase. An injury or condition affecting the gluteus medius can frequently be associated with a wide variety of musculoskeletal syndromes, including back, hip and knee complications from sports injuries.
Anatomy and Biomechanics of the Gluteus Medius
During single extremity weight bearing exercises, such as stance phase of walking or running, lunging and landing from a jump, amongst others, the lower extremity joints are designed to naturally absorb the impact of gravity being placed against the body. When the force of gravity acts upon the body, the joints move into distinct directions and the muscles need to properly function as to counteract these forces. Generally, these muscles function isometrically and/or eccentrically. For instance, with the absorption movements of a pelvic lateral tilt, the hip abductors work to stabilize the movement. With an anterior pelvic tilt absorption movement, the pelvic posterior tilters such as the gluteals and hamstrings work to stabilize mobility. With hip joint flexion, adduction and internal rotation, the muscles are controlled by the gluteus medius and other hip joint external rotators, such as the gemellus muscles, quadrutus femoris, obturator muscles and the piriformis. And finally, the quadriceps controls the absorption movements of a knee joint flexion, the soleus of an ankle dorsiflexion and the tibialis posterior, FHL and FDL, stabilizes midfoot pronation.
The gluteus medius is a proximal hip muscle which purpose is to control proximal pelvic/hip joint motion that in turn controls lower limb kinetics around the knee and ankle. The gluteus medius attaches to the iliac crest and inserts onto the greater trochanter, functioning as a hip abductor, hip external rotator and stabilizer of the pelvis on the femur during stance phase of gait. It�s most significant role, however, is to compress the femoral head into the acetabulum during the stance phase of gait. The muscle is divided into three equal parts: anterior, middle and posterior.
The fibres which make up the posterior section of the muscle travel parallel with the neck of the femur while the middle and anterior sections travel vertically from the iliac crest to the anterosuperior feature of the greater trochanter. It�s been suggested, that each individual part of the muscle functions independently from each other as each of the three portions contain their own supply of nerves which run through the superior gluteal nerve.
Several conducted EMG studies found that the gluteus medius is not completely active during isolated abduction of the hip, an interesting find contrary to previous studies. The researchers also observed that the tensor fascia lata, or TFL, is considerably more active during isolated hip abduction. It was additionally suggested that the three portions of the gluteus medius muscle have a phasic muscle action during the stance phase of gait. First, the posterior fibres of the muscle are far more active at heel strike and then, the muscle is gradually inducted from posterior to anterior as the movement of the structures occurs from an early stance to a late stance of gait. Most specifically, the front section of the muscle is most active while at full stance during the single extremity support phase while the back fibres function effectively at the beginning of a heel strike.
During the same study, it was suggested that the primary purpose of the gluteus medius is to restrain the head of the femur into the acetabulum, or socket of the hip, throughout normal movement as well as to help stabilize the pelvis on the femur in single limb stance. They also proposed the assumption that each of the three distinct portion of the muscle performs a unique function of movement.
Primarily, the posterior fibres of the gluteus medius contract during the early stance phase to secure the joint into the socket. According to the study, this notion was supported by the observation that the posterior fibres have an almost parallel fibre alignment along the neck of the femur. Therefore, it can be concluded that the posterior fibres essentially function to stabilize and compress the hip joint.
Subsequently, the middle and anterior fibres of the gluteus medius, which travel vertically, initiate hip abduction, which is then completed by the TFL. These fibres function together with the TFL to stabilize the pelvis on the femur, in order to prevent the other side from dropping. The researchers demonstrated that the TFL plays the most crucial role when supporting the pelvis against the hip while the gluteus medius only aids this process. The anterior fibres allow the femur to rotate internally in relation to the hip joint during the mid-to-end stance phase. This is important towards pelvic rotation so that the opposite side leg can swing forward furing gait. The anterior fibres play this role along with the TFL.
Furthermore, the study hypothesized that the primary functions of the gluteus medius are to stabilize the femur against the ilium, to perform as hip rotators and to near the head of the femur into the acetabulum, creating a very tight and stable hip joint during gait.
The gluteus medius has been considered to only function while in neutral hip/pelvic postures as it would when supporting the pelvis and hip during single extremity stance. Exercises and physical activities which force these muscles into lengthened or overly shortened positions may in fact not target the gluteus medius but other hip abductors and external rotators instead. The gluteus medius has the largest CSA of the hip abductors and is considered to be the most dominant of the hip abductors. It can generate tremendous amounts of force despite of its size due to its short fibres which are packed tightly together. However, it does not create large forces over a wide range of lengths. Instead, it is designed to function isometrically to balance the hip on the femur.
Injuries to the Gluteus Medius
Injuries or conditions affecting the gluteus medius can be associated with a wide variety of musculoskeletal complications. These type of issues can occur when the muscles of the gluteus medius are unable to properly control the movements and alignment of the pelvis, femur and tibia. These injuries or conditions include but are not limited to: patellofemoral pain syndromes, lumbar spine complications, ITB friction syndromes and hip joint pathology.
For some time, it�s been believed that hip internal rotation is an undesired pathomechanism of the hip joint as hip joint rotation allows the femur to move inwards and develop valgus collapse at the knee. It�s been suggested that this unwanted hip internal rotation is a consequence of a weak gluteus medius and other hip joint external rotators. However, studies have also suggested that, as a matter of fact, these muscles seem to function better physiologically if the hip is placed in some internal rotation.
Direct trauma from an injury to the gluteus medius, such as trigger points, strain injuries, tendon tears and relative trochanteric bursitis, have also been closely associated to having a weak gluteus medius.
Rehabilitation Exercises for the Gluteus Medius
A wide range of studies have investigated the purpose of the gluteus medius whilst performing several lower extremity exercises. The following conclusions were based on corresponding electromyographic, or EMG, data during specific exercises. In a more recent study, researchers looked at the relative contribution between the gluteus medius and the TFL and identified five exercises that best utilized the muscles of the gluteus medius with minimal TFL: Clam with Thera band, sidestep with Thera band, unilateral bridge, quadruped hip extension, knee extending and quadruped hip extension, knee flexing.
Because there�s many exercise variations which may be beneficial to strengthen the gluteus medius, many healthcare providers may utilize a rehabilitation approach depending on the individual�s level of pain when performing the initially recommended exercises. If the individual experiences pain while participating on weight bearing movements, then non-weight bearing variations may be used. Healthcare providers may often also recommend specific exercises according to what they believe may be the most effective program for the individual�s gluteus medius complication. Furthermore, it�s been previously argued that what an individual feels in and around their posterolateral hip, may be the gluteus medius and/or other hip abductors, such as the gluteus minimus, or other deep hip rotators, such as the piriformis, the obturator group, quadrutus femoris and gemellus muscles. Studies utilizing both surface EMG and fine wire EMG on deep muscles are required to demonstrate the interactions between these muscles.
The gluteus medius functions in various ways during hip flexion to extension as demonstrated in the gait cycle, suggesting the muscle works through very neutral hip and pelvic positions, essentially functioning isometrically or through very short ranges of movement. The following exercises direct weight bearing through the hip joint or simulate weight bearing through the hip joint, making them more functional in terms of activation in weight bearing positions.
Standing Short Range Hip Abduction
This specific exercise, manages both the stance limb, isometric, and the non-stance limb, concentrically. First, the individual should stand with a band around the foot with the hand on the same side supported by a broomstick for balance. Then, the individual must carefully move the banded leg into abduction, then external rotation and extension. The stance limb must be in slight hip flexion and remain in this position. Follow by performing 8 to 10 repetitions of slow hip abduction/external rotation/extension. The individual should feel the effects of the exercise in both the stance side of the gluteus medius while in slight hip flexion as well as the abducting side of the gluteus medius into slight hip extension.
Kneeling Clam
This exercise is a variation of a popular clam exercise which has been demonstrated in several studies to activate the gluteus medius muscle. This is performed in weight bearing as the limb can accept axial loading via kneeling. First, the individual should kneel on a bench with a band wrapped around their knees. Keeping the feel together, holding onto a broomstick may be used for balance. Then, the individual must carefully move their knees apart whilst maintaining foot contact. This moves the hip into slight abduction and external rotation. Follow by performing sets of 10 to 15 repetitions and ensure the movement is kept small, about 2 to 3 inches only.
Modified Clam
This is another variation of the clam exercise which resembles the traditional clam exercise but with several variations. The first important difference is that the heels push into a wall or box to simulate weight bearing through the extremity. Then, the exercise is performed as an isometric hold and not an active abduction and adduction movement. Finally, the exercise is performed in two positions: slight hip flexion and slight hip extension. A light weight is generally placed on the knee to act as an external resistance. The goal is to hold the limb static for a specific period of time.
Hip Strengthening Exercises
Before attempting any of the above exercises, make sure you�ve consulted a healthcare professional to avoid further injury. The muscles around the hip can also be strengthened prior to experiencing any complication or may be occasionally directed by a specialist as part of the rehabilitation process. By strengthening the tissues around the hip, an individual can avoid damage and injury by increasing the strength and flexibility of the muscles to promote health and mobility.
Pelvic Manipulation, Massage and Chiropractic
Manipulation is the therapeutic application of manual pressure or force to restore the normal functioning of the body by balancing the structure. Often times, complications to the spine can affect other surrounding tissues of the body, including nerves, which can ultimately radiate pain and symptoms to various organs. Best known as osteopathic manipulative treatment, or OMT, this technique is typically utilized to treat a variety of musculoskeletal injuries or conditions, such as low back pain, neck pain and pelvic pain, caused by sports injuries, repetitive stress injuries and even, tension headaches. Foremost, a healthcare professional must properly evaluate and diagnose an individual to determine the presence of an injury or condition which may be causing painful symptoms. Individuals with pelvic pain, or instance, may experience painful symptoms along with connective tissue restrictions along their thighs, and glutes, including the gluteus medius. Pelvic manipulations may commonly be used in this case to improve blood flow to the affected area, decrease swelling and restore mobility to the surrounding structures.
Massage is similar to a manual manipulation. A massage is a hands-on technique that involves applying gentle, sustained pressure into the connective tissue restrictions, also eliminating pain as well as other symptoms and restoring function. Massage can increase blood flow, which in turn delivers more oxygen and nutrients to the muscles surrounding the affected regions of the body. The increased blood flow may also help carry away unnecessary substances which may have accumulated through time.
While osteopathic manipulation and chiropractic often seem to overlap each other, they do differ from each other. Chiropractic is a form of alternative treatment which focuses on musculoskeletal injuries and conditions as well as nervous system complications to naturally restore the structure and function of the body. After a careful analysis of the individual�s symptoms, a chiropractor may commonly follow through with a series of spinal adjustments as well as manual manipulations to correct any misalignments in the structures of the body. When certain areas of the spine are subluxated as a result of an injury or condition, the surrounding structures can often become irritated and inflamed, leading to complications within the tissues, including gluteus medius issues. A chiropractor will perform chiropractic adjustments to gently re-align the spine in order to progressively reduce the pain and swelling around the affected area. A chiropractor may even recommend a series of exercises according to the individual�s needs to promote healing and speed up the rehabilitation process. Chiropractic care has become a popular alternative for many types of complications, including back pain, neck pain and pelvic pain, among others primarily due to its effective treatment techniques.
In conclusion, a variety of methods and techniques are available to athletes to help them strengthen their gluteus medius, especially when enhancing their performance after experiencing an injury from their specific sport or physical activity. Commonly including several types of stretches and exercises aside from their preventive training, athletes can gradually improve the flexibility and mobility of their lower extremities. Also, chiropractic care as well as physical therapy and massage can tremendously help athletes recover to return-to-play immediately.�
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
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