Overhead athletes place a lot of stress on their shoulders that can lead to tissue injury over time. One of the injuries that occurs is a SLAP lesion, or a tear of the cartilage (labrum) in the shoulder. This injury can be painful and debilitating. For athletes that require their shoulder to perform their sport it is important to know how to treat these injuries.
Treatment for a SLAP lesion is either conservative physical therapy to reduce inflammation and improve shoulder movement and stability or surgery to clean the labrum up and potentially involve more in depth anchoring. Either method can lead to a return to play, but the question remains which is more effective and which leads athletes to return to their prior performance? Athletes don’t just want to return, they need to return at or above their pre injured state. Using performance markers to gauge success sheds light on the best treatment options.
As with most things in medicine and injuries, the answer is not straight forward. Professional baseball pitchers who sustain SLAP tears do not return to the prior performance as well as position players do. The extra strain on the shoulder every pitch may be too much to handle regardless of the treatment tried. Athletes that have a rotator cuff tear in addition to a SLAP lesion have even worse outcomes; they tend not to return at all. Debriding the labrum is less invasive so athletes tolerate this procedure better than more in depth surgical intervention when returning to their sport. The good news is that athletes who underwent more physical therapy had similar return to play and return to prior performance as their surgical counterparts.
When treating overhead athletes efforts can be made to rehab them as long as possible in hopes of prolonging their playing days. Surgery is not a guarantee of continued play, so rushing into surgery hoping to improve your sport may not occur. Like other conservative therapy of the shoulder, the goal is to reduce pain and improve movement and stability. Focusing efforts in correcting GIRD, addressing posterior capsule tightness and improving scapular stability when treating baseball players with SLAP lesions can help keep them playing.
Fedoriw, W. et. al. (2014). Return to play after treatment of superior labral tears in professional baseball players. AJSM (42); 1155. http://ajs.sagepub.com/content/42/5/1155
One of main reasons that many males decide to weight train is to increase muscular size. Even though this is a very common training goal, many struggle to gain the lean muscle mass that they desire.
When you first start training it is very encouraging as you quickly increase strength, endurance, control and gain some size. The longer you train, the harder it is continue making gains. It is also increasingly easy to hit a plateau or get stuck in a rut. One of the challenges with researching how to gain size is that many studies are done on those new to training. Because newer trainees make gains easier it is difficult to draw conclusions to those with longer training histories. The other challenge is the vast amount of information available that may or not be recommending accurate information. When reading articles online one has to consider the source. Some sites offer quality information, but many others are based on personal experiences, pushing supplements or failing to take into consideration the effects of steroids or other physiologic factors.
Luckily, the Journal of Strength and Conditioning Research recently published a research study that helps to clear up the mystery surrounding size gains. The research examined 2 small groups of well trained individuals that followed one of two prescribed programs. Each program was performed 3 days a week for 3 sets of the same 7 exercises targeting all the major muscles. The first group performed each exercise for 8-12 reps and the other performed 25-35 reps per exercise. The study ran for 8 weeks and the results demonstrate that both training protocols were effective at building muscle in the participants. As you would predict, the participants that performed the heavier lifts build more maximum strength while those doing the lighter lifts built more endurance. Practically, the results help with programming for the goal of building size.
If you have been training for a few years and are looking to build some muscle then constructing a program based on the results of this study can help. Spend 8 weeks training in the 8-12 repetition range and then 8 weeks in the 25-35 repetition range. Perform 3 sets per exercise with maximal effort and choose large compound movements: squats, deadlifts, lunges, rows, pull ups, pull downs, bench or chest press, shoulder press, lying tricep extensions, lateral raises and curls. After finishing the cycle, repeat. In order to achieve size gain make sure that you dial in your diet, get adequate sleep for recovery and increase the amount of weight you use as your program cycles. This should help you reach your goals. It's definitely worth a try! Good luck!
Schoenfield, BJ, et. al. (2015). Journal of Strength & Conditioning Research. Oct2015, Vol. 29 Issue 10, p2954.
One of the best ways to improve sports performance is to get faster. Speed is a coveted athletic ability that coaches actively recruit for. We used to think that speed ability was genetically determined, but now know that speed is a skill that can be learned, taught and developed.
Before we talk about how to become faster, it is important to differentiate sport speed from track speed. Speed in a sport setting does not bear the same resemblance to track speed where every run follows the same predictable sets of events. Sport speed is adaptable where each run may be different, so when we talk about improving speed for sport, we are really discussing learning and reinforcing skills that will transfer to on field performance. We also need to remember that sport speed is not just linear, but will involve different lateral movement, change of direction, acceleration and deceleration events that all need to be considered and trained. The development of speed in a track setting will follow different rules since this form of speed is all linear and very repeatable.
For our improvement of sport speed we can break down speed into its smaller components and focus on each component before bringing everything back together to create a newer, faster athlete.
The chain of events for speed development (in a linear sense) are reaction time, acceleration, maximum speed and speed maintenance or speed endurance.
To improve reaction time we have our athletes perform pursuit drills, ball drops and speed initiation on verbal cues.
To improve acceleration we focus on falling starts, wall drills to learn the proper form of forward lean from the ankles, different starts like a split stance, false step or straight step from a stationary position and then work into flying starts and transitions. We also utilize resisted and assisted techniques to improve acceleration such as sled pulls, parachutes, uphill runs, downhill runs and bands. In the weight room athletes focus on improving their explosive power which will translate on the field as greater force to the ground leading to faster acceleration. Plyometric exercises, Olympic lifts and explosive strength exercises like squats and lunges all help develop power.
For many team sports, athletes may never get out of the reaction time and acceleration phases before having to make some type of change, either in direction or speed. So, working with athletes to get as fast as possible in 20 yards may form the majority of training. If athletes do routinely get beyond 20 yards then developing their max speed comes into play. The best way to accomplish raw speed is to spend more time sprinting. This develops the nervous system and the musculoskeletal systems to work at peak levels and is a great way to improve speed. To augment their speed training, have athletes perform strength workouts with the goal of gaining strength and power. Once again, plyometrics, Olympic lifts and heavy strength exercises will all help increase speed. This increase in strength, coupled with practicing being faster will result in increased athletic speed.
Speed endurance or speed maintenance is the ability to maintain maximum speed over longer distances. This is especially important in track events where the ability to maintain speed can lead to victory, but for field sports, this is the ability to maintain speed on breakaway plays. By training athletes to sprint over longer distances we improve their speed capacity. Increasing the length of sprints and tracking time will demonstrate how effectively athletes are maintaining their speed.
Developing each of these components will lead to faster athletes, but there are other considerations to think about. Working with athletes to optimize their form will decrease inefficiencies and improve sprinting quality. Not every athlete will be able to achieve the 'ideal' running form, but they can all improve their form to be the best they can be in their own body. So, improving form along with strength can lead to faster athletes.
Another consideration for field athletes is recovery. Many sports are sprint-recover type sports where they need to be able to react, accelerate, hit top speed quickly and then change pace before doing it again. Having athletes perform sprint repeats while fatigued will help aid their conditioning, but will not help out with hitting max speed since they will be fatigued and max speed training requires that athletes are fully rested.
Other sports have different needs and may need to develop transition speed or change of direction speed. Stealing a base in baseball is an example where athletes start with lateral movement before explosively changing direction into linear movement. This is also teachable. Observing the movements in the sport will offer insight into the types of movements and transitions that are being utilized.
While not a definitive guide to speed, the main thing to remember is to develop global strength and power, work on running form and training fast. Athletes that train fast get fast. Good luck!
Hamstring injuries are one of the most common injuries in sports. Time lost from competition can be substantial, and there is a high risk for re-injury.
One of the reasons that the hamstring is so susceptible to injury is that it crosses both the hip and knee joints. During running, the hamstring works to decelerate the knee at ground contact and then assist the glutes to accelerate the hip into extension. This change in function is believed to be one of the reasons that the hamstring is injured.
Risk factors for injury include a previous hamstring injury and weakness in the hamstrings.
Currently, there is a lack of systematic research on effective hamstring prevention, treatment and rehabilitation programs. Stretching has not been shown to decrease injury risk, and our current knowledge on prevention has been primarily performed on soccer athletes utilizing Russian/Nordic hamstring exercise as an eccentric training technique. This exercise has been effective in reducing the rates of hamstring strains in soccer athletes. However, due to the eccentric action of the exercises, it does cause DOMS (delayed onset muscle soreness), so starting a program should be progressed accordingly. While not studied for prevention, Romanian deadlifts activate the hamstrings eccentrically, and they can be an adjunct to a prevention program.
If a hamstring is strained, the location can affect the time lost from competition. Proximal hamstring injuries, avulsions where the muscle pulls off the bone and larger lesions all increase the time to heal. If you have access to a physician doing corticosteroid injections, this can assist in decreasing the healing time without an increased risk for re-injury.
Rehabilitation of hamstring injuries follows the same guidelines as other rehab programs including decreasing pain and inflammation; restoring range of motion and neuromuscular control; strengthening and progressing to higher speed and higher functioning sport specific drills. A more holistic rehab program focusing on core stability, hip strengthening and neuromuscular control is more effective than an isolated strengthening and stretching program in return to sport and re-injury rates. Adding in eccentric exercises in the late strength phases can assist with injury prevention as well as incorporating agility and running drills to improve proprioception and stride mechanics.
While the evidence for the most effective treatment of hamstring injuries continues to be developed, we know that eccentric training is beneficial at preventing initial strains and recurrent strains. The added benefit of eccentric hamstring strengthening is that they can also help decrease ACL injuries in certain populations.
What have you found to be effective in preventing and rehabbing hamstrings?
When evaluating athletes for lower extremity injuries, it is remarkable how many have tight calves and lack range of motion in dorsiflexion. This lack of mobility is an adaptation that our athletes’ bodies have made in response to requirements of running and cutting. It can lead to changes in force absorption that can contribute to shin pain, foot pain or even anterior knee pain. A lot of these athletes can benefit from some mobility work to improve their active range of motion.Here are a couple of resources with simple, self-performed exercises that athletes can do on their own to improve that motion: Mike Boyle and Sports Medicine Research Blog.
The first involves driving the knee forward over the ankle as a self-mobilization technique, and the second is a PNF contract/relax technique to increase overall range of motion. Both can be performed quickly and simply and can assist with improving motion at the ankle.
Though athletes likely do not spend much time thinking about ankles, increasing their mobility will have a positive impact on running ability and force absorption.
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*This site is for educational purposes only, it is not meant to diagnose, treat or replace medical advice. Before starting an exercise program always make sure that you are healthy and able to do so safely.*