The Achilles — Preventing Non-Contact Injuries

Achilles’ Heel…Or Rather, His Tendon?

The injury you’ve probably heard of — rupturing the Achilles tendon. It’s an injury that plagues professional sports in all facets; no one is immune. Just last year, following the New Orleans Saint’s acquisition of former Dallas Cowboy star, Dez Bryant, the wide receiver would go on tear his Achilles in practice, his season over before it even began, from a non-contact injury.

In Baltimore, our players are no stranger to Achilles injuries: former Ravens linebacker (it really pains us to write “former”) Terrell Suggs tore his left Achilles in 2012 and then, three years later, tore his right Achilles in the 2015 season opener. Jimmy Smith also tore his Achilles in the 2017 — ending his season.

In the scheme of things, majority of these players ultimately return to the field. By way of medical intervention — surgery, or conservative care — we can assist their recovery. But it doesn’t change the fact that we’d like to prevent these injuries from happening at all.

It’s impossible to plan for contact injuries; they are, in most cases, freak accidents, and as much as we would like, we can’t always prevent them from happening. But non-contact injuries we can try to prevent. And, the best way to prevent injuries of this nature, is by proper conditioning and strengthening the muscles associated with these tendon tears.

What is the Achilles Tendon?

The Achilles tendon is located in the back of the leg; it’s the thickest and strongest tendon in the human body. It begins around the middle of the calf and serves to connect the plantaris, gastrocnemius and soleus muscles to the heel bone.1

The tendon can take force of up to 3.9 times body weight when walking and up to 7.7 times body weight in running!2

Who is at risk, and how can I prevent it?

The Achilles tendon is also the most commonly rupture tendon — with the incidence of ruptures being in the range of 5-10 per 100,000 people.3 Barring the obvious young athletes, the population most at risk for Achilles tendon injury are actually men in their 40s.4 Think of the weekend warrior type person — they’re trying to play a pickup game of basketball — and all of a sudden, they feel a pop in their lower leg.

Below, we’ve prepared a few exercises for conditioning: strengthening and recovery in the context of the achilles

 

Loaded Gastroc Stretch

Loaded Lunging

Plyometric Jumps

References

1. Functional anatomy of the Achilles tendon
2. Calcaneal loading during walking and running.
3. The incidence of Achilles tendon ruptures in Edmonton, Canada.
4. The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients.

Quick Fix: Shin Splints

 

You’ve probably heard of shin splints — heck, you’ve probably experienced them. Shin splints are incredibly common, and they affect athletes in a multitude of disciplines; running, dancing, gymnastics, just to name a few. The term is thrown around so frequently, it begs the questions, what are shin splints exactly? Barring the obvious “it’s just pain in your shins,” shin splints are an overuse injury that can cause micro tears and inflammation in the soft tissue surrounding the bone lining of the tibia. Many factors, such as muscle weakness and even the shoes you wear can contribute to the development of shin splints.

Strengthening and Recovery

We’ll spare you all the of the usual platitudes associated with posts like these — today, we’ll move straight to the strengthening and recovery component.

Here are two easy and novel exercises that you can add to your workouts, to hopefully help ward off the ever vexatious shin splints.

 

Clinic Highlight — The Core Stix

 

Mike Kadar wanted something different — as the strength and conditioning coach for the Pittsburgh Penguins, he was searching for a way to train himself and his athletes in a way that would functionally pertain to their craft. Mike sought the expertise of Kregg Koch — a design engineer for NASA’s Space Shuttle Program — to turn that desire into reality.

The Core Stix would become the fruits of their labor; the brain child of these two individuals. Its design based on what they a call a simple, yet profound philosophy:

No one has ever shot a puck, taken a three-pointer or thrown a touchdown lying down, so why are so many core exercises done with your back on the ground or in a seated position?

Usable strength comes from your ability to directly tie your training motions to real-life performance movements, which means you need to train standing up to get optimal results.

Applying the same principals of upright functional training to healing and recovery, physical therapists and seniors quickly started incorporating Core Stix into their routines in order to provide a safe and stable way to build usable strength.

Here at Gold Medal, we couldn’t agree more. Which is why the Core Stix have become such an integral part of clinic, for all of our patients, no matter their age or activity level.

Whether we’re working on functional strength — rehabbing young athletes to return to sport, or providing our elderly patients with exercise progressions, the ever innovative Core Stix knows no bounds. We couldn’t be more proud to offer this at our clinic.

Below, we’ve taken some videos showcasing the versatility of the Core Stix, as well as a companion video to accompany the post.

Tim and Bryan Explain it All

Examples

  • Push/Pulls
  • Resisted Split Squats
  • The Forward Drive

The Art of Warming Up – Dynamic Stretching

Warming up is an art that presents itself in many forms. Anything from cardio to stretching, and many other countless activities come to mind, in the context.

But for our blog post today, we’re going to be talking about dynamic stretching and its impact on your workout.

What are Dynamic Stretches?

The most common type of stretching you’ve probably heard of is ‘Static Stretching’. Static stretching refers to holding a muscle under tension — in a specific position — until a stretch is felt, and rinse and repeat. On the other hand, dynamic stretching involves moving the limbs through their full range of motion, and is repeated several times. An excellent an example of static stretching is something like the doorway stretch for your pecs, as shown below. Whereas an alternative and more dynamic stretch, would be these foam roller snow angels, also shown below.

The Case for Dynamic Stretching

Now that we have an idea of how these two stretching sub-types differ, you may be wondering, why should I consider dynamic stretching?

Static stretching and Dynamic stretching have both shown efficacy in increasing range of motion.1 2  But here’s where the two really start to contrast: while such a benefit to range of motion can be attributed to both, some studies actually suggest that static stretching may decrease overall performance prior to a workout.3 4 And in some cases, dynamic stretching has been shown to even increase overall power output.5

Given the potential for increasing range of motion and a potential boost to overall power output, athletes may want to consider dynamic stretching as a regular part of their warmup. In fact, a 2012 meta-analysis published in the International Journal of Sports Physical Therapy had this much to say:

…To increase ROM, all types of stretching are effective, although PNF-type stretching may be more effective for immediate gains. To avoid decrease in strength and performance that may occur in athletes due to static stretching before competition or activity, dynamic stretching is recommended for warm-up.6

Below, we’ve prepared some examples of dynamic stretching that you could potentially include in your warmup, depending on the activity.

Examples

Good Morning and Air Squat Superset

Leg Swings

Lunge with Thoracic Rotation

References

1. A comparison of two warm-ups on joint range of motion.
2. Acute effects of dynamic stretching, static stretching, and light aerobic activity on muscular performance in women.
3. The acute effects of static stretching on the sprint performance of collegiate men in the 60- and 100-m dash after a dynamic warm-up.
4. Effects of stretching on maximal anaerobic power: the roles of active and passive warm-ups.
5. Acute effects of static, dynamic, and proprioceptive neuromuscular facilitation stretching on muscle power in women.
6. CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION

Pitcher’s Dilemma — Preventing Injury in America’s Pastime

It’s a sport etched in the very heart of our country’s history; it brings us joy and — more often than not — can have us feeling downright dejected. And here in Baltimore, we know a thing or two about the latter…

But regardless, countless kids each year will step up to the plate for the first time in their lives with hopes of emulating their favorite players. Many will find a quick exit from the sport; but some may continue into their High School years, and others may venture past that to achieve even greater success. For those that continue, injuries will be — just like any other sport — part of the game.

When we think injuries, one position in particular brings to mind a myriad of orthopedic affliction: the pitcher.

Young pitchers are in a particularly tough spot. They’re at risk for serious injury, with no clear cut reasoning as to why.1 Many signs point to limiting the inning count to lower than 100 per season, and barring pitchers from playing catcher, as a means of reducing these injuries; and other concepts, such as pitch count, arm angle, and throwing a curveball have become topics of contention in the context.

Perhaps most famous for injuries such as the “Tommy John” (Ulnar Collateral Ligament Sprain), pitchers are also no stranger to the likes of Rotator Cuff Tendonitis, just to name a few. And although we’ve no concrete way of preventing such maladies from happening, proper movement and strength screening, such as Functional Movement Screening (FMS), or Selective Functional Movement Assessments (SFMA), can help to identify areas of problem. With such knowledge in hand, practitioners could focus their efforts on what they need most.

Cue the concept of ‘prehabbing’

Pitching is one of the most complex arts in the world of sports. Similar to the golf swing, for example; it requires timing between the arms, legs and torso, to achieve consistency in the most efficient manner. Lacking the required strength, endurance and mobility in the muscles utilized to execute these movements, plays a role in the breakdown of mechanics as the inning/pitch count rises. Distance running, the long toss, and dynamic exercises that target both the upper and lower body musculature, should be emphasized.

Below, we’ve prepared some awesome exercises and recovery techniques that may help you through the season!

Strengthening

The Prone “Y” & Squats

Recovery

The Posterior Capsule Stretch & Instrument Assisted Soft Tissue Massage

References

1. Risk of serious injury for young baseball pitchers: a 10-year prospective study.

Obligatory — The Bench Press

“Hey bro, how much do you bench?”

Perhaps the most famous verbiage in a gym rat’s arsenal.

And perhaps for good reason — because what would the world of powerlifting be without the bench? It’s the quintessential exercise; it’s the one everyone and their grandmother knows in the context of lifting.

While not being as flashy as the snatch or clean and jerk, it’s still a complex movement with a lot of variables to consider when performing. Your chest, arms and shoulders are all an active component — and focusing attention onto these areas independently can give you that true strength to help you reach your potential with this exercise.

These are are a few exercises that we really like as supplemental work or as substitutes when dealing with pain.

The Floor Press

The Floor Press is the absolute bomb, especially if you’re having shoulder pain or are limited by your shoulder in general when performing the bench. It’s great because it requires you to push through a smaller range of motion to perform. If you’re rehabbing your shoulder, for example, this would be a great replacement for the bench.

The Dumbbell Chest Fly

Awesome supplemental exercise to train your pecs for hypertrophy — with dumbbell in each hand, the chest fly allows you to train each arm independently. Time under tension is important to keep in mind when performing this exercise.

The Close Grip Press

The close grip press can be a great supplemental exercise to train your pecs for hypertrophy, also. Think about pressing the dumbbells together throughout the movement. Time under tension is, again, important to keep in mind when performing this exercise.

Lift Heavy – The Deadlift

The year is 2016 — the stage is set at the Giants Live World Deadlift Championships. Eddie Hall is poised to make history — becoming the first man to deadlift 500kg.

The strain of the lift so great, Eddie would pass out almost immediately after.

While this is on the extreme side of weight lifting — the deadlift at its core is the same at all skill levels. If we were to break it down further, we can isolate the mechanism to the hip hinge.

The hip hinge is the fundamental pattern when lifting anything heavy off the ground. And the range can apply to all weight levels; from lifting a heavy box from the ground to Eddie Hall deadlifting 500kg — the hip hinge is the most efficient and safe way to lift.

Below our some of our favorites for showcasing the hip hinge.

The Hip Hinge

  • Kettlebell Deadlift
  • Kettlebell Swings
  • Single-Leg Deadlift

Overhead Press — The Strongman, The Shoulder and The Oak

 

The Austrian Oak, introduced in 2012 at the Arnold Strongman Classic, is among one of the most interesting lifting events in the modern era. The oak — beautifully crafted entirely of wood — varies in weight yearly, but can typically reach excess of 460+ lbs.

Competitors are not only tasked with lifting this monstrosity from the ground, but they must attempt to press it overhead. Any competitor unable to press the oak is given a “lighter” variant weighing in at around 375 lbs.

In 2015, Žydrūnas Savickas sought to defy all logic by pressing the oak — which was particularly heavy that year, weighing in at 503 lbs — not once, but a total of four times. Žydrūnas would solidify himself as the world record holder for the event, and the only person that year to rep the giant log even once.

The overhead press is an incredibly complex movement, and while Žydrūnas Savickas makes it look easy, it’s important to take into account all of the muscles that are connected to the shoulder.

Although you don’t need to press the Austrian Oak, the following exercises we’re about to show you can impact your ability to lift objects overhead, whether that’s on the scale of putting dishes in the cabinet, or snatching, clean and jerk and the overhead press.

Shoulder Strength

Developing the many muscles of the rotator cuff is integral to developing true shoulder strength. This set of exercises is meant to challenge the rotator cuff and its surrounding muscles. The following exercises are as follows:

  • Sidelying External Rotation
  • Sidelying Shoulder Flexion
  • Sidelying Horizontal Abduction

Shoulder Mobility

Not only is it important to build strength in the shoulder, but it’s just as important to build mobility in the shoulder so you can use that strength. These exercises put a focus on improving that shoulder mobility. The following exercises are as follows:

  • Overhead Loaded Cane/PVC Pipe Flexion
  • Supine Thoracic Extension (Remember: the thoracic spine is tied to shoulder girdle mobility!)
  • Overhead Banded Shoulder Distraction

Go Low – Improving Your Deep Squat

In September 1964, Bob Hoffman and his York Barbell Company laid their claim to the then nascent landscape of powerlifting by hosting the first national — albeit unofficial — lifting meet. The event would serve as progenitor to the Golden Age of American powerlifting and its three pillars: Squat, Bench Press, and Deadlift.

Over the years, the sport would adapt its own standard for these lifts. Most notably, the criteria for an acceptable squat would be determined by the depth to which one could squat down. And while squatting through a full range is important to achieve an ideal stimulus for strength, it’s important to take into account the mobility and flexibility component associated with this complex movement.

Our range of motion keeps us honest; it’s key when considering the amount of stimulus a person can apply to their body.

You may have heard of putting plates under your heels to “squat deeper”; however, this is just a temporary solution to a bigger problem: ankle mobility. A common problem for lifters, those without proper dorsiflexion will find it difficult to keep their torso upright when performing a squat. Being the case, improving one’s ankle range of motion is imperative when trying to go low. Below we’ve collected some of our favorite stretches to improve ankle mobility. Next time you’re at the gym, make sure to include these in your routine!

1. Squat Weight Shifting

2. Loaded Dorsiflexion & Loaded Plantarflexion Stretch

3. Dorsiflexion Mobilization with Monster Band

The Risk of Snow Shoveling and Heart Attack, & What You Can do to Help Prevent It

Snow shoveling can be a strenuous task for those who lead a sedentary lifestyle, and if certain precautions are not taken a heart attack may be in their future.

For many in the US, exercise is not a constant in their lives. Because of this, it can be especially worrisome when the person is expected to do very strenuous activity all of a sudden. Instances such as these occur during a heavy snowfall and the person has to shovel or push a snowblower. This sudden strenuous activity can sometimes lead to injury, and in even some cases a heart attack. Those who are at risk for heart attack when snow shoveling are as follows: those with a history of a prior heart attack, those with a known heart disease, those with a history of high blood pressure or high cholesterol, smokers and those who lead a sedentary lifestyle.

So what can you do to prevent heart attacks if you fall in that category? Here are a few things that you can do before you shovel to ensure you don't increase your risk of heart attack:

  • Talk to your doctor about shoveling before winter sets in.
  • Don't eat a heavy meal, drink coffee, or smoke before shoveling the snow. Blood is diverted to the stomach when eating, while coffee and smoking elevates blood pressure an increases heart rate.
  • Give yourself some time after waking up before shoveling, and be sure to warm up by marching in place an doing some stretches.
  • Use a small shovel, drink lots of water and take frequent 15-minute breaks.
  • Dress in layers while being sure to cover your head, neck, and mouth.
  • Watch for signs of heart attack (lightheadedness, dizziness, shortness of breath, and tightness or burning in the chest and neck/arms).