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PROS ONLY SECTION (Quick take so you don’t have to wade through all the biomechanical lingo)

 For the athletes with Turf Toe, Foot, or other Chronic problems, here’s the quick take:  If you have a knee injury that is slow healing, if you have a hamstring that heeps getting re-tweaked, if you have a chronic ankle injury, then the problem could be your FOOT.  It’s getting overlooked.  I’ve worked with so many athletes with chronic problems that had a biomechanically messed up foot that wasn’t being addressed.  It’s a piece of the puzzle that can stay hidden if not looked for.  Just treating the toe via taping, rest, exercise, etc, is NOT enough and does not address the CAUSES.  A certain foot type can play into the big toe (and chronic ankle sprains, knee injuries, hamstring strains, etc) getting chewed up and undergo additional stress causing further injury.  A biomechanical assessment will determine the causes and determine a 3D plan to address the causes and the compensations.

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The guys at the table would be the following questions: How did he strain his MCL? Why does his hamstring keep getting re-tweaked?  Why does the Achilles stay flared up? Why so many ACL injuries in these players? Why isn’t Kolb’s Turf Toe getting better?  The elephant in the room would be the FOOT.  Yes the foot.  Don’t jump off the band wagon yet.  I’m not saying the foot is the cause of every injury and is the end all.  However, it is often overlooked and is a huge player in long standing injuries and can be the missing piece of the puzzle.

This is part of my story.  I got so frustrated with doing conventional treatments and knew I was missing something.  I started looking into biomechanics and the light went on.  I had an engineer friend convey to me how engineers do an analysis of a bridge and “fix” the bridge.  They would do a stress-strain analysis of the entire structure.  They use all their mathematical genius to assess where in the structure the CAUSE is coming from, BEFORE they fix the broken down component of the structure.  Otherwise, they would be back in 6 months to have to fix it again.  All their stress-strain and analysis scenarios were aimed at finding where in the structure the problem was coming from, and it was not the broken down component.  YES, THAT’S IT! I knew that was the way I wanted to biomechanically look at the human body to find the cuase of injuries instead of using traditional means of treating symptoms.

The foot became a significant piece of the puzzle that was getting overlooked.  The foot plays into 20% of knee problems.  That is not a stat I am going to reference because it is my own stat of having worked in a clinic for 12 years.  I stand by it.  I would see about 1 in 5 knee injury athletes having some type of foot deformity that was playing into their injury.  I’m talking about non-contact injuries.

Now back to Turf Toe.  Again, great stuff out there on treatment techniques. But  what about the WHY.  What is the cause of a long standing Turf Toe problem?  Yes, I get it about the the nature of the sport (if it’s football) and repetitive extension or hyper-extension of the first MTP. But that still doesn’t address a potential CAUSE.  And that cause would be…………..  FOREFOOT VALGUS.

A forefoot valgus is where the medial, or big toe side, of the forefoot is dropped DOWN in relationship to the rest of the foot (I am throwing a plantarflexed 1st Ray in with this as well, in that it does the same thing).  A plantarflexed 1st Ray is where the 1st Ray is dropped, or plantarflexed, in relationship to the other MTP’s. In the above pic, the yellow line is a reference point of what the forefoot should look like —-STRAIGHT.  The blue line (the line of the ruler placed against this person’s forefoot) is a reference point of the forefoot valgus that this person has. The ruler or blue line should be straight. It should be EVEN with the yellow line.  But look how dropped the medial forefoot is.  It’s huge and the angle that the blue and yellow line makes is about 20 degrees or so.  That’s significant.  Make sense?

So in other words, the forefoot/1st Ray/big toe, gets to the ground first, it takes most of the ground reaction forces.  It takes the hit.  It get’s chewed up.  If you add onto that a rigid 1st MTP (or stiff BIG toe), it’s BIG trouble.  It’s simple isn’t it?  Big toe down = Increased load to the big toe.  If you are a stunt man car jumper and one of the axles is off and the same wheel lands first, and before the other whells, every time, don’t you think that tire, axle, side of the car would have some break down or damage?  HELLOOOOO!

I see this all the time in football players, basketball players and even in golfers.  Except golfers don’t get turf toe.  Since the golfer’s foot is fixed, the right rearfoot on the back swing inverts to compensate for the forefoot valgus and they roll their foot as the rearfoot throws them to the lateral border of the foot. Or they just toe out to avoid it and lose the power of their swing.

So you have turf toe and your trainer or whoever puts a graphite orthotic or Morton’s extension in your shoe to prevent extension of the big toe.  Ya, ya, I get it, in that it stops some of the problem and it is a good temporary fix.  But that is “robbing Peter to pay Paul.”  You don’t fix the problem nor get to the cause by doing that and it will cause other problems later down the pike and decrease performance on the field.

Or, they just place an off the shelf orthotic in the shoe.  To me that is just crazy.  That is taking a stab in the dark.  That is shooting an arrow at no target.  I worked with an orthopedic surgeon for a year that was a foot specialist to learn all I could about the foot.  It was an awesome experience.  However, his orthotic methods were antiquated.  He would just give everyone an off the shelf orthotic.  Mostly he did this as a pendulum swing from seeing the other end of the spectrum where athletes would get expensive custom orthotics that didn’t help either.  When you go to the eye doctor, do you just get off the shelf glasses and hope that they work?  The eye doctor is very precise and does all kinds of testing to make sure you have the right prescription.

It should be the same way with orthotics.  A forefoot valgus will need a LATERAL forefoot post.  There are different cases and philosophies on how to determine the degrees of a post.  After working with a podiatrist for 2 years, an orthopedic physician for 1 year, going to numerous foot and orthotic courses, I have seen it all.  I think the most comprehensive, functional, sport specific paradigm that yields the best results is functional testing.  I teach a whole 2 day course on this and obviously can’t cover it all in a “Kolb” article, but functional testing takes out all of the guess work and determines precise degree of posting that yields the best performance of the athlete.  Two degrees difference will not be that significant on a sedentary elderly person, but we cannot use those same “Oh well” standards on professional or high level athletes.

I use a comprehensive functional testing system and customize it for the individual being tested to determine what works best for posting or even if an orthotic is even needed at all. For example, had one person that had a forefoot varus and used 4 degree posting with functional tests of lunges, and a cutting drill; his meniscus symptoms decreased significantly, he could reach further with the lunge tests, and cut off that leg with a decreased time on the drill with the post as opposed to without it.  I performed repeat tests to make sure it wasn’t a result of practice and just getting used to the movements.  So, I thought more would be better.  Used a 6 degree post and tried again.  WRONG…… symptoms increased, quality of motion was worse, excursion distance was worse, time on the drill was worse, everything was worse (I did numerous other tests to verify the results).  After working with athletes that strive to decrease their 40 by .2 sec, posting precision is the least that can be done for them to overcome a chronic problem.

COMPENSATIONS

Asking “What kind of foot exercises should the athlete do?” is another elephant question.  It’s like asking, “What color of shoe strings should the elephant use, purple or pink? In other words, it doesn’t matter.  It’s the wrong question.  Are “towel scrunches” or toe flexion exercises really relevent?  Really??  Is having Adrian Peterson (who used to do explosive jumps onto a 3 foot platform while holding 50lb dumbbells while he was at OU)  doing towel scrunches appropriate?  Not in my house.  It’s pink shoe strings.

Compensations that need to be addressed are usually up at the hip.  If the toe is inflamed and painful then the athlete doesn’t have the range of motion to extend through it.  So he can’t get over his foot.  So his stride length shortens and the hip flexor doesn’t get eccentrically turned on as usual and tightens up.  Or, since he can’t get over it, he has to bail out, or TOE OUT, on that foot and the hip rotators get tight.  Not sure which is the chicken or the egg, but it happens and needs to be addressed.  These are HUGE components of performance and will affect every aspect of the game.

I read one comment from a specialist physician as follows, “Lineman, backs, and the secondary, are always pushing off the toes when they come out of their stance, leading to turf toe.”  Well, that would go for about every position on the field.  If that were the case, we would see a higher incidence of Turf Toe and foot injuries.  It’s not just pushing off the toe or running hard or whatever.  Could it be a forefoot valgus????????

Michael Griffith PT, CSCS

www.3dprformancesystems.com

3D in the Press

Watching the following “hamstring therapy” is what got me questioning traditional methods:

• Athlete on his back with a trainer cranking his leg as far back as it can go to stretch the hamstring.
• Athlete on his back with a band around his foot cranking his own leg as far back as he can to get the hamstring
• Leg curls
• Leg curls with theraband
• Athlete sitting on a stool scooting himself around the training room with one leg
• Athlete back in 6 months with another tweaked hamstring
• Same thing all over again

I couldn’t take it any more.  It caused me to start asking questions about conventional therapy and training as follows:

What does the hamstring do?

What does the hamstring do when an athlete is running down the field or court?

Can you answer those questions?   If you have 1 day of play, weight lifting or physiology then the first question is easy.  The textbook definition of the function of the hamstring is……….flex the knee. But this is the text book definition.  That’s not the functional, 3D performance definition.  Is that the function of the hamstring in SPORT? So what does the hamstring do when an athlete is running down the field or court?  ANSWER: It doesn’t flex the knee! 

What???? Don’t panic. Think about it…..When the foot hits the ground when running, the knee flexes automatically. GRAVITY flexes the knee when running, not a muscle.  Why would a muscle work when it doesn’t have to……it’s given for free? Gravity flexes the knee, not the hamstring.

If the hamstring DOES NOT flex the knee, then why do rehab and training focus on FLEXING THE KNEE?

Why stretch the knee into gross amounts of knee extension?  (I know I’m pushing some buttons right now)

The traditional therapeutic approach of adequate hamstring motion is defined by having the athlete lay on his back while the therapist passively takes the straight leg as back as it can go.  80 degrees is considered the bench mark.  My take is….. SO WHAT! So what if the person can get to 80 degrees.  SO WHAT if he CAN”T get to 80 degrees?  What does that have to do with sport?  Do they need that much to run down the court or cut or jump and hit or rotate or plant and decelerate?  Heck no.  Hopefully you don’t see someone running down the field with their leg up at 80 degrees of hip flexion.

Why do you let a trainer lay you down on your back and crank your leg to your nose?

If the hamstring doesn’t flex the knee when on the field, why do hamstring curls?

If the hamstring doesn’t flex the knee, why waste time doing stool scoots around the training room?

I started asking myself these questions. What does the hamstring do when an athlete is on the field?  What plane of motion does the hamstring have the most influence in? If the hamstring doesn’t flex the knee, how can I rehab it and train it to increase performance on the field or court? Why does the hamstring get strained? Is it the hamstrings fault?

3 Keys to the Hamstring

1) The TRANVERSE PLANE is the main plain of influence for the hamstring

That’s right.  Not the sagital plane with all the years of trying to stretch the hamstring and reach to your toes and crank it to your nose and all of that.  Across the board, every athlete I have seen with hamstring strains has limited transverse plane motion through the lower extremity, especially at the HIP.

2) Attack the Hamstring through the Hip

I can guarantee you that an athlete with a chronic hamstring strain will have limited hip internal rotation.  Once I restore hip internal rotation by ECCENTRICALLY driving the hip into internal rotation through all kinds of strength, agility and explosiveness drills, low and behold…..the hamstring starts feeling better.  Without even touching the hamstring (if there are symptoms then certainly treat those with standard methods of soft tissue work, modalities, etc. I’m focusing on the exercise component).

3) Leave the Hamstring alone

It’s not the hamstring’s fault.  You didn’t strain it because you forgot to do your stretches before the game.  Find the CAUSES and address those, attack the hamstring through rotation at the hip, then start feeding the hamstring eccentrically, mostly with rotation in the transverse plane, not the sagital plane.

• NO TRADITIONAL HAMSTRING STRETCHES
• NO LEG CURLS
• NO DORKY REHAB EXERCISES THAT HAVE NOTHING TO DO WITH SPORT

If you are playing pro ball right now and have a hamstring injury, are you simply doing your rehab and training because it’s always been done that way and everybody else is doing it?

“It didn’t make any difference to me who we play. We have unfinished business with both of them.”  Troy Polamalu

Your hammy has some unfinished business!

Michael Griffith

www.3dperformancesystems.com

Let’s contrast a conventional neck therapy approach to a 3D, QB specific, neck performance, bottom up approach.  Here are a few pics of traditional neck therapy and rehab (they are in a chaotic layout because it matches the reasoning behind them):

OK, so the first one with the lady that is about to be hung, is a bit of a stretch.  But, not really.  Traction as a treatment for disc injuries may have it’s place.  Yet, it is limited in what it can do for a QB that has to take big hits and deal with gravity and increased G’s (not decreased) due to the nature of the position.  I don’t know if Manning had traction or not and it may feel good while he was on it, but it will not help him deal with the torque of the throw or the force of impact of a hit.

The ROM blue pick is just typical therapy exercises for a neck.  Typical, boring, and irrelevant for specificity of the QB position.  This is completely non-functional and does not prepare the neck to react to the demands of the sport.  It is TOP-DOWN.  The QB needs a BOTTOM-UP approach.  We’ll get there in a minute.

The middle one is manual therapy.  Yes, it may have it’s place in restoring motion and helping with symptoms.  But I wouldn’t put my money there.  It is very limited and does not prepare the tissue in regards to gravity, ground reaction forces, chain reaction, and overall performance.  It is passive.  It is TOP-DOWN as opposed to BOTTOM-UP.  The QB position is a BOTTOM-UP position at every level and with every move.  Why treat and train the neck in a passive laying down position?  If the neck could talk it would say, “Wow, this is great.  I love it when he’s on his back.  I don’t have to do anything.  Just so relaxing.  I can move better like this because Mr. Gravity is out of my way.  Wish the waiter would hurry up with my drink.” Then when Manning has to get back on the field, the neck might be more like, “Wait a minute, what the heck is going on here.  I’ve been on vacation, laying on the beach, and you want me to what?  Too much force coming up from the trunk.  I can’t open up that far as he takes the throwing arm back.  That follow through is killing me.  No way I can do all those looks down and across the field while the body is moving in opposite directions.  I’d rather him be on his back again.”

The pic with the guy that has his hands on his head in various positions is an isometric strengthening exercise scheme.  It is absolutely ridiculous.  Not in my house.  Completely artificial and has nothing to do with any sport.  As Rome would say…….NAAAAA!  BLOCKED.  Same for the next pic with the tubing wrapped around his head.  I’m surprised they didn’t wrap it around his neck since it’s a ”neck” exercise.  BLOCKED!!

The last one with the Everlast chick sums it up.  It looks like she is slapping herself upside the head as in, “Duh, why did I do that?”  But actually this is an exercise.  It really is.  It’s so stupid looking you probably think I’m joking, I know.  But it’s another isometric exercise where she is pushing her head into her hand to get certain neck muscles to fire.  Hopefully I have made my point and you’re saying, “You’ve got to be kidding me, surely Manning isn’t doing this stuff?”  I don’t know for sure, but my hunch is that he has done some of these because this is the standard diet of neck rehab regardless of the context.  Unbelievable.

Traditional therapy and training uses a TOP-DOWN approach.  What I mean by that is they drive the neck on the body, hence, top-down.  Manual therapy drives the neck on the body usually laying down, the range of motion exercises above drive the neck on a stationary body, those strengthening exercises really don’t drive anything in that it is mostly stationary.  Everything is aimed at the head and neck with little to no attention paid to how the body moves and its impact on the neck.  This is not sport specific and neglects so many pieces of the puzzle that if left unchecked, could wreak havoc on the neck and decrease QB performance and his ability to execute on the field.

Typically, a post-op neck athlete will have limited motion (rotation or side bending) more on one side than the other.  For example, say Manning has limited rotation to the right.  Lets look at this from the TOP-DOWN and the BOTTOM-UP.  From the TOP-DOWN it’s pretty straight forward.  To get right cervical/neck rotation, you simply turn your head to the right.  Driving is more TOP-DOWN in that your body is mostly locked in and you turn your head on your body as needed.

BOTTOM-UP APPROACH

Let’s look at right rotation from a BOTTOM-UP approach.  Manning’s eyes are fixed straight ahead with little to no movement from his head.  Manning then takes his right arm and reaches across his body towards his left hip (hint hint, as he would in a follow through of a pass), thus causing right cervical/neck  rotation because his body and shoulders moved left on his stationary head.  So…..arm, shoulders, body rotating LEFT on a fixed head causes RIGHT cervical/neck rotation.

It’s hard to find a perfect pic of this, but by time a QB follows through on the throw with his head and eyes fixed down field (unless a lineman is about to plow him over), then his body rotates left on a mostly fixed head causing right cervical/neck rotation.   Make sense?  Golf is a BOTTOM-UP approach: The head and neck are fixed and the body rotates around it.  Baseball is BOTTOM-UP: The batter rotates his body on a fixed head.  And yes, the QB position is a huge BOTTOM-UP driven position.  But this isn’t anything like “please turn your head to the right.”  This is power.  This is force.  This is fast and explosive.  This is QB quick release.  This is QB looks all over the field while his body is cutting and moving all over the place.  This is a ton of force being driven through that neck.  The neck is mostly the reactor and is NOT the initiator as in a TOP-DOWN approach.  Sure it is a combo of both approaches, but primarily it’s BOTTOM-UP.  And if it’s BOTTOM-UP then the elephant question in the room that needs to be asked is what?  You got it….why do all the other neck training exercises in the above pics? And what affect will the the rest of the body have on the neck?

If Manning can’t rotate through the left hip on the follow through as he transfers onto that left leg, then he could take the hit in his neck.  If he can’t open up through his right hip, core, scapula and pec on the right side as he cocks his arm back in the pocket then his neck can take up the slack for the lack of power generated and needed from below—-from the BOTTOM-UP.  The neck gets chewed up.  If force cannot be driven from downtown at the hips and core (or even the big toe) then a compensation will occur somewhere and in Manning’s case it could certainly happen uptown at the neck.  Even  if there were no deficits from below, he still needs to be trained from the BOTTOM-UP to help him deal with what he’s about to get himself into this season.

If I was working with Manning, I would look under every rock to find any possible biomechanical deficits that can play into his neck, or even his knee, to make him efficient as possible.   At least in reference to his rehab, every component needs to have a BOTTOM-UP, QB specific, position specific progression that drives his neck into intense parameters that will prepare him for the rigors of the game.  Anything less will set hip up for potential failure.

Just a few examples of a 3D BOTTOM-UP approach would be aggressive arm and trunk rotation drills with resistance (dumbbells, medballs, tubing) to drive the BOTTOM segment into as much rotation as possible, even beyond what he would normally do on the field, in order to expand the envelope so when he gets in the game his neck can say, “No problem, we’ve been doing way more than that.” I would do those drills with his neck fixed straight ahead and his body rotating all over the place with as much force as possible.  Then I would have him turning his head in the OPPOSITE direction so his neck would have to tolerate even MORE force and motion.  I would have him do this in a static position then dynamically going in a QB back peddle then shuffle drills around cones all with trunk and neck rotation drivers.  I would do my thing with the biomechanical analysis to see if there are any glitches in his legs or hips or even his ability to load off of his First Ray (Big Toe)  so he can generate all the power he needs to scramble or throw.

The BOTTOM-Up approach is a football approach, a functional approach, a 3D approach and can be configured into a QB specific program.

¹ESPN News “Peyton Manning had neck surgery”, May 25,
2011.

Michael Griffith

www.3dperformancesystems.com

Click to PLAY Video

Traditional methods may not cut it.  Why does Tiger keep getting injured?  Will he make it back to the top?  Why does his Achilles get chewed up?  A biomechanical analysis to determine the potential CAUSES of his injuries.

If you have a shoulder or elbow injury, have had one, or are just doing the “pre-hab” exercises to prevent one, I want to show you a different approach, a better approach, a biomechanical approach, and simply, a throwing approach. Here are a few pics of thrower rehab exercises that spurred me to talk about the shoulder and elbow.  When I see this, it just pushes my buttons and I just can’t stand the thought of a pro athlete, or even a little leaguer, doing this stuff.  Warning: DO NOT DO THESE!

In the first picture I will give the guy the benefit of the doubt in that he could just be assessing what the scapula is doing while the athlete is………uh, well uh, what the heck is he doing?  It doesn’t look like a throw to me.  Definitely not a throw.  But this is not what I have seen in the clinic and training room.  Usually he is trying to get the scapula to “stabilize” or stay in a certain position during a “throw.”  Yet that’s not even close to a throw.  No legs, no wind up, it’s artificial and it’s neuromuscular nonsense because it is not a throw.  The second picture is even more ridiculous.  The shoulder external rotators do not even come close to resembling this in a throw.  Completely artificial and trains the proprioceptors to do something they DON’T do in a real pitch or throw.  The scapula is locked up and there is no trunk, hip, or leg motion to generate power for the throw.  Have you ever seen anyone move their arm like that, especially in a sport?  It can actually de-train the throw and decrease performance.

Let me illustrate with a study.  In a research study of pitchers, they did a strength test of the shoulder external rotators of the throwing arm compared to the non-throwing arm.¹ The presumption was that the external rotators of the throwing arm would be stronger than the external rotators of the non-throwing arm because the throwing arm has to decelerate all that force as it goes into internal rotation on the follow through.  Make sense?  Does it really?  If you are a pitching coach reading this, it makes NO sense.  If you understand the mechanics and biomechanics of the throw then you realize it is getting further off base.

What were the results of the study.  Exactly OPPOSITE of what they presumed.  The external rotators of the the non-throwing arm were stronger than the throwing arm.  The person with the traditional, conventional paradigm will be scratching their head.  It doesn’t make sense. But the pitching coach says, “Of course it makes sense!”  Why??

As a right handed pitcher follows through, there is transfer of weight to the left leg as the right arm goes across the body.  Who is the main player or pinch hitter for the right arm on the follow through?  Yes, the left hip and leg.  That left hip and hamstring decelerate hip flexion and rotation - which decelerates the trunk - which decelerates the scapula and the posterior shoulder.  They are a power player muscle group to decelerate and control that follow through motion and have influence all the way up to the shoulder.  Think about it, why would you want the small external rotators muscles to do it all by themselves when you can call on the big guys - the hip and hamstrings?  On the follow through, the throwing arm external rotators can sit back and relax because they know they are getting help from the guys downtown and they don’t have to do much.  Maybe sip on a Pina Colada and watch that knuckle ball go home.  The external rotators of the throwing arm have been trained to relax on the follow through because the big guys are doing their job.

However, on the non-throwing arm, it’s another story.  They haven’t been trained.  There’s no motor planning built into them.  There has been years of training, coaching, mechanics, technique training, sequence training and all that goes into the pitching arm.  The external rotators of the non-throwing arm don’t know what they are doing.  So they say to themselves, “We can do it, we don’t need any help!”  Guess what would happen if that continued?  Impingements, strains, sprains, posterior capsule problems, UCL tears, etc.  In fact, that is exactly what happens.  It’s not the shoulder’s fault because it was “weak.”  The tight and weak hamstring (in the transverse plane, not just the sagital plane) did not help control and decelerate the trunk to dissipate the extreme force of the throw and the shoulder had to compensate, leading to injury.  The scary thing about that study is that they concluded the throwing arm external rotators were “weak” and therefore needed to be strengthened to “prevent injury” so they developed an artificial training program for the shoulder doing sitting down external rotation exercises and a bunch of other completely irrelevant exercises for a thrower.  I submit that by having a pitcher do those exercises, they are predisposing him to further injury.

So, what happens in the training room or clinic?  They do just what the study did; exercises that train the external rotators to be stronger.  Exercises that have nothing to do with throwing.  Exercises that tell the muscles to do something that they shouldn’t be doing in a throw.  Essentially, exercises that mis-train the tissues and can even decrease performance.

What are just a couple of biomechanical glitches that can play into a shoulder or elbow problem?  Quick example:  The right handed pitcher (or thrower from about any position), has a tight right calf.  He flexes at the ankle and knee on the start of the wind up then he strides off of that leg. But he can’t flex through his ankle properly due to the tight calf, and that will cause him to not flex through his knee as well either.  So, he has to get that motion from somewhere else and goes up to the hip to get it.  So there’s increased flexion at the hip when there needs to be extension through that hip.  If he can’t extend through the hip then he can’t eccentrically load his trunk and core then the scapula musculature doesn’t get loaded (eccentrically lengthened or turned on) and the head of the humerus bumps the acromion and boom…….cuff impingement.  CAUSE – tight calf, COMPENSATION – flexed hip/trunk, SYMPTOM – shoulder impingement.  Just doing shoulder exercises with a towel under your arm pit won’t cut it and does not address the cause.

Let’s go even further and look at the foot. Let’s say the pitcher has a rearfoot varus (a bony deformity where the heel is turned inward) with a stiff subtalar joint.  In other words, the foot won’t allow proper motion to turn on all the muscles of the leg and hip, thus not allowing the power and energy transfer to the trunk and arm for the throw.  As the pitcher loads and pushes off of that right leg and the body starts moving FORWARD toward home plate.  Yet, the arm is still moving backward or externally rotating.  So what’s the ball doing at this point?  Is the ball going toward the plate or away from the plate?  The ball is moving forward, toward the plate, yet the arm is still moving backward. It’s because the trunk is moving forward to the plate and taking everything (including the arm and the ball) with it.  But if the foot shuts the leg down, then the hip down, then the trunk down; the chain of power is out of order and the arm takes up the slack for the diminished power from the legs and it wreaks havoc on the elbow.  Low and behold – strains or the UCL starts screamin’.  Not the elbow’s fart, fault, excuse me.  Make sense?

I recently watched Stan Lee’s Super Humans on the History Channel and he has some just amazing stories of superhuman acts.  One of them was called “Killer Punch” and it was about a martial arts expert from China that could generate incredible force in a one inch punch http://www.youtube.com/watch?v=UaqHT4TWHW8&NR=1.  They did a test of how much force he produced in 3 different punches on a test dummy used in car crash tests.  The first punch he generated over 700 lbs of force, which is off the charts. He has one punch he called “Explosive force.”  On the “explosive force” punch, he caused further displacement of the dummy than on the first punch.  He said that he generates the force for this punch starting in his BIG TOE, up through his leg and body and into his knuckles.  My point is that the force starts from the ground up and is not just in his punching arm.  Yes, same thing goes for a knuckle ball, it’s from the ground up.  Hey, maybe we should have him do some knuckle exercises to make his knuckles stronger.

I recall working with a pitcher who was 6 months out from a rotator cuff repair.  He had been getting therapy for 5 months then came to me.  His complaint was simple: he still couldn’t throw.  What?? You’re 6 months out man, you’ve gotta be kidding me.  Yes, he could do the shoulder exercises.  Yes, he could do the band exercises and that one in the pic above.  Yes, he could lift a fairly heavy dumbbell over head.  But he couldn’t throw.  I had him get on the floor in a push up position with all his weight on his non-surgical arm and do some reach throughs with his other arm to get him to rotate his body on that arm to assess his scapula strength.  He was awesome.  Had him do it on the throwing arm that had the surgery, couldn’t even do 1 rep.  Not one.  What the heck were they doing with him?  He couldn’t coordinate a one leg squat and a rotational arm movement similar to a throw.  He couldn’t do agility drills where I had him do reaches with his arm to load his hip then use his hip to drive his arm into rotation…..couldn’t do it.  Had him stand on his throwing leg and reach overhead to load his leg and arm concurrently as in a throw…..looked terrible.  His leg power was sorry.  No 3D power to generate a throw.  His legs, trunk, and arm were disassociated and not linked together as in a throw.  Yes, he had some shoulder strength, but he had no throw-ability.  We did so many 3D drills for the legs with the arm integrated into it that he could throw in a week.  He was one sore puppy though.

If all your training and rehab is just focused on the injured area, you may be missing the link that is causing that area to break down.  Traditional concepts won’t get to the cause to ultimately get the player to his optimum performance or prevent something else from breaking down in the future.

Michael Griffith

www.3dperformancesystems.com

¹ MULLIGAN, IVAN J.; BIDDINGTON, WILLIAM B.; BARNHART,
BRUCE D.; ELLENBECKER, TODD S.  Isokinetic Profile of Shoulder Internal and External Rotators of High School Aged Baseball Pitchers.
Journal of Strength and Conditioning Research. Nov 4, 2004. Vol ume 18:Issue 4.

Do you have an OBLIQUE strain and it’s slow to heal or keeps coming back?  Why current trends are close but not quite enough…..

I’ve been studying the MLB injury list lately and it makes me ask the question:  What’s up with the Oblique strains.”  I broke the injury list down categorically into number of injuries per injury site.   No, it’s not a comprehensive research study or meta-analysis with a large N value with statistically significant values.  It’s just a guy counting the injuries per body part and is just a snapshot of time.  But….it’s still relevant and the numbers don’t just come out of a vacuum.  The list is the list and I bet if you did the same count a year from now it would still show similar patterns.

Here’s the breakdown:

*This is a summation of ALL the “other” injuries such as concussions, finger, thumb, rib, neck, toe, kidney, lat, and even suspension.

It is pretty much what one would expect for baseball injuries with the shoulder at the top, followed by elbow/forearm.  I was surprised the obliques came out ahead of the lower extremity injuries such as the hip, hamstring, quad and it even tied with the ankle.  There is a HUGE message between those lines.

Oblique strains have received more press as of late because it’s kind of new and sensational.  Yet, it’s not really new, there’s just more spotlight on the obliques. I want to add my own take on a component of oblique strains that has not been up to the plate yet.

Actually, there have been some good articles and posts describing the oblique, it’s role in baseball, and some potential reasons for it’s occurrence (Cressey does a good job in his post http://ericcressey.com/oblique-strains-in-baseball-2011-update ).

I’m not going to go into detail on the anatomy of the obliques, origins and insertions, or its function.  I think we could “lose the forest through the trees” on that.  I mostly want to focus on some of the current theories as to the causes and then address it biomechanically.

The obliques are involved in every aspect of baseball performance, but mostly play the Ace role in batting and throwing.  This has to do with the diagonal orientation of the muscle group and the axis of rotation of throwing and batting.

Let’s look at the throwing mechanism first.  Take an axis line through the shoulders and an axis through the pelvis or hips as above.  These axes are what load the core and obliques.  Either they are moving or rotating in OPPOSITE directions, or they are going the same direction except one axis is moving FASTER and/or FURTHER.  In the throwing mechanism, depending on which phase of the throw, the main load to the obliques is due to the axes of rotation going in OPPOSITE directions.  The pelvis is rotating forward and the trunk and shoulders are still rotating backwards.  This is how the pitcher loads the cannon to generate such power.  The core and obliques control the opposite hip and shoulder and, in the case of the throw,  they decelerate backward rotation of the shoulder.  As the shoulder reaches its end point of rotating backwards, stored elastic energy builds up in the tissue and fully lengthens to generate force for the throw.

With the throwing mechanism the axis of rotation through the shoulders and the axis of rotation through the pelvis are going in OPPOSITE directions which loads the core and obliques.  Let’s look at the batting mechanism.   On the wind up for the swing, the batter cocks the hips and the hips and hands load TOGETHER.  The axes of rotation are moving in the SAME direction and pretty much simultaneously. Then it’s not until the follow through that there is huge disassociation of the hips and shoulders and the axis of rotation through the shoulders is moving FASTER and FURTHER than the axis of rotation throush the pelvis.  By the end of the follow through, the left hip is maximally internally rotated and has stopped while the shoulders keep going.  This puts a huge eccentric load to the hip, core, and obliques.   Because the obliques have that diagonal orientation, they get maximally loaded.

Throwing Mechanism: Axes of rotation moving in OPPOSITE directions.

Batting mechanism: Axes of rotation moving in SAME direction where shoulder axis is moving FASTER and FURTHER

One article I read on oblique strains wrote, “repetitive force of the throw will eventually chew up a hip or oblique”.   But is repetitive force really the bad guy?  If it was just because of ”repetitive use” we would see a higher attrition rate and more injuries of every type.  If you follow that line of logic, then wouldn’t every thrower have hip and oblique problems? True, bad repetitive force is bad.  By that, I mean that there is a biomechanical glitch in the system that causes something to breakdown. But repetitive force in and of itself is not bad and generalizations don’t get to the causes.   Another article stated, “Assuming the biomechanics are good, and they should be for a pro athlete…..” Wrong assumption.  Maybe the throwing or batting mechanics look good but the BIO-mechanics don’t.

Here’s is the conventional rehab and training philosophy.  A player has an oblique strain.  “It’s the core’s fault because it’s ‘weak’”.  So, we will do a strengthening program so the core can better resist rotation.  Some even go further and do address tightness in the hips that affect the core.  But neither of them answer ”WHY.”  WHY did the obliques get strained?  The answer is in knowing the difference between COMPENSATIONS and CAUSES.

A compensation would be a tight hip.  Again, saw some good posts and articles on tight hips and how that affects the obliques and how to get more out of the hips and the obliques.  If a player cannot fully internally rotate through the hip, then the core and obliques can take up the slack and take the hit.  A traditional “core” training program where a player is doing crunches, or exercises on a stability ball, or any type of laying down exercise is just a waste of time and can actually de-train the core.  This approach actually sets the obliques up for failure because it proprioceptively trains the tissue to do something it rarely if ever has to do when throwing or batting ( Yet, I’ve seen some cool throws on the ground on ESPN’s Top 10 but never batting on the ground).  A sport specific, functional hip, core, and oblique program is the way to go and will have better results.  But it’s NOT ENOUGH.

Addressing only the compensations and implementing a strengthening program is not enough. A baseball trainer in an article in USA today states, “core strengthening has become a big part of training, and that would ostensibly help prevent oblique-type injuries, but their frequency hasn’t decreased.” ¹ WHY, because it still does not address the CAUSES.

This is the heart of what I’m talking about.  If you’re driving pull over and listen.  You ready?  (Wait, I say “causes” a lot, probably too much.  Let’s see what the Thesaurus has to say instead: Source, Root, Origin, Foundation…..alright, I’m going back to causes).  Is the hip a cause or a compensation?  If the hip rotators or flexors are tight then there’s gonna be a hitch somewhere and, yes, it could be the obliques.  But it’s not because the hip just decides to not show up one day.  It doesn’t get “weak” without a little help?  It doesn’t get tight in a vacuum.  It frequently has a biomechanical “source.”  The foot is a huge player in the function of the hip.  The foot can shut the hip down.  Let me say it again. The hip can compensate for a foot deformity.  It compensates in the form of tightness in one or all three planes of motion.  Once it can’t fully lengthen, especially in the transverse plane, then it’s on the inevitable path to weakness and dysfunction.  It’s off the chain bro.  Compensated forefoot varus, forefoot valgus, rearfoot varus, plantarflexed 1st ray, yada, yada, can all be causes of hip compensation leading to oblique strains.  We can’t get the “cart before the horse” and just try to make the cart stronger and more “stable” and all that.  We need to look at the horse and determine why there is decreased power, strength, and performance (in the hip and obliques) which led to the symptoms (in the obliques).

Another bioemechanical cause could be a leg length discrepancy.  If the left leg is shorter, a player may compensate by opening up his left foot or toeing out, this functionally lengthens the leg.  By opening up the that left hip, due to the leg length discrepancy,  the hip external rotators get shortened.   In other words they get tight.  They shut down eccentrically.  They go to the bullpen and just sit there.  Bye bye hip internal rotation.  Hello strains.   So, when the batter gets to the follow through and has to use all of the left hip internal rotation to decelerate that powerful swing…..he can’t, because the external rotators are tight and won’t let it happen.  The obliques take up the slack, and…..bada boom.  The obliques become the pinch hitter for the hip.  The foot whispers under its breath, “I’m supposed to be the switch hitter but I don’t feel like batting lefty today so I’m making the hip do it.”  I’m telling you the foot gets overlooked.  It hides biomechanically.  Most treatments aimed at the obliques (or hamstring or back) just work on the obliques.  Period.  It’s not even on the grid.

Yes, we need to have a better training program for the obliques besides crunches or stability ball exercises.  But that is not enough.  Yes, we need to attack the HIP  and not just look at the symptoms in the obliques and strengthen the obliques.  But that still is not enough.  Get to the causes.  Find the culprit.  This is NOT just for oblique strains.  It can play into injuries of the hamstring (huge biomechanics), the groin, the back (huge again) and even the elbow.  Yes, I said it, the elbow (I will do a whole post or video on shoulder and elbow  biomechanical CAUSES and try to shut up for now because I’m about to go off).  If a pitcher can’t load the right hip on the wind up/initiation of the throw,  then increased force can get transmitted to the elbow because the hip/trunk was not able to fully add to the power of the throw.

I’ll let Jeff Ham be the CLOSER in his comment about oblique strains in a recent article in the Chicago Sun-Times, “Jeff Tam, who appeared in 251 Major League games over six seasons as a right-handed pitcher, knows that first hand.

‘If it’s not 100 percent healed, you’re going to do it
again for sure,’ said Tam, who suffered three oblique injuries while pitching
for the New York Mets, Toronto Blue Jays and Oakland A’s.”

Michael Griffith

www.3dperformancesystems.com

¹Antonen, M., Nightengale, B., White, P. Oblique injuries putting a strain on several major league teams. USA Today. 7/3/2008

²DeCotis, M. Why all the oblique strains in the MLB?  Chicago Sun-Times.  4/12/2011

And of course all the media was there to highlight and capture the event.  Thought it was going to be just a nice touchy feely clip….but then….boom….the reports just started hammering Yao about the next season; if we was coming back, when he was coming back, how was his foot and ankle feeling, what he was doing for rehab and practice.  They would not let up.  It just seemed a little out of context for the school setting.  All along I was wondering, “Why couldn’t they help him? What if?  What if they could have got him back?

I won’t go into biomechanics on this post.  I mostly want to talk  about the whole scenario regarding Yao (if you want more on the biomechanics and causes for BIGS, I went into it in detail on my recent post:  Bigs: Are they more prone to injury? The answer may surprise you……http://bit.ly/ko3dMi).  Yao acknowledged earlier this year that injuries may force him into retirement.  He has become a “global icon”, connecting the NBA to China and across Asia.  In fact, China is the NBA’s second biggest market.

Looking back over Yao’s injury journey, I was stunned when I studied some of the procedures.  They actually lowered his arch.  I’ve spent years specializing in foot biomechanics and how the foot functionally affects the ankle, knee, and hip for athletes such as throwers, golfers, and ballers, and I have not worked with anyone who has had this procedure.   I spent a year shadowing an orthopedic surgeon  that was a foot specialist so I could learn everything I could from the surgical side of the foot.  Never saw him do that one.  Obviously, it was a special situation and I get it.  However, it still leaves me scratching my head.

My question is this: Were the biomechanical causes ever addressed?  Were they?  Why did he get a stress fracture to begin with?  If he had a stress fracture at his medial malleolus, it was not the ankle’s fault.  What was causing the medial ankle to take the hit or to encounter undo stress?

What if we found one, just one, piece of the puzzle that was overlooked? What if that was enough to take the stress off of the ankle or whatever else was messed up on Ya0? What if?

Yes, maybe he was to the point of no return.  But I just can’t believe it.  I can’t.  And I don’t think I’m just some subjective optimist.  I have seen it many times where an athlete was deemed “done” or slated for surgery and once we got to the causes, he started improving.

I look at Yao and all the work he put in and how much he improved over his career and I just have a hard time grasping it and cannot accept that it’s just because he’s BIG.

I would have done anything to get to Yao.  I called the owner, I tweeted Yao, and sent info to the Rocket’s new caoch, Kevin McHale.  I called Les again, and again, and again. Strike 3 (actually it was many more times than 3).  I was out.

What if?

Well, I do like Yao and he will be successful at whatever he puts his hand to and his next venture I’m sure will be awesome.  He was not only the “face of the franchise” for the Rockets, but for all of Asia and he will be missed.

Michael Griffith

www.3dperformancesystems.com

The transverse plane is the plane of ROTATION.  If this plane is not trained, then there will be diminished performance and the athlete will have a greater chance of injury.  Let me say it again, if the transverse plane is neglected and not strategically designed into a training or rehab progression, then it’s going to be a “Lockout.”

So what’s the big deal with the transverse plane in regards to athletic
performance?  It’s gravity eliminated, meaning it’s the only plane of
motion that you have to work for.  Gravity naturally influences, or
“feeds”, the sagital plane (straight up and down movements).
When a lineman gets in a 3-point stance and has to come up out of it, he
has to fight gravity to come up into a stance position, or better yet, he’ll be
fighting extra gravity as he battles another 300 pounder.  Gravity feeds
the sagital plane, it’s part of the package.  Same for the frontal plane (side
to side movements).  When a running back cuts, which usually involves
a lateral movement, or when a forward has to quickly get across the paint
(again, lateral movement) gravity feeds that plane of motion.  Your muscles
react to and fight against gravity to keep you on your feet, they have no
choice.  That’s why astronauts have to worry about muscle atrophy and
joint problems because gravity isn’t stimulating the tissue.

Not so with the transverse plane.  Gravity does not have a direct influence on
the rotational plane.  Again, this is huge.  You have to work for it;
it must be planned into all aspects of training, rehab, and skill
coaching.  If not, it’s a ”lockout” and you will not have the
necessary power and will even be more susceptible to injury.  I’ve seen
it over and over again in athletes.  How do you develop performance in the transverse plane?  By constructing a transverse plane system that addresses lengthening the tissue, an agility series that drives the hips and core in the transverse plane, an explosive progression that’s rotational, by getting out of the box of the sagital plane and driving the athlete beyond his limits into rotation.  And that’s only the the the beginning!

For example, step 1 would be constructing an eccentric loading (notice I didn’t
say stretching) sequence targeting the transverse plane.  The muscles move
in all 3 planes of motion and you need to lengthen them in all 3 planes of motion, especially the transverse plane.  Not a granny style stretch sitting on the ground in some type of Yoga position and holding it for 30 seconds.  I’m talking a sport specific position that lengthens and loads (with resistance) the tissue to prepare it and enhance it to do what it’s about to do in sport.  The hamstring has a hefty transverse plane component to its function on the field.  Why just do traditional sagital plane stretches.  Attack it in the transverse plane, standing up, add a load, and get that puppy going.  Maybe your back or your knee would say, “Thank you!” I have a gazillion other examples, examples of transverse plane agility, explosive, power, high intensity progressions to enhance performance and address the cause of injuries, and this is just one example.  Do not neglect the transverse plane.

Another mammoth element of the transverse plane is that it is the POWER PLANE for
athletes.  It’s the dynamite for the QB.  It’s the driving force for
the golf swing.  It’s the detonator for the batter at the plate.
It’s the core accelerator for the baller to dunk on his defender.  It’s
everything.  Think about it.  Just about every sport movement involves some type of rotational component.   Because of all the mathematical complexities of
torque such as levers, angular velocity, force, and power, an athlete
is able to use this plane to his advantage.  Or……to his disadvantage.

It is also the PLANE of INJURY.  Most injuries have a transverse plane
element involved.  You “twist” your knee or ankle, you
“roll” this or “torque” that.  It’s the plane of injury because it’s the weakest plane; the plane athletes have the least amount of training in.  It’s also the plane of motion where athletes are the tightest and the weakest.  Bar none.  If they are tight then they are
weak.  If an athlete cannot eccentrically lengthen or rotate through his
hip, then he will be weaker in generating rotational power with a
rotational squat, rotational lunge, and especially swinging a golf club or a bat,
as well as throwing.  He’s “locked out.”  Once it’s been determined that an athlete has a restriction in the transverse plane, say at the hip, then you don’t just stop there and have him do “rehab” or an exercise program.  It must be determined “WHY.”
Usually an athlete doesn’t just get tight a hip in a vacuum.  There is
usually a driver or a CAUSE.  For example (sorry, I’m going to get biomechanical on you for a minute), an athlete can have a forefoot valgus that throws him to the lateral border of his foot (can be a cause of chronic ankle sprains) where he can’t evert through his subtalar
joint (the torque converter mechanism of the lower extremity) which “locks out” internal rotation through his leg and his hip doesn’t get turned on or eccentrically loaded in the transverse plane and, bam, it gets tight. The foot shuts down the hip and is the cause.  Address the cause then attack the compensation; the tightness in the hip.

It’s an unfortunate situation that most rehab programs are still locked into dated
protocols and exercises that are Neanderthal.  Check this ACL protocol
out (I just Google “ACL Protocol” and picked #2).  I picked the “7-12 weeks after surgery” section where it should be getting higher level since it is 3 months after surgery:

Exercise Program:

1. Quadriceps – straight leg raises (10 sets of 30
repetitions each), and quads
sets (10 sets of 30 repetitions each)

2. Hip muscle groups. May progress by adding weights above
the knee. Hip abductors, flexors, abductors, extensors (10 repetitions, 4 sets daily). An isometric variation can be performed by pushing down
on the hip being worked on and sustaining a contraction for 10 seconds.

3. Hamstrings curls – may add weights around the ankle (10 repetitions, 4 times
daily).

4. Calf raises - 3 sets, 10 repetitions – fast and slow sets (each).

5.  Accelerated program – start with sand bags on tibial tubercle. Perform straight
leg raises (10 sets, 10 repetitions each) and progress fulcrum distally one inch per week).

6. Sissy squats. Stand facing the edge of a door and place hands on the door
knobs on each side of the door. Feet should be shoulder width apart. Perform
a half-squat (never past 90 degrees) and slowly rise to a starting position. Build up to 100 repetitions per day.

I highlighted all the “YOU’VE GOT TO BE KIDDING ME” exercises/concepts
in red.  Seriously, I can’t believe this is still in existence.  This just infuriates me to know this is being done to pro athletes or even desk jobbers.  In just a sec I will begin to completely shred it.  After just a brief look at it, do you notice the elephant in the room?  What’s missing?  Yes, you got it, the TRANSVERSE PLANE! Nowhere, nada, on the DL list. This is outrageous.

Point by point: Straight Leg Raise:  Are you seriously going to
have an athlete, even a granny, do these at 3 months.  I wouldn’t have
anyone do it, period.  It’s artificial, non-functional, not sport specific, it’s done lying down (see my previous blog on the calf http://bit.ly/kMDXLS) and has nothing to do with sport.  10 Sets: Why 10 sets?  What’s the point?  If you can do 10 sets of 30 reps, maybe, just possibly, it’s too light.  Insufficient load for an athlete.  Adding Weights
Above the Knee:  Assumed that this exercise is done lying down.  You might as well put weights on your head because it doesn’t matter.  All the points as above complete waste of time.  If you want to load the hip then do it standing up man. Isometric Variation:
May sound fancy but is so far on the other end of the spectrum of sport
specificity.  Again, all the points as above.  Granny would laugh at these.  Hamstring Curls and Calf Raises: My blood is starting to boil when I see these.  I will be doing a written and video post on the hamstring.  The hamstring does not flex the knee when a back
is running on the field.  Why train the hamstring to do something it rarely if ever has to do in sport? Slow: Why do anything slow?  I want speed.  Acccelerated Program: This is anything but accelerated for all the reasons above.  It’s done lying down.  Hello!   Finally, an exercise that describes the truth of this protocol.  Need I say more?

If the transverse plane is neglected it will show up in decreased performance on
the field or court and predisposes the pro athlete to injury.  If the transverse plane is overlooked then it can slow down the recovery of a pre-existing injury.  It just takes longer or the athlete may not see full recovery because the transverse plane deficits are showing up.

This is at the heart of what I do as a performance consultant and using biomechanics
to find the deficits and get to the cause.

If you want to negotiate a better deal for all parties involved in the lockout
then just get more out of the transverse plane.  Then everybody wins.  Everybody is happy.  The hip and the foot can get along and aren’t beatin’ each other up and the knee starts to have less symptoms and everybody is playing so well together that, as a team, there is more power, more agility, and better chances for a W.

Michael Griffith PT, CSCS

www.3dperformancesystems.com

I want to present another option.  A better option.  A more objective option that is not based on assumptions, or wives tales with no statistical, musculoskeletal, or biomechanical foundation.

I want to associate the “BIG” theory with the “RUNNER” theory.  There is the prevailing saying out there, and I’m sure you’ve heard it, that goes, “Running is bad for you, it’s bad for your knees and wears down your joints.”  If you’re a runner, hopefully this statement ticks you off and you have not bought into it. This is just illogical and I will address it in a bit.

Is it true?  Do “Bigs” have more injuries?  When I was trained to determine if a concept is true or not, I had to apply certain criteria.  1). Is it FACTUAL?  The only way to find this out in regards to injury and BIGS is stats.  Injury reports and meta-analysis.  I do not have all of that data at my finger tips nor do I want to take the time in this post to do the survey.  However, from a cursory overview of injury reports, the BIGS do not statistically get injured more than other players.  Obviously, there are many factors to consider in analyzing the data such as contact or non-contact injuries, fewer percentage of BIGS compared to other players, time of season, etc. However, statistically, I do not think it plays out.

Another criteria in determining if a concept is true: 2). Is it Contradictory? In other words, does the theory have contradictions or say one thing then say the opposite?  If the theory is that BIGS get injured more just because they are BIG, then it leaves too many unanswered questions that seem to contradict the notion.  If they break down because they are “BIG”, then why do we not see more injuries in other joints/tissues instead of the one that is getting all the press (i.e. why doesn’t Yao have knee, hip, shoulder, back, problems in addition to his ankle, why just one ankle and not both)? Wouldn’t there be a higher incidence of injury across the board for BIGS, for ALL BIGS?  If it is true, then ALL BIGS would get injured and have a higher incidence of injury.  Why isn’t there a higher attrition rate for BIGS?  There seems to be too many contradictions.

Last criteria to determine truth: 3).  Is it viable?  In other words, can you live by it, does it play out in life, on the court, in the game?  For example, I recall talking to a guy about his religious beliefs as we were driving, and he stated that there is no evil, it is all just in the mind, or just a theory.  Then he proceeded to lock his doors as we got out of the car.  Dude, you can’t live by that philosophy, it doesn’t play out in real life, therefore it’s not true.  Hello! In my experience in working with basketball players, it seems the guards get more injuries.  Yes, it is due mostly to the demands of the position and not “size.”  If you follow that poor logic, one could make the statement that the “SHORTS” will have more injuries because they are smaller and cannot dissipate the forces as well as a BIG.  In fact, I believe size has nothing to do with injury or injury rates.  Come on now.  Be honest.  You guys who have experience in this, wouldn’t you agree?  There are so many other factors that have more influence on injury rates other than SIZE. 

BIGS, your ears should be perking up right now.  This is good news.  You are not just a victim of circumstance or something you cannot control.  Yes, there may be some coordination issues to overcome, but they can be trained and overcome.  A small player has his obstacles to overcome as well, and has the same chances of injury as the BIGS.   

I am going to address it from my perspective, and that has to do with BIOMECHANICS.  I believe this is a major contributor to injury, regardless of the size of the player.  Back to the “running is bad for you, bad for your knees, bad for your joints” (of course most people who say this are not runners, even the physicians) theory.  If you take this to its logical conclusion then EVERY runner would have knee and joint problems and NO ONE should run.  Again, this statement contradicts itself.  There are many runners who compete into their seventies, with no injuries.  If it “ruins” your knees, then why do runners with knee problems usually have it in one knee?  The ANSWER……it’s BIOMECHANICAL. 

A plausible reason most runners continue running and some have repetitive, chronic injuries, is because it’s biomechanical in nature . I’m not saying EVERY runners injury is biomechanical.  There is obviously the occasional strain, or pain from an increased training regiment, or the post marathon recovery.  Most of these are temporary.  I am talking the CHRONIC injuries.  For example, a simple leg length discrepancy of 1/4″ can have an enormous impact.  All kinds of compensations can occur from a leg length discrepancy that cause increased ground reaction forces and wear and tear on one side of the body.  Yes, rest may help, but it does not solve the problem.  It’s a sin to just tell a runner to stop running or just do dorky knee exercises without trying to biomechanically assess and find the causes so they run again. 

Back to the BIGS.  The reason BIGS break down is Biomechanical in nature.  Being “BIG” is just an excuse.  If Yao had my foot at the end of his leg, then YES, the size of that leg would blow out my size 10 foot.  No doubt.  But isn’t it proportionate?  I’m telling you it is illogical and is just an excuse for not going deeper to find out why any BIG has injuries.  A small biomechanical deficit can have a significant impact on the system.  There is the rule of 3′s; where 3 times the forces occuring 3 times faster, makes biomechanical faults 3 times more significant.  If an athlete, say Yao, has a structural foot deficit such as a forefoot varus (don’t worry, I won’t muddy up the waters by going into the details) then it will cause 3 times more ground reaction force and torque at his ankle than further up the chain at his hip.  A small biomechanical fault will amplify the forces of gravity in sport.  It’s not the size.  Or take Greg Oden for example.  He’s had knee cap (patella) problems that have hindered him.  The patella is probably one of the mot reactive joints in the body.  It reacts to what’s coming down from the hip and what’s coming up from the foot.  The hip and the foot drive the patella.  They can drive  it to go places it does not want to go and cause problems.  Just doing knee exercises or patellar mobs is weak and will not solve the problem. 

If a slight biomechanical deficit can have such a major impact, then think how much of an influence CORRECTING THE BIOMECHANICAL FAULT would have on a BIG’s injury or performance.   Let me say it again….correcting the biomechanical deficits can be BIG in helping the BIGS. 

In fact, it can be such a driver in affecting a BIGS injury and performance, that I won’t even start a performance exercise progression aimed at their tight and weak tissue until AFTER  I have addressed the biomechanical faults.  I submit to you that unless the biomechanical deficits are assessed and tackled, then they won’t get better; the BIG will have BIG time problems.

Michael Griffith PT, CSCS

3D Performance Systems