Sports Hernia vs Inguinal Hernia

Sports Hernia vs Inguinal Hernia

Sports Hernia¹

There are two main types of hernias either a sports hernia or an inguinal hernia. Sports hernias are a soft tissue injury to the groin area commonly affecting the abdominals and inner thigh muscles (hip adductors). Sports hernias are caused by fast rapid exercises that involve changing direction rapidly and aggressively. They commonly occur in vigorous sports such as ice hockey, soccer, wrestling and football. Symptoms of a sports hernia include: pain in the groin at the time of injury, the pain gets better at rest and worse with activity especially twisting movements. A sports hernia does not cause a visual bulge in the groin like an inguinal hernia does but over time a sports hernia may lead to an inguinal hernia and abdominal organs may press against the weakened soft tissues and form a visible bulge. Without treatment this injury can result in chronic, disabling pain that prevents you to return to sports.  An MRI may be used to determine if you have a sports hernia and/or bone scans too determine other possible causes of pain. Treatment options include either surgical or non-surgical and rehabilitation takes 4-6 weeks and 6-12 weeks respectively.

Inguinal Hernia²

Inguinal Hernias are weakness in the muscles and tissues of the groin. There are two main areas for inguinal hernias either the inguinal canal or the femoral canal. With an inguinal hernia the abdominal organs can protrude through the weakened area in the lower abdomen/groin. If there is a visual bulge you should seek medical attention immediately to determine if the blood flow is being restricted to your organs. Factors associated with groin hernias include: smoking, long-term coughing, obesity and straining during urination or bowel movements. Groin hernias are more common in men and 25% develop a hernia over their lifetime.

There are both surgical and non-surgical options for an inguinal hernia. Non-surgical approach consists of strengthening the abdominal musculature and trying to maintain the organs inside of the abdomen. Sometimes a hernia truss undergarment is worn to help the organs remain inside of the abdomen. Inguinal hernias rehabilitation takes about 6-12 weeks for both surgical and non-surgical options.

If you think you may have a sports hernia or an inguinal hernia, we can help!  Call Rock and Armor at 208-917-2660

www.rockandarmor.com

Reference List

1. Wilkerson, R. Sports hernia (athletic pubalgia) https://orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/. Updated June 2017. Accessed February 2019.

2.Hewitt DB. Groin Hernia. JAMA. 2017;317(24):2560.

 

 

Shoulder Instability

Shoulder Instability

                  At Rock and Armor we treat a wide variety of shoulder conditions.  Today we will discuss shoulder instability a common injury that we treat both conservatively and also post-surgically. Shoulder instability can be caused by many reasons but two common mechanisms are by trauma to the shoulder or by having a genetic pre-disposition to dislocation such as a shallow shoulder socket, loose shoulder ligaments, and/or weak shoulder musculature.

Shoulder instability can be unidirectional, bidirectional or multi-directional. There are two main ways we look at how to treat instability clinically at Rock and Armor including: Traumatic, Unidirectional instability with, Bankart lesion requiring, surgical repair (TUBS) and Atraumatic onset of, Multi-directional instability that is, Bilateral, Rehabilitation is treatment or surgical, Inferior capsule repair and rotator, Interval repair. (AMBRI).

Shoulder rehabilitation for instability includes: proprioceptive glenohumeral stabilization exercises, scapular and humeral stabilizers (subscapularis and infraspinatus). There will be a progression from isometric and closed chain exercises initially too closed chain multi-direction functional movements later on. Typical rehabilitation for shoulder instability takes approximately 6 months to fully recover.

If you’ve had a dislocation, subluxation, or other shoulder instability, we can help you with the rehab process to get back in the game.  Call 208-917-2660 to schedule an appointment with one of our Doctors of Physical Therapy today.

www.rockandarmor.com

Reference List

1. Severino D. Shoulder Conditions 2a handouts. Lecture presented at: PHTH618. Spring Quarter 2018. Spokane, WA.

 

Shoulder Pain

Subacromial Impingement Syndrome (SAIS)

By Christopher Edwards, SPT

Subacromial Impingement Syndrome, or SAIS, represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy, calcific tendonitis and complete rotator cuff tears. The etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections and surgery.  We have great outcomes working with these injuries at Rock and Armor Physical Therapy and Sports Performance.

SAIS is the most common disorder of the shoulder, accounting for 44–65% of all complaints of shoulder pain during a physician’s visit. The subacromial space is defined by the humeral head inferiorly, the anterior edge and under surface of the anterior third of the acromion, coracoacromial ligament and the acromio-clavicular joint superiorly. The height of the space is approximately 1.0 to 1.5 centimeters. Structures that are located in this area include: the rotator cuff tendons, the long head of the bicep’s tendon, the bursa, and the coracoacromial ligament. Any abnormality that disturbs the relationship of these subacromial structures may lead to impingement.

There are three stages of impingements stage I-III. Stage-I has swelling and bruising of the subacromial bursa and is typically in patients who are less than twenty-five years old. Stage-II impingement represents age related changes, such as fibrosis and tendinitis of the rotator cuff, and is typically in patients who are twenty-five to forty years old. Stage-III impingement is more chronic changes and includes partial or full tears of the rotator cuff and is usually seen in patients over forty years old.

Patients with subacromial impingement generally have decreased scapular posterior tilting, and decreased upward rotation. Weak or dysfunctional scapular musculature, fatigue of the infraspinatus and teres minor and changes in the spinal alignment have all demonstrated a change in scapular kinematics

Both anatomical and biomechanical mechanisms can narrow the subacromial space. Anatomical factors that may narrow the space include variations in shape of the acromion, orientation of the acromion or osseous changes to the acromio-clavicular (AC) joint or coracoacromial ligament. A widely used classification system for acromial shape is flat (type I), curved (type II), or hooked (type III), Another possible source of narrowing in the subacromial space is thickening of the coracoacromial ligament. Biomechanical mechanisms that can cause SAIS include excessive superior translation of the humeral head or abnormal scapular motion that causes the acromion to move inferiorly. These include shortening of the posterior-inferior glenohumeral joint capsule and decreased rotator muscle performance.

Clinically patients that present with SAIS will most likely have an insidious onset or report that it has gotten worse overtime. They will experience pain at night. The patient will most likely have a positive Neers test, Hawkins Kennedy test, empty can test, and lift-off test. There is moderate evidence that exercise and manual therapy is the best treatment approach. It has been shown that the outcomes are similar for patients with SAIS that have been treated conservatively or surgically. However, there are better outcomes for patients that receive surgery if they have failed conservative treatment.

If you have shoulder pain, think it may be SAIS, and would like to get it looked at, our expert team at Rock and Armor is happy to help.  Call 208-917-2660!

www.rockandarmor.com

 

 

 

 

 

 

Reference List

1. Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia). 2012;4(2):e18.

 

Corporate vs Local Training Facilities in the Treasure Valley

In the upcoming months and year there will be some national chain training facilities moving into the Treasure Valley.  As the Treasure Valley grows, we are seeing more and more businesses of all kinds gravitate to the area.  Sports Performance and Training is no different.

As these shiny new models roll into town, be educated consumers when choosing any product, especially a training facility:

• Look at the price of their memberships and one-on-one training rates: I guarantee you will not find a value similar to Rock and Armor.  Big chain brand companies have to pay higher overheads for corporate rates and to pay CEO’s, owners, and franchise fees.
• Compare the expertise of their trainers to ours: You will not find more highly qualified trainers that were also former collegiate athletes than our team.
• Consider local roots and involvement in the community. Many of our trainers were born here or played collegiate sports at BSU.  We have roots in the community and will be here for a long time.  Many of the big box training facilities will be flying their employees in who have little or no investment in the community.
• Shop local: We are a locally owned and operated business. This allows us to keep our costs down, level of product up, build into the lives of our clients, and purposefully serve our community with relentless passion.

Thank you for training and working with us here at Rock and Armor.  We desire to see this community grow and all individuals achieve their goals.  We believe we offer a higher level product at a better price than any existing training facility in the Treasure Valley, and any franchise/chain that will come in the future.  If you have not already tried Rock and Armor, today is a great day to start!  Call us at 208-917-2660 to schedule an appointment today!

http://www.rockandarmor.com

ACL Considerations

Anterior Cruciate Ligament (ACL) injuries can be an excruciating ordeal to overcome. There are so many questions such as graft options, physicians, rehab protocols, etc.  We can help guide you at Rock and Armor, if you have suffered this injury.  Below are some key points nicely put together by one of our current students, Chris Edwards, SPT, from Eastern Washington University.

ACL Graft Options1

1. Bone-Patellar Tendon-Bone (BTB) autograft- Is considered the gold standard in ACL reconstruction. Requires the harvest of the central third of the patellar tendon with attached bone blocks from the patella and tibial tubercle. BTB is the graft of choice for active individuals especially under the age of 25.

Advantages- Bone to bone healing, ease of harvesting, good clinical outcomes, lower graft failure rates.

Disadvantages- Anterior knee pain, low risk of patella fracture and patellar tendon rupture.

2. Quadrupled Hamstring graft- Semitendinosus and Gracilis tendons are harvested from their pes anserine attachment and then folded to form a quadrupled construct.

Advantages- Decreased donor site morbidity and greater initial biomechanical strength.

Disadvantage- less reliable healing because it relies on bone growth into tendinous soft tissue opposed to bone to bone healing, also unable to stretch hamstrings for up to 6 weeks post-surgery.

3. Allografts- Include cadaveric patellar, quadriceps, hamstring, and achilles tendons.

Advantages- eliminates harvest site morbidity

Disadvantages- infection risk, increased failure rates in more active individuals (due to graft weakening from sterilization processes).
Technique2

Attachments: Tibial attachment- medial to the anterior horn of lateral meniscus, Femoral attachment- posterior lateral aspect of the intercondylar notch on lateral femoral condyle. Graft fixated with interference screws, Graft strongest and fixation weakest initially.
Incisions- Two 1 cm incisions around the patella tendon for the arthroscopy equipment. Small 2cm incision below the joint along the inside of you knee where the tunnels are drilled and the graft is obtained, small incision above and outside the knee where the fixation for the graft on the femur was placed.

Protocol3
Pre-Operative: increase range of motion (ROM), decrease swelling, decrease pain, restore normal strength for ADL’s and gait, prepare for surgery.

Post OP days 1-10: RICE medicine, early ROM exercises (passive extension exercises, seated AAROM for knee extension and flexion), quadriceps strengthening (quad sets, SLR in immobilizer), hamstring strengthening (heel slides, avoid until 4-6 weeks if hamstring graft used), 50% weight bearing use two crutches, suture removal, maintain passive extension, and return to desk job.

Days 10-14: Maintain full passive knee extension, achieve 100-120 degrees of knee flexion, develop muscle control to wean off knee immobilizer (able to perform SLR with no sag), early closed chain exercises (partial squats, calf raises), 50-75% weightbearing use 1 crutch (progress to no crutches if they can walk with no limp with a reciprocal gait pattern), and stationary bike (if 100 degrees of knee flexion).
Weeks 3-4: Full extension ROM, continue strengthening exercises, expected ROM 100-120 degrees of knee flexion (add wall slides), and start elliptical training.
Weeks 4-6: Push ROM exercises want 125 degrees of knee flexion (closing in on full flexion), strength building (Goal at week 6 is affected leg quad strength to be 60% of non-affected), add double leg balance activities (airex pad, tilt board).

Week 6-12: Week 6 want to maintain full extension and receive 135 degrees of knee flexion, can start hamstring curls if hamstring graft used, start flat treadmill, begin outdoor bike on flat road, strengthening exercises (week 8 goals are quadriceps and hamstrings of affected leg to be 80% of non-affected leg), add single leg balance activities if good knee control.
Week 12-20: Continue strengthening, introduce light jogging and running if can perform all ADLs and exercises without an increase in swelling, introduce agility.

24 weeks: Earliest you should plan to return to sport. Return to sport goals include quadricep and hamstring strength at least 80% of unaffected limb, full motion, no swelling, good stability and can complete a running program.
Return to Sport Tests4,5

Return to Sport tests include: Y balance, triple hop test, single hop distance test and isometric knee extension strength. Experts recommend not to return to sport until the Y Balance ANT has < 4 cm difference between affected and non-affected leg, be able to jump at least 90% the distance on the affected leg as the non-affected leg and to have at least 85% strength in the hamstrings and quadriceps on the affected side compared to the non-affected side.

If you need some guidance following ACL injury, please feel free to reach out to us at rockandarmor@yahoo.com, call 208-917-2660, or DM us on instagram or FB @rockandarmor

Reference List
1. Klinge SA, Sawyer GA, Hulstyn MJ. Essentials of Anterior Cruciate Ligament rupture management. Rhode Island Medical Journal. 2013;96(5):28-32.
2 Hosea, T. ACL reconstruction: techniques and avoiding pitfalls. University Orthopaedic Associates. 2015;1-38..
3. Evans, IK. ACL reconstruction rehabilitation protocol. Sports Medicine North Orthopedic Specialty Center. 2018; 1-23.
4. Teyhen DS, Robertson J. Return to sport: when should an athlete return to sport after an ACL surgery?. J Orthop Sports Phys Ther. (2011);41(6):388.
5. Garrison JC, Bothwell JM, Wolf G, Aryal S, Thigpen CA. Y balance test™ anterior reach symmetry at three months is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction. Int J Sports Phys Ther. 2015;10(5):602-11.

Cooler Temps = A Great Time to Train Indoors At Rock and Armor

Fall and winter are great times to move your training indoors with out incredible team at Rock and Armor.  Whether you are looking for space for hitting/pitching on the weekends, or speed, strength, and agility training with one of our highly acclaimed Performance Coaches, Rock and Armor can help you and your team take their game to the next level. Whether you desire 1-on-1 training, team training, or want to join one of our existing classes, we can customize a routine to meet your needs and help you get bigger, faster, stronger, and stay ahead of the competition.  Visit our website at https://www.rockandarmor.com/class-schedule for a list of current classes.  Don’t see what you are looking for? Call 208-8917-2660 and we will meet to discuss goals and appropriate training this fall/winter.  We look forward to helping you reach your goals!

Scapular Dyskinesia

Scapular Dyskinesis

By Cody Suder, SPT, CSCS

• The scapula is a bone on the back side of your shoulder, commonly referred to as the shoulder blade. It serves as an attachment for many muscles that contribute to the shoulder, upper arm, thorax, neck, and chest.
• Scapular (shoulder blade)Dyskinesis appears to be a nonspecific response to shoulder dysfunction. With scapular dyskinesis, cases may be result of loss of muscular coordination, leading to abnormal scapulohumeral rhythm and various other shoulder pathologies as a result.
• Scapular dyskinesis can result in inhibition or disorganization of activation patterns in scapular stabilizing muscles.

Types of Scapular Diskenisis:

• Type I (Scapular tilt): Type I is characterized by prominence of the inferior medial scapular border.
• Type II (Scapular winging):is the prominence of just the medial border of the scapula.
• Type III (Scapular Shrugging): associated with shoulder impingement and rotator cuff injury and displays prominence of the superior medial border.

Muscles Involved:

• Scapular Upward Elevation: This movement occurs during arm elevation, such as moving the arm forward or to the side(flexion and abduction). Muscles involved include upper trapezius, lower trapezius, and serratus anterior.
• Scapular Downward Elevation: This movement occurs during lowering phase of elevated arm movements (adduction and extension). Muscles involved include levator scapulae, latissimus dorsi, pectoralis minor, and rhomboids.
• Scapular Protraction: This movement occurs during pushing activities, such as performing a push-up or closing your car door. The main scapular protractor is the serratus anterior.
• Scapular Retraction: This movement occurs while performing pulling activities, such as performing a row or closing a door. Scapular retractors include the trapezius(middle and lower fibers) and the rhomboids.

Is your scapular dyskinesis causing shoulder dysfunction? If so: what can you do on your own?

• Stretching muscles that attach to your scapula.
  • Pec Stretch (doorway stretch)
  • Posterior shoulder stretches (arm cross body)
  • Upper trapezius stretch (ear to shoulder)
• Strengthening muscles that attach to your scapula.
  • External rotation: keeping elbows at side and flexed to 90 degrees, rotate arms to the side.
  • Scapular retraction: pinching your scapula together as if to pin a tennis ball in the middle of your back.
  • Serratus Punches/ push-up plus: while lying on your back push your arm up to the sky as if to reach for something above you. OR, while performing a pushup, at the top of the motion try and push your back to the ceiling.
• What can your Physical Therapist do for you?
  • Provide manual mobilization (specific joint techniques) that allow for more efficient and normalized movement patterns.
  • Provide specific strengthening and stretching exercises to pinpoint your specific dysfunction and return to prior level of pain free functioning.
  • Implement modalities, such as electrical stimulation, ultrasound, heat and ice, that require skilled intervention to help relieve pain, normalize tissue, and speed recovery processes.
  • Provide you with home exercise programs that allow you to minimize future problems and provide you with your own self-care and independence.