Posts in athletes
Reducing Knee Pain In Cyclists

Cycling is one of the most popular outdoor activities in Boulder.  Cyclists we encounter in our Boulder Physical Therapy practice most commonly complain of pain on the front of their knee or anterior knee pain.  Research shows 1 in 2 competitive cyclists have experienced this knee pain resulting in lost training and competitions in over half of those affected (Clarsen et al. 2010).  A cyclists exposure to the impact of poor pedaling biomechanics is amplified by the volume of their training.  It is not uncommon for a competitive cyclist to flex and extend their knee over 5 million times per year during their training sessions and competitions (Callaghan et al. 2005).  In addition to training errors, bike biomechanics remain one of the key sources of an athlete's knee pain.

Athletes who have excessive movement in their lower bodies both reduce their cycling economy and performance, as well as, increase their injury risk.  In particular, the movement of the knee toward or away from the frame increases stress across the knee especially during the power portion of the pedal cycle.  The suboptimal mechanics change the alignment of the knee and the ability of the leg muscles to import forces on the foot and pedal.  Commonly, bike fitters use shoe orthotics or wedges to modify the relationship between the foot, shoe, and pedal.

Research has shown a rigid cycling shoe is the most economical and efficient interface with the pedal allowing cyclists to pedal at a lower % of their VO2 max for a given work load compared to a softer shoe.   Research regarding orthoses or wedges on cycling alignment and mechanics are fewer in number.  The limited research shows these orthoses or wedges 5-10 degrees can temporarily impact mechanics but their long term efficacy as a tool remains to be limited (Fitzgibbon et al. 2016).  They are most likely to benefit those athletes with true structural alignment impairments in the leg.  

Conversely, many of our patients's symptoms improve quickly with Physical Therapy interventions to correct impairments such as limited range of motion and muscle imbalances in the leg.  Once these are addressed an athlete is better able to use cuing and movement retraining to improve static and dynamic alignment of the knee while cycling.  In summary, athletes need the capacity to control the knee position through strengthening then the appropriate retraining to use that strength in an optimal cycling pedal cadence.  


Improving Athletic Performance in Adolescents

Resistance training is an essential part of any training program due to its' ability to reduce injury risk and improve sports performance.  Adolescents can safely resistance train if they are properly supervised and can perform movements correctly.  One of the foundations of any strengthening program is the squat.  The squat is an incredible training tool for the development of strength, speed, and sports performance.  This exercise focuses on the transfer of forces and weight in a vertical direction where as a newer exercise, the hip thrust, focuses on the transfer of forces in a horizontal direction.  This second exercise may be best for sports requiring horizontal transfer of forces such as sprinting.  

Contreras and colleagues studied these two exercises to determine which strengthening exercise showed the greatest improvement in adolescent performance (J Strength Conditioning Research 2016).  The authors randomized 28 adolescent athletes (14-17) to either a front squat or hip thrust training program, twice per week for 6 weeks.  Athletes were tested both before and after the training program on a battery of athletic performance tests including sprinting, jumping, and strength testing.  At the conclusion of 6 weeks, the athletes who performed the hip thrust training program showed beneficial effects on the sprint times indicating the exercise may be a helpful addition to strength programs for horizontal movement athletes (football, sprinting).

Athletes are encouraged to work with a local Physical Therapist to determine the most important exercises for their strength training program to reduce injury risk and improve performance. 

Return to Play after Achilles Tendon Rupture

Achilles tendon ruptures mainly occurs in middle aged adults, males > females, participating in sports with high levels of jumping or high force activity.  The repair and recovery time of these tendon ruptures is lengthy due to the post operative immobilization, weight bearing, and exercise restrictions.  Prior research has shown only 1 in 2 athletes returns to play at 1 year post op.  Among these athletes who do not return some may either choose not to return to their previous sport due to fear of reinjury while others have placed themselves at greater risk of injury due to not restoring their leg's strength, balance, agility, and coordination to pre injury levels.  

A recent article in the British Journal of Sports Medicine reviewed the available evidence to determine an athlete's ability to return to play after achilles tendon repair.  (Zellers et al. 2016).  The authors reviewed 108 studies of over 6500 patients and found on average 80% of athletes return to play at pre injury levels.  The average time to return to sport after a course of Physical Therapy was 6 months.

Athletes are encouraged to use Physical Therapy following an Achilles Tendon injury to accelerate their healing and improve their chances of recovery.  

Reducing ACL Reinjury Risk

Athletes often return to sports around 6-9 months after ACL reconstruction and Physical Therapy.  In a previous ACL post we described how important these Physical Therapy sessions are to an athlete's recovery.  Each session after surgery is designed to move the athlete closer to the all important return to play.  New research is showing how instrumental this path to recovery is to reduce the risk of ACL re injury.  

Grindem and colleagues studies 106 pivoting sports athletes who underwent ACL reconstruction and Physical Therapy.  The athletes were followed for 2 years to document their rehabilitation, functional performance, and finally return to play.  The authors reported athletes who returned to high level sports had 4 times the risk of re injury compared to lower and mid level sports participation.  Among all athletes, those who did not pass their functional testing before returning were 8 times more likely to re injure their ACL.   Importantly, this re injury rate was cut in half for each month the athlete stayed in rehabilitation and delayed their return to sport up until 9 months.  In short, having athletes who complete 9 months of Physical Therapy and pass their functional tests can reduce their reinjury risk by 84%.

Athletes are advised to work with a local Physical Therapist for 9 months to allow a safe return to competitive sports.  

Risk Factors for Knee Injuries in Adolescents and Teenagers

The knee is one of most commonly injured areas among our Boulder County student athletes.  Injuries range from the traumatic (ligament tears) to overuse (tendonitis) across a variety of indoor and outdoor sports.  Prior research has shown overuse injuries to be the most common knee injury affecting our student athletes but data regarding the risk factors for these two types of injuries has been limited.  

Recently a large study was conducted to document sports participation, injuries, and pain levels of over 1300 8-15 year old children (Junge et al. Med Sci Sp Ex. 2016).  The authors documented the frequency, severity, and type of knee injuries within this group in order to determine the risk factors associated with these injuries.  The authors reported 952 knee injuries (85% overuse) were sustained by the athletes in the study.  Participation in gymnastics was the greatest risk factor for traumatic knee injury.  

Within the overuse injury category female sex, prior knee injury, and a higher frequency of practices and games per week were associated with a higher risk of injury.  The majority of these overuse conditions were self limiting in nature and are successfully managed with conservative care including Physical Therapy.  To learn more on now to reduce your child's risk of knee injury contact your local Physical Therapist. 

Imaging's Role in Youth Baseball

In our previous blog posts we have written on the limitations of MRI for many injuries and conditions.  In general, these expensive tests have high rates of false positives where patients without pain often have positive results including ligament/labrum tears or tendon changes.  The incidence of false of positives increases in athletes with the majority of major league baseball players, regardless of symptoms, demonstrating rotator cuff tears or labrum injury.   It appears these changes are no different in our little leaguers.  

An article in the Journal of Bone and Joint Surgery examined 10-13 year old little league baseball players.  Each player underwent an MRI on both elbows at the start of the season.   The authors found many of the players with or without pain had imaging findings in their elbow.  Adding to our existing data that many athletes have positive MRI findings without pain or injury.  Two factors were associated with a positive MRI and elbow pain including year round baseball play and working with a private pitching coach.  

Athletes are encouraged to work with a local Physical Therapist to treat their elbow pain and reduce their risk of throwing injuries.