Posts tagged mobility
Is Lack Of Mobility Or Flexibility A Factor In My Running Injury?

Lower extremity stiffness (“leg stiffness”) describes the resistance the joints and muscles in your lower body will have to movement when your foot contacts the ground during running. Think of your leg as a spring; the more tightly coiled spring will be stiffer, the more loosely coiled will be more deformable. A stiffer leg is associated with less joint movement (less mobility) and increased loads to bones and cartilage whereas a less stiff leg is associated with increased joint motion/mobility and relies more heavily on active muscle contraction to dissipate forces when your foot hits the ground.

 Leg stiffness may be one of many variables that contribute to running related injuries. A recent study of 92 runners {Goodwin:2019bk} identified 4 variables that may allow us to more easily predict leg stiffness with clinical measures versus technical laboratory analysis. Less mobility in the ankle joint, hip and big toe joint along with increased BMI are associated with greater leg stiffness. What is the clinical significance of this for our Boulder runners? For runners suffering from knee pain or stress fractures, reducing leg stiffness by improving the mobility of hip, ankle and foot may reduce joint loading. Conversely, in runners with soft tissue injuries such as Achilles or tibialis posterior tendinopathy, increasing leg stiffness with targeted strengthening exercises to improved stability and control of the joints of the lower extremity may be an important component of rehabilitation.

Contact your physical therapy experts at Mend to learn more about how your mobility may contribute to running injury.

No long term benefits found with a 4 week foam rolling program

Foam rolling is an effective home exercise to improve muscular pain, flexibility, and performance. Our previous blog posts detailed the performance benefits of performing foam rolling either before or after your exercise workouts. Our current understanding of the mechanisms behind these benefits are based on two categories: local circulation and improved stretch tolerance. As our nervous system adapts to the stimulus of foam rolling we are able to roll deeper and tolerate a greater stretch than we could before the stimulus of foam rolling. Up until this point, only the short term benefits of foam rolling have been studied. A new research study examines the impact of a long term foam rolling program on flexibility, strength, and performance.

Hodgson and colleagues randomized recreationally active college students to one of three groups: control, rolling three times per week, or rolling six times a week. Each of the intervention groups performed foam rolling of their dominant hamstring and quadricep muscles at their given frequency for 4 weeks. Participants range of motion, strength, and jumping ability were measured before and after the study period. The authors reported no long term benefits of foam rolling or significant interactions for any measurement except a slightly better jump height in the three times a week group. In contrast to the acute benefits of foam rolling, no long term or training benefits were noted after 4 weeks of foam rolling. This study supports our current understanding on the short term nervous system adaptations which follow acute bouts of foam rolling.

Like bathing, the effects of foam rolling do not last, which is why we recommend performing it daily.

Calf Dry Needling Improves Overhead Squat Depth
boulder-dry needling-treatment-trigger point

Dry needling is a commonly utilized Physical Therapy intervention which targets taught, tender bands of muscle tissue.  This effective treatment has been previously shown to reduce muscle pain and improve muscle performance and function.  In our Boulder Physical Therapy clinic we commonly see an immediate improvement in muscle length and mobility following the dry needling intervention.  A recent study examined the effectiveness of dry needling on functional movement.  

Lake and colleagues enrolled 30 healthy males into their study published in the International Journal of Sports Physical Therapy (2018).  Participants were then randomized to one of three groups: calf dry needling, stretching, or dry needling and stretching.  Each participant performed a series of lower quarter functional movements both before and after the treatment, as well as, 4 days post treatment.  Authors reported a significant increase in overhead squat depth following dry needling of the calf musculature.  This effect is likely secondary to improved ankle bend or dorsiflexion allowing each participant to squat deeper on reassessment.  No significant differences were noted in the Y balance functional testing.

Click Here to learn how the experts at MEND can improve your pain and function with dry needling

Utilizing the Squat to Screen for Ankle Mobility
squat-screening-test-ankle mobility

The role of ankle mobility on injury risk and performance has been previously described in our prior blog posts.  These posts have described the correlation between a lack of mobility at the ankle and knee injuries including patellofemoral knee pain and ACL injury, as well as, ankle sprains and achilles tendonitis.  A lack of ankle mobility has been shown to alter knee and hip biomechanics as well as reduce dynamic ankle stability.  A new article reviews the utility of using squat testing as a screening for ankle mobility.

Rabin and colleagues put 53 healthy participants through weight bearing and non wearing ankle mobility measurements as well as squat testing (J Strength Conditioning Research. 2017).  Athletes were screened with both an overhead and forward arm squat to determine their ability to detect a loss of ankle mobility in participants with limited mobility on ankle measurements.  The authors reported high screening utility (sensitivity 1.0, negative likelihood ratio 0.0) for the overhead squat, but better diagnostic properties in the forward arm squat (specificity .84-.88, positive likelihood ratio 3.49-6.02).  Screening athletes first with the overhead squat followed by the forward arm squat is an easy clinical method of assessing ankle mobility.

Influence of Posture on Shoulder Function and Pain
shoulder pain-posture-range of motion-strength

Shoulder pain is the 2nd most common orthopedic reason patients seek out medical care behind low back pain.  Shoulder pain has many causes including lack of mobility, shoulder blade and rotator cuff weakness, but posture is often criticized as a risk factor for shoulder pain.  Clinicians and patients believe a poor posture places structures such as the rotator cuff at risk for injury or the posture changes the function of muscles in the upper body.  In our practice, we often find stiffness or a lack of mobility in the middle back (thoracic spine) either precipitates or perpetuates a patient's shoulder symptoms.  Poor mobility in the thoracic spine requires more of the neck and shoulder during a given functional movement.

A recent review article searched the available evidence to determine posture's role on shoulder pain and function.  Barrett and colleagues examined 10 studies to determine if posture influences shoulder range of motion or the development of shoulder pain (Man Ther. 2016).  They found moderate evidence showing no difference in thoracic posture between those with and without shoulder pain.  Conversely, the did find strong support that better posture allows for greater shoulder range of motion compared to a slumped posture.  Their final conclusion stated no significant contribution of thoracic posture on the development of future shoulder pain, but further research is needed.  

Why Rolling Your IT Band Is A Waste Of Time
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In a prior post we discussed the prevention, treatment, and prognosis for iliotibial band syndrome.  The iliotibial band is commonly injured due to poor running biomechanics (cross over running gait) and muscle imbalances.  Specifically, weakness in the gluteus medius and maximus and an overutilization of the tensor fascia lata muscle which connects into the IT band.  In the presence of this muscle imbalance the IT band is compressed against the knee bone creating friction and pain. 

Often patients in our Boulder Physical Therapy practice ask if they should add foam rolling to their IT band, as in the picture above, to help "release" or "stretch" the IT band.  This extremely painful foam rolling does little for your IT band flexibility due to the strength of this structure.  The IT band is an extremely tough tissue and will not stretch with foam rolling, massage, or any other intervention.  Chaudhry et al found it would take a load of over 9000 newtons (925 kg) to change the IT band by only 1% (2008).  To put the amount of force in perspective, a lion's jaw produces 4,450 N of force.  Thus, the juice is not worth the painful squeeze of the foam roller.  Patients are advised to work with a Physical Therapist to determine the underlying cause of the IT band pain.  To improve flexibility patients should work the soft tissue at the hip vs. the IT band tissue at the thigh.