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Why the Frequency of ACL Injuries are on the Rise

“Bellamy Knee Injury” by joncandy is licensed with CC BY-SA 2.0.

Over the past month, our physical therapy clinic in Bethesda has seen an increase in the number of people recovering from ACL injuries and repairs. Although this is a sign that sports are returning to normal, there are some important things to keep in mind when dealing with an ACL injury.

The ACL, also known as the Anterior Cruciate Ligament, is the tissue found in the knee joint that connects the thighbone (femur) to the shinbone (tibia). These ligaments run diagonally in the middle of the knee, controlling the back and forth motion and provide rotational stability.

ACL injuries commonly occur in sports involving sudden movements or changes of direction, such as soccer, football, or basketball. The anterior cruciate ligament can be injured in several ways, including:

  • Rapid changes in direction
  • Sudden stopping movements
  • Slowing down while running
  • Incorrect landing from jumping
  • Direct collision or contact, such as a tackle in football.

Depending on the severity of the ACL injury, treatment can include rest and rehabilitation exercises to regain stability and strength. In severe cases, surgery may be required to replace the torn ligament.

According to Mike Reinold, a leading physical therapist, there are a few important steps to take after surgery:

  • Diminish pain and swelling after surgery using compression wraps, ice, and compression machines.
  • Restore full knee extension through a variety of range of motion and stretching exercises.
  • Gradually improve knee flexion with further stretching and functional movements such as mini-squats and lunges.
  • Maintain patellar mobility with soft tissue mobilization around the knee.
  • Restore volitional quad control using neuromuscular electrical stimulation (NMES) on the quad following the ACL surgery.
  • Restore independent ambulation by improving the ability to walk without limitations or a limp.

Although ACL injuries are impossible to avoid, a proper training program can help to reduce the risk of an ACL injury. If an injury does occur, our performance training and physical therapy clinic in Bethesda will get you back to normal in no time!

3 Critical Questions To Ask Your Physical Therapist on the First Visit

Physical therapy (both in person and virtual physical therapy) is most effective when you are actively involved. While the physical therapist is responsible for identifying issues and developing a plan, the patient should be actively involved by asking questions and providing necessary background information. Here are three important questions to ask your physical therapist to get the most out of your session in Chevy Chase or Bethesda.

1. Why did this happen, and how can we ensure it doesn’t happen again?

Solving the underlying issue and resolving any pain or discomfort is essential when working with a physical therapist. But beyond that, you also want to ensure that the problems don’t resurface. By asking about the root cause of the injury or pain, you’re able to better prevent the problem from becoming a long-term issue.

2. What do I need to be doing at home?

Unfortunately, time with a physical therapist is limited. Outside of a few hours a week, most time is spent away from your PT. When meeting with a physical therapist, it’s vital to clarify any exercises you should or shouldn’t be doing at home. A great physical therapist will make sure you have the tools and exercises needed to take control of your health, both inside and outside of the session.

3. How can you be sure I’ll make progress?

If you decide to work with a physical therapist, the intention should be to progress towards your goal. Oftentimes the  healthcare system will establish general objectives, such as reaching a “baseline” or returning to ADLs (active daily activities). Although these standard guidelines are a good starting point, the purpose of physical therapy is to reach your goals, not the goals of the insurance companies! By asking this question directly, you set a clear intention for the results you desire.

Physical therapy works best when there’s an active partnership between you and the PT. The more engaged you are in your health, the more progress you will make. By asking these three essential questions, you’ll set clear intentions for your physical therapy and build a better working relationship as a result.

Fact or Fiction: Do our bodies actually fall out of alignment?

We are excited to begin a series of posts discussing common myths in the realm of athletic physical therapy. Today’s myth commonly applies to back pain physical therapy as well.

Many of our patients have been told that their body may be “out of alignment”, or that their joints need to be “re-aligned.” Unfortunately, this is not the greatest advice.

Human beings are never in a static position. Even at rest, the simple act of breathing creates movement. By definition, being in alignment means that our bodies are in a straight line, or that all parts of our body are consistently in the appropriate relative positions to one another.

We cannot consistently be in alignment because we are always moving. If our body was constantly aligned, we would be unable to move anywhere.

Your body can feel as if it is out of alignment when you overuse or rely upon specific movement strategies or body positions. This can happen for a myriad of reasons and results in feelings of stiffness and discomfort that often temporarily feel better with an adjustment.

An adjustment can be helpful if the causes of stiffness or discomfort are also addressed. The root causes of stiffness or discomfort are typically addressed by focusing on movement limitations that are present.

Any relief provided by an adjustment will be temporary when the root cause of the discomfort or stiffness is left unaddressed. Check out the article below for some activities that may help!

3 Home Exercises to Help Your Back Pain

We hope that this provided some insight into a common rehab myth. Stay tuned for more to come!

Could this be the missing piece of your marathon training?

In a previous blog post, we introduced mat Pilates and how it helps people that are struggling with back pain.  However, many athletes use Pilates to improve other aspects of their performance and CHP’s own, Dr. Ciara Petry, uses it as part of her physical therapy treatment sessions.

As you know, Bethesda and Chevy Chase are packed with athletic people and runners of all levels. Many of these runners are preparing for a variety of races. Running volume increases as a runner prepares for a race, which increases the need for cross training. Cross training allows runners to enhance qualities that improve running performance.  However, it is important to avoid adding more pounding to the body in the process.

At Cohen Health and Performance, we have found Pilates to be incredibly helpful in this regard. Weekly supplementation of Pilates training helps to improve performance and/or reduce the risk of running related injuries.

Pilates includes low impact and multi-planar movements that enhance core stability, mobility, and other foundational components necessary for healthy running.

In an article published in 2018, Finatto et al performed a study measuring the effect of a 12-week Pilates mat program on running performance. The participants in this study were separated into 2 groups. Both groups participated in a run training program, however one of the groups also participated in classic mat Pilates training 2x/week for 1-hour per session. The study found that the Pilates group had been more resilient to fatigue when running. It was also found that runners in the Pilates training group significantly improved their 5-km times, thus suggesting that distance runners can transfer the gains made in Pilates to running!

Integrating Pilates into a runner’s performance training just 1-2x/week can improve running efficiency and performance. How cool is that?!

Here at CHP, we help our athletes conquer injury and optimize performance. Reach out today to schedule a running analysis with one of our performance physical therapists and to Dr. Ciara Petry, a certified Mat Pilates instructor, for personalized Pilates sessions!

Article for Reference: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194057

Why Some Warmups Aren’t Useful

As performance physical therapists in Bethesda and Chevy Chase, we work within a very knowledgeable and active community.  Our clients and patients understand the importance of warming up.

Warming up is commonly touted as essential for anyone wishing to avoid injury during exercise, performance training, or running.

We agree with this statement; however, warmup routines are often implemented in a non-productive way.

There is a time and place for everything, however this does not mean that you need to stretch, roll around on the ground, and perform “activation” drills prior to being ready for exercise.

In addition to increasing total body temperature, a warmup routine should prepare the body for the specific workout that is going to take place. For this reason, we call warming up “movement preparation.” The body is being prepared to move!

Movement preparation should include drills that train the skills necessary for the day’s workout. Many times, these drills will look similar to the exercises within that day’s work out.

If you are getting ready to run, perform activities that practice things necessary to run effectively. If you are going to lift weights, practice movements similar to the lifts you are going to perform (ie. If you are going to squat, then squat in your warmup!).

This advise applies regardless of whether you are healthy, injured, in performance physical therapy, or training for performance.

Below are 2 drills that we often use during movement preparation prior to running. Each drill practices single leg balance, the ability to shock absorb on one leg, and trunk rotation. These are all attributes necessary for running.

Single leg knee to chest
Forward lunge with cross connect

Furthermore, if you have been sitting at a desk for the majority of the day, you may need a more comprehensive warmup. On the other hand, if you have an active job requiring you to move in a variety of different ways then your warmup may not need to be as comprehensive.

Movement preparation is necessary, however it is essential to be purposeful, rather than mindlessly performing the same thing before every workout.

2 Simple Drills to Improve your Running Times

As a dedicated runner you likely have suffered an injury at some point. Perhaps it forced you to seek performance physical therapy. Whether you realized it or not, this injury limited your ability to train effectively.

At CHP, we consistently help runners in Chevy Chase and Bethesda overcome injuries that otherwise would limit their ability to train, ultimately causing disappointing results.

There is not a one size fits all solution to helping all runners; however, we often discover that runners are limited by their hamstrings.

Are you concerned that hamstring stiffness or weakness could be limiting your performance?

Your hamstring is responsible for keeping your heel close to your bottom during the heel recovery phase of the running cycle. This portion of the cycle occurs as you bring your leg back underneath your body to prepare it to strike the ground again. The closer you can keep your heel relative to your bottom, the better! This allows you to efficiently move your leg faster through space, resulting in faster times. Below is a drill we prescribe to many runners to improve this attribute.

 

 

When running the hamstrings also need the ability to lengthen as the thigh is in front of the body. This should be achieved without drastically changing the position of the pelvis. Many runners struggle to maintain control of their pelvis as the hamstring lengthens. This increases the stress placed onto a variety of soft tissues through the lower body and alters foot strike position. Below is a drill to improve these capabilities.

 

 

A thoughtful and more scientific approach to training, specifically designed for runners is likely all that you need to drastically improve your running performance. It may not even require you to train any harder, just smarter!