Before you decide that your client has “tight” external rotators of the hip from your visual, static assessment, you better check them for femoral retroversion.  Retroversion is the result of a reduced femoral neck angle relative to the line through the femoral condyles.

The reduced angle will result in a greater degree of hip external rotation and a reduction in hip internal rotation. 

To identify this you’ll use Craig’s Test which you’ll find with a quick Google search.

Bill

A recent study in the American Journal of Sports Medicine has identified another potential contributor to ACL injuries in female athletes.

It seems that females tend to have an imbalance between the heads of their gastrocnemius with the lateral gastroc being much more active than the medial gastroc during straight ahead running and cutting.  This may actually increase the strain on the ACL in some situations (it certainly does so when tested statically).

The theory is that the increased lateral gastroc activity is an attempt to increase knee joint stability since female knees tend to be more lax.

Females also tend to cut and land from jumping with smaller hip and knee angles which are known risk factors in ACL injury.

Take these issues into consideration when training your female athletes.

Bill

The approach that you take to improve joint range of motion or mobility depends on the needs of the individual.  We can’t assume that one method will be effective in every case. That’s why some form of assessment is usually in order to determine which method to apply to achieve the desired result.

For example, if the goal is to increase hip internal rotation, the method(s) you choose may depend on whether it’s a muscular or capsular limitation.  Muscular issues respond to a variety of methods from simple static stretching, PNF techniques, or dynamic mobility exercises to name just a few.  Capsular restrictions will tend to respond best to passive joint mobilization and low-load, passive tension (prolonged low intensity stretching).

Here’s a quickie test to determine muscular limitation from capsular limitation using the same hip internal rotation restriction.

Lie supine with the hip and knee bent to 90 degrees and internally rotate the hip.  The flexion of the hip “relaxes” the hip capsule and brings the muscles under tension.  Limitation in range of motion will tend to be muscular in origin.

Lie prone with hip in neutral alignment.  Bend the knee to 90 degrees and internally rotate the hip.  Because the hip is in neutral there is less tension on the muscle tissues, so any limitation will tend to be capsular.

Select the best method to achieve the desired result.

Bill

I caught a video clip of a strength coach going through a series of hip mobility drills and stretches designed to increase hip range of motion to improve squat performance.

I applaud his intent but question the effectiveness his exercise technique.

When you’re performing mobility drills or even simple stretches, you must not only attend to which joints you’re trying to move but also those that you’re trying NOT to move.

Try this example.

Lie on your back and pull your knee to your chest as tight as possible.  You should feel a stretch in your glutes and maybe in your hamstring.

Now my question to you:  Did you feel your back flatten toward the floor?

This stretch is designed to improve hip flexion flexibility RELATIVE to flexibility of the spine.  If you felt your spine flatten (reduced lordosis), you not only stretched the hip but also the lower back.  In doing so, the relative flexibility is unchanged and your gains will be limited.  You can also perpetuate low back pain this way.

Now perform the knee to chest stretch but this time work to keep the lumbar spine in its natural lordosis.  Your hip flexion will seem limited because the spine is no longer moving, however, you will be targeting the increase in mobility of the hip more effectively.

Especially during more dynamic mobility drills there will always be required elements of stability that are essential to proper exercise performance and effectiveness.

Bill

I’ve seen health, fitness, and rehab professionals recommend intentially using light weights (<=5 pounds) to train the rotator cuff in healthy trainees to help prevent cuff injuries.  The reasoning is that with increasing intensity you’re increasing the recruitment of the bigger muscles (pecs, lats, deltoid) that also provide rotational force and the benefit of the cuff muscles is reduced.

I’ve never really agreed with this reasoning and there’s a study in the new issue of Physical Therapy (August 2007) that backs me up.  It showed that with increasing intensity, the bigger muscles were certainly recruited as needed but the rotator cuff muscles also increased their intensity of contraction as well.

So in other words, there’s no reason to limit loading in hopes of making your rotator cuff training more effective.

Bill

P.S.  In the same issue, they surveyed a group of OCS’s (PT’s with an Orthopedic Certified Specialist designation) as to their frequency of use of ultrasound in the treatment of their patients.  83.6% of the respondents indicated that they would use ultrasound to reduce soft-tissue inflammation eventhough there’s a lack of evidence to support such treatment.