3/2/20: Knee Pain and Hip Strength
One of the most common injury areas in sport is the knee complex. With growing awareness of knee injury due to social media, professional sports, and increased sport participation more research has been provided to identify potential risk factors. In recent years proximal hip strength has been shown to correlate with potential knee injury.
A theory that hip abductor weakness and hip external rotator weakness relating to knee pain has been described in multiple articles. According to Powers, C., excessive hip internal rotation and adduction can create a distal knee valgus force. This valgus force collapses the knee inwards thus creating excess medial shearing at the knee. (1) Proximal strengthening at the hip has been theorized to potentially decrease distal forces at the knee.
A systematic review by Peters and Tyson in 2013 identified eight studies discussing patellafemoral pain syndrome and hip strengthening. All eight studies utilizing hip strengthening were found to be effective in reducing pain and improving function, while only 80% of knee strengthening programs were found to reduce pain. (2) This systematic review provides evidence that hip strengthening may reduce pain and improve function in patients suffering from knee pain.
A second systematic review conducted by Santos, Oliveira, Ocarino, Holt, and Fonseca in 2015 discussed the effectiveness of hip strengthening in patellafemoral pain syndrome. Seven studies were included. (3) All studies demonstrated pain reduction with hip strengthening, and five studies were shown to improve function.
Although a complex diagnosis, knee pain may benefit from interventions utilizing hip and core strengthening. A complete “lower-extremity chain” approach should be taken when treating knee pain in formal physical therapy.
Ivy Rehab Physical Therapy, Physical Therapist
1. Powers, C. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. Journal of Orthopaedic & Sports Physical Therapy. 2010; 40(2): 42–51
2. Peters, J. and Tyson, N. Proximal exercises are effective in treating patellafemoral pain syndrome: a systematic review. Int J Sports Phys Ther. 2013 Oct; 8(5): 689–700.
3. Santos, T., Oliveria, B., Ocarino, J., Holt, K., and Fonseca, S. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Braz J Phys Ther. 2015 May-Jun; 19(3): 167–176.
2/19/20: Helpful Tips for Post-Exercise Recovery, An Athletic Trainer’s Perspective
When I think of recovery, I consider it as getting over something or getting back to my normal self. According to Dictornary.com, recovery means, “The regaining of or the possibility of regaining something lost or taken away, restoration or return to health from sickness or to any former and better state or condition.” With this definition in mind, how does recovery play into post-exercise? An athlete's post-exercise routine may consist of stretching, as stretching can be helpful in our recovery process. According to Harvard Health “stretching keeps the muscles flexible, strong, and healthy, and we need that flexibility to maintain a range of motion in the joints. Without it, the muscles shorten and become tight. Then, when you call on the muscles for activity, they are weak and unable to extend all the way. That puts you at risk for joint pain, strains, and muscle damage.” Stretching is not only beneficial for our muscles but it is helpful in our overall well-being. According to the American Council on Exercise, stretching can “decrease stress, reduce pain and stiffness, improve health, enhance range of motion, improve function, may reduce risk of injury, enhance performance, improve blood flow and circulation, minimize wear and tear on joints, and improve quality of life.”
In a recent systematic review article from Frontiers in Physiology, a study was conducted on evaluating the impact of recovery techniques on delayed onset muscle soreness (DOMS), which is perceived fatigue, muscle damage, and inflammatory markers after physical activity. They examined massage, compressive garments, water immersion, electrostimulation, stretching, anti-inflammatory interventions relying on cold exposure such as cryotherapy, and active recovery such as a low impact form of exercise like riding a stationary bike or swimming. At the conclusion of the study it was found that massage seemed to be most effective for both DOMS and perceived fatigue while massage and cold exposure such as water immersion and cryotherapy helped with inflammation. I would suggest an athlete devote time to stretching post-exercise as well as using a foam roller, assuming they are unable to get a massage, in order to maximize recovery and relieve soreness in their muscles. If cold water immersion or cryotherapy is not available, considering following the stretches and foam rolling with icing using a cold pack.
Ultimately, we know stretching can help with muscle soreness and flexibility, but it should not be painful, and it will not prevent against injuries on its own. Some other topics to keep in mind beside stretching for post-exercise recovery are hydration, diet/nutrition, and sleep. Drinking half of your body weight in ounces is recommended in staying hydrated which can aid with muscle soreness. Making sure you have a balanced diet that consist of complex carbs, good fats, and protein will not only help get you through a practice or game, but can aid in muscle recovery and overall brain function. Getting 6-8 hours of sleep will help in mental and physiological recovery which assists with complete full body recovery. If you have any questions regarding the information presented here, please reach out to me through our email listed below.
April Locke, ATC
Ivy Rehab Physical Therapy, Head of Athletic Training
Dictionary.Com. 2020 January. https://www.dictionary.com/browse/recovery?s=t
The Importance of Stretching. Harvard Health Publishing. 2019 September 25. https://www.health.harvard.edu/staying-healthy/the-importance-of-stretching
Matthews, Jessica. 10 Reasons Why You Should Be Stretching. American Council on Exercise. 2017 April 19. https://www.acefitness.org/education-and-resources/professional/expert-articles/6387/10-reasons-why-you-should-be-stretching
Dupuy O., Duzi W., Theurot D., Bosquet L., and Dugue B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Frontiers in Physiology. 2018 April 26. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931?pg=2&reDate=21012020
11/4/19: Concussion Statistics and Differences in Youth Soccer Groups
Youth concussion awareness has gained considerable interest in the past 10+ years due to an increase in youth sport participation and media presence. According to a study by Tsushima, Siu, Ahn, Chang, and Murata in February 2019, the overall incidence of concussion was 12.1% in a sample of over 10,000 youth athletes participating in five different sports.1 Furthermore, researchers determined that females were at a one and a half times higher risk than males.1 Tsushima et.al. also stated that athletes with a previous history of a concussion were three to five times more likely to receive a second concussion versus those without a history.1
Concussions result as a direct or indirect blow to one’s head causing the mildest form of a traumatic brain injury.2,3 Rapid acceleration and deceleration of the brain causes a cascade of neurochemical changes that alters one’s mental status.2,3 Although most concussions within youth sports resolve within three to five days, a minority of cases can last for multiple weeks or months.
A study performed by Colven, Mullen, and Lovell in 2009 described differences in groups between youth males and females having a history of one or more concussions. 141 females and 93 males ranging from eight to 24 years old recently diagnosed with a concussion were included in this study.4 ImPACT testing consisting of reaction time, memory, and visual motor-speed exams were utilized and compared.4 Significant differences were noted as females scored worse on neurocognitive testing and reported increased negative subjective symptoms versus males.4 Furthermore, females with a history of a prior concussion performed significantly worse on ImPACT testing that those who did not.4
This research supports evidence that high-school-aged females may require a longer period of time to return to baseline function, especially those with a previous history of a concussion. Return to school functions, physical activity, and return to sport should be adjusted accordingly to accommodate these factors. Initial treatment should consist of rest followed by a gradual return to physical and cognitive activity.
1. William T Tsushima, Andrea M Siu, Hyeong Jun Ahn, Bolin L Chang, and Nathan M Murata. Incidence and Risk of Concussions in Youth Athletes: Comparisons of Age, Sex, Concussion History, Sport, and Football Position. Arch Clin Neuropsychol. 2019 Feb; 34(1): 60–69.
2. Christopher C. Gizacorresponding author and David A. Hovda. The Neurometabolic Cascade of Concussion. J Athl Train. 2001 Jul-Sep; 36(3): 228–235.
3. William J. Mullally. Concussion. The American Journal of Medicine. 2017 August; 130(8): 885-892
4. Colvin AC1, Mullen J, Lovell MR, West RV, Collins MW, Groh M. The role of concussion history and gender in recovery from soccer-related concussion. Am J Sports Med. 2009 Sep;37(9):1699-704