by Nick Mattis, SPT
The development of strength and coordination in children is a rapidly evolving topic that many parents are concerned with. Questions surrounding what the best movements to perform are for child growth and the progression into sports are discussed in this article. Early and applicable activity in children can lead to long-term athletic development (LTAD). Strength, coordination, and motor skill competency are all vital components in the growth of children in activities. There are eight Athletic Motor Skill Competencies (AMSC) to which form a foundation of targeted areas of growth in children. Which is one of the athletic motor skill competencies? The competencies include: Lower-body unilateral, Lower-body bilateral, Upper-body pushing, Upper-body pulling, Antirotation and Core bracing, Jumping/Landing/Rebound mechanics, Throwing/Catching/Grasping, and Acceleration/Deceleration/Reacceleration. Through the progression of each competency, children will become more well-rounded in movement that is applicable to many scenarios as well as decrease the risk of injury through properly strengthened muscles and instruction of form.
The early stages of development begin in childhood. Which age is considered childhood for girls? Childhood is considered in girls <11 years of age and boys <13 years of age. At this age, the brain is more neural plastic than adolescent years, meaning the brain is able to adapt, change, and form new learning pathways. This allows the children to learn, process, and repeat movements at a greater success rate than later in life. Approximately how much training-induced gains can be achieved by pre-pubertal youth compared to adolescents? Children are able to achieve almost 50% greater gains in motor skills in comparison to adolescents with resistance training. Therefore, the movements should be introduced at the pre-pubescent age to maximize the growth of the child. At this age, it is important to get the child to adhere to the long-term program. This often involves making the program in to fun games with play like movements. An example of this is performing movements like animals. There are several benefits to these movements such as child enjoyment, easy to perform, and effective. What is the main purpose of animal shape exercises? The most important benefit of the animal exercises is the enhanced locomotion skills the child receives from the exercise. Asking the child to “walk like a gorilla” will effectively improve lower extremity strength and range of motion as the child walks in a squatted position with it seeming like a game to them. Which is recommended for teaching children key body positions and movements? Similarly, cues can be given to the children when performing the motion to help instruct them in a way they will remember. When they are “walking like a gorilla”, you can tell them to “duck under the branch” so they will squat lower in the exercise. Using cues like this will be easier for the child to remember and perform compared to verbalizing squatting lower. In Table 1 of the article is a list of several animals and how to perform the movements like them. What physical attributes does the vulture exercise help to improve? A great exercise for single-leg balance is the vulture exercise where one stands and balances on one leg.
It is important to introduce smaller, simple movements before larger more complex movements. The complex movements are often combinations of several simple movements. Therefore, mastering the simple movements will make a more fluid and easier complex movement when it is time to progress. For example, simple movements such as the tuck, arch, and pike should be performed and mastered first. Then the individual can progress to more difficult movements such as a squat, handstand, or bridge. Which represents an appropriate progression? An appropriate progression would be as follows: tuck, straddle, and lastly bridge. It is important to recognize and understand the difficulty of each exercise to make proper progressions. Figure 5 in the article shows levels of intensity of exercises for proper progressions. Which of the following horizontal pushing exercises is classified as the highest intensity? The barbell bench press is the highest intensity for the horizontal pushing exercises, while the press up hold (plank) is of the lowest intensity. What is the most likely result of constant movement variation during game-based activities? When progressing the exercise, studies have found that rather than continually performing the same motion over and over, there is greater retention results in the child with constant variation in the movement. The constantly changing movement is found to have greater retention in the child’s brain rather than repeated continuous movements. Similarly, it is not as important to train children for sport specific movements as it is to make them well rounded in many movements. What is recommended for practitioners using more structured training with young athletes? Practitioners and parents should be training the young athlete to develop gross athleticism relevant to sports performance. This will develop the child’s movement skills to be applicable to many different sports and other scenarios. Not only will they accel at multiple sports, but they will also not be stuck with one sport as a kid lacking skilled movements to participate in other sports.
Physical Therapy First:
Here at Physical Therapy First, we have a team of skilled therapists that are able to assess, educate, and treat your child in recovery from injury to return them to their optimal functional level. Through manual techniques, therapeutic activities and other interventions, we can restore ROM, increase strength, and return you back to activity. Call today to schedule an appointment.
1) Radnor, John M. PhD1; Moeskops, Sylvia MSc, CSCS1; Morris, Stephanie J. MSc, CSCS1; Mathews, Thomas A. MSc, CSCS1; Kumar, Nakul T. A. CSCS1; Pullen, Ben J. BSc1; Meyers, Robert W. PhD1; Pedley, Jason S. PhD1; Gould, Zach I. PhD, CSCS1; Oliver, Jon L. PhD1,2; Lloyd, Rhodri S. PhD, CSCS*D1,2,3 Developing Athletic Motor Skill Competencies in Youth, Strength and Conditioning Journal: December 2020 – Volume 42 – Issue 6 – p 54-70. doi: 10.1519/SSC.0000000000000602
by Logan Swisher, PT, DPT, OCS
Fibromyalgia syndrome is characterized by chronic and diffuse musculoskeletal pain. The exact cause of fibromyalgia is unknown but abnormalities of the pain processing in the nervous system, such as hyper-responsiveness and hyper-excitability, may explain the chronic pain. Myofascial trigger point pain is defined as pain from one or more hyperirritable or hypersensitive palpable nodules in skeletal muscle which can refer pain locally and globally over the body. Myofascial release is a therapeutic intervention aimed at providing pain relief by restoring impaired soft tissue function. Dry needling, on the other hand, is a minimally invasive technique where an acupuncture needle is inserted directly into myofascial trigger points with the end goal of decreasing local and referred pain. This article aimed to compare the effectiveness of dry needling vs. myofascial release for patient with fibromyalgia.
64 total participants (58 women and 6 men)
-32 participants assigned to the dry needling group
-32 participants in the myofascial release group
In this single-blind randomized controlled trial patients were assigned to a dry needling or myofascial release group. Pain pressure thresholds of trigger points in the cervical muscles were assessed as well as quality of life, impact of fibromyalgia symptoms, quality of sleep, intensity of pain, anxiety and depression symptoms, and impact of fatigue at baseline and 4 weeks post treatment.
Significant improvement was found in most pain pressure thresholds of the myofascial trigger points in cervical muscles in the dry needling group as compared to the myofascial release group. Dry needling also demonstrated higher improvements in quality of life, quality of sleep, anxiety, depression, fatigue and intensity of pain, whereas, myofascial release demonstrated significant improvement in intensity of pain and impact of fibromyalgia symptoms.
When appropriate, dry needling therapy should be strongly considered with myofascial release techniques for patients with fibromyalgia. Here at Physical Therapy First, we have therapists trained in dry needling and myofascial release techniques. We will complete a thorough evaluation and comprise a multimodal treatment plan to address your current functional limitations and pain levels to help you restore your previous level of activity.
Castro Sánchez AM, García López H, Fernández Sánchez M, Pérez Mármol JM, Aguilar-Ferrándiz ME, Luque Suárez A, Matarán Peñarrocha GA. Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome. Disabil Rehabil. 2019 Sep;41(19):2235-2246. doi: 10.1080/09638288.2018.1461259. Epub 2018 Apr 23. PMID: 29681188.
by Logan Swisher, PT, DPT, OCS
Osteoarthritis (OA) is the most common cause of disability in adults and it is estimated that 14 million individuals in the US have symptomatic knee OA. Total knee arthroplasty (TKA) has been proven as an effective and cost-efficient intervention for end- stage knee osteoarthritis. Most people who undergo a TKA have marked improvements in function and reduction of pain compared to their preoperative condition, however, others have varied recovery of their functional abilities and not all patients experience significant improvements after surgery. The aim of this study was to examine if preoperative measures could predict functional ability at 1 year and 2 years after surgery.
-155 participants at initial evaluation
-155 participants at 1 year follow up
-125 participants at 2 years follow up
Measurements of participants age, height, weight, bilateral quadriceps muscle strength, knee flexion and extension range of motion, the Timed “Up and Go” test (TUG), stair-climbing task (SCT), and two subsets of the Knee Outcome Survey (KOS) which were the activities of daily living and pain subsets.
The TUG, SCT and KOS scores at 1 and 2 years showed significant improvement over the scores at the initial evaluation. A weak quadriceps muscle in the limb that did not undergo the surgery was related to poorer 1-and 2-year outcomes. It was also found that older participants with higher body masses also had poorer outcomes at 1 and 2 years.
The study revealed the importance of rehabilitation regimens after TKA incorporating exercises to improve strength of the non-operated limb as well as treat the deficits imposed by surgery. If left untreated, weakness in the non-operated limb may continue to impede functional ability and result in poorer postsurgical outcomes. There should also be an emphasis on treating age-related impairment, such as poor balance and strength, and reducing body mass to help improve long-term outcomes. At Physical Therapy First, our physical therapists will perform a thorough 1-on-1, hour long appointment and work with you to create a plan of care that helps you reach your goals.
Zeni JA Jr, Snyder-Mackler L. Early postoperative measures predict 1- and 2-year outcomes after unilateral total knee arthroplasty: importance of contralateral limb strength. Phys Ther. 2010 Jan;90(1):43-54. doi: 10.2522/ptj.20090089. Epub 2009 Dec 3. PMID: 19959653; PMCID: PMC2802824
by Nick Mattis, SPT
Netball is a popular court-based game in Australia and New Zealand that is rapidly gaining popularity in the United States. The game involves a lot of movement with rapid change of direction and immediate stopping when in possession of the ball. These rapid movements and immediate stopping can place excessive amounts of force and stress on the joints of the body, specifically the lower extremity. Netball has several rules, with one being the footwork rule. Once receiving the ball, if the player lands on one-foot, single leg landing (SLL), they are allowed to place the opposite foot on the ground to slow their momentum and pivot. If a player lands with both feet on the ground, double leg landing (DLL), they are allowed to pivot around one foot. The footwork rule in netball may result in vertical ground reaction forces in which of the following ranges? The footwork rule results in the body absorbing vertical ground reaction forces (VGRFs) of up to 5.7 times the players bodyweight. This rapid absorption and stabilization of the forces by the soft tissues in the leg can stress the tissues to injury. One of the most injured joints in netball is the knee. A range of 4.5-32.7% of tears occur in which tissue? The meniscus is most common soft tissue injury in the knee (4.5-32.7%) with the Anterior Cruciate Ligament (ACL) following closely behind (17.2–22.4%). Due to the common occurrence of these injuries, it is important for practitioners to understand how the injury occurred and the level of activity required to return to sport to formulate an appropriate rehabilitation plan.
Situation and Mechanism of Knee Injury
Since netball requires a lot of agility and due to the high impact movements, there is a risk of soft tissue injury from the excessive loads. Medical professionals need to understand how, where, and when the injury occurred. So, it is important to look at statistics to get an idea of how the injuries frequently occur. Most netball soft tissue injuries of the knee happen during which of the following? The majority of netball injuries occur in match play compared to training. Incidence reports injuries occur 7 times more frequently in match play than in training. Which of the following statements is true regarding netball soft tissue knee injuries? Most netball soft tissue knee injuries occur on outdoor courts, specifically asphalt. There are not nearly as many reported injuries with the indoor courts. Most netball soft tissue injuries occur in which maneuver? Landing from a jump causes the highest frequency of soft tissue knee injuries in comparison to change of direction and deceleration. There have also been patterns of body kinematics that have been associated with knee injuries. Knee abduction and trunk aberrant motion occurs in as many as 83% of noncontact ACL injuries in netball. One of the patterns is knee abduction combining with ipsilateral lateral trunk flexion. This causes a knee valgus and puts the knee at a more susceptible position of injury to the ACL, MCL, and valgus collapse. Injuries are classified in three ways: contact, indirect contact, and noncontact. Contact injuries occur at the knee through an opposing player or object making direct contact with the players knee (1). A netball soft tissue knee injury that occurs after contacting another player’s foot would be an example of which type of injury? An indirect contact injury to the knee would occur through an opposing player contacting the player in another location besides the knee that results in injury to the knee. An example of this would be stepping on an opposing player’s foot (1). A noncontact injury to the knee would occur when there is an injury at the knee without an external factor such as contact from an opposing player or object (1).
As stated before, landing from a jump causes the highest occurrence of soft tissue injury to the knee. It is important to use and apply a screening tool to identify those at risk or who have sustained soft tissue knee injuries. This tool is called the Landing Error Scoring System (LESS) (1). Concerning movement screening, the real time landing error scoring system (LESS) evaluates which physical characteristic? The LESS is used to grade generic DLL movement patterns (1). This is a 17-question examination of movement identifying the landing movement from the head down to the toes. Through this assessment one can make predictions of those at risk of a soft tissue knee injury. Limitations on this measure include it only examining DLL and does not examine SLL that is often occurring in netball; therefore, it cannot be related specifically to netball requirements (1).
There are several types of training that can be applied and useful to the netball athlete including strength, balance, and plyometrics. There has been one specific type of training though that has been found to assist netball players and be sport specific to their requirements. Which of the following types of training have resulted in decreased vertical ground reaction forces, increased knee flexion angles, and decreased knee abduction angles during single-leg and double-leg landings? Plyometric training has been found to be extremely effective in improving the biomechanics (listed previously) of netball to allow for softer landings that place less stress throughout the knee; therefore, reducing the risk of soft tissue knee injury. During which of the following should landing mechanics that carry over to match play be emphasized? Netball landing mechanics should be emphasized when performing plyometric training. It is important to make the training sport specific to strengthen the musculature and surrounding soft tissue to meet the demand of sport to reduce the risk of injury when playing.
Here at Physical Therapy First, our team of skilled therapists are able to assess, educate, and rehabilitate you in the recovery from a soft tissue knee injury. Our therapists are also trained in injury prevention and can offer athlete specific consultations to help reduce the risk of injuries. Through manual techniques and other sport-specific interventions, we can restore your ROM, increase strength, and help you return back to activity. Your therapist can help you improve your biomechanics to get you back to your individual functional needs. Call today to schedule an appointment.
1) Clark NC. Noncontact Knee Ligament Injury Prevention Screening in Netball: A Clinical Commentary with Clinical Practice Suggestions for Community-Level Players. Int J Sports Phys Ther. 2021;16(3):911-929. Published 2021 Jun 1. doi:10.26603/001c.23553
by Nick Mattis, SPT
The glenohumeral joint (shoulder) has a high level of mobility which comes at a price of low stability. Due to the extensive range of motion of the shoulder, the shoulder is not as stable as several other joints in the body (i.e. elbow, knee). Passive stabilizers of the glenohumeral joint include which of the following? There are several passive stabilizers of the joint such as the glenoid labrum, the ligamentous structures, and the bony articulation of the joint (2). Active stabilizers of the glenohumeral joint include which of the following? Then there are active stabilizers of the joint such as rotator cuff muscles, deltoid, biceps brachii, and latissimus dorsi. These active stabilizers are able to contract to assist with keeping the humeral head in the glenoid fossa. Active and passive stabilizers can become strained/torn/ruptured when the humeral head enters abnormal positioning outside the center of the glenoid cavity. During the dip exercise the humerus often reaches the end range of extension and can place the humeral head in an abnormal position. Which of the following describes the movement of the humeral head at the end of a range of movement during a dip exercise? As the humerus rotates posteriorly as the arm goes back, the head of the humerus translates anteriorly. To keep the humerus from slipping out of the glenoid cavity, the active and passive stabilizers resist excessive anterior movement of the humeral head. The main active stabilizer preventing the excessive anterior translation in the dip is the clavicular head of the Pectoralis Major (PM). The passive stability to the anterior translation is produced by the Anterior Band of the Inferior Glenohumeral Ligament (AB-IGHL). During the dip exercise, which of the following tissues are of particular concern regarding injury and subsequent lack of joint stability? The PM and the anteroinferior joint capsule are the tissues of highest concern to be injured. The Pectoralis Major and the AB-IGHL receive the highest amount of stress on them in the bottom of the dip position. Damage to these structures can result in Anterior Instability of the glenohumeral joint.
Damage to the PM can result in a strain of the muscle. The clavicular head of the PM is assists in flexion of the GH joint. Which muscle is responsible for controlling the depth of the movement during the dip exercise? When performing a dip, this portion of the PM is actively elongating to eccentrically control the speed and depth at which the dip is performed. Glenohumeral movements that are at the highest risk of injury include which of the following three events? There have been three risk factors identified that can result in injury of the PM: 1) external rotation of the shoulder while in the end range of extension, 2) moderate to maximal loads placed on the PM, 3) eccentric contraction of the muscle (3).
Anterior Shoulder Instability:
Anterior Instability (AI) occurs when there is laxity either the active and/or passive stabilizers on the anterior surface of the GH joint. This can result in an anterior dislocation or subluxation of the joint. Repetitive loading of the passive AB-IGHL (performing dips frequently at high loads) can result in deformation of the ligament and lead to AI due to the excessive load at end ranges of extension combined with and externally rotated positioning. Similarly, injury to the active stabilizers can also result in AI. During exercise when the humeral head is pushed forward (anteriorly), which of the following rotator cuff muscles is responsible for actively contracting to resist this movement? The subscapularis and teres minor of the rotator cuff are recruited in end ranges of extension to reduce the amount of anterior translation of the humeral head.
Which of the following accurately describes the dip exercise? The dip is classified as a closed-kinetic-chain exercise that is performed at body weight, with the use of a band to reduce body weight, or the addition of a weight belt to add body weight. When considering the potential risk of injury during and prescription of the dip exercise, which of the following is recommended by the authors? Tips for the prescription of dips include limiting the depth of the dip to avoid the end range positon to reduce stress placed on the PM and AB-IGHL. The authors recommend within session programming variation for the purpose of? Repetitions, load, frequency, and rest time should all be managed and to reduce muscular fatigue. Reducing muscular fatigue will prolong the technique of the dip. Poor technique can often result in the 3 risk factors mention before that result in the highest risk of injury.
Physical Therapy First:
Here at Physical Therapy First, our team of skilled therapists are able to assist you in the recovery from shoulder instability. Through manual techniques and other interventions, we can restore your ROM, increase strength, and return you back to activity. Your therapist can help you properly decide whether exercises such as the dip are appropriate for you based on your individual functional needs. Call today to schedule an appointment.
1) McKenzie, Alec K. BClinSci; Crowley-McHattan, Zachary J. PhD; Meir, Rudi PhD, CSCS; Whitting, John W. PhD; Volschenk, Wynand BA (HMS Hons) Sports Science, CSCS Glenohumeral Extension and the Dip: Considerations for the Strength and Conditioning Professional, Strength and Conditioning Journal: February 2021 – Volume 43 – Issue 1 – p 93-100 doi: 10.1519/SSC.0000000000000579
2) Terry GC, Hammon D, France P, Norwood LA. The stabilizing function of passive shoulder restraints. Am J Sports Med 19: 26–34, 1991.
3) Provencher CMT, Handfield K, Boniquit NT, et al. Injuries to the pectoralis major muscle: Diagnosis and management. Am J Sports Med 38: 1693–1705, 2010.