Archive for the ‘Posture’ Category

“Stressing Out Over Stress Fractures”

Monday, July 21st, 2008

This is a good title.  Dr. Suzanne Hecht (UCLA>>>now University of Minnesota) and I wrote this article originally for USECA.  I may have used parts of it before in lectures or after in other articles/lectures; but, here it goes again:

GETTING STRESSED OUT ABOUT STRESS FRACTURES?

So what is a stress fracture?  Dr. Hecht writes –

A stress fracture is an overuse injury to the bone that occurs when the bone cannot keep up with the demand that is placed on it leading to microfractures (mini breaks in the bone) and swelling of the bone marrow.

Dr. Hecht continues by describing typical symptoms of a tibial stress fracture include the following: 

·        Pain develops gradually

·        Shin pain occurring during or after workouts

·        Pain improves with rest

·        A sudden increase in training time or intensity

·        The shin may be sore to touchX-rays are often negative early on in the course of a stress fracture. 

Remember…just because the x-rays are negative doesn’t mean your gymnast doesn’t have a stress fracture.  The physician may recommend further testing to confirm the suspected diagnosis or may suggest treatment options and repeat the x-rays in 2-4 weeks to see if the stress fracture can be seen.  A bone scan is a common test used to look for stress fractures if the x-rays are negative.  Other physicians might order a MRI scan.

Dr. Hecht emphasizes that stress fractures of the front portion of the tibia (anterior) are very concerning.  These fractures can show up as a dark black line on the x-rays and physicians commonly refer to this finding as “the dreaded black line”.  This stress fracture worries physicians since the bone in this area is on tension and doesn’t like to heal.  The anterior tibial stress fractures should be taken very seriously and treated with extensive rest of the leg or placement of a rod into the tibia to help facilitate healing.  Stress fractures of the inside, back portion of the tibia (posteromedial) heal better and can be treated more liberally.  

A note from “The Posture Lady” regarding

BIOMECHANICS OF THE LOWER BODY

Poor biomechanics of the lower extremities and pelvic area often lead to conditions such as tibial stress fractures.  Be sure to check for muscle imbalances.  Finally, emphasizing correct standing posture cannot go unnoticed and should be an important part of the training process.

Comments from “The Posture Lady” 07/21/2008:  I have seen preschool kids, as young as two or three years old, stand in severe knee hyperextension.  My 3 and 1/2 year old son stands with “loosey goosey” looking knees, in complete knee hyperextension, every day and I remind him EVERY DAY that he needs to stand with his knees “soft.”  I believe we need to go this far back and start educating parents and kids about correct standing posture.

There are many elite gymnasts that stand in knee hyperextension.  This can be seen especially when at the chalk box or awaiting a turn on vault or beam.  It’s a horrible stance.  This is not to say that the gymnast’s legs should not look straight and gorgeous once airborne, but just to say we are NOT meant to stand in knee hyperextension.  I will soon learn how to post a picture from my mentor (RIP) Florence Kendall, PT.  She gave me permission to use the very picture that best shows the problem and consequences of knee hyperextension.  From the book, “MUSCLES Testing and Function” 5th edition, page 84, ISBN 0-7817-4780-5  (I’m in the book too – pages 395,396,397, if you want to see some crazy-short hip flexors and ITBs as a former elite gymnast.  What a mess.)

Back to the problem with this picture.  A gymnast that stands in knee hyperextension risks the possiblity of ending up with a posterior (backward) bow in the tibia and fibula.  I wonder if this helps lead to stress fractures or bones that “just pop and crack.”  My gut says, yes.  It saddens me that an elite gymnast may get to this point from something that might be prevented with education as early as the preschool years.  Let’s work to help fix the issue.

The gymnast should stand with good posture at all times.  The femurs (thighbones) should be in neutral rotation with the patellae (kneecaps) facing straight ahead.  The feet should be in good alignment; turned out only 7 to 10 degrees and arches maintained. 

If a gymnast has difficulty holding the arches up, the following suggestions may help:

-Reinforce the idea of contracting the side buttock muscles to help align the legs and lift the arches.

-Strengthen the posterior Gluteus Medius muscle with the following exercises and suggestions…

KICKS (with good hip turn-out and tight abdominal muscles) / JUMPS (pay close attention to straddle jumps very early in the gymnast’s career and make sure that they turn the leg out from the hip) / SIDELYING HIP ROTATION / HEEL PUSHES / POSTERIOR TIBIALIS STRENGTH / CORRECT WALKING and CORRECT CHOREOGRAPHY

Correct landings during the development of the young gymnast will help that athlete in the future.  The gymnast should have correct ankle range of motion and correct hip turnout.(“Quick Tests” and Corrective Exercises such as knee/foot mechanics and hip turn-out exercise)

The pelvis should be in good alignment with normal back curvature – the low back should curve in only slightly.  The gymnast should have good lower abdominal muscle control during landings.  The hip flexors and quadriceps should not be overdeveloped and over-used.  The Hamstring and gluteal muscles should contract sufficiently during landings.(“Quick Tests” and Corrective Exercises such as hip flexor stretch – two- joint muscles)

AVOID PAINFUL TIBIAL STRESS FRACTURES BY REALIZING THAT THE BASICS OF GOOD POSTURE, MUSCLE BALANCE AND BIOMECHANICS ARE THE POINTS THAT NEED TO BE STRESSED!  

More details on specific exercises to come…

The Power of Positive Posture

Thursday, May 1st, 2008

The word “posture” is finally a buzz word again.  If you read Florence Kendall,’s early work called “Posture and Pain,” you can imagine “posture” was a household word.  In the 1940’s or so, Florence and her husband (Henry O. Kendall) took 5000 posture pictures of guys at West Point!  People knew what posture was.

One of my mentors, Dr. Shirley Sahrmann, reminded me that in the 1950’s teachers and parents reminded children about good posture, but then we “lost” the idea in the 60’s and 70’s with that era of slouching (and other habits!).  I’m glad the word is back and I’m glad to see it in print and to hear it.

Now-a-days you hear the word “posture” on TV shows like “Dancing With the Stars” and “America’s Next Top Model.”  You read about it in magazines and see it in USAG’s compulsory writings (thank goodness!). I would like to see the word used more by moms and dads and teachers in the schools again.

I’d like to think that we could all play a part in educating the people that we work with on the power of positive posture…

“Stand even on both legs.” “Keep your knees soft.” “Stand up tall.”  “Sit up tall.” “Pull your shoulder blades down” “Pull your abs UP and IN.” “Lift your chest up and forward.” “I give you permission to bug me about MY posture!”     

So…You’re Sitting At Your Computer…

Friday, April 18th, 2008

So…You’re Sitting At Your Computer…

Posture Alert:

SITTING POSTURE: The low back should be straight and relaxed flat against the back of the chair, with the feet flat on the floor (put something under your feet if they don’t touch the floor). The chest should be slightly up, shoulders pulled gently back and shoulder blades pulled gently down and back and in toward the spine.  Get up and move around every 15 to 30 minutes.

Lift your arms up over your head as if you are doing a wall slide exercise (sitting or standing): Place your hands up beside your head with your elbows touching the wall (or imaginary wall).  If needed, correct your feet and knees (face them straight ahead, with “soft” knees if you are standing), then tilt your pelvis to flatten your low back against the wall by pulling up and in with the lower abdominal muscles.  Keeping your arms in contact with the wall, move your arms slowly to a diagonally overhead position.  (Hold several seconds and repeat 5 to 8 times.)

Stop slouching!

“Got Posture?!?!?!?”

Posture = A Family Affair

Wednesday, April 16th, 2008

Posture training.  This is the area to get a gym mom (or dad or grandma) involved.

Let the professional coaches coach.

Coaches, give permission to the gymnast’s caregivers to bug the heck out of the kid about their posture.  Just like they bug the kid to brush their teeth, go to bed, and eat healthy.  This gives the parent a great responsibility and in turn teaches the child that posture is a lifelong concept.

Encourage positive remarks and give the gymnast permission to bug their parents (and YOU, the coach) about their/your posture!

Positive Posture =

“Stand even on your feet.  Lift your chest high.  Pull your shoulder blades gently down and back and in.  The palms of your hands should face in toward your body.  Pull your abs. up and in.  Soften your knees when you stand.  Sit up tall.  Point your feet straight ahead when you walk.  Look confident.  Stand tall.  Don’t be afraid to show that chest off.   Take a break from studying and stretch your arms up against the wall.  Move around for awhile; you’ve been sitting at that computer for more than 15 minutes.  Wear your backpack even on both shoulders.  Sit with your legs out in front of you.  Criss Cross Apple Sauce.  You look tall and beautiful.  You’ll be strong with that good posture.  YOUR POSTURE LOOKS AWESOME!”