Great results with Rugby players in 1st Biomechanics Coaching session

In the last week I’ve done a lot of work with Rugby players of various levels, here are some of the highlights!

– Around 50% of the people got to totally clear on the basic screen within 1 hour, indicating that all basic dysfunctions have been fixed.

– One guy who had problems/pain with his shoulder and failed 4 out of 4 of the shoulder tests ended up passing all the shoulder tests….after 10 minutes of self-releases on his hip!

– Another guy who started with one leg over 10mm longer than the other walked out at the end of the session with no difference in his leg length and much less dysfunction and tightness in the hips.

– A girl who had back pain ended up pain free by the end of the first session, her hamstring flexibility also drastically improved.

These type of results are not out of the ordinary for one hour of Biomechanics Coaching, and unlike most other types of rehab/injury prevention approach you are given the tools to fix the problems yourself. All the above results were achieved without massage, without joint manipulation and without me even touching the person!

The next step on anyone that gets to the stage where they are passing the vast majority of the basic tests is to make sure that the results ‘stick’ and start building stability to support the new alignment of the various joints. The end result is a stronger, faster, pain free athlete who is able to perform consistently and efficiently!

If you are interested in getting a Biomechanics screen, please get in touch via the contact page and you too could be the next to get great results like the ones above.

Who Can Benefit From Biomechanics Coaching?

Recently a few people have asked me variations on the question of “I’m not injured, can Biomechanics Coaching benefit me?”

The answer is – yes, in fact that is the perfect situation! Here’s why…

The Biomechanics Coaching system is not about immediate pain relief (although some of the techniques can give great results for this too!) but it is about looking at the body as a whole and noticing and correcting patterns that are causing inefficient or faulty movement patterns. This will mean that the athlete is in a better position to be able to display strength, speed, fitness etc.

Let’s use a theoretical example – for instance, a rugby player who has problems with his  hamstrings. They always feel tight and he sometimes pulls a hamstring, but is generally recovered well enough to train again within a couple of weeks. This situation is far from ideal, but can be managed. However, if and when the injury is more severe he will be out for a much longer period, and find it harder to get back to peak levels.  In this case an ideal situation would be for him to consult with a Biomechanics Coach as soon as he notices there is something not right (regular tightness and minor tweaks in this case would be signs that something is not right). The Biomechanics Coach would then do a full screen on the player, finding any problems and giving him the tools to correct them with simple exercises he can do anywhere. In this example, he may just have tight hamstrings….or he may have problems with the sciatic nerve that runs down the back of the leg, or a tightness or weakness in the hip that is causing the hamstring to work harder than it should, or a spine stability problem…..and so on. Whatever the case, the player will have the information about the cause of the tightness and a proven way to improve the situation.

Another example might be a girl who plays tennis. Perhaps she is having shoulder problems, mainly on the backhand. She has seen a physio and got some shoulder strengthening exercises but still hasn’t got 100% pain free. If this person came to see me, as a Biomechanics Coach, I would not only look at the shoulder but also the feet, knees, hips and spine as well. The reason for this is that there could be many problems elsewhere on the body that could cause shoulder pain, and looking at the shoulder only may not get to the root of the problem. In fact it is often the case that a shoulder problem has its origins lower down the body, for instance in the hips (especially in a sporting environment where the legs are always involved as well).

The most shocking example I have heard along these lines is of a tennis player who had multiple surgeries to a painful shoulder with only minor improvements. He ended up visiting a Biomechanics Coach and becoming pain free within a few sessions by working on his….opposite leg! In this case, as with many that I see on a daily basis, the pain was not an indication of the root of the problem but rather just where the weak link in the chain happened to be.

Often as Biomechanics Coaches when starting to work with someone we have to go backwards to go forwards – meaning that the person wanting to be able to perform better in their chosen sport may be looking for a harder exercise or training program to get to the next level, when often the answer is to fix something seemingly minor that may be causing problems with every movement they make. To give you a visual idea of this, here is a ‘performance pyramid’ that Biomechanics Coaches use:

Here we can see that where we want to be improving is ‘Global Muscle Performance’. However, if there is a problem in ‘Core Stability’ our performance will be affected as we will not be able to get into position/stay tight/output as much power as possible with the global muscles. And further down the line, if we have problems with (for instance) muscle spasm, we may not be able to get optimal firing patterns to stabilise the core and/or perform at the higher levels. This may mean that to improve a skill such as sprinting for instance we have to go all the way to the bottom of the pyramid and reduce a muscle spasm or mobility issue in the hip, then build on top of the larger base our pyramid has.  In this way peak performance can be reached safely.

Biomechanics of the Knee and Common Knee Injuries

Knee Biomechanics

Contents:

Knee Anatomy

What Can Effect Knee Biomechanics

– Incorrect Hip Function

– Incorrect Foot Function

– Weak Muscles In The Hip

– Imbalances Between The Muscles Of The Leg

Conclusion

 

A common place to have problems in the body, ranging from aches and pains to more serious injuries is the knee. These injuries can be sudden and seemingly come from nowhere like an ACL tear, or they can be wear and tear problems such as the wearing down of the cartilage inside the joint. But why do these problems occur and how can we help prevent them, or recover from them once they happen?

 

Knee Anatomy

The picture above shows the structure of the knee. If you’re mechanically minded, you will see it’s primarily a hinge joint, with potential for a bit of rotation, and some clever person has designed it with a nice pair strong strap down each side to keep it stable whilst allowing free movement. So what causes problems with it?

Knees. Vulnerable, especially to arrows…

The knee is effectively a passenger – no matter what it wants to do, it’s stuck in the middle of the leg between the hip and the foot and it pretty much has to go where they tell it to. The knee biomechanics are often dictated by other joints. This is fine if everything is working right, but what about it either the foot or the hip is in the wrong place, or even worse if both the hip and foot are trying to get the knee to do opposite things? Contrary to what you may think, knee pain is often not an issue of a problem with the knee joint. Long term injuries such as wearing away of cartilage are of course problems located within the knee, but even these are often a symptom of bad alignment of the knee for years. Most of the muscles connecting near the knee are concerned with flexing and extending, but when it comes to rotation and lateral movement the knee is often at the whim of the hip and the foot.

“Stuck between a hip, and a foot place”
(the other option for this picture was some kind of ‘stuck in the middle with shoe’ gag, so think yourself lucky)

What Can Effect The Knee Biomechanics

So now we’re seeing that the knee is often a downtrodden victim, bowing to the whims of the foot and hip, let’s see what commonly goes wrong with those areas. Here’s a quick list:

  • Incorrect hip function
  • Incorrect foot function
  • Weak muscles in the and hip
  • Imbalance between muscles of the leg

Incorrect Hip Function

The hip can often cause problems with the knee due to incorrect function causing the knee to be put in the wrong position, twisting and torquing which can cause excessive wear and tear or in extreme cases sudden snapping of the ligaments holding the knee stable.

The Piriformis muscle

The muscle to look at first for hip function is the piriformis. This little blighter sits right in the centre of the body, and can often protest about it’s tough working conditions by going into spasm. This can cause all sorts of problems within the body, but affecting the knee biomechanics specifically it can cause problems by transmitting stress that should be taken up in the bigger, stronger hip joint down into the knee. This type of problem will be all the more obvious if you perform repetitive impactful exercise such as running. To reduce spasm in the piriformis anti-spasm exercises, massage and stretching can be beneficial (usually in that order in terms of effectiveness)

Another major contributor to incorrect knee biomechanics and knee pain/injuries is if the foot is not working properly. The knee is delicately balanced on top of a stack of bones consisting of the shin (tibia/fibula), then the talus and calcaneus (ankle and heel), with a whole host of other bones in the foot held together by tendons, ligaments and muscle. The way it should work is that the weight is mostly supported on the heel when standing, and the toes are like controls, steering which way the whole unit further up. If there is a problem with the foot (collapsed arch etc.) the issue doesn’t just affect the foot but is transferred up the body. In this way a foot problem can be known to cause a neck problem in extreme cases! In some cases the foot may need support from orthotics or the ankle may need to be mobilised, but sometimes the foot function is affected by the strain of carrying too much weight. This is usually an issue of a hip weakness.

Weak Muscles In The Hip

As suggested in the previous paragraph, weakness in the hip can cause problems further down. The hip has some of the biggest and strongest muscles in the body, and has a large part in the side-to-side and rotational movement of the knee. These movements in turn can put more or less stress on the knee and foot.

Glute Max & Medius

The most commonly weak muscle in the hip is the Gluteus Medius. This muscle runs down the outside of the hip and when contracted in a side-lying position lifts the leg out sideways from the body. However this is not the major function in normal life. When walking, running or jumping, every time the foot hits the ground the Gluteus Medius (amongst other muscles) must work to stabilise the knee and prevent it from collapsing inwards. This is a very common problem for women especially, due to their wider pelvis causing a mechanical disadvantage for the gluteus medius. This ‘falling in’ of the knee puts a pressure on the surfaces of the bone that rub over each other, and can wear away the cartilage and cause arthritis in the long term.

Knee falling in due to weak glutes

The best ways to strengthen the gluteus medius are generally standing exercises such as squatting with a band around the knees providing something to push against, standing abduction of the leg (i.e. pushing the leg out to the side) against cable or band resistance, and various single leg stability exercises such as squats, reaches, deadlifts etc. I also like using more simple exercises such as clamshells (lying on your side and pushing your knees apart with band resistance) and glute bridges with a band (lying on back and pushing the hips in the air) in the warm-up in order to activate the glutes and get the mind-muscle link working. A stability band is ideal for this type of work.

Imbalances Between The Muscles Of The Leg

The last common problem that can affect knee biomechanics that I will mention is an imbalance between the muscles of the leg. This is less common that some of the others but can certainly cause or contribute to knee pain. The basic story is this – the muscles in the front of the leg attach to the front of the shin, the muscles in the back of the leg attach to the back of the shin. Therefore, is the muscles on one side are stronger or tighter than the muscles on the other side, they are able to create a pulling force on the knee which can move it out of optimal position. This means, similarly to the last point, that there is more stress on certain areas of the knee that are designed to rub together.

Great image showing how the muscles of the leg affect the knee

The solution to this is to strengthen the muscles that are weak and/or stretch the muscles that are tight. Again, I prefer to use as ‘functional’ a movement as possible for this so would prefer a front squat or a lunge to strengthen the quads as opposed to a leg extension, but some people could benefit from isolation exercises at certain times.

In Closing…

I hope this article has given you some ideas as to the wide range of factors that can affect the knee biomechanics and cause pain and injuries. As you can see it is a complex subject and this has only really scratched the surface, but the main take-home point is that it is often not just a problem at the knee. Often I see people running or playing sports wearing knee supports whilst still having incorrect biomechanics and movement patterns – this will not solve the problem long term and could even make things worse by making you reliant on outside aids to perform without pain. Please comment or ask questions below!

Hip Rotation Deficits And Lower Back Pain

Hip Rotation and Lower Back Pain

Here is an interesting study I found regarding lower back pain being related to problems at the hip. Read at least the bolded bits, and see underneath for my comments! :

Low back pain (LBP) is arguably one of the most common diagnoses treated by rehabilitation specialists. LBP constitutes a perplexing problem that can exact enormous human and societal costs, and whose successful evaluation and treatment continue to elude the efforts of those who care for these patients. A myriad of potential causes of low back pain exists, but evidence is mounting to support the possibility that low back pain may be a result of hip rotation deficits. Several investigators have reported that LBP may be related to hip pain secondary to limited range of motion in the hip.

Ellison et al sought to determine the prevalence of passive hip rotation deficits in healthy subjects (n=100) and those with low back pain (n=50). Researchers suggested that there was an association between those with hip rotation ROM imbalance and the presence of LBP. 48% of subjects with LBP had increased lateral rotation than medial rotation of the hip.

Vad and others investigated hip rotation deficits in a group of professional golfers to determine if these deficits correlated to LBP. LBP is the most common musculoskeletal complaint experiences by both amateur and professional players. Forty-two male, professional golfers were categorized as having no history of back pain or those with a history of low back pain greater than two weeks affecting play within the past year. 33% of golfers had previously experienced LBP. Researchers found that a statistically significant correlation was observed between a history of LBP and decreased lead hip internal rotation and FABER’s position distance, and lumbar extension loss.

Cibulka and coworkers investigated rotation deficits of the hip with those experiencing signs/symptoms suggestive of sacroiliac joint (SIJ) dysfunction. In one-hundred male and female patients with low back pain, unilateral hip rotation deficits were found to correlate with SIJ dysfunction. In those with LBP but without evidence of SIJ dysfunction, significantly greater hip external rotation than internal rotation bilaterally, whereas those with LBP and signs suggesting SIJ dysfunction had significantly more external rotation than internal rotation unilaterally. Specifically, the deficit was observed on the side of the posterior innominate.

In a case study, Cibulka describes the treatment of a patient who had signs/symptoms of a sacroiliac component of LBP. The patient described right low back pain and evaluation of this patient found excessive right hip lateral rotation and limited right hip internal rotation. Of note, the patient frequently crossed his right leg over his left leg. After restoring hip rotation and SIJ dysfunction via manual therapy techniques, the patient no longer complained of LBP. The case suggests that hip rotation asymmetry may contribute to the SI component of LBP.

Finally, Warren also described a patient case with SIJ dysfunction and concomitant asymmetrical hip rotation deficits. After six physical therapy visits focusing on stretching, manual therapy, and postural education, hip rotation ROM was restored and the patient resumed full-time work and golf without back pain.

Based on this summary of relevant research, it appears that evidence supports the relation of deficits in hip rotation to both LBP and SIJ pain. Specifically, it appears that a loss of internal rotation is implicated in these cases. Biomechanically, this finding in the physical examination is plausible. Using gait as an example, a decrease in hip internal rotation will not allow the pelvis to rotate over the stance limb, thereby limiting the coupling mechanics (a whole other discussion!!) of the sacrum and lumbar spine. Additionally, muscles in the low back, like the multifidus, will not achieve their normal length-tension relationships. Potentially, that could also be a source of low back pain. The lack of motion in the sacrum and low back may lead to degenerative changes and excessive compression of the facets on one side. The clinical significance then is that the therapist must screen every patient for hip rotation deficits in cases of SIJ or LBP.

REFERENCES:

Porterfield JA, DeRosa C. Mechanical low back pain: Perspectives in functional anatomy. 2nd ed. Philadelphia: WB Saunders, 1998.
Ellison JB, Rose SJ, Sahrmann SA. Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain. Phys Ther. 1990; 70(9): 537-541.
Chesworth BM, Padfield BJ, Helewa A, et al. A comparison of hip mobility in patients with low back pain and matched healthy subjects. Physiotherapy Canada. 1994; 46: 267-74.
Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 1983; 8: 643-51.
Mellin G. Correlation of hip mobility with degree of back pain and lumbar spinal mobility in chronic low back pain patients. Spine. 1988; 13: 668-670.
Offierski CM, MacNab I. Hip-spine syndrome. Spine. 1983; 8: 316-321.
Vad VB, Bhat AL, Basrai D, et al. Low back pain in professional golfers: the role of associated hip and low back range of motion deficits. Am J Sports Med. 2004; 32(2): 494-497.
Batt ME. Golfig injuries: an overview. Sports Med. 1993; 16: 64-71.
Cibulka MT, Sinacore DR, Cromer GS, Delitto A. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine. 1998; 23: 1009-1015.
Cibulka MT. The treatment of the sacroiliac component to low back pain: a case report. Phys Ther. 1992; 72: 917-922.
Warren PH. Management of a patient with sacroiliac joint dysfunction: a correlation of hip range of motion asymmetry with sitting and standing postural habits. J Man Manip Ther. 2003; 11: 153-159.
Ellison JB, Rose SJ, Sahrmann SA (1990). Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain Phys Ther DOI: 2144050

Source: Low Back Pain and Hip Motion Correlation ~ MikeReinold.com

This is one of the major issues that a biomechanics screen deals with, looking specifically at piriformis. To give a short background, the biomechanics screening process came about as Martin Haines (who’s been doing physio work for years with the likes of Arsenal and UK Athletics) noticed that the same problems were coming up again and again. Over time and through trial and error he also found the things that most commonly caused problems and also what worked to resolve those problems. This is a very powerful tool, to have a screen and then a specific technique related to that screen that has been statistically proven to have good results in improving the results of that screen. This means that it is possible to use the system and do a lot less fumbling in the dark with the majority of problems.

Anyway, two tests on the basic screen specifically test Piriformis/Hip Rotation, which is linked with pain and disfunction throughout the body if not working correctly. We don’t test so much for range of motion as per the study above, but more if the hip is able to function correctly or if there is muscle spasm. Another common symptom of the hip not working correctly is that it ends up stuck in a certain position, which can end up with one of the legs looking longer than the other. A lot of people prescribe orthotics for this ‘problem’, seemingly without knowing or looking into the fact that the leg length can be changed within minutes by releasing piriformis. In one of the pictures on the Biomechanics page you can see the difference in leg lengths achieved in 2 minutes by using anti-spasm exercises. This was using no massage or stretching.