Ski season is a much-anticipated time of year for many people. Ski season is also a much anticipated time of year for many Physical Therapists as we know that we will get to treat all sorts of injuries. In order to prevent these injuries from occurring, there are a few important rules to follow.

1. Make sure to keep fit throughout the year, not just a few weeks prior to going skiing

It is very important to maintain a good level of fitness year round so that your muscles are primed to perform when you ski. Going to the gym 3 times per week to perform some basic strengthening exercises can save you a lot of rehab time!

1. Keep your abdominals strong

Having strong abdominals doesn’t equal having a six-pack. Strong abdominals aide in control of the upper and lower body and also assist in dampening forces that can cause injury to the lower body. A strong core will allow the skier to move better and not compensate using the lower body which may lead to injury

1. STRETCH

Maintaining a flexible lower body can save you a headache in the future. Muscle strains are a common injury for skiers and can be avoided by stretching hamstrings, quadriceps and calves prior to skiing for the day. Stretching year round can’t hurt either!

1. Balance Exercises

Performing balance exercises is by far the most overlooked way to aide in preventing injuries. If your balance is better, there is less chance that you will fall or slip while skiing thus you will be able to prevent injuries. Some simple balance exercises that you can perform at home include standing with your feet together and closing your eyes, standing on one leg with arms across chest or trying to walk in a straight line with your feet going directly in front of one another. If you REALLY want to improve your balance, you should come to our 200 Park Avenue office and use our Biodex Balance System SD. It will not only challenge you but it will provide you objective data to tell you where your balance is good and where it is bad.

Good luck to all this ski season, enjoy!

Richard Brooks, DPT - Grand Central Facility

In re-reviewing the updated NfL injury reports, I stand corrected on Tuesday’s post regarding the prevalence of ACL tears suffered by players this season.  I’d counted ten, and the number appears to be at least 15, or possibly 16.

Joining his colleague Ernest Graham on my list is Tampa Bay Safety Cody Grimm, who tore his right ACL and MCL and was placed on IR at end-September.  Like Grimm, Dominique Foxworth, a Baltimore Ravens CB, was placed on Injured Reserve on 9/28, only in his case, this was reportedly due to post-op complications that have rendered him ineffective following ACL surgery that took place after he suffered the injury during practice in July of 2010.  Foxworth should get honorary mention on this list.  Jameson Konz, Seahawks TE, is out for the season after tearing his ACL during his NFL debut in the Seahawks upset of the Giants on October 9th.  Other October ACL injuries include those to Indianapolis Colts rookie Tight-end Ben Ijalana, who was hurt in week 4, and Green Bay Packers RB , Alex Green, who succumbed to his ACL in week 7.

I couldn’t get a read on what is going on with Michael Sims-Walker, Jacksonville Jaguars  wide-receiver, whose still or again ailing knee put him on IR this week. At 27, Sims-Walker has a “long” history of knee issues that included ACL surgery while in college, and a  knee sprain and staph infection in 2008.  Sims-Walker is slated to undergo a new knee surgery, the details of which have not been reported. He was added to this ACL list as a result.

Keep in mind that there are so many more players out with knee injuries, many of them sprains or cartilage damage.  ACLs by no means corner this market. Add to that the insane number of hamstring strains and other extraneous related injuries and you will be astounded at the number of guys who are out or playing hurt.  Also staggering are the stats on achilles, foot and ankle injuries, which seem far more prevalent than shoulder and back problems this season. Concussions, as always, remain a big concern as well.

My next post will be on hand fractures, such as the one with which Chargers RB Willis McGahee plans to play this weekend.

What injuries would you like to read about?  Let me know!

Follow Abby on Twitter @abcsims

There have been so many season-ending injuries in the NFL this season,and complete ACL tears seem to lead this category.  By my count, there are already 10 players who are looking on from the sidelines after having ACL surgery.

When watching replays on TV or at the stadium, I’m actually amazed there aren’t even more ACL tears.  Feet are planted while the body rotates, a tackle forces a knee to hyperextend, pushing it beyond the straight or locked out position, or most commonly, a players legs are grabbed in a tackle while his body keeps moving (generally with the knee bent), forcing his knee to move in a manner that is simply not possible with the ligaments intact.  It is so easy to wind up injured.

NFLers currently nursing post-operative ACL’s include:
Running Backs Ernest Graham (Tampa Bay), Tim Hightower (Redskins) and Jamaal Charles (Chiefs)
Wide Receivers Kenny Brit (Titans) and Domenik Hixon (Giants)
Tight End Tony Moeaki (Chiefs)
Safety Eric Berry (Chiefs)
Cornerback Bradley Fletcher
Linebacker Thomas Davis (Panthers)
And even kicker, Nate Kaeding (Chargers)

Hixon is on his second ACL surgery in just two seasons, Fletcher tore his in a practice collision and Moeaki was injured in the final game of the rushed pre-season.  Taking the trophy in this unwanted competition, Davis is on ACL surgery number three in less than two years. I hope he’s been saving his money and has a plan B.

The Anterior Cruciate Ligament is the primary stabilizer of the knee. It is located between (and attaches) the rear outer base of the femur (thigh bone) and the top of the front inner tibia (the larger of the two bones in the lower leg). It is called the anterior (front) cruciate because it crosses another ligament (the posterior cruciate) that is located behind it, with the two ligaments essentially forming an “X”.

The ACL is comprised of two distinct bundles which serve complementary functions.  The posterolateral (outer/rear) bundle restricts or checks the motions of  hyperextension  and excessive forward gliding of the upper tibia with the knee straight.  It also limits internal rotation in the knee. When the knee is forced into hyperextension or inward rotation, this larger band risks injury.

The smaller anteromedial (front/innermost) band is taut in flexion (when the knee is bent) and is therefore most likely to be injured with force to the knee in a bent position.

The anatomy of the ACL explains why it can sometimes suffer only a partial tear, and why in these cases, it may be possible for an athlete to avoid surgery.

Follow Abby on Twitter @abcsims

NFL quarterbacks are padding the injury reports, and their injuries are not only impacting game outcomes but resulting in unanticipated trades. Some injuries, like the clavicle (collarbone) fracture suffered by Raiders QB, Jason Campbell, are obvious game changers.  With the team possibly playoff bound, and with a field leader definitively unable to go, it was abandon hope or find a replacement to preserve the possibilities.  Hence the arrival of Carson Palmer.

Other QBs, playing injured because that’s what football players do, are struggling to play to their healthy potentials and squeaking by or taking the losses as a result. Tony Romo is a case in point. With a winable game on the line, even his coach, Jason Garrett, lacked confidence in Romo’s ability to throw for distance in the final series.   Game, set, match.

Poor Sam Bradford, of the St. Louis Rams, has had one setback after another.  In September he played with a finger injury, and now he is likely out with a high ankle sprain. This after a college career that saw the 2008 Heisman winner through at least two shoulder injuries that resulted in surgery during his senior season.  Though in a walking boot this week, Bradford is still not officially counted out for this Sunday. So what that it’s his left ankle and he throws off his right? He’d still have to be able to move out there, yes?  A high ankle sprain is a big deal, especially if severe. Bradford can’t possibly be effective if he plays hurt, particularly while still in the acute post-injury period. (For more on the nature of high ankle sprains read an earlier post on Maurice Pouncey).

Matt Schaub of the Texans is another QB with a new injury.  His sore hip isn’t expected to keep him on the sidelines, but may impair his mobility and make him vulnerable.

Michael Vick finally pulled one out for the Eagles on Sunday, in spite of an early scare (again?), when it seemed like he’d suffered another concussion.  This year’s self proclaimed “dream team” is a major disappointment, but Vick has been a warrior and is like one of those inflatable punching bag dolls who just keeps taking hits and bouncing back for more.

I think the quarterbacks featured in the NFL injury report would vote unanimously to beef up their offensive lines.  These guys are taking a beating.

The most dramatic quarterback injury story this season is that of Peyton Manning.  After three neck surgeries, and despite his insistence otherwise, it seems likely that Manning’s Hall of Fame career is over.  The Colts’ recovery has been as tortuous as Manning’s.  Here is another team with a huge disparity between it’s starting QB and his back-ups.  Injuries are certainly altering the destiny of many teams this season.  The impact has been felt at many positions, though quarterbacks may get the most attention.

Though not losing their starting spots because of injury, still other starting quarterbacks are looking at sitting down the rest of the way.  Whether you call it age or fading ability, Donovan McNabb and Kyle Orton have been replaced by their next in line.  It appears their careers are soon to be history. For McNabb, it’s been a spiral downward  that has deflated a legacy that might have led to the Hall of Fame.  Though they say he hasn’t been the same since leaving Philly, to me, McNabb failed to live up to expectations while an Eagle. He somehow always came close but fell short.

As my husband, sportscaster Dave Sims, always says about the expected and unexpected things that happen in baseball, “That’s baseball”.  You can sum up this quarterback situation by saying, “That’s the NFL”.

Follow Abby on Twitter @abcsims

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Though I CAN’T honestly say it was smart for him to play yesterday, Ben Roethlisberger certainly did play smart. Throwing for touchdowns on their first three possessions, and tying a Steelers’ record with five TDs overall, Big Ben came through probably even beyond his own expectations. 

With his sprained and contused foot protected as well it could be, and in a shoe one size larger to accommodate that protection, Roethlisberger somehow  overcame his pain and limitations. TV commentators said Roethlisberger had been reluctant to have injections, fearing that his sensation would be so reduced or his toes so numbed that he might not be able to function effectively.  I would have been even more concerned that by masking his symptoms, Roethlisberger might have exacerbated his injury without knowing the extent of the damage he was causing, thereby enabling him to push through. That still might be the case, however, even without an injection.  The competitive nature of the man and his sport, peaking adrenaline and living in the moment all can contribute to pushing limits beyond their bounds. 

Roethlisberger changed up his game to enhance his success and minimize the stress on his foot at least somewhat. He went to a shorter passing game, changing up the routes, and he threw off a flatter foot.  He dropped back and released or handed off the ball quickly, avoiding contact, and ran only when he had to.  How can we judge, it worked.  However, I wouldn’t be surprised if he is on crutches and non-weight bearing today to ease the load. The Steelers’ staff can treat Roethlisberger’s contusion and sprain all day, every day between games, but there is only so much that can be done to accelerate healing. The body has it’s own time clock. 

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Michael Vick has said he’ll be on the field for Sunday’s contest at home against the 49ers, despite having suffered a significant contusion to his right (non-throwing) hand in last week’s loss to the Giants. Reports say his hand remains swollen, sore to the touch and in a protective cast. That means its function is also impaired because of pain with use.   Though he  backed down from his initial take on typically  not getting calls from the officials, Vick smartly has not, at least publicly, ever indicted his offensive line.  However, with that line being what it is, and with Vick a moving target who is more difficult to protect, should he play? Remember, as it was,  in the Eagles-Giants game, Vick was playing only one week after leaving the field in the third quarter of his homecoming versus Atlanta having been dealt a mild concussion. Michael Vick is certainly a warrior. He is one of those guys who wants to be out there, but at what cost?

Dallas’ Tony Romo is another one of those guys.– a selfless leader. He completed the game in week two against the 49ers, returning in the third quarter  having knowingly suffered a rib fracture in the first half.  Romo painfully, but heroically, went on to make a 77 yard pass to set up a win in OT.  It was only later that he was also diagnosed with a small lung puncture along with the isolated rib fracture.

Romo also played last Monday night in a boring squeaker against the Redskins. His performance was  clearly hampered by his injury and the offense sputtered. It would be surprising if Romo did not taken pain meds or have an injection to combat the pain associated with his issues. His breathing was likely still painful and throwing, especially for distance, had to have heightened his symptoms. Should he have played?

Jay Cutler went to fan and media purgatory after taking himself out of the NFC title game with a knee injury last January.  Cutler even came under fire from some fellow players.  Turned out, to everyone but Cutler’s surprise, the injury was real and it was significant.  He’d suffered a Grade 2 MCL (medial collateral ligament) sprain/tear.  Though he’d been known more as the warrior type prior to this incident, that didn’t shield Cutler from the abuse.  I wrote about it then, but Vick and Romo bring the dilemma of the injured player back to the headlines.

I’m not of the mind that players should simply tough it out when doing so is likely to contribute to an exacerbation of their  injuries.  Not allowing for a proper healing response delays recovery, often causing an injury to become an even bigger issue both on and off the field.  Such situations can also result in chronic conditions.  Not only can this potentially  impact performance, it can, and often does, impact life. Just look at the struggles of many NFL veterans.

Football being football, there is  the unwritten rule to target an opposing team’s weaknesses. We all know that doesn’t just mean a hole in the defense or a size mismatch on coverage.  Football puts a target on each players back under the best of circumstances. The already vulnerable become even more so.

The Cowboys were fortunate to come away from the Redskins game with a win. They didn’t win because of Tony Romo, and, if you ask me, Tony Romo didn’t win at all. He lost a week to help him recover.

Your thoughts?

Follow Abby on Twitter @abcsims

I’m all for the glass being half full, silver linings and making lemonade, but I’m having a lot of difficulty understanding the optimism in the reporting of injuries in pro sports these days.

It generally isn’t the media at fault, but I question the wisdom of the collective universe of team spokespeople and medical departments. Unless the motivation is to mess with the heads of fantasy team managers, which is highly unlikely, why tell us players are questionable when there has to be no doubt.

Why take it day-to-day when week-to-week or month-to-month is more like it? Is management setting the players up for unrealistic expectations or just us fans. Is this supposed to be a motivating tool? If so, I don’t think it is working.

With my background in rehab, if reporting has been accurate, and even without the opportunity to personally assess an injury, I am rarely fooled. Ask my husband — I am always muttering when I read the injury reports — first because I hate to see anyone hurt, and second because the outcomes of competition will obviously be influenced accordingly.

Most disconcerting is the feeling I have that many players will push themselves to return too soon. Maybe it’s a contract year. Perhaps there is a back-up who’ll be given the chance to shine. Or it could simply be that losing just isn’t in the vocabulary. Then there’s the ridiculous “no pain, no gain” mantra.

Players want to play.

However, that doesn’t make it sensible to assume muscle strains will heal in a couple of weeks or that a neck injury that entails neurologic symptoms (see Peyton Manning) can be managed while the player sits out practice, or even worse, doesn’t! We’ve seen every kind of example, even when there hasn’t been time to assess a player’s healing response (i.e., Ike Davis).

Clearly money is a factor, and player contracts as well as the desire to win can override sensibility. Just look at what it’s taken to finally take concussions seriously.

In this age of “need to know” and instantaneous reporting, we sometimes even see predictions before an accurate diagnosis is made (Ike Davis again comes to mind). What ever happened to saying “We’ll let you know when we have all the information?” Why isn’t that enough?

Timetables for recovery only work if we know what is going on, allow for the body’s necessary natural healing response, see how the initial phase of recovery is progressing and have a motivated patient without medical complications coming into play. It isn’t magic but there is an element of guesswork. I’ve always found it better to err on the side of conservative estimations that may need to be upgraded during the rehab process.

Better to exceed them than not live up to them.

I’m also confused about pitchers returning from surgery, rehab and rehab starts just in time to close out a season that isn’t playoff bound. As they say on Saturday Night Live, “What’s up with that?” An entire off-season awaits and there is no prize for rehabbing fastest.

The prize of winning and career longevity may be thwarted by pushing the limits of recovery when there is no real need.

What do you think?

Follow Abby on Twitter @abcsims

The Mets have provided way too much material for me this season, and now, with their season spiraling totally out of control, still more injuries have taken center stage. I wrote in early April that a rash of oblique strains had dominated baseball’s preseason. Well, in the case of the Mets, here we go again.

In spring training it was Jose Reyes, he of hamstring fame, who led the Mets in oblique strains. This time, it is starting pitcher Jon Niese who was placed on the DL with a right “ribcage injury,” said to be an intercostal strain. Niese is soon to be joined by Scott Hairston, right-handed pinch hitter and occasional starting right fielder, who is supposedly headed to the DL with a left ribcage injury, reported alternately as either an intercostal or oblique muscle strain. As of this writing, Hairston awaits word of x-rays, presumably to rule out a rib fracture, and he is slated to undergo an MRI to assess the severity of his injury.

Whether obliques, intercostals or hamstrings, muscle strains can be nagging injuries and overly optimistic expectations for a return to competition are generally just that.

So, for the record, let’s take a moment to distinguish between the obliques and the intercostals.

The Intercostals
As their name implies (costal means rib), the internal and external layers of the intercostal muscles are situated between the ribs. They attach the base of each rib to the rib below.

The external (outer) intercostals assist in respiration by pulling up and out on the ribcage during inspiration (as the diaphragm contracts) to enlarge the chest cavity as air is taken in.

The internal (inner) Intercostals are involved in exhalation to pull the ribs down and in when we are involved in physical exertion or breathing out forcefully. When we breathe out while at rest, the action is passive (not requiring muscle action).

Because of their intimate relationship to the ribs, x-ray is necessary to determine that rib fracture is not central to the diagnosis when injury occurs.

The Obliques
The obliques are the abdominal muscles that rotate and side-bend the trunk. The fibers of the obliques are oriented in a diagonal pattern, with the internal obliques (the innermost layer) going in one direction and the external obliques (an outer layer) in the other. They attach to the low back, ribs, the pelvis and the midline of the abdominals.

The internal and external obliques have opposing functions, though when working together they assist in forward flexing the trunk. In baseball, these muscles are most likely to be strained due to the powerful and explosive torsion motions required when batting and pitching.  Take a look at these diagrams to better visualize the obliques.

The Internal Obliques
The diagonal orientation of the internal obliques is key to understanding their function. When they contract (shorten), the internal obliques act to side-bend and rotate the torso toward the same side. In other words, a right-handed batter forcefully contracts his left internal obliques to rotate his trunk to the left as he moves into the swing and follow-through.

Another important function of the internal obliques is to assist in respiration. They work when we exhale forcefully to push the diaphragm up, thereby forcing air from the lungs.

The External Obliques
Because the external obliques run on a diagonal that is perpendicular to their more internal counterpart, They assist in side-bending and rotating the trunk toward the opposite side. That means that the right external obliques take over to swivel the trunk to the left when a batter bats right-handed. They also serve a role in respiration to assist with inspiration (breathing in) by pulling the chest downward and compressing the abdominal area to allow for expansion of the lungs with air.

The Mets may not be cursed, but the injuries this season have been nothing short of crippling.

Follow Abby on Twitter @abcsims

In today’s world, health and exercise are very important and
many people choose to “pay out of pocket” in order to afford a personal
trainer. The role of a personal trainer is to develop a personalized exercise
program for a client and progress that exercise program based on the client’s needs
and stated goals. Well, what happens when you aren’t seeing any results from
working with a personal trainer because their education isn’t advanced or
because they “over worked” you and now you are injured?

That is where the licensed Physical Therapist steps in.  A Physical Therapist not only prescribes a
tailored exercise program to meet aesthetic or athletic goals but we can also
rehabilitate the mistakes that a personal trainer can make.  A Physical Therapist now holds a Doctorate
degree whereas a personal trainer holds a certificate that DOES NOT require any
formal education and can be attained online for a cost.

It just makes sense that if you are going to pay out of pocket
to have a trainer that you should hire the most qualified professional. A
Physical Therapist has a vast educational background in exercise as well as a
complete understanding of the muscular system which will allow for a
better-tailored exercise program for each individual client. A Physical
Therapist also understands how to AVOID causing an injury which will allow the
client to exercise to the maximum without risking injury. The bottom line is
that if you are just looking to get fit or if you have a history of injury and want
to achieve your fitness goals by using the “gold standard” then the choice is
clear, you will seek the help of a Physical Therapist.