Transcript Notes - ITCCCA

Injury Prevention
Getting it right before the season starts
Nate Porcher DC ART DNS FMS
Copyright Dr. Nate Porcher
Quickly About Me

Prospect HS Alum

Taylor University in Indiana – Track and FB Letterman

Trinity International University in Deerfield – FB and Baseball
Letterman

National University of Health Sciences –Doctor of Chiropractic

Hundreds of hours of postgraduate training in Functional Evaluation,
Rehabilitation, Soft Tissue Correction, Strength and Conditioning

Spent some time working in the training room with athletes at
Benedictine University in Lisle

Sports Medicine-Focused practice in downtown Arlington Heights—
Foundation Sport & Spine
Copyright Dr. Nate Porcher
Topics Covered
 Common Injuries—why they occur
 Prevention of Injuries
 The Role of the Diaphragm in Core Stability
 Tri-planar Training for Sagittal Plane Athletes
 SHIN SPLINTS!!!!
 The Benefits of having a sports healthcare practitioner
as part of your team—PRESEASON SCREENING,
management of injuries that have occurred
Copyright Dr. Nate Porcher
How often do injuries
occur?
 The most common running injuries
 Shin splints/stress fractures
 Hamstring or other muscle pulls/tears
 Plantar fasciitis/Heel pain
 Patellar Tendonitis/knee pain
 IT Band Syndrome
 Low back stiffness/pain
 What other injuries plague your program?
Copyright Dr. Nate Porcher
What are your current methods of
Injury Prevention?
 How have these reduced soft-tissue injuries?
 Once injuries occur, how are you managing them?
Copyright Dr. Nate Porcher
Main cause of most of these injuries
In General: OVERUSE (of a bad motor strategy)
In Particular:

IT Band Syndrome—weak core/glutes

Shin Splits—more complex (will cover in depth later)

Patellar tendonitis—weak glutes, poor core/pelvic stability, weak
tibialis anterior, and dominant quads/hip flexors

Plantar Fasciitis—weak foot intrinsics, weak tibialis anterior,
poor hip extension

Low Back Pain—weak core/glutes/improper motor patterns
Copyright Dr. Nate Porcher
The “Intangibles”
 Anatomy Fallen Arch, hip anteversion, integrity of
connective tissue in the body, etc, etc.
 Body Chemistry/Nutritional Status
Copyright Dr. Nate Porcher
Re-Envisioning the CORE
Copyright Dr. Nate Porcher
The Role of The Diaphragm
 Is it just for breathing?
 Let’s take a closer look
at the design of the
diaphragm
 In my clinic—
diaphragm function
tested on day one, and
diaphragm rehab starts
day one.
Copyright Dr. Nate Porcher
One muscle, two amazing
functions
 Breathing function
 Postural function

Diaphragm contracts/
drops

Diaphragm
contracts/drops

Decreased pressure in
thoracic cavity

Pelvic Floor contracts,
stiffens

Air rushes in


O2/CO2 exchange
happens
Abdominal muscles
reflexively contract
(TrA, Obliques, QL,
rectus abdominus

Diaphragm relaxes


Elasticity of ribs and
lung tissue forces air out
Intra-abdominal
pressure increases
greatly

Punctum fixum is
created
Copyright Dr. Nate Porcher
Creating the Punctum
Fixum
 What’s the big deal? Why the diaphragm?
 Punctum Fixum – FIXED POINT
 i.e. intra-abdominal pressure stabilizes the anterior hip
capsulethe glute medius attaches to the hip and
pelvisstable hip increases glute med firing/stabilability
 i.e intra-abdominal pressure stiffens the abdominal
fascia, T/L fascia, and stabilizes the rib cagecreates a
solid basis for the obliques to pull up and over
 Need an example?
Copyright Dr. Nate Porcher
The role of the ribcage
position over the pelvis
 Intra-abdominal
pressure is
compromised by poor
posture
 This will cause buckling
of the lumbar spine and
poor core stability, poor
base for oblique systems
Copyright Dr. Nate Porcher
How do you know it’s
not working
Observations:
GOOD
NOT AS GOOD
How do you know it’s
not working?
 Here are a couple of tests:
 Diaphragm Test with Breathing IN
Copyright Dr. Nate Porcher
Another test
Copyright Dr. Nate Porcher
One more test
 Intra-Abdominal Pressure (IAP) Test
Copyright Dr. Nate Porcher
How to destabilize the
core:
 Situps, Crunches, V-ups, supine toe-touches
 THROW THEM OUT!!
 “The spine only has so many bends before a disc will
herniate.” Stu McGill –University of Waterloo
 3,350 Newtons of compressive force in the disc with them
 PLUS, They’re NOT FUNCTIONAL!!
Copyright Dr. Nate Porcher
Some basic exercises for
stabilizing the core
 Use (some of the tests) as the exercises
 Have athletes gain awareness/ability to use the
diaphragm first as a muscle of respiration
 Have them start to gain awareness/ability of the
postural/stabilization function
 Side bridge/plank progression
 4-way bench planks
 Supine IAP test in Triple Flexion (knees, hips, and
ankles at 90 degrees
 Can add physioball as an advancement
Copyright Dr. Nate Porcher
More Exercises
 Bird Dogs– must maintain proper stabilization
strategy of core and KEEP BREATHING.
Complex exercises
Variations of Side Planks
(remembering to have intraabdominal pressure)
Once the Core is Solid
 Implementing the role of the oblique muscle slings
 Dynamic movements using the slings to move
 Chops, Lawnmowers (for power)
 i.e. throws, running, etc.
 Dynamic movements using the slings to stabilize
 i.e. throws, running, etc.
Copyright Dr. Nate Porcher
Continuing Onto Global
Exercises
 This idea of increasing abdominal pressure NEVER
GOES AWAY with any exercise!
 Guess why these guys wear belts when lifting?
Triplanar Training for the
(primarily) Sagittal Plane
Athlete
Copyright Dr. Nate Porcher
What exactly does that
mean?
 Review of Planes of Movement
 Sagittal
 Coronal/Frontal
 Transverse
Examples of Poor
Stabilization
Another Example
Another Example!
Combined Frontal/Transverse
Plane Instability
Contrasting Those Examples With
Olympic Athletes
Two Bads and One Good
Making Basic Lifts Tri-planar
 Sometimes with movement, sometimes with stability
 Use Dumbells or (better yet), Kettelbells
 Squats
 Goblet, 90, Overhead
 Lunge. 90, overhead
 Single-Leg RDL
Copyright Dr. Nate Porcher
Making it even better with
Therabands®
 Lunges, step-downs with Therabands®
 Tri-Planar Squats (from the last few slides)
Copyright Dr. Nate Porcher
Tri-Planar Plyos
 Jumping Lunges
 Tri-Planar Box Jumps
 Burn-outs
Copyright Dr. Nate Porcher
SHIN SPLINTS
Dr. Nate Porcher DC ART DNS FMS
Why do all my athletes have
shin splits?
 Medial Tibial Stress Syndrome:
 1st things 1st—Rule out Stress Fracture/Compartment
Syndrome
 2nd—Understand the tissue pathology
 3rd—Determine the appropriate course of action
 4th—Implement the appropriate course of action
Copyright Dr. Nate Porcher
RSI of soft tissues in general
and shin splints in particular 
 RSI—Repetative Strain Injury
Copyright Dr. Nate Porcher
What’s the latest Research Say?

Bennet et. al. The relationship between isotonic plantarflexor endurance,
navicular drop, and exercise-related leg pain in a cohort of college crosscountry runners. International J Sports Phys Ther. 2012 Jun; 7(3): 267-78.

Greater Navicular drop tend to have greater chance of leg pain

History of shin splints in last month 12X more likely to re-develop



In other words...
Yuksel et. al. Inversion/Eversion Strength Dysbalance in Patients with
Medial Tibial Stress Synrome. J Sports Sci Med. 2011 Dec; 10(4): 737-42.

Prolonged pronation will lead to longer lasting traction stress on the soleus fascia, which
in turn can facilitate the development of MTSS (all due to stronger evertor muscles)

Also, likely due to less eccentric power/strength/endurance of the medial soleus
Rathleff et. al. Dynamic midfoot kinematics in subjects with medial tibial
stress syndrome. J Am Podiatr Med Assoc. 2012 May-Jun; 102(3): 205-212.

More navicular drop, faster navicular drop
Copyright Dr. Nate Porcher
My thoughts...

If they need orthotics—send them, this will help with navicular drop velocity
and depth.

Still—orthotics are not the final solution, but one piece in the puzzle!

Should be combined with “short foot” training, coronal plane glute med training

=less contralateral hip drop, less internal rotation lower leg, less pronation of the
midfoot.

Isokinetic strength does not equal plyometric power.

Eccentric strength of the lower shank external rotators (i.e. GLUTE
MED/MIN) is a driving force behind decreasing overpronation in the foot.

Exercises that get the soleus to adapt rapidly from an eccentric muscle to a
concentric one should be implemented (plyos, blind box drops, tri-planar
burnouts

Correct tissue pathology, because ice, rest does not heal fibrotic, tight, painful
scar tissue. Send them for this too!
Copyright Dr. Nate Porcher
How to I break the cycle?
 Break up the adhesions:
 Best two ways: ART® (Active Release Techniques®),
and FAKTR® (Functional and Kinetic Treatment w/
Rehabilitation®)
 Correct joint restrictions to proper biomechanics
 Subtalar eversion restoration
 SI joint mobilization (if it’s no moving, the glute med
won’t fire properly!!)
Copyright Dr. Nate Porcher
How do I break the cycle?

Dampen the inflammatory cascade:



With proper nutrition (Diet high in Omega-3 FA, avoidance of
high Omega-6 foods)
Re-Train:

The short foot muscles (dampen forces through the ML arch
and T Arch)

The G Meds/Mins to dampen internal rotation forces
experienced from ground reaction forces.

Plyo/reaction strength/power of Gasroc/Soleus mm.

Any other multiplanar instabilities with tri-planar training.
Use Corrective Taping, when warranted

KinesioTex Tape—change muscle firing, help drain.
Copyright Dr. Nate Porcher
Pre-Season Functional
Movement Screening
 Gray Cook—The guy behind the FMS™ screens
 “What often happens is people are putting exercise and
performance on top of dysfunctional movement, which
can impair performance and cause injuries”
Copyright Dr. Nate Porcher
Who should get screened?
 All athletes who are pain-free, and wanting to perform
at a high level. (Sound familiar?)
 WHY?
 The screens identify imbalances side to side
 The screens identify the weak link in the chain
 The screens point to corrective exercise strategies to help
optimize later training and prevent injury
 (The athlete who experiences pain with the screen should
be referred to a healthcare provider)
 The screen should always be used as a follow-up tool to
monitor progress
Copyright Dr. Nate Porcher

How to implement the
screen
Pre-season screening by certified FMS practitioner
 Develop categories for athletes with different types of
dysfunction to fit into
 Develop programs for those athletes--add it into their
resistance program
 Be judicious about what full-body lifts to use with athletes
who have poor dynamic function, ease them into them
once base function is corrected/core is strengthened
 When an athlete has pain—send them for professional eval
RIGHT AWAY

Don’t let the injury progress to a season-ending situation!
Copyright Dr. Nate Porcher
Thank you!
Copyright Dr. Nate Porcher
Image Resources

Title page:http://www.erinchapmanfitness.com/wp-content/uploads/2013/05/shin-splints-ice-1.jpg

http://www.runaddicts.net/wp-content/uploads/2010/06/injuries-664x300.png

Diaphragm diagram: http://balancedbodymind.com/wp-content/uploads/2013/10/ijspt-08-062-f002.jpg

Diaphragm diagram 2: http://www.muscleimbalancesyndromes.com/wp-content/uploads/2012/04/Kolar-inspiratory.jpg

Turtle Shell 6 pack:http://www.ign.com/boards/threads/attn-people-that-give-fitness-advice-to-others-on-the-boards.452450163/

Exercises: http://www.gymra.com/blog/strength-training-for-running/#!prettyPhoto

Westside Barbell: http://www.criticalbench.com/westside-barbell.htm

Running: http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&docid=Eck7FY0cvHEasM&tbnid=gT32iHT1v3f2M:&ved=0CAEQjxw&url=http%3A%2F%2Fwww.iachiropractic.com%2Fblog%2F10-things-i-learned2012%2F&ei=Vo3NUvoRho3aBYitgJgK&psig=AFQjCNEaDgmd43LiMONBGmbeOiEbF3Sn7A&ust=1389289159110539

Diaphragm tests: All copyright Prague School

http://runnersconnect.net/wp-content/uploads/2013/05/RC8_GluteMedius_Role-300x195.jpg

Shin splits:http://www.drxuacupuncture.com/wp-content/uploads/2011/07/Fig-7.23.jpg
Copyright Dr. Nate Porcher
How to reach me:
 Nate Porcher DC ART DNS FMS
Email: [email protected]
Office: (847) 342-3000
Web: www.foundationsportspine.com
Location:
115 N. Arlington Heights Road
Suite 104
Arlington Heights, IL 60004
Copyright Dr. Nate Porcher