1 out of every 6 youth athletes will have this injury

The general population believes that injuries are part of the game. You get them, treat them and HOPEFULLY move onto play again. I think in contact sports, yes, injuries will happen. Bruises, contusions and other collision type injuries will probably happen and there isn't much we can do about it.

But non-contact overuse injuries should NOT happen. Plain and simple. Let me explain why.

A non-contact injury means that the athlete had as much control in preventing the injury as anybody. Aside from stepping in a hole or off the side of first base (even that can be prevented by stepping evenly on the base) the athlete is in complete control. But the athletes feedback mechanism in his body or his muscular system could not handle the stress of running. Can you believe it? Somebody can actually hurt themselves running!!

Today I'll explain one of the most common youth injuries, how it happens and what you can do to prevent it.

Knee pain is one of the most common overuse injuries that afflict young children. Slow developing, overuse knee pain can have a slew of causes. But with just a few quick exercises to add to your day, you can prevent knee pain from slowing you down!

First off lets take a look at the anatomy of the knee.

The upper leg bone (femur) ends in the shape of two big knobs. These are called condyle's with the one to the inside of your leg being medial and the one to the outside being lateral. On top of these sit the patella (knee cap). The knee cap slides up and down the groove as we flex and extend our knee. It helps to think of the knee cap as a train and the femoral groove as the tracks.

Usually the patella runs smoothly up and down the track. However, as is usually the case with overuse injury knee pain, the patella gets pulled to one side or the other.

As you can see in the picture, there are quite a few muscles that affect the knee. If one of these muscles begins to tighten up due to overuse, or if one becomes weak, the patella will be pulled to the side of the stronger muscle. As a result it is very important to keep the muscles that directly affect the patella flexible.

There are also indirect factors that can cause knee pain. The two most common are immobile ankles (tight calves) and immobile hips (tight/weak glutes).

I'll start with tight calves first. Basically the muscles of the calf regulate the ability of the ankle to move. If the ankle cannot move into a dorsiflexion position (foot comes up towards the shin) then during squatting the knees will suffer from an increase in shearing force. Shearing force occurs when one bone (the femur) has energy moving in a sliding force across an adjacent bone (tibia). As a result the knees will suffer a lot of pain as the passive tissues attempt to prevent the shearing force from actually causing movement. Tight calves are a hallmark of knee injuries in youth athletes.

The muscles at the hips on the other hand control the rotation of the femur. If the muscles at the hips get weak they will allow the femur to rotate internally. When this happens, again the patella will not track correctly in the femoral groove. As a result the patella will get irritated as the added friction will begin to wear on the back side of the patella. Also if the glutes are weak, then the quadriceps will begin to over develop and over-recruit. When this happens there becomes an increased risk of Osgood-Schlatter's disease which is a painful swelling of the tibial tubercle.

Soleus Stretch

So what can we do to keep these things from happening?

Beginning with the calves, simple calf stretching daily for a total of 60-90 seconds will help keep the calves flexible. Most important is stretching the lower calf. To do this we lean against a wall as if attempting to push it over. This will stretch the back leg. Then simply bend the back knee slightly while keeping the heel of the back foot on the ground. Hold this for :15-20 seconds and repeat 3 times on each leg.

To stretch the glutes you do a seated glute stretch by sitting in a chair and laying your ankle across the opposite knee, sit up with a tall posture and lean forward from the hip. You should feel a stretch in the hip of the leg that is off the ground.

Split Squats

For strengthening, simple hip bridges, single leg Romanian Dead Lift and split squats work well. Just be sure to push through the heel of the foot that is doing the work. 

Next week we will look at common back injuries in youth athletes and how they can be prevented.

What your squat says about your injury potential

A squat is the most simple of movements. But at the same time it is the most complex. And because it is the most complex, how you squat tells a lot about how your body is working. 

http://www.elon.edu/images/e-web/athletics/strengthconditioning/sc9.jpg

Each joint has to control force from a handful of different muscles pulling on it in different directions. A simple way to envision this is a telephone pole being held up by stabilizing lines to keep it straight up. If one of those lines were to be released, what would happen to the pole? It would lean into the direction that still has the lines attached.

The same thing goes on in the joints of the body. However, because the knee is the joint of two long bones (femur, tibia) it is particularly important that this joint has muscles pulling with equal force in each direction. The squat tells us all we need to know about how a player controls the motion at the knee and the hips.

However, for many youth soccer players, equivalent strength isn't the case. Often times the quadriceps are the strongest muscle acting on the knee while the hamstrings and gluteal muscles of the hip have the greatest input into controlling the lateral motion and rotation at the knee. 

ACL tears are most common in female soccer

The knee is meant to flex and extend forward and backward. However, there is very little room for movement from side to side or for the tibia to rotate under the femur. The gluteal muscles and hamstrings help control these motions. However, so many soccer players are not strong enough in the gluteal or hamstring muscles to prevent excessive movement in these planes of motion.

This is how the dreaded ACL sprain/tear occurs. A combination of the femur shifting forward on the tibia, the tibia rotating outward under the femur and the knee caving inward towards the other knee. It's what I call the Perfect Storm. The reason this is the perfect storm is that it is the most vulnerable position for a player to be in. At that point, the player has the least amount of muscle recruitment and control over what happens next. And inevitably, knee injuries will occur.

So how can you prevent this? Well the first step is to TRAIN your players on what the position of vulnerability looks like. After that you need to develop strength in the muscles that prevent these three motions from occurring. The final step is to train them how to change direction and decelerate effectively to keep themselves out of this position. Click on the picture to the right to read about how a promising soccer player's season and possibly career was cut short due to this nasty, but PREVENTABLE injury.

Knowing the types of exercises and skill sets to train to prevent ACL injuries are what we do here at Pair & Marotta Peak Performance. "Bullet Proof Your Knees" is a 6-week soccer pre-season program that focuses on developing hamstring and gluteal strength properly align the knee in a high speed movement. The "Bullet Proof Your Knees" camp starts Tuesday, August 30th and will run every Tuesday and Thursday from 4-5pm. For more information, email aaron@pairmarotta.com or visit www.pairmarotta.com/fitness.

SAVE YOUR SEASON!!

Sports these days are the most intense they've ever been. That is until next year roll's around.

However, there are ways to prevent fatigue, acute injuries and overuse injuries over the course of the season. Research on strength training in youth athletes improves strength, balance, coordination: all of which combine to improve sports performance.

As muscles fatigue and breakdown over the course of a season, the potential for disastrous injuries such as ACL tears, meniscus tears, ankle sprains and ROTATOR CUFF strains. An in season strength program serves to strengthen the muscles and nervous systems, that are stressed during the course of a season.

Exercises such as a Single Leg Squat, Plank to Pushup and Dumbbell chest press, strengthen muscles that act on key joints (knee, core, shoulders, respectively) and help protect those joints from the injuries stated above.

Aside from preventing physiological fatigue, strength training also has the potential to reduce psychological burnout by incorporating a new stimulus into the "everyday" routine of playing baseball or softball.

So perhaps the question is not why SHOULD you enroll your child in our In-Season Baseball/Softball strength program, but rather why WOULD you not?