THE MISSING LINK
Vladimir Camurungan, PT, FAAOMPT
A recent study by the Minnesota Amateur Sports Commission has showed that approximately 30 million children and adolescents participate in organized sports. There has been a massive increase in acute and overuse injuries in the young athletes participating in sports. It has gotten to the point that sports have been designated as the leading cause of injury in adolescents which has increased the number emergency department visits by child and young adult athletes.
Consider the following statistics: the incidence of knee injuries in young individuals participating in sports are over 1 million emergency room visits and 1.9 million primary care visits annually. Foot and ankle injuries account for 30% of visits to sports medicine clinic among adolescents. Ankle sprains alone account for 10% of all injuries seen in the emergency room for teenagers. The incidence of back pain in young athletes participating in sports has been shown to be twice as high as others in the general population of the same age. The yearly costs to deal with these injuries in our younger population have been estimated to be 10 billion dollars in total.
There are certain types of back, knee and/or ankle pain that are insidious in nature and, even with treatment, can only be temporarily relieved. As Physical Therapists, how many of us have seen young athletes/patients with unexplained back pain. These athletes/patients come to us stricken with restricted motions and we had prescribed stretching exercises. When they came back for recheck the pain was still persistent and the decreased motion persisted. There were also cases of patients who had normal motion and a negative MRI who were prescribed typical strengthening exercises only to find out that at the end of our treatment they still suffered from persistent pain and the inability to do any bending forward or squatting motions.
We have a generation of athletes that move poorly but they are unable to identify why. These young athletes cannot fully squat, balance on 1 leg, and touch their toes yet these teenagers are playing basketball, soccer, lacrosse and football. According to a study made by the Functional Movement Systems Group, all these movement asymmetries and irregularities make it 51% more likely for these athletes to reinjure themselves.
Are we missing something in our evaluation of these adolescent athletes? I think we are. And one of the missing links that we have strayed far from is the evaluation of fundamental movement patterns and how well our young athletes/patients can accomplish them.
A good way of understanding this is by going back to the young athletes/patients with lower back pain and/or knee pain. They have a negative MRI and a normal range of motion yet they cannot flex forward or squat in standing and are unresponsive to stretching and strengthening exercises. However, when you have them lay supine they have a full range of motion for straight leg raising and hip flexion. The active motion is quite different during weight bearing and non-weight bearing positions. These athletes are prime example of patients suffering from a motor control disorder of the lower quadrants. The contraction patterns between the stabilizers and the prime movers have changed. The theory behind the cause of impairments is as follows: if the stabilizers of the low back (multifidus and transversus abdominis) and hips (Gluteus Medius) are not contracting properly then the patient will have to get stability by contracting the bigger muscles of the lumbar and the hip (this is referred to as a High Threshold Strategy). If this happens then it will be hard for them to complete the full correct motion because the prime movers of the low back and the hip are being used as stabilizers. The correct treatment approach for this type of disorder is the prescription of corrective exercises that address the proper activation of the low back and hip stabilizers.
For further explanation on this physical ailment, please look at our brochure on Lumbar Stabilization on the website. One can find this under the selection titled “Our Courses” on the homepage. This course offers one of the effective ways of identifying stability/motor control disorder as the cause of musculoskeletal impairments. The different causes of muscular impairments, when treated with appropriate techniques, will allow the patients to heal properly and make long-term gains. Remember; do not prescribe a mobility treatment to a stability issue and vice versa. Know your tools and know them very well!