Physical therapy for athletes has evolved in the past decade with a shift in understanding where the root causes lie and how to best deal with them. Gone are the days when everything could be cured by orthotics; now more attention is on hip strength, mobility and practicing good technique when you swim, bike or run.
We talked to four top sports physical therapists from around the country (read about them on page 80) and got their insight on which injuries might be lurking around the corner—and how you can prevent them in the first place. This is part one of this article – we’ll bring you Part Two next week.
The deal: “Somewhat obviously, this is usually an overuse injury from swimming,” says Nate Koch. “It’s a result of improper biomechanics resulting in the stroke technique being off: The swimmer may not be using enough body roll and the reach isn’t proper.” Koch says that the internal rotation of the arm compresses tendons and bursa. A sign of shoulder impingement is that the morning after a hard swimming workout you wake up and your shoulder is sore.
First aid: “Lots of people don’t want to miss workouts,” Koch says. “The coach has it on the schedule and they can’t bring themselves to take the break.” But rest is exactly what you should do, Koch explains. Because an impingement comes from tightness and lack of “space” in the shoulder, work on mobility around both the shoulder blade and scapula.
Prevention: In addition to refining your stroke mechanics, consistent mobility and flexibility in the shoulder complex is the No. 1 prevention tool. Koch says to follow the example of most collegiate swimmers and spend time before and after each swim workout performing simple rotator cuff and mid-back mobility exercises to help counter all of the muscular imbalance created during a swim workout.
The deal: Sharp pain deep in the hip or in the lower back can be caused by any number of things, Koch says. “Diagnosing the specific problem is hard even for the trained eye,” he says. “It could be 20 different things, but all that stuff is usually related to spine. Sometimes we feel like a sacroiliac joint clinic.” Back pain usually originates from somewhere else—typically the hip, says Bryan Hill.
First aid: Figuring out the cause is important. A professional bike fit will ensure it’s not your cycling mechanics. “Flexibility is key,” Hill says. “If you work on hip mobility, the back pain will likely decrease. Alternate heat and ice, and warm up and stretch before and after workouts—especially rides.”
Prevention: “Spinal mobility is important,” Koch says. “This means improving your core strength and the mobility of the pelvis and spine.” This is particularly important if you have an office job and are stuck in a chair all day. “When you’re sitting, the pressure on the discs in your lower back is up 30 percent compared to when you’re standing,” he says. The solution? Get up from your chair on the hour, walk around and perform a few light stretches. A proper bike fit and a look at your swim and run mechanics by a professional are also great preventors.
The deal: Femoral acetabular impingement (FAI), or pain in the groin and front of the hip areas, are problems that can arise from being on the bike a lot. Groin sprains are more common than FAI, and usually a result of being hypomobile or inflexibile.
First aid: “Massage or ART (Active Release Technique) are great in the acute phase, as well as ice or modalities,” Hill says. “Adjusting bike fit or seat height may be a factor that will help overall. Long-term, there is no substitute for consistent stretching and flexibility work through yoga, personal training, physical therapy, etc.”
Prevention: Koch says that a less aggressive aero position on the bike is a smart way to ward off the potential for FAI. Similar to how you prevent shoulder impingement in your swim program, be sure to follow up your bike workouts with stretches to mobilize the joints and bring your muscle tissues back to center.
Iliotibial band syndrome
The deal: In addition to triathletes and runners, Jill Boorman works with professional baseball players in the off-season, when she sees a lot of ITBS problems. “They’ve just come off playing 162 games where they’ve always been moving forward,” she says. The result is a pelvic instability—tight hips that are lacking lateral mobility, and the IT band pays the price. Runners and triathletes, Koch adds, who spend a lot of time running downhill can be especially vulnerable to developing IT band pain, which can show up on the outside of the knee or at the origin of the IT band in the hip. Also, Hill says, a foot dysfunction can be a sneaky reason for the knee and hip relationship to be off in running.
First aid: “I love ice for this,” says Boorman. Icing can reduce the inflammation and the pain. She also encourages her clients to follow hard runs with swimming to “massage” the legs. Using a foam roller on the legs, massage and ART are also useful.
Prevention: To prevent ITBS problems, Koch teaches his clients exercises that improve lateral hip mobility, like monster walks and clam exercises. He also advises them to adopt a foot strike that is light and fast. “The more time your foot spends on the ground, the more forces the leg has to absorb,” he says. “The less time you’re on the pavement the better.” Hip mobility is the key, but making sure that alignment while running is important, adds Hill. “Have a professional do a video run assessment, work on form and run with experienced runners to model their mechanics.”
Patellar tendinitis or PF syndrome
The deal: According to Steve Berkey, “Patellar tendinosis is a pain that occurs under the kneecap from the knee not tracking correctly.” Because there are so many causes, it’s important to have a professional assess your lower body. Hill says the primary “big rocks” to assess are (1) foot position (flat or high arch) (2) knee strength on a single leg (using the simple single-leg squat test for range) and (3) hip mobility, primarily the hip flexor. “If any of the three or a combo are not biomechanically efficient, the risk for knee pain rises,” Hill says.
First aid: Ice with a bag that conforms to the knee, Berkey says—like a bag of frozen peas. Do 15 to 20 minutes of icing per treatment. Stretching, massage and, in some cases, orthotics can solve the problem.
Prevention: Berkey says that patellar tendinitis is usually related to weak hip muscles and poor running technique. Exercises to strengthen and mobilize the hips should be paired with a focus on improving your running technique. “These are the things you can work on with a PT so you can steer clear of the surgical options that can come up with knee pain,” Berkey says.