Recently, a group of Furnace Brook PT therapists were attendees at the first annual Harvard Sports Medicine Conference. Here are three takeaways we all felt could improve our clinic thought process.
Intrinsic Foot Strengthening: “The Foot-Core Paradigm”
Dr. Irene Davis spoke about the importance of intrinsic foot strengthening to improve postural alignment and weight-bearing stability / endurance. Although intrinsic foot strengthening is already a well-known component of most exercise programs for lower leg injuries, Dr. Davis’ presentation made me re-think my approach to the topic with renewed vigor. Dr. Davis tried (and succeeded in my humble opinion) to draw an analogy between our “core”, which is generally considered to be the abdominals, iliopsoas, quadratus lumborum, multifidi, and glutes, and a similar system within the foot. It is widely accepted that trunk strength and stability is essential for maintaining spinal stability during fluid, efficient motion. She proposed that a similar relationship exists with intrinsic foot musculature and maintenance of the longitudinal arch in weight-bearing. Much like the multifidi muscles in the spine, our foot muscles are have small cross-sectional areas and short movement arms, indicating that they’re naturally meant to be stabilizers. Why is this theory relevant? Well, 10% of the world’s population will experience plantar fasciitis at some point in their lives, and the proposed #1 cause of plantar fasciitis is pes planus, or flat foot, which occurs when the medial longitudinal arch collapses in weight-bearing. Strengthening your feet should not be overlooked!
Gluteal Strengthening: “Hip Injuries: Rehab and Return to Play”
Dr. David Nolan delivered a presentation focusing on optimizing rehab outcomes when performing glute and hip strengthening exercises. Dr. Nolan primarily talked about recent studies involving EMG measurements of exact levels of isolated glute activation during common rehab exercises. The gluteus medius consistently displayed improved levels of activation when the hip was biased into extension. Meanwhile, gluteus maximus actually showed higher activity when the hip was placed into slight abduction while performing extension based exercises. These results emphasized the need for continued attention to form and positioning during exercise to truly make sure we’re strengthening the intended muscle groups effectively.
Hamstring tendinopathy: “Hip and Hamstring Tendinopathies
Dr. Adam Tenforde presented on the etiology and treatment of proximal hamstring tendinosis. While this is certainly a topic that has been covered in depth, it is always beneficial to hear some of the points of emphasis again. Proximal hamstring injuries are most common in runners, particularly endurance athletes. They present with complaints of gluteal pain surrounding the ischium, which worsens with sitting and high intensity / high speed training. Most commonly, the mechanism of injury is an eccentric overload during the swing phase of gait, and is very easily exacerbated without proper treatment. Generally speaking, the injury is often precipitated by the presence of muscular imbalance, a prior history of hip / knee injury, changes in training regimen, or an improper warm-up routine. Dr. Tenforde’s primary words of caution were with regards to initiating treatment of these injuries: DO NOT AGGRESSIVELY STRETCH THEM! Stretching, particularly done with too much intensity in the early phases of recovery, will only serve to further irritate the healing tissues. Plans of care need to be individualized, but overall should focus on correcting muscular imbalance, addressing malalignment, improving core strength, and gradually introducing eccentric loading to the hamstring muscle group.