News & Events

Understanding the Sports Hernia

What is it?

A sports hernia is a tear in the lower abdominal wall in the inguinal (groin) area. This typically initiates as groin (muscles that flex and adduct the hip) pain extending into the lower abdominal area. Unlike the classical hernia, the sports hernia does not result in a bulge.

Sports hernias are not related to a specific incident. Rather, gradual pain brought on by overuse and activity secondary to a strong adductor muscle group in the thigh compared to weak abdominals.

Symptoms are usually brought about by physical activity requiring twisting, kicking, sitting up, and quick bursts, but will abolish with rest. However, if not properly treated pain will immediately return with sporting activities even with a trial of rest.

Who gets them?

Anyone that is physically active may develop a hernia since it is a result of an imbalance between muscle groups which impairs mechanics.

However, it is most common in soccer and hockey players as these sports require hip flexion and adduction with kicking and skating. These muscle groups insert just below the abdominals (the area of the sports hernia) and overpower a weaker abdominal group.

How are they treated?

Sports hernias can effectively be treated with conservative physical therapy. With an effective screen, muscular and movement imbalances can be detected and corrected prior to pain.

If pain is already present, it can be treated with soft tissue therapy, maintaining hip capsule and internal rotation mobility, stretching, strengthening of the lower extremity (especially single leg) and core, and incorporating agility/plyometric activities.

Proper performance of these exercises is imperative as surgery is most likely the next option after 4-6 weeks of conservative treatment. 95% of athletes return within 3 months of a standard repair and 99% return in 4 weeks of a minimal repair.

Consult with your local physician or physical therapist for proper screening, evaluation, and treatment of abdominal or groin pain.

Written By: Eric Horstman, DPT, PT

Kachingwe A, Grech S.  Proposed Algorithm for the Management of Athletes with Athletic Pubalgia (Sports Hernia): A Case Series. J Orthop Sports Phys Ther.  2008;38:768-781.

Shoulder Saving Tips – Part 1, Shoulder Don’ts

As we see more and more shoulder injuries in our clinic, one of the places our patients commonly hurt their shoulder is at the gym.

Unfortunately, what people do not know or realize is there are common exercises and approaches that many perform at the gym that may set people up for an injury.

In this blog, I want to address some of the common questions I get from patients as well as talk about some of the common training errors I see every day at the gym. 

This topic is far too long to try to compact into one article so lets start with talking about the DON’TS at the gym. Stay tuned for part 2!

  1. Never go behind the head with a bar
    This “don’t” applies mostly to lat pull downs and military shoulder press. Going behind the head places the shoulders in a fully externally rotated position and puts the ligaments in the front of the shoulder on a significant, potentially damaging stretch. In addition, in this position, the rotator cuff is not designed to produce force and asking it to do so could cause damage to the cuff especially if heavier loads are being lifted.


  2. Avoid dips
    Dips are a staple in all gyms, and is a great exercise to develop the chest and the triceps. However, this exercise is at the expense of the labrum in the shoulders. The labrum is a cartilaginous ring that deeps our shoulder sockets and provides a stability bumper in our shoulders. As the shoulder moves into extreme degrees of extension during the dip, the upper arm bone is shoved upward and then rotates from a backward to forward position on the rim of the socket. This shearing and rotational force can create a tear and detachment of the labrum from the socket. An injury otherwise known as a SLAP tear. Does this always happen? No, but this exercise has to be high on your high risk, low benefit filter when selecting it as an exercise.


  3. Don’t Bench Press or Push-up Incorrectly
    A lot of people do not realize that there is an incorrect way to do a bench press or a push-up. The key point is not to flare your elbows away from your side. The right position as you lower the bar or your body is to keep the upper arms at no more than a 45-degree angle to the torso. Flared elbows (closer to 90-degrees) has been shown to increase stress through the shoulder joint, the ligaments on the front part of the shoulder, and the subscapularis muscle (part of the rotator cuff).


  4. Don’t Do “Shoulder Day” at the gym
    This “don’t” makes the list because of the fatiguability of the rotator cuff. The rotator cuff works directly against the larger and more powerful deltoid to keep the ball of the shoulder centered in the socket. The rotator cuff fatigues well before the deltoid does which puts excessive strain on the rotator cuff and the labrum. Having a “shoulder day” where you are doing 3-4 or more exercises for the shoulders will exhaust your rotator cuff, and if you push through the fatigue to get your reps in, you will likely develop a problem.


  5. Ditch upright rows
    I am completely perplexed that this exercise still exists and is still being taught by personal trainers, physical therapists, and strength coaches. If I said to you, “I am going to give you an exercise that pinches your rotator cuff in between 2 hard bones and have you do it repeatedly,” would you do it? That is exactly what an upright row does. In this lift, your shoulder is maximally internally rotated which positions a prominent aspect of your arm bone right under the bottom of your shoulder blade. In between these two is your rotator cuff. Trying to raise your arm in an upright row will impinge your cuff eventually leading to tendinitis or a tear.


I could go on and on with more “don’ts” but I think the above hits the major errors I see and answers a majority of the questions I get in the clinic.

I hope this was helpful and look forward to Part 2 – Shoulder Do’s very soon.

Written By: Travis Manners, PT, SCS, CSCS, President and Founder

Do you experience shoulder pain? It is time to start getting on the road of recovery! Come in for an evaluation today.

Lifting Weights Overhead is a Privilege, Not a Right

The Truth about Overhead Weight Lifting that Everyone Should Know

Today’s fitness mindset is evolving. Today, more and more people are doing exercises that require them to lift or hold weights overhead.  In the past, the most common overhead exercise was the military press. People would use that exercise to try to sculpt their deltoids.  

Today, thanks in part to CrossFit and it’s branch-offs, overhead squats, snatches, jerks, and hand stand push-ups are commonly found in many people’s routines.  But should they be?

In the last 10 years (and really more so in the last 3 years), I have noticed an increasing trend in my practice.  The number of people in their 30’s and 40’s who are coming into our facility with damaged shoulders (torn rotator cuffs, torn labrums, dislocated shoulders, etc.). All of these injuries were a result from lifting weights over their heads.  

The ability to lift weights over our head requires a lot of things to work just the right way to keep the forces and stresses from overloading (i.e. damaging) our shoulders.  This is why I say lifting weights overhead is a privilege and not a right.

You do not have the right to press or hold weights overhead just because you think you should be able to.  You have to earn the right!

I want to share with you 3 easy tests you can do to see if you should be lifting weights overhead. It just may save you the agony that my patients face when they realize that they may have to spend hundreds or even thousands of dollars to fix their overhead lifting injury. 

Should you be lifting weights overhead?
Take these 3 simple tests.

 
Test #1 – Arching over a foam roller

mike_5 mike_6

When we lift overhead, our upper back (thoracic spine) needs to be able to extend to allow our shoulder blades to optimally position themselves within the socket of our shoulder joints. 

If the shoulder blade, and thus the socket, are not in the correct place more force is taken on through the rotator cuff, labrum and ligaments to keep the weight over our head.  In this test, you should be able to arch over a standard 6″ foam roller and touch your head to the ground while your rear end stays on the ground.

 

Test #2 – Raising your arms without moving your lower back

mike_3

Exercises like the snatch and the overhead squat require the torso to be completely straight so that the weight is balanced over a stable, vertical base. The arms must be able to raise without subsequent movement from the lower back.  This test looks for exactly that.  Stand with your back up against a wall and your feet about 12 inches away.  

With your head, shoulders, low back, and butt against the wall, slowly raise your arms up straight overhead and touch your thumbs to the wall. If any part of you lower back comes off the wall as you raise your arms up, you didn’t pass the test.

 

Test #3 – Face to wall squats

mike_2 mike_1

Test 3 builds on Test 2. In Test 2, we are looking to see if you can move your arms overhead without low back movement. In Test 3, we are looking to see if you can squat down vertically and without a forward lean.  

With overhead squats and snatches, your arms know they have to be vertical. If you can not place your torso under them for that solid base then you end up over reaching backwards and injuries can happen.

This test looks to see if you can vertically squat.  First, face a wall and place your feet 3-4 inches from the wall.  Then, place your hands behind your head and perform a squat.  You should be able to squat down without touching the wall or loosing balance.

“Remember, lifting weights overhead is extremely technical to do correctly, and that technicality is essential to keeping your shoulders healthy.”

Not everyone can or should be doing these lifts.  Try these tests.
How did you score?  Can you pass all three?

Written By: Travis Manners, President and Founder PT, SCS, CSCS

An Almost Foolproof Way to Relieve “Jumpers Knee” Pain

patellaBasketball season is upon us and with basketball comes the potential for knee aches and pains.  One of the more nagging and painful injuries basketball players can develop is patellar tendinitis, otherwise known as “jumper’s knee”.  I can always pick the players out on the floor who suffer from this injury because they all seem to wear the same brace. 

Though this brace can help certain people with the pain and keep them playing, in my experience other factors exist that continue to cause the symptoms.  In evaluating young basketball players, one of the common findings I have seen is poor flexibility in the quads, hip flexors, and IT band as well as poor mobility in the ankle.  Though other factors exist (including muscle weakness, foot posture, and poor mechanics), these problems can be easily remedied on your own with a couple of simple exercises. 

pretzel_stretchPretzel Stretch 

Step 1:  Lay on your non-injured side with your body in a perfectly straight line.   

Step 2:  Using your hand, pull your heel toward your rear end.   

Step 3:  Pull your thigh back so it is in a straight line with your torso.   

Step 4:  Put your bottom foot on the front, top aspect of your knee and push your top leg back and down toward the floor. 

*Hold for 20-30 seconds and repeat 3-5 times 

 

wall_quad_stretchWall Quad Stretch: 

Get into a half kneeling position and place the top of the foot of the down knee against the wall.  Make sure your torso is straight and tighten the butt cheek on the down leg.    

* Hold for 20-30 seconds and repeat 3-5 times 

 

wall_ankleWall Ankle Mobility Exercise: 

Standing with your feet staggered, place your lead foot roughly 4-6 inches from the wall.  Press the knee toward the wall, keeping your knee over your second toe.  The knee should just barely touch the wall without the heel lifting off the ground.  If your knee easily hits the wall, move your foot back and repeat.   

 *Once you have reached the optimal foot position, hold each for 5 seconds and repeat 10 times. 

Good luck and remember, if your symptoms do not improve it’s possible those previously mentioned factors could be coming into play.  If that happens, consult us for a more complete evaluation.

Written By: Travis Manners, PT, SCS, CSCS 

Understanding Exertion Therapy

Concussion Treatment #1

The treatment of concussions has been widely debated over the past few years. What was previously known and proven with research about concussion treatment suggested that the patient must rest, both mentally and physically. This is indeed true for initial treatment of concussions. There has now been a shift with concussion treatment that suggests moderate amounts of exertion may be used to help treat those who suffer from lingering concussion symptoms.

If you read my earlier blog 3 Unexpected Treatments for Concussionsit may have stuck out to you that I used the term “exertion therapy.” You may have even thought to yourself, “is this guy insane?” People with concussions need rest. They don’t need to exert themselves!”  If this is what you thought, then you definitely aren’t alone.

As we all know, not all concussion injuries are the same. Sometimes people have symptoms months or years after sustaining an injury, this is called Post Concussion Syndrome (PCS). I will share a case study that comes to mind; he was a colleague of mine who played football and whom experienced long-term concussion symptoms.

football-official-standing

Case Study

He was a running back and had played football since he was eight years old. Throughout his career he suffered his fair share of hits and injuries and received two concussions before playing in college. On his last football game of his career he sustained his 3rd concussion, what a way to wrap up your collegiate career right?

This concussion was different than his previous injuries. He lost consciousness and had severe migraines for weeks, months and even years to follow. He had tried everything to relieve the pain. He had visited neurologists and multiple chiropractors. He had gotten mixed results and he never got rid of his migraines and overall neck stiffness. I reconnected with him years later and had heard his struggle. That was when I told him to come and get it checked out by a physical therapist. He was diagnosed with Post Concussion Syndrome.

Eighty percent of people who suffer a concussion are symptom free within 2-3 weeks of their injury. However, this means that 1 in 5 people make it past this 3-week time frame and continue to have symptoms.

 

Post Concussion Syndrome (PCS) Symptoms

  1. Elevated heart rate – Tends to be high even at rest for those with PCS.
  2. Depression – Many people with PCS begin to feel some level of depression due to their decreased tolerance to activity. This can be especially true in an athlete who is used to a regular high level of activity.

Thinking back to the case study that I shared above, there are a few techniques that can be used to help address symptoms of PCS that can speed up recovery time.

Exercise is a great start, and that’s the basis of exertion therapy. Of course I am not suggesting that three weeks after a concussion you should go out for a 10 mile run and then that evening suffer from a throbbing headache.What I am suggesting is that your daily exercise routines should be monitored by a professional.

This is crucial so that your exercise does not negatively affect your concussion recovery. Sometimes it is hard to know if your workout negatively affects you without having someone monitor you, so let me help clarify what I can do for PCS patients.

PCS patients who are seeing me are taken through a graded exercise test, which helps me to find how high they can get their heart rate prior to their symptoms getting worse. I then use this information to help them develop a program they can use to get moving again.

If this situation describes you or someone you know then contact us today to get a more comprehensive evaluation!

Written by, Josiah Parker – PT, DPT

Question: Do you have any questions about exertion therapy treatment for physical therapy?

Rehab Report – Tommy Armstrong Jr.

What do we take away from Nebraska Huskers Tommy Armstrong’s violent helmet-to-turf collision during the Nebraska Ohio State game? Listen to the Rehab Report on AMSPORTS590 as Travis Manners and the Omaha Sports Insider team discuss his injury and also breakdown the proper protocol for a concussion injury. 

Click below to listen now.

3 Unexpected Treatments for Concussions – That Work!

I often get asked about what I do for a living and when I respond that I am a physical therapist many people ask me what kind of injuries I see. My response usually begins with the orthopedic injuries, which everyone kind of already expects, but one area in particular that almost always catches people off guard is when I tell them that I treat concussions.

What can a physical therapist do for a concussion?

That is a great question! Let me share with you the basics on what a concussion actually is.

Concussions: A mild form of traumatic brain injury, which is caused by a bump, blow, or jolt to the head. These injuries may be classified as mild but the symptoms they cause can be devastating to the people who are experiencing them.

Symptoms: Dizziness, headaches, poor balance, trouble concentrating, depression from lack of participation ability. Surprisingly, the symptom most correlated with a lengthened recovery is dizziness. For more information on the basics of concussions visit www.concussionfocus.org.

Now that you understand the basics of a concussion, I promised that I would begin to reveal the three unexpected concussion treatments…and here they are!

  1. Exertion therapy is used to help get the body back to regulating its normal functions like heart rate, and also returning the patient back to sport or work.
  2. Finally, the musculoskeletal piece is used to help with neck or back pain, which often goes hand in hand with a concussion.
  3. Vestibular therapy is used to help address dizziness, headaches, and lack of balance.


In order to avoid getting too long winded, I will be breaking down each one of these three main areas in future blog posts. For now I know this is a very general overview so if you have any further questions feel free to contact me!

Written by, Josiah Parker – PT, DPT

Question:  What do you want to know about concussion therapy?

Jennie A., Collegiate Track & Field Athlete

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