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Desirea D. Caucci

POSTED: Friday, July 12, 2013, 9:27 AM

Stretching is commonly misconstrued as using a certain muscle group often or a quick tug on the muscle. Many of my patients state that they are surprised their muscles are tight since they “remain active,” “run often,” or “stretch a lot.” When I ask them to demonstrate their stretches, they generally show a poor form hamstring stretch held briefly and maybe show one or two other ineffective stretch positions.

Preventing athletic injuries and keeping your body fit must include stretching—the right way. As we play sports and participate in regular workouts and athletics, some muscle groups continue to strengthen and, thus, shorten. We must be aware of this change so we can incorporate an effective stretching routine to prevent muscle imbalances from developing and causing injuries.

It is also important to consider postures we typically hold ourselves in while working 40 hours per week. Commonly, we sit in the car to get to work, sit a computer for several hours, sit for meals and relaxation, all contributing to common patterns of muscle tightness.

Once you identify which of your muscles are tight, you can begin putting together a daily stretching program to target these muscles. Commonly tight muscles I see are hip flexors (upper front of thighs), quadriceps (front thigh to knee), hamstrings (back of thighs to knee), neck and chest muscles. If you need help identifying your specific tight muscle groups, your local Physical Therapist can assist you and provide specifics on proper form to effectively stretch these areas.

All stretches should be held at moderate intensity (approximately 6-7/10 intensity) for at least 30 seconds. Bring the muscle into the stretched position and hold steady (no bouncing) while deep breathing. After 30 seconds, remove pressure for a few seconds and then repeat the stretch at least three times. Our muscles have elastic properties that respond quickly to steady, consistent stretching. You will notice the intensity of the stretch reduces during the hold, allowing you to stretch a little further with time and subsequent repetitions.

Stretching should not be confused with “warming up.” While warming up is critical to prevent injuries as well, it does not involve stretching the muscles as I have described above. Rather, an effective warm up is a lighter version of the activity in which you are about to engage. For example, walking briskly or light jogging before a run. Usually 10-15 minutes of this light activity is an effective way to bring blood flow and "warmth" to the muscles required for the higher level activity. I recommend the actual stretching to be completed after the warm up or after your workout when the muscles are their loosest.

Your stretching routine can be completed in less than 10 minutes at the end of your workout. Another great method of exercise that focuses on stretching and complements all athletes' workouts is yoga. Completing this on a weekly basis is an effective way to stretch and maintain lengthened, balanced muscles. Neither requires a lot of time to add to your current workout routines when you consider the pay off of preventing an avoidable muscle strain injury, tendinitis, bursitis or even a complete muscle tear requiring surgical repair.

POSTED: Thursday, June 27, 2013, 5:50 AM

As a Physical Therapist, I work with injured athletes on a daily basis. One particular professional athlete I was working with recently validated a trend I have been noticing for years. He was recovering from a knee surgery and, from looking at the size of his muscles and extra large stature, I assumed his strength would be off the charts or at least stronger than most average-sized patients.  

While his quadriceps and hamstrings tested strong, his gluteal, hip and trunk muscles were extremely weak. He had difficulty holding some basic exercise positions on my treatment table, yet he was one of the fastest players on the field. But, he was recovering from a non-impact injury and it became clear to me that this pattern of weakness was the main reason for his injury.

The body was designed to be balanced in strength in all planes. However, due to current trends in weight lifting, poor body mechanics habits and inefficient use of all of our muscles, most people have developed a quadriceps dominant pattern of movement. This means over-utilizing the muscles in the front of the thighs and generating power from smaller, less efficient muscles. This faulty pattern leads to common athletic injuries involving the knees, foot/ankle, hip and low back.

By size, the gluteus maximus is a massive muscle designed to be the primary extender of the hip, especially during running. Most people do not even know how to activate this muscle and they tend to rely on the next accessible hip extending muscle group, the hamstrings. This explains the common "hamstring pull" injuries that afflict athletes of all levels. If the body was functioning in perfect balance, the posterior gluteus maximus and the anterior quadriceps would be working in a 1:1 ratio; this is something I rarely see in my patients.

The quadriceps dominant pattern is an epidemic. I see this displayed in most of the athletes I treat. From a 7-year old multi-sport athlete to the older weekend warriors to the elite runners, gymnasts, cyclists, ball players and professional level athletes, I see remarkable similarities in poor use of the posterior and lateral hip muscles in addition to the trunk stabilizers. It is easier to substitute the long strap muscles for the smaller stabilizing muscles, but at the risk of major injuries that can take these amazing athletes out of their sports altogether.

Retraining the hip and trunk muscles requires careful progression from the most basic non-weight bearing activation to more static and dynamic weight bearing conditions and finally to sport simulation movements. More coaches, trainers and physical therapists need to begin incorporating hip and trunk focused work-outs from the elementary aged athletes on up. This would prevent many unnecessary non-impact injuries and keep athletes excelling in their sports.

Read more Sports Doc for Sports Medicine and Fitness.

POSTED: Friday, May 31, 2013, 5:25 AM
Filed Under: Desirea D. Caucci | Running

Over the past several years there has been a growing trend among the fitness and shoe wear communities to promote barefoot running or running with minimally supportive shoes. This shift has been brought to the forefront with the growing trend of bringing things back to a more “natural” state; let the runners’ bodies control the foot and ankle forces instead of stiff and bulky running shoes.

While some elite athletes have successfully trained and competed barefoot, others have been just as successful with good old fashioned running shoes. More information about the effects of barefoot running and different types of shoe wear on the forces throughout the foot, ankle and rest of the body will be helpful in deciding which method of running is best for you.

Researchers who have spent decades studying the biomechanical forces of runners continue to debate which method is better. One side argues that barefoot running reduces stress and strain by eliminating heel strike during stance. There are proponents growing in number who assert that the most natural gait pattern for runners involves contacting the ground with the mid-foot or forefoot, not the heel; opposite of the natural walking cycle when the heel should hit the ground first. They further theorize that runners begin adapting to shoes by developing a heel strike running pattern because of the design of the running shoes, causing more impact force at contact.    

There is no debate that heel strike running causes a transient impact peak force, but proponents of the heel strike running pattern argue that the rest of the body suffers with the absence of heel strike. In order to land on the mid or forefoot, there is reduced step length and reduced hip and knee flexion, thereby reducing the muscular shock absorption with each step by 50 percent. Subsequently, increased joint stress is transmitted to the knees, hips and lumbar spine. This shifts the loading from the large and strong hip muscles to the smaller muscles of the foot and ankle.  

Like other areas of the body, runners need to have a balanced system of muscles working together to reduce joint stress. In my research, those runners who utilize a mid- or forefoot pattern tend to over-develop their quadriceps and calves while the posterior gluteal muscles remain significantly weaker. A 1:1 balance of the posterior gluteus maximus with the anterior quadriceps muscle groups is ideal. In fact, many lower extremity overuse injuries (most common to for runners include knee and foot/ankle) can be traced back to weak gluteus maximus muscles and a quadriceps-dominant pattern.

So which running style and which type of shoe, if any, is best?  There is not one universal running form that is recommended for all; some body types perform better with heel striking while others perform better with mid- or forefoot gait patterns. But in my experience with patients I favor the heel strike pattern once the gluteal muscles are strengthened appropriately.

The past few months alone, I have treated several patients with running injuries after they consciously shifted their running form from heel to mid- or forefoot patterns. Many patients complained of Achilles tendon pain and plantar fasciitis. In most cases, education on returning to their natural heel strike running form, shoe wear modification, and increased activation of the hip and core muscles yielded pain-free running. However, if you have been a pain-free mid- or forefoot runner, then stay that way. If you are a runner who has pain, then you should be evaluated by a Physical Therapist who can analyze the factors (weakness, imbalance, compensations, inflexibility, shoe wear, etc.) that are contributing to your problem.

As far as shoe wear, new research is confirming that the bulky stability and motion control shoes are actually increasing the stresses on the foot and ankle that they are intended to minimize while the minimalist shoes and barefoot running are increasing joint stress by encouraging the mid to forefoot strike pattern. Therefore, the best advise lies somewhere in the middle. Even if barefoot running was optimal for the body, it simply is not practical or safe for running on surfaces that may be hot, rocky, wet, or covered with pieces of glass or debris.

POSTED: Friday, May 10, 2013, 4:55 AM

Everyone has at least heard about, if not attempted working out with the latest trends in exercise like Crossfit, Insanity, and P90X. The allure is exciting; building better bodies, getting in shape with a guided workout routine and in the Crossfit world, developing close social networks with people of common interests. While all of these methods can be highly beneficial in improving your overall health and fitness, they can also lead to injuries.

An increasing number of patients have been coming to physical therapy for injuries obtained during their workouts. Some are major blow-out types of injuries like ACL tears, Achilles ruptures, and rotator cuff tears while others present with lingering tendonopathies, back pain, and exacerbations of previous injuries. In my opinion, most of these problems can be avoided with proper preparation, education and preventative exercises.

These styles of exercise require high levels of fitness, strength, coordination and endurance. Most people’s bodies are not used to performing at such high levels, and jumping from a sedentary or low level activity level type of lifestyle to high level is the perfect recipe for injury. There needs to be a transition period or ramp-up into such high levels. This is best accomplished by first participating in a supervised low to moderate level fitness program to learn about proper form, body mechanics and safe strength training progressions. Once this is completed, these principals will apply to higher levels of exercise.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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