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Inquirer Daily News

Archive: August, 2013

POSTED: Friday, August 30, 2013, 6:00 AM
n this Tuesday, Aug. 27, 2013, photo, Flint Powers Catholic defender Connor Macksood battles for the ball with Detroit Country Day's Alex Manning during a high school soccer match at Flint Powers Catholic soccer field in Flint, Mich. Detroit Country Day defeated Flint Powers Catholic, 1-0. (AP Photo/MLive.com, Michelle Tessier )

With the start of high school soccer, we can all think back to our athletic days: sitting in a cramped locker room waiting to get our ankles taped, hoping they have any favor of Gatorade other than lemon-lime. Butterflies in our stomachs as we wait for game time. So how do these high school experiences compare to a professional soccer sideline and locker room? 

Parents always tell me they want their child to be treated just like the pros. When it comes to injuries sustained on the field, they are. The care the high school athletes receive is actually more similar than one would expect. An ankle sprain is an ankle sprain and the high school player is treated just about the same as the pro. We perform a quick injury assessment to determine the severity and if it is minor, tape the ankle, and get the player back on the field. 

If it is more serious, we tell the coach to call for a sub and get the player to the bench for ice. The level of care is identical for concussions as no player, whether high school or pro, is allowed to return to the game if he or she has a concussion. 

POSTED: Thursday, August 29, 2013, 5:30 AM

A pain in the butt. Sometimes that is how the infamous athletic injury begins — just a pain in the butt. Many times I see runners, cyclists and other athletes who have pain in their back, legs and hips. Often they all can point to one specific spot that hurts.

This spot that hurts is generally in the piriformis muscle. When it is irritated it is called piriformis syndrome, sometimes it is lumped into the broader term of sciatica.

The piriformis muscle is a small muscle located in the glute region. It attaches from the tail bone to the hip. It is the cause of a lot of pain in the butt, the back and the hip. It is a common injury of many recreational and professional athletes, but also for people who sit for most of the day. Many people classify as generic back pain or sciatica but in fact it is a different diagnosis all together. The good part about piriformis syndrome is that if caught early, it can be easily treated.



POSTED: Wednesday, August 28, 2013, 6:00 AM
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As fall sports begin in earnest this weekend, I am often asked if head protection can prevent a concussion while engaged in play. Since most fall sports head protection-related questions are directed at football and soccer, we will deal primarily with these two sports. 

According to the recent Team Physician’s Consensus Statement on Concussion (TPCC) and the National Federation of State High School Associations (NFHS), there is no football helmet, or mouth guard for that matter, that can prevent a concussion. Helmets have been designed to prevent skull fractures, cerebral bleeding, and other head trauma. Mouth guards have been developed to protect teeth and against oral injuries. 

Helmets in fact, when fit inappropriately, can increase the incidence of concussion. Helmets can also increase the incidence of a concussion when used for illegal means in football such as spearing. Schools generally provide the helmets that are worn by their football players, and these are usually refurbished helmets that have been used by previous players. Helmets used in schools should meet the standards for reconditioning set forth by NOCSAE (The National Operating Committee on Standards for Athletic Equipment) to be sure they are appropriate for wear.

POSTED: Tuesday, August 27, 2013, 6:00 AM
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Shoulders take a lot of abuse in our daily lives. We lift and carry heavy objects, reach in awkward ways, hang bags from them, throw things and undoubtedly stress them with the repetitive tasks demanded by our professions. Additionally, the misguided workout positions, routine recreational pursuits and participation in sports unintentionally lead to the most common shoulder injuries.  

I usually see people in my office by the time things have gotten so bad that they can no longer participate in their sports, workouts, and many of their regular daily activities.

One injury that involves the shoulder is rotator cuff dysfunction. Whether in the form of tendonitis, weakness, or tears, the muscles that make up the rotator cuff are usually part of the problem.
Four shoulder blade muscles work together to make up the rotator cuff. These muscles are responsible for all of the motions involved with throwing (lifting the elbow out to side, rotating the forearm backward, forward and extending the arm behind back). When these muscles are working properly they do more than just allow us to throw. They help keep the shoulder in the correct position to allow for pain-free reaching in all different directions. When rotator cuff weakness or dysfunction develops, an imbalance of the forces at the shoulder occurs with reaching and the shoulder joint position is altered. Over time, this causes friction on the tendons when we reach in different ways and “tendonitis” or "bursitis" is a common result.

Similarly, since the shoulder is not being held in proper alignment, the tendons may also become ‘pinched’ between the shoulder bones, resulting in impingement syndrome.  I see this develop commonly in people who lift weights to strengthen the larger muscles of the front of the body (chest, biceps, deltoids), but neglect the smaller mid-back and shoulder blade muscles.  This muscle imbalance at the shoulder is similar to many of the dysfunctions I have written about previously that also develop at other joints (low back, knees/hips/ankles) due to an imbalance of forces where the larger muscles dominate without the control of the smaller stabilizing muscles.

Other common shoulder injuries involve separations, dislocations and generalized laxity of ligaments. In all cases, the ligaments, which are responsible for joint stability, have been injured and are less effective at holding the bones in place. The surrounding shoulder muscles need to compensate for the ligament damage with proper strength and stabilization training to control large shoulder movements in addition to quick, smaller arm motions.

Another common problem involving the shoulder is ‘frozen shoulder’ or adhesive capsulitis. This may occur secondarily to painful dysfunctions like the ones described above, after periods of immobilization (i.e. with fracture healing) or due to an unknown cause. In any case, significant loss of shoulder range of motion develops as the capsule of the shoulder tightens due to disuse over time. A cycle of pain and dysfunction develops, consciously or not, in which pain with shoulder movements causes one to stop performing the painful movements. This lack of movement and disuse allows the capsule to tighten and the surrounding muscles to weaken. Further attempts at use of the shoulder cause more pain so, over time, lack of movement takes over and people end up with a shoulder that is “frozen.”

With traumatic injuries or slowly progressing shoulder pain, it is always beneficial to seek treatment sooner than later. I have seen some people fully recover within days after initiating a rotator cuff strengthening program. This quick recovery will not happen, though, if months or years worth of damage is already done. Symptoms can still be alleviated and even fully abolished, but the rehab will be much longer.

Be kind to those hard working shoulders, be aware of pain with any shoulder movements and be sure to seek treatment should the need arise.

Below are links to a few basic videos of shoulder strengthening exercises that target the posterior muscle groups, rotator cuff and postural muscles:



POSTED: Monday, August 26, 2013, 9:24 AM
Filed Under: Kevin Miller | Soccer | Working Out
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When it comes to your training you should always be looking to finds ways to improve. Many of us who train have a tendency to get stuck in the same old routine. We do the same exercises day in and day out and wonder why we stop seeing results. This week I want to share with you TEN WAYS that you can improve your training.

1. GET TO SLEEP BY 10:30

When I ask most people when they fall asleep, the majority of people respond by telling me they are unable to fall asleep before midnight. It’s very common for people to tell me that they are unable to fall asleep before 2 a.m. This is a growing problem for a lot of people today. Research has shown that when we sleep our body begins the process of repairing itself. If we are unable to get an adequate night’s sleep how can we expect to feel alert and energize for the next day?

POSTED: Friday, August 23, 2013, 6:00 AM
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Most athletes at one point or another encounter foot pain. Foot pain alone can encompass many different diagnosis and options for treatment. As a therapist, one of the things that I see most often is people ignore foot pain, try to ‘walk it off’ and wind up creating bigger problems, as untreated foot pain will often lead to knee, hip and back pain. What started out as a simple foot issue could take you out of your sport for a long time if left untreated. 

This article is not meant to take the place of seeking medical treatment for an accurate diagnosis. But many people, especially runners and those involved in plyometric activities are prone to foot pain. Foot pain can be persistent and difficult to treat because it is often ignored until it becomes a significant issue and other muscles are involved; but also because you walk around every day, inflaming the already painful area. Taking time off of our feet is not an option for most of us. Upon experiencing foot pain performing some of these remedies right away can save you from missing time in your sport.

  1. Kinesiotaping. Kinesiotaping can help relieve the immediate symptoms of foot pain.  It is safe enough to be worn through activities and while walking around.
  2. Roll a frozen water bottle. Many people underestimate the value of ice.  It can save you a lot of pain in the long run. This is the first question I always ask my patients—did you ice? The answer (unless they are a previous patient of mine and were taught) is most often ‘no’. Unfortunately sometimes a little bit of ice is all that is needed to reduce the pain and help restore normal activities.
  3. Massage ball. Running a golf ball, a lacrosse ball, or another firm ball under your foot for 5 minutes each day with medium pressure will help take some of the tension out of your foot that is causing you pain. This should be uncomfortable but not unbearable or overly painful and you should expect some discomfort.
  4. Foam roll. Foam rolling should be in the plan of everyone who exercises. Foam rolling the muscles above the foot will help loosen the muscles in the bottom of the foot. Most of the muscles that attach on the foot start from up above the ankle. Foam rolling them out will help reduce the pain in the foot and the whole lower leg.
  5. Stretching the bottom of the foot. This is best achieved barefoot. Stand with your foot close to a wall with your toes touching the wall. Slowly move the foot forward so that the foot stays flat but the toes are up against the wall. Again this should not hurt; it should be a gentle stretch. Hold for 30 seconds, repeat 6 times. Do this multiple times throughout the day.
  6. Change your footwear. One of the easiest things to do but the one thing people like doing the least is changing footwear. Flip flops, bare feet and high heels can be the cause and perpetuation of foot pain. Wearing supportive shoes, like sneakers, will allow the foot to have cushion and proper support, which will help alleviate pain.

The sooner you begin to acknowledge and treat any pain or discomfort the sooner it will begin to heal.  Ignoring the pain does nothing but make the road to recovery longer.




POSTED: Thursday, August 22, 2013, 6:00 AM

In founding Alex’s Lemonade Stand, young Alexandra “Alex” Scott utilized her passion for selling lemonade to raise awareness and find cures for childhood cancer.

Next month, her father Jay will turn his own passion—running—into a means of raising those same funds in his daughter’s memory.

Jay Scott, Co-Executive Director of Alex’s Lemonade Stand Foundation, is issuing a challenge to all supporters to collectively run (or walk) 1 million miles this September. The event takes place throughout National Childhood Cancer Awareness Month and is appropriately dubbed “The Million Mile Run.”



POSTED: Wednesday, August 21, 2013, 6:00 AM
Team West pitcher Jazmine Ayala in action Wednesday. Team Southeast from McLean, Virginia was defeated 9-0 by Team West from Tucson, Ariz., in the 2013 Little League World Series Championship game Wednesday night Aug. 14, 2013 in Portland. (AP Photo/The Oregonian, Ross William Hamilton)

The scapula is the keystone of the upper body. All upper extremity motion depends on how well or how poorly the scapula moves. When the scapula is weak, both the shoulder and elbow are at an increased risk of injury. In the normal healthy shoulder, the scapula moves properly and creates a stable base allowing the rotator cuff muscles to control the shoulder.

When the individual throws or reaches overhead, the scapula dictates the position of the arm and minimal stress is placed on the shoulder and elbow. When the scapula moves poorly however; that relationship is reversed and the arm dictates the position of the scapula. This often leads to shoulder injuries such as impingement, rotator cuff strains/ tears, and labrum tears. In the elbow, it can lead to ligament sprains/ tears and muscle strains. The scapula can be compared to the core; without a solid core, poor performance and injuries often result. The same holds true for the scapula.

Dynamic sports such as baseball, softball, volleyball, and swimming often lead to scapula dyskinesia or poor scapula position.Any scapula weakness will contribute to poor performance, increased pain, soreness and injury. Many athletes believe they have a strong upper body and don’t learn about their scapula weakness until after they feel pain.

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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