Acromioclavicular Joint Injury

acromioclavicular joint injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Acromioclavicular joint is a joint between the clavicle and the scapula. Acromion is a continuation of the scapular spine and hooks over anteriorly. It articulate with the clavicle (collar bone ) to form the acromioclavicular joint.

Problems types

The most common problems are arthritis, fracture and separation. Arthritis is characterized by a loss of joint’s cartilage. Arthritis of acromioclavicular joint is common with weight lifter, especially with bench press and a little less with shoulder press. When there is a problem with the rotator cuff, it’s possible that there is also acromioclavicular joint’s arthritis.

Acromioclavicular separation

acromioclavicular joint injury type grade

When there is an acromioclavicular joint separation, it means that the ligament that connects the acromion and clavicle is damaged and that the 2 structures don’t align properly. Separation’s state can be weak or severe, that is why there is a system of « grade » according to which ligament is torn and the severity of the tear.

Grade I Injury – This is the weakest damage and the acromioclavicular joint is still aligned.

Grade II Injury – This is an average damage. Ligaments are only stretched but not fully torn. In case of stress (physical effort), the acromioclavicular joint becomes painful and unstable.

Grade III Inury – This is a serious damage. Ligaments are completely torn and the collar bone is no longer attached to the scapula, which creates a visible deformity.

Treatment of acromioclavicular joint arthritis

If the rest, ice, medications and change of the training program (changing the exercises) don’t work, the next step is a shot of cortisone. A shot of cortisone in the joint may have calmed the pain and may be permanently swollen. As each individual is unique, the effects may vary and it’s possible that it doesn’t swell permanently.

If non-surgical methods fail, it’s possible to perform a surgical operation. The pain is localized at the bones end that make contact with each other and the goal of the operation is to remove some of the end of the clavicle. This ambulatory surgery can be done with a small incision of 1 inch (2.5 cm) long or with the arthroscopy technique with 2-3 incisions. The results and recovery of these 2 surgical techniques are about the same. Most patients have a full movement by 6 weeks and can return to do sport by 12 weeks.

Treatment for acromioclavicular separation

Separation can create very painful injuries, so the first thing to do is to decrease the pain. Hold the arm in a sling, put ice and pack the shoulder for 20-30 minutes every 2 hours as needed. Acetaminophen and non-steroidal anti-inflammatory medications can also help calm the pain.

When the pain begins to subside, it’s important to move the fingers, wrists and elbow (and eventually the shoulders) in order to avoid having stiff or « frozen » shoulder. The length of time needed to regain complete movement and function depends on the severity or injury’s grade.

Recovery from Grade I acromioclavicular separation usually takes 10-14 days while Grade III takes 6-8 weeks.

When surgery

Grade I and II separations require very rarely surgery. With a Grade III injury, after surgery, it’s possible to have full body physical activity with some restrictions.

Statistics

  • More males than females suffer acromioclavicular joint injuries

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-Steph

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Anterior Cruciate Ligament Injuries

anterior cruciate ligament injury tear

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Knee is the largest and most complex joint of the body. There are 4 primary ligaments (with their muscles and tendons) and secondary ligaments for the knee to function properly. Here are the ligaments of the knee : there are 2 ligaments on the side the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) and two crossed ligaments in the center of the knee, the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL).

Anterior cruciate ligament connects the front top part of the shine bone to the back bottom part of the thigh bone and keeps the shin bone from sliding forward.

anterior cruciate ligament

Injury

anterior cruciate ligament injury tear

There are several ways to have an injury to the anterior cruciate ligament :

  • The injury can be done because of a direct hit on the knee, which often happens in team sport.

  • The injury can be done without contact with an object in a situation where the knee forced to be in a abnormal position, which causes a tear in one or more ligaments of the knee. Or when an athlete in the race change direction. Or when an athlete make a hyperextend of the knee when landing a jump, which often happends in agility sports.

Diagnostic

In the majority of cases, the doctor is able to identify what is the injured ligament. But the knee can also be injured at the joint on the surface and in this situation, it’s more difficult to diagnose because of knee swelling. To make an accurate diagnosis, it will be necessary to use a MRI scan or arthroscopy.

Prevent

There are several fast, powerful movements that lengthen (eccentric phase) and shorten (concentric phase) a muscle. These prevention programs are for injuries without contact. These exercises are to improve the nerves/muscle control of the knee. These prevention programs use plymetrics, balance and strength/stability exercises.

Plymetrics

It’s a fast, powerful movement that lengthens (eccentric phase) and shortens (concentric phase) a muscle. The concentric phase increases the muscle power. Here is an example, an athlete who jumps from a box and immediately jumps into the air after touching the floor.

Balance

Balance exercices are done with the wobble or balance board. It’s also possible to perfom exercices by throwing a ball with a partner while balancing on one leg.

Strength/stability

To improve single-leg core strength and stability, there are excellent exercices such as jumping and landing on one leg with the knee flexed and momentarily maintaining this position.

Surgical treatment

In the past, there was a technique that consisted of stitching the ligament together but it was rarely successful. Currently, the technique involves reconstructing the anterior cruciate ligament by building a new ligament from tissue taken from one of the other tendons around the knee or from on organ donation. This tissue passed through drill holes in the thigh bone and the shin bone, and then ancored in place to create a new anterior cruciate ligament. Over time, this transplant becomes mature and becomes a new living ligament in your knee.

Recovery

recovery

Rheabilitation of the knee after the reconstruction of the anterior cruciate ligament requires time and work. To have a complete function, this can last between 6 weeks and 6 months depending on the severity and level of activity. Rehabilitation rate may take time depending on the specific requirements of the sport/physical activity of the individual.

The overall success rate of the anterior cruciate ligament surgery is very good. A lot of study show that more than 90% of patients are able to return to sport without symptoms of knee instability. It’s true that some patients complain of stiffness and pain after surgery, that is why it’s necessary to make an aggressive rehabilitation until the new surgical technique to reduce these problems.

Statistics

  • One of the most commonly injured ligament in the knee

  • Female athletes participating in basketball and soccer are 2-8 times more likely to suffer anterior cruciate ligament injury.

  • Athlete who suffer anterior cruciate ligament injury at increased risk of arthritis development later in life.

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-Steph

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Tear Of Hamstring Muscle

hamstring muscle anatomy tear

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

In bodybuilding, tears of hamstring muscles are common. This often happens during squat when the torso is too much inclined. All hamstrings muscles (except biceps femoris short head) are extremely stretched and squeeze strongly to straighten the pelvis. Precisely at this point, there may be a muscle tear in the upper or middle part of this muscle group.

It’s possible that the tear of hamstring muscle occur with machine (leg curl). There may be a muscle tear with a heavy weight at the beggining of the movement when legs stretched and muscles stretched.

Usually, tears of the muscular fibers of hamstrings are small and not serious (it’s rare to see a major muscle tear or tendon disinsertion) but these tears are always painful and causes complications.

Indeed, often after a tear on this muscle group, there is a fibrous scar that causes a painful and disabling rubbing for sport practices. And it’s important to note that this scar isn’t elastic and can tear again during an intense effort.

Tip to avoid hamstring tears

To avoid theses muscle tears during squat or deadlift, it’s important to make specific stretching movements for hamstrings, before or between sets.

There are also other exercise like « Good-morning », stiff-legged deadlift or Romanian deadlift which helps because of their combined actions of muscle building and stretching.

After a tear of hamstrings

To avoid having a fibrous scar, it’s necessary to do a re-education a week after the tear. It’s important to do stretching exercises for the back of the thigh slowly. This allows you to stretch the injured muscles and to soften the scar so that it doesn’t tear when you start again the training.

feedback of hamstrings muscles

hamstring muscle anatomy tear pelvis

In modern societies, we sit for several hours. This can create in some people a feedback of hamstrings muscles. This muscles retraction of the back of the thigh puts the pelvis in retroversion and this creates a bad position of the spine.

This poor position of the spine causes the natural curvature of the spine to be lost over time. This results in poor posture, flat buttocks and round back that can trigger spinal pathologies.

To limit this feedback of hamstrings muscles, it’s recommended to do exercises that have a combined action of muscle strengthening and stretching at the back of the thigh as the « Good-morning », stiff-legged deadllift and Romanian deadlift. Then after this exercise session, it’s advisable to do some sets of stretching for hamstrings.

Action of hamstrings at squat

hamstring muscle anatomy tear squat

During squat, hamstring muscles squeeze to straighten the pelvis. This prevents the torso (in this phase the torso is bound to the pelvis by the contraction of the abs and lumbar) from bending too much forward.

hamstring muscle anatomy tear

Note

Fibrous scars can also be treated in parallel by a physiotherapist with manual or mechanical massages to soften the lesion.

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-Steph

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Adapt Your Training To Your Morphology (Part 2)

anatomy body squat morphology knee big belly

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

If you didn’t read Part 1, click here.

Legs

Improve your squat position

anatomy body squat morphology knee big belly

To reduce the lower back’s effort and limit the hamstrings tension, it’s possible to do like powerlifters by putting the barbell on posterior deltoids.

This technique decreases the cantilever and increases the power of lifting from the back. This allows you to lift heavier weights.

By using powerlifter of weightlifting shoes (solid raised heel) or a wedge under the heels, this reduces the cantilever by having the buttocks not too back by the advancing knees. This allows for greater amplitudes with the thighs flexion.

With that, we feel better the quadriceps work by limiting the torso’s inclinaison and the work of the gluteus maximus and spinal erectors.

The low barbell and raised heel combination allows you to lift heavier weights. This technique is recommended for rangy people and people with stiff ankles to correct their positioning at squat.

Front squat to target quadriceps

anatomy body squat morphology knee big belly

Front squat limits the torso’s inclinaison. This has the effect of reducing the work of the lower back, decrease the tension of hamstrings muscles and adductor magnus muscle.

On the other hand, front squat increases the cantilever, which forces quadriceps to make more effort to extend the thigh on the leg.

Which means it’s the perfect squat for thighs. But it’s not possible to lift heavyweights like the classic squat and it’s recommended to do it with heels elevated for better stability.

For rangy people, front squat is very hard to do. The torso of rangy people is more inclined, which make it more difficult to hold the barbell which may fall forward during the execution of the movement.

Spread the legs to less incline the torso

anatomy body squat morphology knee big belly

There is a squat’s technique to limit the torso’s inclination. This involves spreading the legs with the feet outward. Some powerlifters do this technique with the legs almost wide apart. With the legs apart, this limits the legs flexion.

To be able to squat with the legs apart, it’s necessary to have an adequate bone conformation of the hip joint and to be flexible of the thighs adductor muscle. Which means, it’s a technique that can’t be used by everyone.

The advantage of the big belly

anatomy body squat morphology knee big belly

Having a big belly for squat and deadlift allow to compress it against the thighs. This helps to limit the inclination of the torso and the back’s rounding. This has the effect of protecting the lower back and limiting the risk of herniated disc.

It’s for this reason that we can see a lot of heavyweight champion of powerlifting or weightlifting with a big belly. They take care to keep their belly fat with an excessively rich diet.

Different forms of knees

anatomy body squat morphology knee big belly

In bodybuilding, it’s important to take into account the different morphologies of the individual and especially for the knees.

Arched legs (genu varum) are not more risky than normal legs. For people with X legs (genu varum) or people who can overly extend the thighs (genu recurvatum), it’s often recommanded to not do leg exercises with very heavy weights.

Cases of genu valgum are often :

  • In people who were overweight during their youth when leg bones weren’t fully developed and still « malleable ». Legs are deformed because of the overload. Now, they have this X shape.

  • In women. The fact that women have wider hips to have children, this influences the femurs direction which are generally more inclined.

For people with genu valgum. If the genu valgum is to excessive, the joint would be overused. The medial collateral ligament would be extremely tense. The lateral meniscus, the articular surfaces coated with cartilage of the external condyle of the femur, and the external lateral tuberosity of the tibia would be subjected to excessive friction, which would cause pathologies of wear.

For people with genu recurvatum. These are people who are essentially very flexible named hyperlaxes or women whose muscular and ligamentous hyperlaxity is related to reproductive function.

Rarely pathological, knees with genu recurvatum can sometimes have some problems like the meniscus pinching. This can happen when the knees are rapidly expanding and the meniscus haven’t had enough time to slip, or during an exercise with a heavy weight that has forced the hyperextension of the thigh.

It’s for this reason that it’s recommended to people suffering from a genu recuvatum pathological never to totally block the knees at the end of extension to the squat or to the leg press.

Note

For 2 people who are the same size, it’s important to consider the torso-leg ratio.

anatomy body squat morphology knee big belly

Type A :

People with proportionally long legs and a short torso will have trouble doing a proper squat without tilting their torso excessively forward.

On the other hand, the short torso (which limits the cantilever) facilitates the execution of the good-morning, classic deadlift and Romanian deadlift.

Type B :

People with proportionally short legs and a long torso will have the facility to squat safety without tilting their torso excessively forward. It’s for this reason that the great champions of powerlifting squat specialist have this type of morphology.

Share this article if you think it can help someone you know. Thank you.

-Steph

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Deadlift Correctly (Part 1)

deadlift

I read an Nerd Fitness article  and I learned good stuff.

I see there are many people who are avoiding deadlift because they are afraid of getting hurt. It’s funny, it’s like squat.

Doing deadlift with good a technique is excellent for health, it allow your to have stronger joints and a stronger posterior chain.

All exercises can be dangerous when they don’t do with the proper technique, which is why it’s important to seriously study each exercise.

Why

why

In workout programs, you can find the deadlift in the day of legs of back. This can be disturbing but the truth is the deadlift is a polyarticular exercise.

The deadlift (polyarticular exercise) works several different muscle’s group :

  • Your hands, your forearms, your arms to keep the barbell in the right position and the barbell is stable during the movement.

  • Your shoulder and trapezius help to hold the weight and keep it stable.

  • Your back and core help to keep your body tight and stable so that your spine is safe.

  • Your posterior chain  and your legs act as lever to lift the weight.

What is interesting is that deadlift is a basic human movement like the squat. It’s a « functional » movement that we do every day to take an object on the ground. Lifting a chair or taking a bag on the floor is deadlift.

Training yourself to do deadlift with a good technique at the gym, will allow you to do these daily tasks by decreasing the risk of injury. I imagine you’ve seen a person hurt his/her back by lifting something off the floor. It happened because the technique was bad.

Let things be clear, everyone needs to do deadlift. Look at that grandmother 

grandmother deadlift

Also, deadlift is the purest way to measure the strength. You lift or you can’t. Sometimes with gym’s members, we do a deadlift party, it’s fun.

Choose

Attention : if you have spinal injuries, go see your doctor before starting

The origin of the word « deadlift » is : you lift dead weight (motionless) of the ground.

In short, you take a barbel with weight and you get up with the barbell in your hands until your shoulders, hips and knees locked. Your arms should be straight during the whole movement and when you’re standing, the barbell is at the level of your hips.

Here are the different type of deadlift most common :

Conventional Deadlift

conventional deadlift

Your hands are at your hips width, outside of your feet.

Sumo Deadlift

sumo deadlift

You have a wide position with your hands inside of your feet.

Hex or Trap Bar Bar Deadlift

hex trap bar bar deadlift

You need to use a special bar. In this way, you make the movement with another biomechanics.

Snatch Grip Deadlift

snatch grip deadlift

You use a wide grip like to do a Snatch.

Straight Leg Deadlift, Stiff Legged Deadlift, Romanian Deadlift

Many people are troubled by these variants. Here is an excellent article by Bret Contreras to see it in detail. Click here .

Deficit Deadlift, Rack Pulls

deficit deadlift rack pulls deadlift

These accessory movements allow you to increase or decrease the range of motion.

Dumbbell Deadlift Variations

dumbbell deadlift

You can do this when you don’t have access to a barbell and weights or as accessory movement.

In this article, I refer mainly to conventional deadlift.

Now, let’s talk about equipment :

Flat shoes

Converse Chuck Taylor Classic  are good (this is what I use). There’s also Vibrams, you can do in socks or with Powerliters shoes.

Chalk

chalk

This is optional but it can help you to not let your hands slip when you lift very heavy weights.

Deadlift can be taught in 1-2 sentences but there are complexities at different steps of the movement that you should know to avoid injury. I will develop this in the next parts.

Share this article if you think it can help someone you know. Thank you.

-Steph

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How To Do Stiff-Legged Deadlifts

stiff legged deadlifts

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Podcast :

Standing with your feet slightly apart. The barbell is on the floor in front of you :

  • Inhale, bend your torso forward with your back arched. If you can keep your legs straight or slightly bent.

  • Take the barbell with a pronated grip and straighten your body with your back rigid (your back is not more arched than the starting position). It’s at the hips level that the tilt occurs. Exhale at the end of the movement.

  • Returns to the starting position without the barbell touch the floor and do it again.

To avoid to have injuries, keep your back straight, it’s important.

This exercise works all the spinal erectors, it’s the muscles that run along each side of your spine. These are the muscles that allow you to straighten your spine.

When you straighten your torso, during the tilt forward of your hips, this exercise works the gluteus maximus and hamstrings (except the thigh biceps short head).

This exercise stretches the back of your thighs when you return to the starting position.

It’s possible to raise your feet compared to to the barbell (with a plate weight or a step) so that the exercise is more effective.

Note

This exercise can be used as a stretching movement for hamstring with light weights.

The heavier the weight and the greater the gluteus will work compared to the hamstrings to straighten your hips.

Share this article if you think it can help someone you know. Thank you.

-Steph

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