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Health and Wellness
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Djimmer Bosman, Master’s Degree in Physical Therapy
Djimmer is the CEO and partner of the DTC and Aurora locations and has over 16 years of experience and specializes in manual therapy. He graduated from the “Physical Therapy Academy” in Groningen, the Netherlands. Djimmer is developing the Golf Fit program and is involved with the Front Range Volley Ball Club. He enjoys time with his wife and 3 children and wears a double hat as soccer coach and dad.
Djimmer has offered to answer any questions club members have (at no cost), relating to training smart or potential injuries sustained during training. This is offered as a service to club members outside of the regular therapy services provided by Ascent Therapy and Wellness Centers.
Don't hesitate to contact Djimmer with any questions at:
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Overuse injuries aka cumulative trauma disorder.
A study reported in The Journal of Orthopedic and Sports Physical Therapy follows 131 tri-athletes before and during their competitive season. 50% sustained an injury in the 6 months pre-season, 37% during their 10 week competition. Out of these injuries, 68% of the pre season injuries were related to overuse compared to 78% of the injuries during competition.
Factors that play a roll include: years of experience, high running mileage, history of previous injury and inadequate warm up or cool down.
Most common overuse injuries for tri-athletes per event:
Swimming: impingement syndrome, due to multi directional instability of the shoulder (“loose shoulders”) as well as poor posture
Biking: IT-band cross friction syndrome at the knee as well as Patello-Femoral syndrome (irritation of the knee cap)
Running: Plantar Fasciitis, shin splints and stress fractures.
One of the most common causes of cumulative trauma is the inability to control pronation. Pronation is a normal movement pattern that takes place in the body as it stores or absorbs energy. It occurs at every joint in the body, but particularly in the feet. The inability to properly absorb load in the foot joints will lead to excessive forces elsewhere, usually in the joints closest to the foot: the knee and hip. “Easy” fixes such as new or better shoes, over the counter inserts or custom orthotics don’t always cure the problem: driving around with a bad shock can wear the tire on your car. Buying a new tire will not fix your shock!
A functional evaluation of your body will establish if you are pronating and are unable to control it properly. The evaluation takes about 1 hour and looks at all the joints in your body, the way they interact or not and how you compensate for this.
The most common weakness in the link of joints and muscles lies in the hips. Very few athletes will specifically train their hip muscles, especially the smaller rotators. These muscles play an important roll in stabilizing your thigh bone (Femur) and the ability for your feet, ankles and knees to absorb shock. A few simple exercises can assist you in preventing a break down in this chain.
Remember that most overuse is cumulative, not from running too much or too long, but from running consistently with an improperly balanced body. Not from swimming too many laps, but from swimming without proper stability. Not from biking too long, but from biking without the right mechanics.
As a well conditioned tri-athlete, you have the ability to continue training and racing by compensating for a very long time. But sooner or later this will lead to a break down i.e. overuse injury of which the origin can be difficult to track down, especially if it has been masked for a long time. The eventual complaint or break down may not be the actual cause of the problem.
If you experience excessive fatigue, chronic pain or soreness that does not improve with rest, you may be setting yourself up for cumulative stress disorder or overuse trauma. Listen to your body and don’t be afraid to stop training and ask questions.
Djimmer Bosman, PT Ascent Therapy Clinics and Wellness Centers 8101 E. Belleview Ave, Suite i Denver, CO 80237
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Around this time of year, Djimmer starts to see many Shin Pain patients. In light of this Djimmer has been kind enough to publish a quick breakdown of what the most common causes of shin pain are, and what to look out for.
If you're in pain, read the article below and feel free to contact Djimmer at
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with any questions.
Shin pain is a common complaint among athletes, particularly runners. The main causes of shin pain are medial tibial stress syndrome (MTSS), or “shin splints”, tibial stress fracture and chronic exertional compartment syndrome.
Many of the disorders are overuse injuries; contributing factors include too much activity, inadequate strength and flexibility, muscle imbalance, inappropriate running surface and terrain, lower extremity malalignement and inappropriate footwear.
Proper diagnosis can be challenging and is reliant upon a thorough history, including training history, especially recent changes in mileage, footwear, intensity and running surfaces. Focus should be on pain onset, relationship of pain with specific activity, associated symptoms such as cramping or numbness and alleviating or aggravating factors.
Medial tibial stress syndrome or shin splints is the most common description of shin pain but often times misdiagnosed. Other terms to describe this condition are periostalgia, medial tibial periostitis and traction periostitis.
MTSS is thought to be an overuse injury of the muscle tendon units of the deep posterior compartment, as well as periosteal inflammation of the medial tibia. The exact pathofysiology is not well known. The 2 muscles most likely contributing to MTSS are the posterior tibialis and the soleus.
Clinically MTSS usually presents itself as localized palpable pain at the medial border of the distal 3rd of the tibia. Pain is initially mild, progresses with exercise and decreases with rest. In advanced stages or with continuous exercise, pain may develop earlier and not decrease at all with rest.
Physical examination will show a diffuse area of pain along the medial border of the distal tibia. Pain will be reproduced with dorsal flexion or with resisted plantar flexion. In more severe cases swelling, thickening or nodules may be palpated.
If the diagnosis is unclear, radiographic imaging tests may be done and they should come back negative.
Treatment includes relative rest to allow the inflammation to subside and the tissue to heal. Patient can continue non weightbearing cross training, such as bicycling, swimming or running in the pool, as long as this is painfree.
NSAID’s (non-steroidal anti-inflammatory drugs) or anti-inflammatory modalities such as ice massage, ultrasound or e-stim can be used in acute stages.
After the acute stage, strength and stability exercises should be started, addressing faulty body mechanics that result in overuse of the muscles in the anterior and posterior compartments. A proper bio-mechanical assessment is a necessity to prevent future flare ups and development of a chronic problem.
Djimmer Bosman, PT Clinic Director,
Ascent Therapy Clinics and Wellness Centers- DTC
7939 East Arapahoe Road,
Suite 270
Greenwood Village, CO 80112
phone: (720)529- 4802
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This e-mail address is being protected from spambots, you need JavaScript enabled to view it
www.AscentWellnessCenters.com
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Most of us remember the pain of stretching and still use it during our warm-up routine. But is it really beneficial or even necessary?
It is a common misunderstanding that in order to prevent injury we must turn ourselves into contortionists. Out of habit, many athletes perform static stretches during their warm-up. But this can actually cause tiredness and decrease coordination, thus increasing risk of injury!
Is stretching beneficial in preventing injury and does stretching improve flexibility and performance?
Static vs. dynamic stretching.
A conventional definition of flexibility is the range of motion available at a particular joint while the body is at rest. But during activity or competition this is not relevant, since the athletes body is not at rest. Instead flexibility during movement must be reviewed as a dynamic controlled quality: it allows the joint to go through as large a range of motion as can be controlled. The controlling nature of flexibility involves the range of motion used in skill performance and the length of the movement available for force production /reproduction.
The opposite of dynamic flexibility would be instability: which is any degree of mobility that cannot be controlled.
Flexibility for sports is more than maximal lengthening of soft tissue; it is not a posed static position. It is about movement and control of multiple positions that must occur rapidly to meet the demands of an athlete’s sport.
Sport-specific flexibility requires an integrated expression of joint stability, strength, movement awareness and soft tissue extensibility.
Dynamic range of movement expressed in sports movement is significantly greater than can be expressed statically. This is due to the elasticity of the involved tissue and reciprocal inhibition, which allows the opposing muscle to relax. This is why a pitcher can externally rotate beyond 90° when pitching but statically may not be able to get within 10-15° of that dynamic range!
Quote: “While there is no proven connection between joint looseness and overall athletic performance, too much looseness can be a real liability in sports that require rapid changes of direction and acceleration, such as basketball, tennis and soccer, while too little of it would seriously restrict a gymnast or figure skater; and so the quality of joint looseness is largely sport specific.”
(Arnot & Gains, 1984).
Evaluating flexibility.
It is important to assess flexibility through observing the athletes in their respective sports. Is the athlete smooth in his/her movement, can he/she get in the required positions dynamically? Has there been a pattern of injury?
More detailed functional assessment should be dynamic and intra-individual!
Results are highly individual and therefore should NOT compare flexibility norms. It is a mistake to have norms set that make inter-individual comparisons on this highly individual physical quality.
Now what does this mean for rehabilitation and our patients/clients? They should be allowed the same intra-individual flexibility assessment. Do they functionally require a SLR past 60°?! We should not use the standardization of norms set in a “laboratory setting” to justify continued stretching/mobilization in order to achieve a pre-determined range.
When do we stretch?
Too many people still equate stretching with warming up. However, stretching is NOT the same as warming up. As a matter of fact, you would have to warm up in order to effectively stretch and gain flexibility.
Static stretching before warming up or competition can lead to fatigue and decrease in coordination, leading to possible injury. It is not logical to use static stretching to prepare for dynamic action.
The optimum time to develop flexibility is post workout! The proper way to warm up is to engage in sport-specific movements or conditioning while gradually increasing the intensity level. This could include 5-10’ of jogging, 10-15’ of dynamic stretching followed by 10-15’ general and sport specific drills.
Dynamic stretching must include multisegmental and tri-planar movements against gravity with neural excitation.
For example with running: stretching must include joint movement even when the muscle is lengthened because that is how they function during running activity: muscles are stretched to provide eccentric segmental stabilization long enough for forward momentum and concentric muscle action to create segmental mobility elsewhere in the body.
Summary:
To go back to the question posed at the beginning of this article: “Is stretching beneficial in preventing injury and does stretching improve flexibility and performance?”
Stretching can be beneficial in preventing injury if done properly. It should be done dynamically and sport or activity specific.
Stretching is more than just “warming up” and vice versa, warming up is more than just stretching.
It is important to relay this message to clients, patients and athletes alike. Being able to touch your toes does not make you “stiff or flexible”. Spending 10 minutes performing static stretches prior to a work out does not warm you up nor will it prevent injuries from occurring.
Flexibility is more than just loose or long muscles. It incorporates strength, coordination, balance and dynamic stability.
Ultimately it is about control: the ability to control an action or activity will significantly reduce injury and improve performance.
Djimmer Bosman, PT Clinic Director,
Ascent Therapy Clinics and Wellness Centers- DTC
7939 East Arapahoe Road,
Suite 270
Greenwood Village, CO 80112
phone: (720)529- 4802
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
www.AscentWellnessCenters.com
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Copyright © 2010 Rocky Mountain Tri Club. All Rights Reserved.
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