Ulnar Collateral Ligament (UCL) reconstruction, also known as Tommy John surgery has become common among baseball pitchers and other throwing athletes. Due to the repetitive motions of overhead throwing athletes, like major league pitchers, overuse and improper wear can lead to microscopic trauma. This, over time can contribute to weakness and laxity causing injury in the ulnar collateral ligament.
Causes of UCL injury
The ulnar collateral ligament provides the primary resistance to valgus (lateral displacement away form midline) stress that occur during the late cocking and early acceleration phases of throwing, during a forehand stroke in tennis, or in a trailing arm during an improper golf swing (1). It is commonly injured due to repetitive trauma of a valgus force.
How Tommy John surgery works
Even though Tommy John surgery is very common these days among athletes it is still a surgery that requires an extensive and lengthy rehabilitation process. For surgery, surgeons drill holes into the ulna and humerus bones so the new tendon can be weaved like a figure eight. Tendons are commonly taken from the palmaris longus tendon in the forearm, hamstring tendon, or the big toe extensor tendon.
Implications of Tommy John Surgery
Just like any surgery, changing the structure of the body can have lasting implications and is a major stressor on the system. Athletes typically return to full level activity within a year, however surgery includes moving major muscle in order to get the bones for re-attachment of tendons. This process can have potential issues including nerve or blood damage, which can lead to permanent numbness and/or weakness. Additionally, the ulnar nerve which passes around the elbow joint may need to be moved to prevent future exasperation in the elbow region.
Tommy John surgery should not be taken lightly and is not a substitute for improper mechanics, poor strengthening program, and lack of proper recovery protocols and/ or rest. For instance, it is not uncommon for individuals to seek Tommy John surgery regardless of the injury because it is believed to improve overhead activities. However, this is not the case and getting this type of surgery does not imply increases in athletic performance. It is important to prevent UCL reconstruction by following a proper exercise routine, taking adequate rest and adhering to a good nutritional program to promote recovery and ligament health.
Prentice, W. E., & Arnheim, D. D. (2011). Arnheims principles of athletic training: A competency-based approach. New York: McGraw-Hill Higher Education.
Adaptation can be defined as the processes of change by which an organism or species becomes better suited to its environment. As we have discussed in previous posts, bones adapt and become stronger when subjected to stress. This stress makes bones become stronger and as a result able to tolerate more force, decreasing the potential of breaking. Additionally, other types connective tissue also show these same characteristics.
What is connective tissue?
Connective is a type of tissue that provides support holding the bodies tissues together. It is composed of a cellular component and an extracellular matrix that give it its unique characteristics. The extracellular matrix has a fibrillar component that contains collagen and elastin. Collagen is the most abundant protein in the body which is responsible for the functional integrity of connective tissues providing it a tensile strength approaching that of steel (1). Elastin makes up a smaller portion of the fibrous component in extracellular matrix but allows fibers to deform under applied force (1).
What are types of connective tissue?
The various connective tissues in human body include cartilage, bone, tendons, capsules, ligaments, adipose, blood, lymphatic, elastic, fibrous etc.
Ligaments connect bones to other bones and are comprised of a small number of cells (about 20%) and a large extracellular matrix (80-90%).
Tendons connect muscle to bones and are also comprised of a small cellular component and large extracellular matrix
Cartilage is a connective tissue that can be found throughout the human body. There are 3 main types: hyaline cartilage which helps reduce friction and absorbs shock, elastic cartilage which provides shape and support, and fibrous cartilage which provides rigidity and absorbs shock that is transmitted between joints
How does connective tissue adapt?
Other types of connective tissues adapt similarly to bone. In fact, connective tissue can change their structure and function in response to external or internal applied forces (1). Connective tissue can do so through altering the composition of the extracellular matrix, which as stated, is comprised of collagen and elastin. This dynamic behavior of connective tissue gives it unique properties allowing it to adapt to in order to tolerate more stress.
How can we prevent connective tissue strains, ruptures and overuse?
Micro-progression. Connective tissue adapts slower than muscles. This is because many types of connective tissue lack the blood supply that muscles do and as a consequence leads to increased recovery rates. It is important to understand this fact. We want stronger connective tissue but must induce the adequate amount of stress for adaptation. Too much stress and to frequently will lead to injury, while not enough stress and proper progression will not produce the necessary change for increased fitness.
Levangie, P. K., & Norkin, C. C. (2001). Joint Structure and Function: A comprehensive Analysis. Philidelphia: F. A. Davis Company
Desire is to express a yearning to obtain. When one has a strong response toward something that they can achieve it is said they Desire. Desire is what drives one toward the attainment and achievement of success in a given field.
This desire for self-improvement is the backbone of what drives athletes and those that train at the Athletic Training Institute. It is this aspiration that pushes coaches and athletes at ATI to continually improve their craft each and every day.
A desire to provide a service and training experience like no other.
A desire not just to become a better athlete but embody a combination of the mental, spiritual, motivation, professionalism, intellect, emotion, and drive that transcends the physical.
Are you achieving what you think you are when you stretch?
Many people stretch on a daily basis because of the believed health benefits. But, is stretching actually improving fitness? Is it promoting optimal health? Is it even increasing flexibility?
Many engage in stretching in an effort to increase flexibility, warm up prior to exercise, increase performance, prevent injury, reduce muscle soreness and/ or alleviate stiffness. There are various types of stretching like static stretching (which is what people typically engage in when they think of stretching), contract and relax stretching also known as Proprioceptive Neuromuscular Facilitation (PNF), and dynamic stretching.
It is usual to think that stretching is beneficial, as it is frequently discussed and common to hear “stretching is good for you”.
But the truth is– the benefits of stretching has never been proven.
In fact, there is evidence that stretching does not prevent injury (2,3,5), does not decrease muscle soreness (2,3), is not a proper warmup (4), and can actually decrease exercise performance and increase the potential injury (4,6). So then why do people continue to stretch?
For starters, many people regularly engage in stretching because it feels good or do so because it helps relieve muscle pain and stiffness. But the important question to ask is: why does the pain or stiffness shortly return after stretching? Why is the pain there in the first place?
We know that the body operates within the range where it feels stable. Stability is the key when talking about the symptoms of tightness because these symptoms are essentially a check engine light for a malfunctioning part in the body. Stretching a tight muscle can certainly relieve it from being tight but is basically placing a Band-Aid over the cause.
Paul Ingraham of PainScience.com sheds light on what may actually be happening when we stretch, stating “increased flexibility may simply be an increased tolerance for the discomfort of excessive muscle elongation”. Basically, Paul is stating that stretching may not increase elongation but may only be increasing the bodies tolerance of stretching”.
This is important and something we need to consider when asking “are we achieving what we think?” Are we actually changing the length of a muscle or are we just increasing the body’s ability to tolerate the stretch? It turns out the latter is probably correct. In addition, we need to also ask why the body is limiting the length of a tissue? It is common for people to feel tightness and stiffness in one area but be caused by other muscles not being able to shorten effectively in another area.
Lastly, why do we need increased range of motion (ROM)? If you are an athlete that requires extreme ROM to compete, then yes you need to increase ROM. However, for the majority of the population increased range of motion beyond a certain amount does not improve health or decrease injury. People who habitually stretch rarely see increases in ROM except when done diligently over long periods of time. It is important to consider why it takes so long to increase ROM when stretching; the body operates where it is stable and stretching does not increase length of a muscle but increases the muscles tolerance to a stretch!
We know how important the gut microbiota is for optimal health. We also know that gut dysbiosis has been found to be associated with diseases like Type 2 Diabetes, mellitus, cardiovascular, and inflammatory bowel disease as well as brain pathologies like autism, Alzheimer’s, Parkinson’s, and amyotrophic lateral sclerosis (ALS). Additionally, we know the implications that antibiotic use can have on the delicate microbiota ecosystem. But, there is also another area of concern that can have profound implications on gut health, and that is Non-Steroidal Anti- Inflammatory Drugs (NSAID’s). NSAID’s are commonly taken to treat inflammatory issues like arthritis and other injuries. But, what if taking NSAID’s are actually making the symptoms worse via creating more inflammation, and blunting the healing process?
NSAIDs and the gut lining
The lining of the gut is only 1 cell thick. This is important to note because this thin layer, known as epithelial cells, is all that lies between the gut and the blood stream. The gut epithelial cells are held together by junctions that allow nutrients like vitamins and minerals passage while keeping food particles at bay. However, when there is damage to the gut lining, intestinal hypermobility (better known as “leaky gut”) results.
We know that inflammation is at the core of almost all deteriorating conditions. Therefore gut health is critical to overall health because when one has a leaky gut, the gut lining that is normally selectively permeable (allowing passage of nutrients) is impacted, food particles can pass through the wall causing inflammation. It turns out that NSAIDs can impact this gut lining reducing gut barrier function.
It is unfortunately far too common to see athletes pop NSAIDs during not only competition but also on rest and recovery days. It is also common to see average folks taking them to reduce everyday pain. We now know how pivotal gut health is to overall health and especially brain health. If we are to improve recovery, health, energy, cognitive performance, and nervous system function then we need to be aware and take steps to promote gut health. When we improve the health of the gut we will see reductions in inflammation. With this reduced inflammation an increase in recovery will follow. This increased recovery will probably limit the need for NSAIDs to be taken in the first place!
Start with addressing health and examine the cause of your symptoms rather than taking pills to treat them. Additionally, be conscious that taking NSAIDs can damage the gut lining increasing the potential for “leaky gut” and associated inflammation.
In the past we discussed that Anterior Cruciate Ligament (ACL) injuries are on the rise, noting some staggering statistics on its prevalence. We also mentioned some functions of the ACL, like being a key player when slowing down from a run or sprint by helping prevent forward movement of the shin out from under the femur. The ACL is commonly injured when there is frontal shin movement forces with a fixed foot, excessive internal rotation forces on the shin when the foot is fixed or hyperextension forces on the knee when the shin is fixed. In the recent ACL post we also posed some questions about why ACL injuries are on the rise, noting an important one being loss of muscular integrity leading to improper motion and stability.
When we workout we create micro tears in muscle fibers. As a result, the body increases inflammation to start the healing process. With the stress of working out, the resulting inflammation can alter the communication between the nervous system and muscle system. This ultimately leads muscles to not be able to contract properly.
Have you ever completed a workout and tried to come back too soon to do it again and noticed decreases in performance? When working out in this state, with muscles are not optimally recovered, your body is not able to produce forces like normal. This is because they have not fully healed, and many athletes operate in this state since it is common to do different types of movement and exercise when in an under recovered state. An example is for an athlete to lift legs one day and practice the following day. After a workout, inflammation accumulates to start the healing process. This reduces contractile properties of muscles that act as stabilizers to joints.
Since muscles are the first line of stabilization in the body, if they are weak and unable to control motion, ligaments will take the load. This is why over-training can cause increased injury rates. When in an over-trained state, the nervous system is operating in a more sympathetic state, which is also termed the “fight or flight” branch of the nervous system.
With new technology we are beginning to understand this relationship between the nervous system, inflammation and injury. For instance, we are currently seeing many professional teams start to monitor the state of the nervous system of their players to determine if they are in an under recovered state. What many people do not understand is that when the nervous system is in a state of sympathetic overload, the result is higher levels of systemic inflammation. Since inflammation decreases muscle contractile efficiency, when the body is inflamed we can see higher levels of injury because sympathetic hyperactivity leads to greater inflammation which decreases muscle contraction. Decreased muscle contraction decreases joint stability and leads to greater forces on knee ligaments such as ACLs and greater potential for injury.
However, what if there was a way to determine the integrity of the muscular system to ensure an athlete or client poses necessary stability for movement BEFORE injury?
Bones play a very important role in motion and are the hardest connective tissue in the human body. Its unique makeup, consisting of cellular components (osteoblasts, osteoclasts etc.) and an extracellular matrix (minerals, reticular fibers etc.) allow for material distribution and thus providing unique properties of remodeling and shape changing when subject to challenges, stimuli or stress. For instance, bones can adapt to various stimuli including, mechanical load, diet and injury.
In movement, the function of the skeletal system is to supply the muscular system with rigid levers to pull against for appropriate movement. For any demographic, having proper bone integrity and health is critical.
Each person’s bones begin with a specific genetic makeup and develop their architecture during growth to meet the demands of activity because of external loading. Adequate bone adaptation to stress requires that cells within them perceive mechanical signals. A positive stress on bone will increase bone density via simulating osteoblast activity, which is part of the cellular component and is responsible for the bone formation. This occurs when a stimulus exceeds a certain threshold. However, negative adaptions can occur when the muscular system is not able to provide suitable external load. When there is inadequate external force, osteoclast (bone resorption) dominates osteoblast activity and as a result bone mass diminishes. This occurs when the stimulus falls below threshold, increasing the rate of bone remodeling.
This is why exercise has such a profound impact on bone health. Improving the muscular systems ability to enact mechanical forces on bones provides an optimal environment for bone formation and health. It is important that the muscular system both support the weight of the body and be able to tolerate external loads.
Everyone should be able to handle their body weight for exercise as well as external forces. When the body is subject to weight, either through moving through space, or via external loading, the muscular system is required to work, and as a result pulls on tendons that pull on bones to provide a stimulus for positive growth.
From a nutritional standpoint, for strong healthy bones it is important to have adequate levels of Vitamin D and Calcium. Remember, just as it is important working with a skilled professional to improve muscular integrity and oversee an exercise routine, it is important to work with a professional who understands the body as a unit. Taking another pill to increase calcium and Vitamin D levels could potentially make matters worse. Treat the cause rather than the symptom!
Looking at the most successful individuals in any field, a characteristic trait they all share is “Grit”. Angela Duckworth is leading the field trying to tackle questions like what is grit and how do we get grittier? Angela defines Grit as “perseverance and passion for long-term goals”. She and her team today continue to research individuals with high Grit, looking at how these achievers uphold their motivation through adversity.
As Merriam- Webster defines Grit: firmness of mind or spirit: unyielding courage in the face of hardship or danger.
Grit is the cornerstone of achievement
If you have Grit you view long term success as a process, enduring the hard times while putting in unrelenting effort to overcome limited talents that you may have. People with Grit embody a type of resilience that others do not. They understand that talent is not fixed, effort produces results, and live with desire and determination each day. In other words, people with Grit have a ‘growth mindset’: the belief that the ability to learn a skill is not fixed and can change with a certain amount of effort. It is about putting in the work day in and day out and overcoming any obstacle in the way, staying the course amongst challenges.
Do you have grit? Do you keep pushing when things get tough? Do you believe you can improve your weaknesses? Do you put in the work every day to achieve your goals or improve your shortcomings?
Academics, intellectual talent, relationships, leadership, athletics, health can be improved.
Warming up is often an overlooked component of training. Especially for young athletes, it is easy to jump into a weightlifting session or agility program before the body is ready. However, from athlete to general training enthusiast, the warm up is an essential part in preparation for the demands of an exercise session.
Each client has a different starting point with exercise. Due to past experiences, injuries, surgeries, and other factors, every individual may need customized warm up protocols to not only improve the training session but prevent future injury. This may include evaluating the muscular systems contractile capabilities via Muscle Activation Techniques or utilizing specific exercises. A proper warm up is a time to determine how an athlete or individual is feeling: to assess their preparedness. If an individual is not feeling 100%, due to poor sleep, stress, or inflammation, the routine may need to be adjusted so they still gain the benefits of training without the implications of stressing the body when not prepared.
A warm up also increases core temperature and coordination for the session. Improving core temperature will aid in muscle elasticity, preventing the potential for injury and improving muscle function. Additionally, for an athlete, if the scheduled routine is more dynamic and lateral in emphasis, a proper warm up will mimic similar dynamic movements scheduled for the training session but in a controlled fashion. This allows the individual to learn how to do dynamic or speed movements under control while at the same time teaching them how to fire specific muscles. A proper warm up is not only about getting muscles warm but includes education and assessment. Doing this type of warm up on a continual basis is another way to micro progress individuals and athletes for long term success and injury prevention.
The Gut- a critical player in health, brain function, well-being and performance.
“All disease begins in the gut” – Hippocrates
Currently, 4 out of 5 Americans take antibiotics every year, many of whom are not aware of the short and long-term deleterious effects antibiotics can have on their health. In fact, 30% of all antibiotic prescriptions are unnecessary and 50% may be prescribed inappropriately. What makes these statistics so profound?
The gut microbiota is a dynamic population of microorganisms that are essential to optimal health. These microbes are responsible for an array of physiological activities effecting nutritional status, metabolism, immune regulation, mood, blood sugar, vitamin synthesis as well as digestion. In normal situations and healthy individuals, the gut microbial interactions maintain a state of equilibrium in the intestinal tract, however, the microbial interactions can become disrupted or unbalanced due to antibiotic use, toxic chemicals, infections and dietary changes leading to gut dysbiosis.
As a diverse and stable population of microorganisms, when there is a disruption in microbial composition a multitude of issues can occur. For instance, gut dysbiosis has been found to be associated with diseases like Type 2 Diabetes, mellites, cardiovascular, and inflammatory bowel disease as well as brain pathologies like autism, Alzheimer’s, Parkinson’s, and amyotrophic lateral sclerosis (ALS). This state of dysbiosis can cause irreversible changes in the intestinal microbiota with variations and damage to genes or protein which can lead to intestinal epithelial cell harm. Epithelial cell health is important because they help absorb substances and provide a barrier against harmful elements (clearly not something you should damage).
Antibiotic use is commonly prescribed to kill specific microorganisms. However, antibiotics do not discriminate between good and bad gut bacteria and can cause imbalanced gut microbiota that can last months or years after treatment ceases. Antibiotic dosages can decrease the naturally occurring intestinal microbiota and increases the number of yeasts like candida albicans. Research has shown that antibiotic treatment can induce gut dysbiosis via decreasing the diversity of the microbiota in the gut. As mentioned entering a state of gut dysbiosis is something to be avoided.
Lastly, given the shocking statistics on antibiotic usage in the U.S it is important to educate yourself on proper gut health protocols and think critically whether you need to take antibiotics. If antibiotic usage is a must, take necessary action to mitigate the negative health effects that can accompany treatments!