To Stretch or Not to Stretch: Part II

About a year and a half ago, I did a blog post on whether or not you should stretch before or after exercise. Yesterday, an article came out in the New York Times summarizing recent research on the role of stretching in preventing injury, muscle soreness, etc. Basically what the authors summarized was that stretching does not reduce the number of injuries or muscle soreness. On the other hand, stretching does not increase the number of injuries or muscle soreness. This does not mean, however, that stretching is bad and that you should not do it. If you like to stretch before or after a workout, and it makes you feel better, then you should continue to stretch. If you do not stretch or do not want to stretch, then at this point, there is no scientific evidence available that states you are at greater risk for an injury or muscle soreness.

Dislocated Elbow

The elbow, being a true hinge joint, is one of the most stable joints in the body. It is formed by the articulation of the humerus, radius, and ulna. Dislocations of the elbow are rare, however, there seems to have been a few more elbow dislocations lately. It takes a very large force to dislocate the elbow, and most dislocations occur in the posterior (backwards) direction. If you do not like to look at pictures of injuries, I would advise you not to scroll down any further. But, if you do and would like to learn, take a look at the pictures and video.

This injury occurred this summer during the NBA playoffs. Rando, the injured player, got tangled up with Wade. As he landed, he put his arm out to brace his fall, and the force from the ground caused the resulting elbow dislocation.
This injury occurred during the 2008 Bejing Olympics. The weightlifter was attempting to lift a very large amount of weight, and the force from the barbell caused the forearm to be forced posteriorly (backwards) in relation to the upper arm.

This injury occurred last week during the Oregon-California game, and was very similar to the basketball injury. The running back was being tackled and when he attempted to brace his fall, he dislocated his elbow. Once a physician reduces the dislocation, it is possible to make a fairly quick return to play (except for the weight lifter) while wearing an elbow brace to stabilize the joint. This must be treated as a serious injury, because there are many nerves and blood vessels that run behind the elbow that could be damaged by the dislocation.

Motor Milestones

We have been discussing infant reflexes, spontaneous movements, and motor milestones in motor development the past few classes. Since Cameron is now 6 months, I thought I would post pictures of him achieving these milestones. I will do another post once he turns 12 months in order to show the next stage of milestones he will progress through.

Spontaneous arm and leg movements

Lifting head

Smiling

Lifting head and shoulders, rolling over

Reaching and grabbing feet

Smiling some more

Sitting with support
Reaching and grasping

Sitting with slight support

Dangerous situation

If you keep up with the NFL, then you know that Peyton Manning just had his third neck surgery in the past two years. This one was more serious than the first, and involved removing the disc between two of his cervical (neck) vertebrae, which will allow the two bones to fuse together. If you look at the picture above, you can see the nerve roots coming out of the side of the spinal cord, and the herniated disc is pressing, or impinging on the nerve root. These nerve roots carry motor signals from the brain down to the muscles, telling them when to contract and relax, and they also carry sensory information, such as touch, temperature, and pain, up to the brain. When the disc impinges on the nerve root, it disrupts these signals, causing muscle weakness (because the signal has trouble getting to the muscle), pain, discomfort, etc. Peyton's first two surgeries were less invasive and attempted to increase the space for the nerve root to pass through. The first surgery allowed him to play last year, but he began having many of the above symptoms after the season concluded so he had a second surgery in May. As Peyton prepared for this season, he was still having some of these symptoms, including weakness in his triceps muscle. This muscle extends the elbow and is crucial for a quarterback attempting 40 to 50 passes a game. Cervical nerve root seven innervates the triceps, so this leads me to believe his problem was the disc between the sixth and seventh cervical vertebrae. The doctors say Peyton should regain full function and be able to play football again. However, the risk of future injury is greater, and when you are dealing with the neck, it is an especially delicate situation. Peyton is only 35 years old, and hopefully has a long life ahead of him. I am not sure it is worth the risk to continue to play football if it could jeopardize his quality of life. But, that is his decision.

Motor Development

One of the classes I am teaching this semester is Motor Development, and I have such an invaluable resource to use this semester. That would be Cameron, my almost five month old son. I was working on some future lectures and came across his two month ultrasound picture from a year ago (above). I've also attached a recent picture of him (below) to show just how much he has grown and developed in a year. It will be fun and interesting to watch and track his growth and development as I teach about it this semester.

Difference in Response Latency of the Peroneus Longus

This month, I (along with my co-author Dr. Weimar) had an article published in the Journal of Sport Rehabilitation. The study examined the peroneus longus muscle, which is found on the outside of the lower leg and is the main muscle that can help prevent an ankle sprain when a person rolls his or her ankle. We reported that when you invert (roll) your ankle, it takes the muscle of the dominant leg longer to respond than the muscle of the nondominant leg. This increase in response time for the dominant leg could potentially lead to a greater number of ankle sprains of the dominant ankle versus the nondominant ankle. I am currently conducting a research study to investigate this further. The primary goal of my research is to understand the factors leading to ankle sprains and eventually develop protocols to help reduce the number of ankle sprains. If you want to read the whole article, you can check it out at this link. I also had to attach a four month picture of Cameron. He is continuing to grow at a rapid rate and is doing well. And yes, he is wearing an Auburn outfit because I do have two degrees from Auburn.

NATA 2011

This Wednesday, I went down to New Orleans for the 2011 National Athletic Trainers Association Annual Meeting and Symposium. I presented some research on ankle sprains and was able to attend a few other sessions. Overall it was a good experience. I received some positive feedback on my research, was able to catch up with some old friends, and see what other types of research related to athletic training is being conducted. It was, however, the first night I had spent away from Cameron since he was born, and that was tough. I was sure glad to get back to Hattiesburg on Wednesday and see him!!

Mechanical Analysis of Human Movement

This summer, I am teaching a new course called "Mechanical Analysis of Human Movement." It is basically a Clinical Biomechanics course designed for our students that plan on pursing a career in a health related profession or a graduate degree in exercise science. The students will learn how to apply biomechanics to evaluate movement, injury, disorders, etc. The class is taught over a three week period, and we just completed our first week. The students are doing very well and I am confident that they will be able to learn about Inverse Dynamics, which is a graduate level skill, by the end of the semester. I will provide an update on the class as well as inverse dynamics at the end of the semester. Also, I would be remiss if I didn't post an updated picture of Cameron. He is seven and a half weeks old and growing fast!! We just wish that he would sleep a little more.

Cameron Charles Knight

I apologize for the lengthy delay between blog posts, but our lives have changed a lot in the past two weeks. During the early hours of March 22, Amy and I welcomed Cameron Charles Knight into the world!! He weighted 4 lbs, 15 oz. and measured at 18.25 inches. Other than being a little small, he was a perfectly healthy baby. He has been eating like a champ and we have no doubt that our little guy will soon be much bigger. Despite the lack of sleep, we have had so much fun with him these past two weeks. The picture on the bottom is from the day he was born, and the one top is from yesterday. He is already starting to change before our eyes. I am sure I will have many more posts in the future relating to Cameron and his growth and development.

Dangerous Game

Baseball is a game that is played and enjoyed by many people. Unfortunately, it can also be a very dangerous game. Yesterday during a spring training game between the Braves and Cardinals, Brian McCann lined a foul ball into the Braves dugout, and it struck one of the Braves coaches, Luis Salazar, near the left eye. After he has hit in the face by the ball, Salazar fell and hit his head on the ground. Salazar was unresponsive and unconscious for several minutes, and was airlifted to a local hospital. The good news is he is alive. The bad news is he suffered several facial fractures that required multiple surgeries today, more surgery in the future, and it is still unknown if he will regain vision in his left eye. This was an unfortunate accident that likely could not have been prevented. However, most college, minor, and major league dugouts do not have netting/fencing to protect the players and coaches in the dugout. If a ball is lined into the dugout, the people in the dugout literally have a few milliseconds to react. Fortunately, this type of situation does not happen often in baseball, but when it does, the results are scary. In 2007, Juan Encarnacion was struck by a foul ball in his face while in the on deck circle, lost vision in one eye, and never played another baseball game. Hopefully Salazar will make a full recovery, and baseball will take steps to increase the safety of players, coaches, and fans.

Albert Pujols: Is He Worth It?

Some of you may or may not know this, but I am a huge St. Louis Cardinals fan, and have enjoyed watching Albert Pujols play for the Cardinals over the course of the past 10 seasons. How much do I like the Cardinals and Pujols? When my wife and I adopted our dog a little over two years ago, we decided to name him Albert (we call him Albe for short). From a kinesiological and mechanical perspective, Pujols has one of the most efficient and consistent swings in baseball. From a fan's perspective, he has helped the Cardinals win a lot of baseball games over the past 10 seasons. However, his contract expires at the end of this season, and the Cardinals and Pujols failed to reach an agreement on an extension before his self-imposed deadline at the start of spring training. That means he will likely become a free agent after the 2011 season and every team can bid on him. Rumors have surfaced that Pujols is seeking a 10 year contract worth 300 million dollars, which would make him the highest paid player in baseball history. I don't know if he really asked for this type of contract, but there is no doubt it is going to take a lot of money over many years to sign Pujols. The real question that has to be answered is he worth that much money and that many years. On the surface, the answer to the question appears to be yes. When you look at the first 10 years of Pujols's career in terms of most major offensive categories (batting average, home runs, runs batted in, runs scored, etc.), he ranks in the top 3 all time. There is no doubt that he makes the Cardinals a better team and generates millions of dollars in revenue through ticket sales and merchandise sales for the Cardinals. But if you dig a little deeper, you will see that his numbers have declined slightly over the past few seasons. Also, Pujols is currently 31 years old, and most baseball players show a sharp decline in their statistics around 35-36. So, while Pujols may currently be worth $30 million a year, will he still be worth that the last 5 years of his contract? The other factor that has to be considered is his elbow. Pujols has a partially torn ulnar collateral ligament in his right elbow, that could possibly rupture at any time, which would require Tommy John Surgery to repair and cause him to miss anywhere from 7-12 months of action. The bottom line is this: Albert Pujols is the best player in baseball, and has been for the past several years. He deserves to make a lot of money. Is he worth $300 million for 10 years? I'm not so sure about that, and I'm glad I don't have to make that decision. While I do feel the Cardinals could increase their payroll over $100 million, they are not the Yankees or Red Sox with unlimited financial flexibility. While I am a big Pujols fan, I am an even bigger Cardinals fan. I would love to see Albert finish his career in a Cardinals uniform, but not at the expense of sacrificing the Cardinals competitive chances with an extremely large contract. Hopefully both sides will be able to reach a compromise and he doesn't end up playing for the Cubs next year.

American College of Sports Medicine Southeast Chapter Regional Meeting

Last week, myself and two other faculty members (Drs. Hale and Kavasis) traveled with a group of seven students to the American College of Sports Medicine Southeast Chapter Regional Meeting in Greenville, SC. The students included Nigel Collins, Katelyn Graben (graduate student), Kelly Harkins, Jenny Morton, Eddie Neal, Laura Beth Roby, and Lindsey Triplett. The students each presented research in poster format that they have worked on with us over the course of the past year. They were also able to attend other presentations based on the latest research in kinesiology and sports medicine. The students did a wonderful job with their presentations and representing Mississippi State University. The picture above is of Eddie, Lindsey, and Kelly, who represented us and performed very well at the student quiz bowl. The experience was very positive for both the students and faculty and we hope to take even more students to the conference next year.

Will Maurkice Pouncey Play?

I'm sure that everyone is aware that the Super Bowl is this Sunday. One of the biggest questions entering the game is whether or not Steelers center Maurkice Pouncey will be able to play in the game. Pouncey suffered a high ankle sprain during the AFC Championship game 9 days ago against the Jets. I have previously blogged about high ankle sprains, so I won't go into a very detailed description of the injury. In Pouncey's case, he was blocking down field when a defender landed on the posterior (back) side of his lower leg, forcing it forward. This mechanism forces the ankle into hyper-dorsiflexion (imagine planting your foot on the ground, and then moving your lower leg towards the top of your foot past comfortable limits). When this occurs, the talus, which is the bone between the tibia (on the medial, or inside of the lower leg) and fibula (on the lateral, or outside of the lower leg) is pushed up between the tibia and fibula, and this causes tearing of the ligaments that hold these two bones together. Rehabilitation for a high ankle sprain typically takes 4-6 weeks, although this will vary based on the severity of the injury. I've been involved in cases in which the player was able to play a week later, and others in which it took 6-8 weeks for the athlete to return. The best treatment of a high ankle sprain is rest, but for football players during a season, this is not likely an option. I imagine Pouncey has not put any weight on his ankle since the injury occurred, and has been receiving almost around the clock treatment to help control the swelling and pain and regain range of motion. As it gets closer to game day, he will probably attempt some football type drills to see if he can tolerate the injury. In my opinion, it will be very difficult, but not impossible, for him to play Sunday. If he does play, he will be in a lot of pain and will have limited mobility. But since it is the Super Bowl, I would not rule it out.

The Jay Cutler Debate

If you pay any attention to sports and the NFL, the big debate right now if over Jay Cutler and if he could have returned to play against the Packers on Sunday in the NFC Championship game after injuring his knee. During the game, very little information was given out about the severity of the injury, causing many current NFL players and those in the media to question Cutler's toughness and desire. Yesterday, a MRI revealed that Cutler had a Grade II sprain of the medial collateral ligament (MCL) of his left knee. A while back, I blogged about MCL injuries and more specifically, Troy Polamalu's MCL sprain. With a grade II MCL sprain, there is some tearing of the fibers of the ligament, which would result in a great deal of pain and loss of stability to the medial side of the knee. Since it was Cutler's left knee, and he is right handed, it would be exposed when he is throwing the ball and susceptible to further injury. The knee was also examined by the team's athletic trainers and doctors, and they determined he did not need to play. In my professional opinion, it would be very difficult for a quarterback to play after immediately sustaining a grade II MCL sprain. Some stories have come out that Drew Brees played this season with an injured MCL. One, we do not know the severity of the injury, and two, I am sure Brees received extensive treatment during the week before Sunday and was properly taped and braced for the games. I think many people do not like Jay Cutler, and they just wanted to pile on him. I have no personal like or dislike towards Cutler, but it would be difficult for any player, especially a quarterback, to play immediately after suffering a grade II MCL sprain.

Happy New Year

I hope that everyone had a great holiday season and a happy new year. Classes started back today at Mississippi State so it is time to get back into the swing of things. I'm teaching three courses this semester, one of which is a new course for me and the department. Sport Biomechanics should be a really fun and exciting class for the students to learn how to apply mechanical principles to sport performance in order to evaluate skills, improve technique, and prevent injury. I'm also teaching Anatomical Kinesiology and Motor Learning, and team teaching a research readings class with two other faculty members. It should be a busy semester but very exciting. The picture on the left is from a 4D ultrasound taken last week. My wife Amy and I are very excited for the arrival of Cameron Charles Knight (Cameron and Charles are both family names) this March. I might even be able to use him in my Motor Development class in the Fall!!