The Deep Line as Patrick states, consists of the following:

Posterior tibialis > interosseuos membrane > Knee capsule > adductor hiatus > intermuscular septum > femoral triangle > psoas > anterior longitudinal ligament > diaphragm > pericardium > mediastinum > parietal pleura > fascia prevertebralis > scalenes

Patrick goes on to explain how breathing plays a very important role in the function of this line and provides some excellent strategies for correction and progression.

This got me thinking…

Often times I will use the Bunkie Testing method to assess the various lines throughout the body. I wrote a piece about the Bunkie Test late last year and it can be viewed here. Kevin Neeled also wrote a piece and shot some video on how and why this testing method may play an important role in kinetic linking for hockey players. You can read that here.

As mentioned last fall, the Bunkie Test consists of tests for the following

• Anterior power line
• Medial stabilizing line
• Lateral stabilizing line
• Posterior stabilizing line
• Posterior power line

Do we truly know that we’re testing each of the above? Who knows, but based on Patrick’s article, I think we need to revisit the test and see how we can start testing the DEEP FRONT LINE. That is, the Deep Stabilizing Line. Maybe we can’t. But perhaps we can. I am not trying to reinvent the testing method here. I am simply seeing a flaw in the testing procedure and am now looking for a way to improve it. Joe Heiler of Sports Rehab Expert recently invited me to do an interview and discuss the Bunkie Method of Testing. I hope to do this interview in July so maybe I’ll have some answers by then.

Perhaps there are other ways to test this. I can’t remember off the top of my head right now so if you can think of one, make sure you let me know.

When a patient does present with “dysfunction” of this Deep Front Line, aside from attacking their breathing patterns, I progress to improving their rolling patterns as well. Generally, I will work the supine to prone rolling pattern to improve this line and specifically target the right arm / left leg or left arm / right leg combinations as needed. Carson Boddicker has written several pieces on these topics, one of which is a must read.  For an introduction, make sure you read Core Competencies. Mark Young makes a good argument about testing the roll, but personally, I think quality is more important than quantity in this case…but that’s just my opinion!

Progression from here would be to the Dead Bug tract (not dissimilar to Patrick’s videos) and onward to chops and lifts (thanks Mike) and beyond to really attack their stabilizing function. Check out Nick Tumminello’s video of the Vertical Pallof Press for anterior stabilization (to combat lumbar extension).

Lots of info to digest here and certainly plenty of hot links to click on. So thanks to Patrick, Mike, Kevin, Mark, Carson, Nick, and Perry for unknowingly being participants in this post!

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DO YOU SWIM?

If you answered “yes” to the above, please proceed to the next question. If not, thanks for visiting!

Question # 2:

DO YOU PREPARE YOURSELF TO SWIM?

If you answered “no” to the above, please view the following videos to help you prepare for your next run using the GRID by Trigger Point Performance Therapy.

Quadriceps – 60 seconds each leg (Total = 2 min)

Tensor Fascia Lata – 30 seconds each hip (Total = 1 min)

Mid – Latissimus Dorsi – 30 seconds each side (Total = 1 min)

Thoracic Spine Rotation – 30 seconds each side (Total = 1 min)

Quadruped Reach & Roll – 60 seconds

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This review integrated the results of two studies that investigated the effect of pain, tear size, location and humeral head migration on the clinical outcomes and risk of progression in patients with rotator cuff tears.

As always, for a complete understanding of the study, please read the articles below. To access my review, please visit Research Review Service

The two studies reviewed:

1. Proximal Humeral Migration in Shoulders with Symptomatic and Asymptomatic Rotator Cuff Tears
2. Outcome of Nonoperative Treatment of Symptomatic Rotator Cuff Tears Monitored by Magnetic Resonance Imaging

Main findings:

• Proximal humeral migration was significantly related to rotator cuff tear size and the involvement of the infraspinatus tendon.
• Progression of rotator cuff tears was more likely to occur in patients older than 60 years, those involving a full-thickness tear, and in shoulders demonstrating fatty infiltration upon magnetic resonance imaging.

Clinical application:

Conservative management alone may not be sufficient in those individuals presenting with the specific characteristics described above. Therefore, simultaneous referral for orthopaedic consultation would be warranted in prudent case management.

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In sports, distal biceps tendon ruptures (DBTR) have been reported in to occur waterpolo, weightlifting, football and gymnastics, and professional hockey player. The management of acute, complete distal biceps tendon ruptures is a surgical emergency, with improved prognosis and decreased risk of complications when surgery occurs within ten days of injury.  Primary health care providers are often the first professionals to assess the acutely injured individuals and therefore, confidence in making a definitive clinical diagnosis of complete DBTR may prevent the inherent cost and time delay in obtaining “confirmatory” imaging.

Clinical presentation and patient history are important factors in diagnosing complete DBTR. Rupture of the distal biceps tendon predominantly affects males within the 40 to 60-age range and typically occurs as a result of an eccentric contraction at the dominant elbow.  Therefore, these injuries may occur in sports with a large extension force applied to the elbow from a concentrically flexed and supinated position (another reason why you shouldn’t do barbell curls), generally resulting in injury at the tendinous insertion to the radial tuberosity. Sometimes chronic in nature, injured patients often describe an acute traumatic event with hearing a “pop” or feeling sharp pain. Typically they are aware of the nature of their injury.  Pain is often sharp and well localized, although dull and achy sensations have also been reported. Ecchymosis, swelling, and proximal retraction of the muscle belly are common signs in acute tendon ruptures though not always present.

Orthopaedic tests for this DBTR have recently been described and individually have been accurate in detecting complete tendon ruptures. Elmaraghy et al described the Biceps Crease Interval and reported a sensitivity of 96% and diagnostic accuracy of 93% in 29 patients with a diagnostic threshold of an interval greater than 6.0cm or crease ratio greater than 1.2.  A high interrater reliability of measuring the BCI was also reported (0.79). The Hook Test by O’Driscoll et al was reported to have 100% sensitivity and specificity (33 of 33 patients with complete DBTR) although interrater reliability data for this technique was not included. A positive Flexion Initiation Test has also been described in the literature although its requirement of attempting to flex a 10-pound weight in an acute symptomatic individual seems impractical and may not be clinically useful

Diagnostic imaging for distal biceps tendon ruptures are still commonly performed though may not entirely be necessary. With respect to diagnostic ultrasound, its utility seems questionable as diagnosis can be difficult in partial tears or complete ruptures without tendon retraction. In addition, sonography has been equivocal in cases of long-standing injuries with a delayed diagnosis. It may seem to play a role, however, in rare, atypical presentations; rupture without traumatic mechanism, clinically suspected partial tears, clinically suspected complete, non-retracted tears, and incomplete clinical pictures. Lastly, although relatively quick to obtain and of minimal cost, its accuracy is generally highly operator dependent.  The detrimental risk of the time delay associated with obtaining an U/S may outweigh any potential benefit in addition to as appropriately applied clinical assessment protocol in most cases.

Magnetic resonance imaging is considered the gold standard imaging procedure in the detection of distal biceps tendon ruptures. It can also be useful in rare, atypical presentations such as clinically confusing cases where the biceps tendon can still be palpated in the antecubital fossa, as well as in complete non-retracted tears. In fact, the use of MRI in clinically confusing cases MAY lead to a change in the treatment protocol. Unfortunately however, MRI comes at an increased cost, decreased accessibility and lengthy wait times and this may negatively affect the prognosis of acute distal biceps tendon ruptures.

Surgical delays greater than 10 days post injury increase the risk of complications and the extent of anterior dissection required. Therefore, in light of the questionability of ultrasound, and the expense and wait time of MRI, I have developed a rapid and thorough clinical assessment protocol, and have included it below. This protocol MAY circumvent the need for diagnostic imaging, however, it must be noted that if either of sonography and MRI have the potential to change the treatment protocol as described in Magee above, then its use may be warranted.

Photo source

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Let me tell you why:

• POSTURE: In order to jump rope efficiently and for long periods of time, it is important that one maintain an ideal posture throughout the exercise. As such, improving ones posture will effectively facilitate a neutral spine position in each of the Cervical (neck), Thoracic (mid/upper back), and Lumbar (low back) regions, thereby promoting proper function of each of the active, passive, and neural components of spinal stability. Perfect posture promotes movement efficiency (see MovementU) and therefore, training to maintain ones posture may translate into increased efficiency during running.

• BILATERAL SHOULDER EXTERNAL ROTATION: In general, the glenohumeral joint is isometrically held in a bilateral external rotation position throughout the jump rope exercise. Reinold et al. recently demonstrated that the concentric bilateral external rotation exercise facilitated scapular control without the need for arm elevation, while simultaneously utilizing a good lower trapezius to upper trapezius activation ratio. While isometric contractions certainly differ from concentric contractions, one may hypothesize that isometrically maintaining the shoulder girdle complex in this position may facilitate optimal patterning of the thoraco-scapulo-humeral joints…especially  since isometric contraction of the glenohumeral external rotators play an important role in force coupling with the powerful pectoralis major during the early pull phase of swimming (this force coupling helps keep the head of the humerus centered within the glenoid fossa: aka dynamic stability). Similarly, bilateral external rotation may  also play a rehabilitative role in those athletes presenting with signs of Type 1 “SICK” scapulae (inferior prominence of the medial border) for the same reasons noted above.

• ECCENTRIC HIP ABDUCTION: During the stance phase of running, the hip plays a contributing role in absorbing ground reaction forces sustained by the body upon impact. This is so via eccentric contraction and control of the abductors of the hip (i.e. Gluteus Medius). Each “foot contact” of single and alternating leg rope jumping is not dissimilar to the stance phase of running as the hip abductors are called into action with every repetition. As such, incorporating rope jumping in the off season may result in preventing dynamic valgus (aka “buckling in”) of the knee, thereby minimizing energy leakage while running. The end result: A more efficient, powerful running gait.

• Low Intensity Stretch Shortening: Plyometric exercise has been scientifically demonstrated to be effective in improving performance and economy in certain distance runners. Since, jumping rope can be viewed as a lower intensity form of plyometric exercise, improving the stretch shortening capabilities of the deep flexors of the foot and ankle may translate into similar effects. At the very least, since mid- and forefoot runners tend to have a single and greater peak force upon impact (as opposed to the double peak seen in rearfoot strikers), performing low intensity stretch shortening exercise may strengthen the ability of the lower leg musculature to act as shock absorbers, subsequently minimizing chances of dynamic instability (i.e. overpronation) and/or tendinopathy (i.e. of the achilles).

Unless I am mistaken, the efficacy of jumping rope for triathlon performance has yet to undergo scientific investigation. Therefore, definitive conclusions from the above statements must certainly not be made. However, as with many currently performed exercises, the theoretical rationale for rope jumping as an off season exercise in triathletes may seem plausible and thus, may enable this exercise to be performed without much scrutiny.

So…JUMP AWAY!

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• An avulsion fracture of the olecranon process occurring as the olecranon impacts in the fossa when a forceful jab misses the target.

Boxer’s Elbow (as defined by Cubos, J: www.jeffcubos.com)

• One of a multitude of injuries likely to be sustained by Miguel Cotto on November 14, 2009 in his fight with Manny Pacquiao.

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