Bindings, Landings, and Crashes: What to do about your ankle pain?

At some point or another, while wakeboarding, you may have experienced some ankle pain. It may have been while riding, after a landing, or something you have noticed later after you took your set.  You may have noticed swelling, tenderness, or an inability to bear weight on your foot. While riding, the ankle undergoes multiple forces that shear the bones and lead to inflammation. Bindings that don’t fit correctly, hard landings, or major crashes can cause the ankle to become injured.

Because the ankle attaches the lower leg to the foot, there is a complex network of muscles, tendons, ligaments, and bones involved.

    

image: medical-dictionary.thefreedictionary.com, http://home.comcast.net/~wnor/lljoints.htm

Bindings 

Typically, if your bindings don’t fit correctly, a pinching sensation will be felt in the front of the ankle. Because the binding is too tight around the metatarsals and forefoot, all the motion from leaning to stay on edge or landing must come from the joint between the talus and the tibia, instead of being able to translate through the foot . This “pinching” sensation is the bones putting pressure on the tendons and ligaments that cross the joint. Repetitive pinching can lead to inflammation and longer-lasting pain. Also, the lack of motion translated through the foot leads to a heavier heel stike on landings, cause heel pain after multiple tricks.

Landings

Landing hard, like into the flats or casing the wake, can lead to ankle injury. The force from the board hitting the water is dispersed through the joint , leading to pain that can manifest in a variety of areas. The pain will most likely be felt in the weakest part of the ankle,  which for most is the lateral, or outside, part. Because the ligaments in this area are the smallest, it is the most frequently sprained area of the foot. Making sure landings are absorbed with the knees, or are positioned correctly over the second wake will help prevent these injuries. If the injury has already occurred, proper treatment to resolve the injury is important so the ankle joint remains strong and doesn’t develop stress patterns and ongoing pain.

Crashes

The ankle is affected during many of the infamous wakeboard crashes. The worst seems to be the “foot came halfway out of the binding” crash. During this maneuver, the front of the ankle becomes stretched and the backside compresses. This overstretches the ligaments and muscles of the anterior ankle and pinches the calcaneous, of heel bone, into the talus and achilles tendon. This stretch and compression can lead to inflammation, swelling, and pain. Other crashes can cause the ankle to bend laterally depending on how you fall. This can lead to the more normal presentation of ankle sprain. Sometimes, however, the pain from crashes can be felt up the shin due to the design of bindings. It is important to treat the entire lower leg, below the knee, when the ankle is involved to ensure no causative factors are missed.

So what to do?

1. Make sure your bindings fit properly. Get advice from a representative or an employee of a local boardshop to make sure your bindings are the correct size and shape for your foot and your riding style.

2. Strengthen the ankles. Simple calf raises, toe and heel walks, and ankle ABC’s can do wonders to strengthen and prevent injury.

3. Treat injuries as soon as they happen. Remember RICE. Rest comes first. Don’t ride on a hurt ankle if you don’t have to. You will lead to further damage and possible stress fractures. Ice should be your best friend. 10-15 minutes 2 times per day will help calm inflammation and swelling, as well as numb your pain. Compression and Elevation will also help to reduce swelling.

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Supplementation for Athletes

Everyone knows the easiest way to get essential nutrients into our bodies is from what we eat and drink. So what if what’s in our diet just isn’t enough? Gaps in the diet happen. Travel, stress, and excessive exercise all can deplete our bodies and if they aren’t properly refueled can lead to slower recovery time, decreased resistance to sickness, fatigue, and overall decline in general health. Supplementation can bridge those gaps.

As athletes, our bodies take a beating from the constant rebuilding of our muscles. To properly rebuild that muscle, however, you must have the essential building blocks or nutrients to make healthy tissue. Making sure we have all those building blocks available is what leads to faster recovery time, vivacity, and strong , healthy tissues.

Supplements come in a variety of shapes and forms. It is essential to purchase your supplements from a trusted source to ensure you are really getting whats in the bottle. Whole food supplements are typically the best choice, making the nutrient the most bio-available and ready to utilize in the body. The common misconception, however, is the lack of “nutrition facts” on the side of whole food supplements. Instead of saing 100%  DV of Vitamin C, it will read buckwheat, beet juice and carrot root. Move your view from reading percentages and think about eating real food. When you eat an orange, you know there is vitamin C inside, but there is no label telling you so. In this post, I will try and guide you in the right direction for choosing the right supplements and ingredients for your needs.

Multivitamin: Multivitamins are important to enhance the diet and ensure nutrients are ready and available to be utilized in the body. The multivitamin doesn’t need to contain 100% of all the daily values, but aim for one that contains both vitamins and minerals. Again, whole food supplements are the best and may need to be taken a few times per day to be absorbed at the best potential. Look for ingredients like beet root, beet juice, buckwheat, carrot root, calcium lactate, magnesium citrate, oat flour, and alfalfa. These ingredients yield a high value of usable vitamins and minerals.

Whey Protein:  Proteins are the building blocks of our DNA, cells, and tissues. Proteins are also essential to the way these cells and tissues function. Adding whey protein into the diet, whether as a recovery drink, meal, or just daily nutrition, is an easy way to support the body as well as satisfy hunger. Protein will sustain hunger longer which can contribute to weight control.

Joint Support:  Glucosamine, chondroitin, MSM are the big three that come in joint support formulas. They have been shown to reduce the progression of osteoarthritis and help control symptoms.  Also look for supplements containing Boswellia, Tumeric, Ginger and Bromelain. These last four ingredients contribute an anti-inflammatory effect as well as an analgesic effect, helping to reduce joint pain.

Omega-3s/EPA/DHA:  Omega-3s are important to help maintain cardiovascular health. Omega-3s reduce inflammation, reduce rates of heart disease, and increase blood flow. These can be found in supplements like fish oil, crill oil, and flax seed oil.

Water: No, water isn’t exactly a supplement. But, it should be consumed everyday in large quantities. Water makes up 70% of the body so there needs to be plenty of it available to replenish the tissues. Muscles, tendons, ligaments, and discs all can become dehydrated, lose elasticity, and become more prone to injury. Its easy, and its free!

Like what was said earlier, the best way to get the proper nutrients is through eating whole foods, but if your diet isn’t enough, these go-to supplements are the way to go to make sure you’re getting what you need as an athlete!

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Shoulder Pain Part 2: How can you prevent it?

Preventing shoulder injury  is all about balance.  The balance comes between proper muscle strength and flexibility. It is important to be strong,mobile, and be able to accommodate to any condition or situation. Wakeboarding is a one-sided sport with dominance in both hand and foot. Balancing is the key to make sure you are riding long through this upcoming season and many more to come injury free!

Where to start: A training program designed to increase muscle strength while not sacrificing range of motion and flexibility.

What will help: Neuromuscular reeducation. Training your muscles to fire when needed, in proper sequence, to ensure each muscle works to its highest potential. This will include sport-specific exercises to engage and retrain the musculature.

Shoulder Strength Exercises:

1. Kettle Bell Swings- With a kettle bell or weight in hand, squat with kettlebell between legs. Swing the weight up as you stand and continue swinging until arms are overhead. Lower back down into a squat. Repeat. Make sure to maintain a tight core to protect the lower back.

Image: dk-workoutlog.blogspot.com

2. Wall Angels- Begin this exercises with your feet, buttocks, lowback, and neck/head all against the wall. Bring arms up overhead, while maintaining contact with the wall. Act as though you are doing a snow angel against the wall. The purpose of this exercises is to train the upper back and shoulders, while maintaining a neutral spine. For a demonstration, watch this video by Men’s Fitness UK.

Wall Angel Demo

3. Triplane Flying Pushups- Attach a full circle resistance band, like the Superflex band around a chin up bar or something of equal height. Attain a push up position with the band around your waist. Move from central, left, and right completing a full push up and exploding to the next position.  For added difficulty, add an incline or Bosu ball to the sides to vary the push up surface.

Thanks to Ned for introducing me to this exercise!

Neuromuscular Retraining

1. Handle Pass on Indo Board: Attach a handle to small weight. While maintaining balance on the Indo Board with knees slightly bent, begin to pass the handle. Continue around 15 times and then switch directions and repeat.

2. Resistance Band Handle Movements- This exercise will be varied depending on what tricks you are working on/towards. You can do these on solid ground or on an Indo Board. The purpose is to do handle movements against resistance which is anchored to mimic a line and handle. Doing repetitive motions mimicking tricks will help to build, not only shoulder strength, but muscle memory. For example, moving your arm in a crosswise fashion across your face and body to mimic a whirlybird, or pulling the resistance band to the middle of your back for landing blind. This will help to coordinate muscle movement while building strength.

Again, preventing shoulder injury is a fine balance between strength and flexibility. Train properly and you should remain injury free!

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No Gym Required: The 10 Best Body Weight Exercises

Have trouble getting to the gym? Memberships and equipment too expensive? Not to worry. Some of the best and most efficient exercises to stay strong and lean can be done with just the use of your own body.  Body weight exercises can be just as efficient at burning fat and building muscles than their weighted or machine versions.  Below are 10 of my favorite for a full body workout!

Photo: trialx.com

1. Squats: Squats target the entire lower body. The quads, hamstrings, glutes,  calves, and peroneals are worked to stabilize and balance as the torso lowers.  Begin with toes pointed forward, shoulder width apart. Sit back, like you are sitting on a chair, with full body weight on the heels. Make sure your core is tight and there is a slight arch in the lower spine.  Don’t let your knees go forward past your ankles. Work up to 3 sets of 25.

2. Tuck Jump: Tuck jumps also target the lower body but give an extra kick to the abdominals and increase cardiovascular endurance. This exercise also trains the muscles for explosiveness, which is helpful when taking off at the wake.  To do this exercise, jump as high as you can and lift your knees to your chest. Work up to 3 sets of 15.

3. Side Lunge: Side lunges work the medial and lateral muscles of the leg, called the adductors and abductors. Begin standing with legs together. Take a giant step to the right, bending the right leg and keeping the left extended. Return to beginning position. Repeat on other side. Work up to 3 sets of 10 per side.

4. Single Leg Deadlift: The single leg deadlift targets mainly hamstrings, but is useful in balance in coordination. Begin with feet together standing. Step forward with right leg and bend forward at the waist with all the weight on the right leg and the left leg coming up behind you. Return to standing by squeezing the glutes and hamstrings. Repeat on opposite leg. Work up to 3 sets of 15 per side.

5. Burpee: The burpee is an all purpose fat burner and muscle toner. Begin standing. Plant hands on the ground, jump back into a pushup position, and jump feet back between hands. Jump up and return to standing. Repeat. Work up to 3 sets of 10. For added difficulty, add a pushup while in pushup position.

6. Tricep Dip: This exercise targets the triceps, but also works the muscles of the shoulder and forearm. Begin sitting on a sturdy chair. place hands on edge of seat, begin buttocks. Lift up on hands and drop buttocks down in front of chair. Push up and lower back down. Repeat for 3 sets of 15. For more of a challenge, straighten legs in front of you.

7. Pullup: The classic pullup is beneficial for entire upper body strengthening. Changing the grip can alter which muscles are targeted the most. Change between under grip for more bicep work, over grip for posterior shoulder muscles, wide grip for lats, and holding to a towel draped over the bar for an added grip challenge. Work up to 3 sets of 10.

8. Pushup: The pushup strengthens shoulders, chest, glutes, and core. Vary the hand position, much like the pullup, for variation in target muscle. Wide hand placement will target lats, narrow hand placement will target triceps. Elbows in and back will target the anterior deltoid and pec minor. 3 sets of 15.

9. Bicycle: The bicycle strengthens the abdominals circumferentially, meaning all around. Lie on your back supporting the head and neck with your hands. Crunch up and bring left knee to right elbow while the other leg is extended. Switch. Alternate sides and build up to 3 sets of 10 per side using good form.

10. Plank: The plank builds core stabilization as well as glute and shoulder strength using isometric contraction, meaning holding with no movement. Begin in a pushup position with elbows on the floor. Maintain tight glutes, abdominals, and keep body in a straight line. Hold for 30 seconds. Repeat for 3 sets.

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Shoulder Pain Part 1: Why do you have it?

Why do you have shoulder pain?

The shoulder girdle is simply a shallow ball-in-socket joint. Because of the lack of depth in the socket, a vast and complex array of muscles, tendons, and ligaments act to stabilize the joint, holding your arm to your body but giving a wide range of motion at the joint.   Nine muscles cross the shoulder joint, and 17 attach to the shoulder blade! Because of the joint’s complexity, the chance of getting shoulder pain at sometime in your life is, unfortunately, pretty high.

Picture: tennismd.com

So what happens? Firstly, we are all “handed” creatures. Because of our dominance to one side, in life and in sport, its easy to develop muscle asymmetry.  When a muscle is overdeveloped, it works harder than the other surrounding muscles and can get fatigued, leaving you prone to injury and pain. The surrounding muscles also compensate for weaker ones, causing pain patterns. Secondly, we are also creatures of habit. We often do things repetitively. Working on a computer all day, texting, driving, wakeboarding… When activities become repetitive, wear and tear can develop in the tissues of the joint causing an overuse injury. This leads to the inflammation causing tendonitis, bursitis, and microtearing of muscles and tendons. Thirdly, we are involved in a sport that involves falling. Sometimes very hard. Trauma finds the shoulder like wakeboarders find glassy water. Fast. The shoulder is supported by a lot of muscles, but is often most weak compared to the other joints in the body. Trauma can tear muscles, tendons, ligaments, and cause separation or dislocation of the joints.

Finding out why you have shoulder pain generally takes looking into what you have in your history.  Questions like: Did you have any trauma growing up? What sports were you involved in? What other body parts have you injured? and What does your daily routine involve? can help give clues as to why you are having shoulder pain. A thorough examination of the tissues of the shoulder, including orthopedic and neurological testing can also be done, as well as imaging, to give the full picture.

Stay tuned: Next up is how to avoid getting shoulder pain and what you can do to help it if you already have it!

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To travel pain free, free the iliopsoas!

It’s holiday season and that means it is time for traveling! Whether its home for Thanksgiving, a snowboard trip out west, or just down the road for a get-together, a holiday pain free is one worth celebrating!

Most people have encountered a bout of low back, hip, or leg pain after a long road trip or a plane ride.  When traveling, we may attribute it to our heavy board bag and luggage or those god-awful seats in the airplane. Ironically, the pain that is experienced in the lower back, hip, or leg may actually be coming from your front side.

A muscle called the iliopsoas connects the front side of the lumbar vertebra (the bones in the low back that make up your spine) to the femur (the thigh bone). The muscle acts to flex the abdomen down to the thigh or to lift the thigh to the abdomen. This muscle is also referred to as a hip flexor. Because of the attachment to the spine, if the muscle is overcontracted, shortened, or spasmed, pain can be felt in the low back, hip, or leg. If the iliopsoas is contracted for a prolonged period of time, it can cause the glutes to fire improperly, tilt the pelvis forward, and jam the facet joints in the spine.

Image: http://www.themeanings.com

To prevent the psoas from ruining your holiday, here are a few helpful tips:

1. Move around. -The most common tip to travelers is to move around as much as possible. If in a car, take frequent gas/bathroom breaks to allow you to get out of the car and move around. If in the plane, try and get up at least once during the ride. Moving around will not only stretch the iliopsoas, but increase blood flow to the lower body.

2. Stretch. -To stretch the iliopsoas, kneel on one knee with the other foot in front with knee bent. Contract glutes and gently push foward, stretching the back hip flexor. Keep back straight and hold for 10-30 seconds. Repeat on opposite side. Be sure not to push front knee over front foot and keep a 90 degree bend in the front knee. To add additional stretch, raise arm overhead and reach away from side of stretch.

Image: www. sportsinjuryclinic.net

3. Activate the glutes. See post “Glutes Are The New Core”

4. Release the iliopsoas. The easiest way to have the iliopsoas released is to have a therapist or healthcare professional do it for you. If this is not available, find a ball, slightly larger than a tennis ball. Lie face down onto the ball, supporting your body with your elbows and feet. The ball should be positioned a little to the side and below the belly button. Continuously breathe and push your body into the ball for 10-30 seconds, releasing the trigger points in the muscle. The iliopsoas trigger points are very painful, so be sure to support your body with your elbows and toes to vary the depth of the therapy.

To travel pain free, free the iliopsoas. Happy Holidays!

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Protecting the ACL: Knee Strengthening

Unfortunately, the most common injury among wakeboarders happens to be tearing or rupturing of the ACL. The ACL connects the front of the shin bone, or tibia, to the back of the thigh bone, or femur. This stabilizes the knee joint and prevents the knee from hyperextending. Tearing the ACL happens from deceleration, like landing a jump or a trick, or from a twisting or shifting movement with the leg attached and anchored to the wakeboard. Bindings make us particularly more vulnerable to stress and tearing of the ACL. The ACL is most weak when the feet are pointed outward, knees inward, and torso flexed forward.

How can you protect the ACL? Multiple factors are involved with stabilizing and conditioning the knee. Strengthening the surrounding musculature is most important to help decrease the stress to the ACL  involved with deceleration in the knee joint. This includes the quadriceps, hamstrings, hip abductors, hip external rotators, abdominals and obliques. The muscles assist in stabilizing the knee and prevent hyperextension. Below are a few exercises to add to your normal routine to make sure you protect your knees!

1. Body Weight Squats: Begin with knees and ankles separated, shoulder width apart, standing straight up. Hands can be on the waist or out in front for balance. Bend at the hip and knee, pushing buttocks backward like sitting in a chair. Make sure your knees don’t push forward of ankles. Return to stand. Repeat 25 times.

2. Heel Pulls: Lying on the floor, place one heel on top of a small plate weight (begin with 10 lbs). Stabilizing with your hands against the floor near your hips, pull heel with weight towards your buttock then back down to start position. Repeat 10 times per leg.

3. Box Step: Stand in front of a box, chair, or bench about 2 feet high. Step up onto the box, straighten the knee and step back down. Repeat on both legs 15-20 times. When this exercise becomes easier, add dumbells to hands.

4. Abductor Lifts: Lying on your side with bottom leg bent and top leg straight, lift top leg up. Hold for 3-5 seconds and lower to starting position. Repeat 15-20 times and repeat on opposite leg. Ankle weights will increase the intensity.

5. Adductor Lifts: Lying on your side with bottom leg straight and top leg bent and planted in front, lift bottom leg and hold for 3-5 seconds. Lower to floor and repeat 15-20 times. Repeat on opposite leg. Ankle weights will increase the intensity.

The next step in preventing ACL injury is to add coordination and proprioceptive exercises to help with the dynamic, or moving, strength of the knee, like in jumping and landing. Focus and attention should be made on maintaining an upright torso, increased knee flexion or bend, and lowering the center of gravity to help absorb the deceleration, both in the exercises and in landings behind the boat or cable.

1. Box Jumps: Stand in front of a box, chair or bench. Jump up with two feet to stand. Jump back down. Special attention should be made on bending the knees and absorbing the landing. Repeat 15-20 times.

2. Bosu/Indo Squats: Stand on the wobble board side of the Bosu ball or on top of an Indo board. While maintaining a tight core, bend at the waist and knee into a controlled squat and return to standing. Make sure chest is up and knees are not bowing in while in the squat position. Repeat 10-15 times.

3. One-Legged Star Plyometrics:  Begin the 4 star drill by drawing (or imagining) a box on the ground. Each corner of the box will have a number that corresponds to it.

1                           2

(5)

3                           4

Perform the 4 star drill by hopping from one spot to the next. You can follow the order from 1 to 4, or you can change the order for some variation. You can also add a fifth spot at the center for even more difficulty.

Keep your ACLs protected and strengthen those knees!

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Is an old injury causing your new pain?

We all are aware of the new pains that pop up unexpectedly, without cause. We wonder if we tweaked a landing or overtrained this week. The underlying cause could be from injuries you have sustained previously, whether in childhood, or just last season and fascia could be to blame.

Whats fascia? Fascia is the connective tissue covering of every muscle fiber, muscle group, blood vessels and nerves designed to bundle them together. The fascia is dense, yet flexible, and acts to transmit tension and allow muscles to glide over one another. The fascia keeps the body interconnected.

Image: nypainreliefnow.com

When injured, fascia changes in its condition and function. The body’s reaction to injury to the fascia causes scar tissue build up and the muscles can no longer glide along one another smoothly. The body compensates, leading to altered biomechanics, asymmetric posture, and pains that are possibly in a totally different area then the initial injury! Fascial restrictions can pull the body out of its normal alignment, compressing joint surfaces and bulging disks, resulting in pain, loss of motion, and weakness.

So how can you treat fascial dysfunction and restrictions? Going to a health care practitioner that specializes in sports injuries is the easiest. This could be a chiropractor, soft tissue specialist (massage or acupuncture), sport specific trainer, or other fitness expert. They will begin by doing a series of functional assessments that will allow for an evaluation of the body’s biomechanics and distinguish weak areas from those that are overcompensated. These assessments are typically small exercises, like an overhead deep squat or a bridge, that allows the practitioner to see discrepancies in the small muscles as well as the large muscle groups. Palpation (or feeling) in the tissues themselves will also help the practitioner to find areas of fascial dysfunction.

Once the areas are determined, several techniques, designed to reduce the scar tissue and adhesions in the fascia, can be used to help promote the normal glide of healthy, well-functioning fascia. Deep tissue massage, myofascial release, active release, and Graston techniques are some of the most well known and effective. All are aimed at increasing functional range of motion, reeducate muscles, break up the restrictions in the fascia, and decrease pain patterns.

Don’t be haunted by an injury from long ago and free your fascia!

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The Perfect Warm-Up: Foam Rolling

What’s the best way to get warmed up before you ride? I used to think it was running to the dock and throwing my lifejacket over my head. I’ve learned, however, that method was far from optimal. When I began working at Orlando Sports Chiropractic, I learned about a technique called foam rolling. It takes less than 5 minutes to do, feels like a deep tissue massage, and comes with a vast array of health benefits!

Foam rolling’s benefits include increasing muscle flexibility, increasing blood flow to the muscles, decreasing joint soreness and stiffness, and balancing muscle length to promote muscle symmetry. Foam rolling also breaks up scar tissue, or adhesions, in the muscle fibers which can help to increase function and decrease the likelihood of injury. The positions used in foam rolling also help to strengthen the core and increase proprioception, our body’s awareness of itself in space.

For a mere 20 dollars at a sporting goods store and about 5 minutes, sounds like a pretty efficient warm up (and cool down!) to me!

Video: http://www.teamosc.com

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Staying Warm in the Offseason: Bikram Yoga

Nothing like the days getting shorter, the water getting colder, and the wetsuits coming out of storage. As winter approaches, riding time becomes less and less and free time increases. Why not stay warm and stay in shape?

Bikram yoga is a style of yoga consisting of 26 postures, done at a temperature of 105 degrees. According to Bikram, “It has been proved and experienced by millions that these 26 postures systematically work every part of the body, to give all the internal organs, all the veins, all the ligaments, and all the muscles everything they need to maintain optimum health and maximum function.  Each component takes care of something different in the body, and yet they all work together synergistically, contributing to the success of every other one, and extending its benefits.”

Image: onday32sherested.tumblr.com

The heat increases flexibility and cleanses the body of toxins and wastes, while impurities are flushed out with sweating. The classes are 90 minutes long and include 2 breathing exercises. The class allows for deep stretching, increasing flexibility and preventing injury. Not only does Bikram encourage lengthening of the muscles, but holding the poses (called isometric contraction), promotes strengthening and toning of the muscles. The typical participant burns from 500 to 1200 calories per session, which contributes to weight loss.

Bikram yoga is not for the faint at heart, this type of yoga is far from relaxing! If you’re up for a challenge this offseason and are in need of some cross-training to stay in shape, heat it up and give Bikram yoga a shot!

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