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Training
Injury Free Pt.I
An Interview with Dr. Patrick O'Brien
Anyone who has been actively involved
in serious training for any length of time has no doubt encountered
some type of injury at one time or another. So what are we athletes
supposed to do when posed with this sort of situation, God forbid?
Should we stop working out? Ha! Yeah right! Should we go see our
family doctors? Probably not the ideal choice either since most
M.D. 's I've encountered know as much about weight training as Ron
Jeremy knows about monogamy. Every once in a blue moon someone comes
along who truly knows training related injuries up, down,
and side to side. That someone is Dr. Patrick O'Brien. Dr. O'Brien
is not your average chiropractor. He walks the talk and repairs
athletic injuries without missing a beat. He has focused on resolving
athletic injuries for the past 6 years. I met Pat ironically through
one of my own training clients and to this day I haven't sent him
an injured athlete he hasn't fixed. Dr. O'Brien earned his D.C.
from Northwestern College of Chiropractic Medicine. He earned his
certification in Active Release Techniques through Dr. Mike Leahy
(of Muscle Media 2000 fame) and is the owner of Health Architect,
a private chiropractic clinic located in Minneapolis, Minnesota.
The intent of this interview is to inform the readers of Shapeshifter
about training-induced, soft tissue injuries as well as basic steps
for injury prevention. Keep training injury free!
SSM Hi Pat.
Tell us a little bit about what you do and how you initially became
involved in treating sports and weight training related injuries.
Dr. O'Brien It
stemmed from being involved in sports from a young age. I was always
curious about how the body worked from a biomechanical standpoint.
As I experienced injuries in my own training and began to learn
more about the body, I knew that I wanted to work hands on with
athletes. I knew there was an element to manual medicine and hands-on
health care that wasn't being met and that was frustrating to me.
I know when an athlete experiences an injury they want to be fixed
"now". They can't afford to miss training or suffer a
loss of performance, especially if they have contracts on the line
that are worth alit of money. As I began to delve deeper into learning
about myofascial work I was able to begin fixing some of these athletes
that no one else was fixing. If you think like an athlete and have
the technical background to go with it, those are the types of patients
that will naturally gravitate toward working with you.
SSM What are
some of the more common resistance training injuries you treat on
a regular basis?
Dr. O'Brien
Rotator cuff injuries are by far the most common injuries I treat
in athletes. This is most often due to imbalances created by internal
rotation and pushing movements without compensating with time spent
on the external rotators and pulling movements. I also see a lot
of tennis elbow, tendonitis, and quite often I treat psoas/hip flexor
imbalances. People don't work on them and many doctors don't treat
them or have the knowledge to really understand what's going on
in that environment.
SSM What would
be the primary cause of a psoas/hip flexor imbalance?
Dr. O'Brien
A lot of athletes develop this problem from chronic overuse of certain
movements in their respective sports. Most often this includes cyclists,
climbers, and sprinters. Usually when there is a large extent of
hip flexor involvement there will also be T.F.L. (tensor fascia
latae), and glute involvement as well. Heavy squats would be a good
example of this. Generally, people are overusing these muscles without
getting the oil changed so to speak.
SSM What about
stretching regularly? Will this help avoid these types of problems?
Dr. O'Brien
To some extent stretching will help prevent injuries and loosen
the individual up. Stretching tends to affect the mid belly of the
muscle the most. As you diverge from the mid point of the muscle,
the stretch decreases exponentially as you move toward the tendon.
In other words, if an individual has an injury closer to the origin
or insertion of a particular muscle, stretching will not likely
solve their problems. Most of the time, fixing an injury will involve
finding the muscle's biomechanical abberation or scar tissue and
work it out. Many times there will be synergistic muscle involvement
as well.
SSM What is
an adhesion and how would an individual develop this in the muscle?
Dr. O'Brien
An adhesion is an area of the muscle that has been injured or overstretched,
causing scar tissue to be deposited as sort of a natural cement
the body uses to repair itself. When this happens, the scar tissue
will deposit in a random, cross-hatch pattern that does not align
with parallel muscle fibers. This will decrease the stability, R.O.M.
(range of motion), functionality, and strength of the muscle. People
can develop adhesions by acute or repetitive training incurred injuries.
SSM What is
the difference between an adhesion and myofascitis?
Dr. O'Brien
An adhesion, like we stated would be a point where the muscle has
been damaged and scar tissue has been deposited. Myofascitis would
be a condition where the individual will experience an inflammation
of the myofascia (muscle and fascial tissue).
SSM Pat, I've
heard quite a bit over the past few years in athletic and weight
training circles about A.R.T. (Active Release Techniques). Some
of the results athletes have reported about their success with these
techniques are almost unbelievable. Can you tell us a bit about
these techniques and how they are used to treat training injuries
and restore structural balance to the muscle?
Dr. O'Brien
Active Release is a very specific treatment, originally developed
by Dr. Mike Leahy, designed to address the removal of muscular adhesions.
The doctor must first have a very thorough understanding of biomechanics
so they know what to look for and how to approach fixing a patient.
This usually takes a few years of experience to develop proficient,
hands-on tactile senses in order to effectively treat a patient.
These techniques would be an addition to a doctor's base of knowledge
in treating and restoring structural integrity and balance to the
injured muscle(s).
SSM Would A.R.T.
have any similarities to the way accupressure or acupuncture works?
For example, if an adhesion was causing a nerve entrapment in a
muscle, removing that adhesion could dramatically increase the athlete's
strength, even in movements that are involving other muscles. How
would you explain this phenomenon?
Dr. O'Brien
I have somewhat of a split diagnostic approach. In western medicine,
I'll talk more about a nerve/muscle adhesion that affects another
part of the body because it's impacting that peripheral nerve. It
will affect that nerve's function by facilitating an increase or
decrease in nerve conduction, as well as proprioception and many
other factors that come into play. I don't know if I'd say A.R.T.
affects the body like acupuncture or accupressure because these
are dealing with meridians. Meridians are specific channels in the
body that energy flows through and there are certain points in those
pathways called acupuncture points. These points need to be addressed
very specifically using a certain amount of pressure (accupressure)
or with a needle (acupuncture) in a certain direction, depth, and
with a specific treatment perspective in mind, however I wouldn't
relate the two treatments. I have for example, performed subscapularis
Active Release treatments where the individual's bench press increased
20-30lbs immediately because the injury to that muscle was destabilizing
the general shoulder structure. I wouldn't draw a parallel between
that and acupuncture as much as I'd say it was simply causing a
major structural deficit in the shoulder.
SSM What are
trigger points and how can these be used to treat injuries?
Dr. O'Brien
A trigger point can be similar to an adhesion but is generally less
involved. It will often times be a tight spot in the muscle that
may experience inflammation but not necessarily contain scar tissue.
It's basically a general term for a knot in the muscle. When you
push on that knot it will affect the general tenicity of the muscle
and cause it to relax.
SSM I've heard
of some doctors using trigger point injections in athletes, what
does that involve and why is it beneficial?
Dr. O'Brien
Trigger point injections are used to break up some of the tenderness
and tightness in the muscle. This is generally done with Lidocane
as far as I know, which is a prescription pain killer. That isn't
really my area of expertise, and a person must be an M.D. to perform
this sort of thing.
SSM In a nutshell,
what is the significance of maintaining the structural balance of
agonist/antagonist muscles, in terms of longevity and preventing
unnecessary training injuries?
Dr. O'Brien
Balance is the key to productive training, functional strength,
and injury prevention. Period.
SSM Is it safe
to say that this is one of the more common causes of injuries that
you treat? Athletes focusing on the Yang and neglecting the Yin?
Dr. O'Brien
When there is structural/strength imbalances in opposing muscle
groups it predisposes the individual to injury because the body
cannot handle the same training loads or frequency with out eventually
breaking down in some way.
SSM What is
your opinion of supplements such as glucosamine, chondroitin, and
MSM for speeding recovery of cartilage, ligament, and tendon related
injuries? Do you prefer the HCl or sulfate form of glucosamine,
or is there no significant difference?
Dr. O'Brien
I've used glucosamine with hundreds of patients clinically and have
experienced excellent results with it. Glucosamine HCl is the type
I prefer because it has a higher ratio of glucosamine to binding
salts versus the sulfate form. It works excellent for cartilaginous
injuries.
SSM Can you
explain a bit about how glucosamine lends itself to cartilage repair?
Dr. O'Brien
It works in the formation of the ground substance (proteoglycans)
as well as some of the other sulfates involved in the joint matrix.
It will increase synovial fluid thickness, promote nourishment to
the joint, as well as slowing some of the enzymatic processes that
stimulate breakdown of the joint. Some studies have also shown (by
using an electron microscope) that it does help to build the cartilage
directly as well as indirectly.
SSM What are
some basic preventative maintenance protocols that weight training
athletes can follow to maintain long term structural balance and
healthy joints?
Dr. O'Brien
It would serve most peoples' best interest to have their body assessed
from an analytical standpoint before starting a training program
to find if there are any adhesions in the muscles, remove them,
and restore balance to the body. I would also recommend developing
a training program with strength coach or a trainer who is knowledgeable.
This will help prevent bad habits and using poor biomechanics that
will eventually lead to injury. I think more athletes need to also
pay specific attention to performing exercises to stabilize the
spine and functionally strengthen the low back and abdominals. Also,
be sure to consistently perform movements to develop a solid strength
base in the rotator cuff. This is especially true if an individual
plans on lifting heavier loads to promote strength and mass gains,
because the shoulders will have an greater than average demand for
increased stability.
SSM Is A.R.T.
something that most athletes and weight trainers should take advantage
of on a regular basis as part of their program?
Dr. O'Brien
I think if an athlete is serious about what they do, understand
their body, and expect a lot out of it, they need to keep their
edge. The way they keep that edge is through superior nutrition,
proper training, and also taking care of the body. If you drive
your car more than the average person you have to change your oil
more frequently or things begin to break down and eventually your
engine burns out altogether. Many competitive athletes I treat will
visit me on a 3 to 4 week basis during their competitive season
to maintain balance through biomechanical adjustment and myofascial
treatment.
SSM What if
a person doesn't have any readily apparent problems? Is it possible
for an adhesion to form that would not necessarily cause pain or
discomfort that could lead to larger problems?
Dr. O'Brien
That is actually very common. Pain is ultimately most people's indication
of whether or not something is wrong in the body. This is not always
the most accurate indication. Often times an adhesion may simply
decrease ROM (range of motion) in a particular muscle. The structural
imbalance, even though it's not causing any perceived pain, may
cause a more serious injury to occur when greater intensity is applied
to the imbalanced muscles. For instance, if they have a decreased
ROM in the low back, a more serious injury may occur when they attempt
a heavy deadlift. It sounds crazy, but it happens.
SSM Well Pat,
this has all been very informative and interesting. Thanks for your
time. I'm sure many athletes will benefit from your wealth of injury
prevention knowledge and more importantly begin to incorporate some
of these basic protocols into their own programs to keep training
injury free.
Be sure to check out part II of "Training
Injury Free" in next month's Shapeshifter Magazine.
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