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Andrew Luck is having a rough time starting the NFL 2019 season. This season can define his status as an elite quarterback in the NFL or not.
He has physically gone through a lot of events that could have been prevented. This article goes over the timeline of his injuries. Everything happens for a reason, and Andrew Luck’s sequences of injuries show this.
We will breakdown why his body is doing what it is doing and how to rehabilitate from a combined Holistic, Sports Medicine, and Orthopedic specialist perspective. Click Below on the picture of HERE to watch the video of Dr Ngo’s explanation.
Week 4 to 6 of 2015 season: Andrew Luck missed 2 in-season game due to a “sore” Right shoulder. Later found out that he suffered 2 broken ribs to the Right shoulder complex. (click HERE to read)
Oct 2015 season: Diagnosed with “sustained torn cartilage on two of his ribs and was still coping with significant pain”.
Game 9 of 2015 season: Andrew Luck reported ankle injury.
November 2015: Andrew Luck suffered an abdominal injury and lacerated kidney late in Sunday’s 27-24 win over the Denver Broncos (click HERE to read on this past injury).
Offseason 2015: Andrew Luck had an Acromionclavicular Joint injury while snowboarding. (Click HERE to read).
January 2017 + Rehab the entire 2017: Right shoulder labrum surgery
2018: Andrew Luck got the COMEBACK Player of the YEAR award!!!
March 2019: LEFT Calf strain to “high ankish” injury with talks of it being an Os Trigonum problem. (Click HERE to read.)
Aug 2019: Realize it is front ankle situation, even if the pain is near the Achilles Tendon region as Andrew Luck is having trouble rolling out of the pocket (lateral and rotational movement). (Click HERE to read).
Andrew Luck has admitted that the injuries have affected his confidence and mind at times as a result of these injuries.
HERE IS WHAT YOU HAVE BEEN WAITING TO READ.
We would like to start by saying that the body works together, heals together. There is no one injury that does not impact the entire functionality of the human body’s ability to move well. The good news, and the reason in writing this article is to demonstrate how Andrew Luck’s situation makes perfect sense.
Although it is easier to talk about it after the fact. You cannot predict who will get hurt, but the odds are stacked against Andrew Luck.
The vestibular system, and vestibular rehab, is one of the most underrated system in our body. We all take it for granted until it affects us. As a Sports Medicine Physical Therapist who has helped 1000’s of active youths to adults in Long Beach, I did not take this system seriously until I started to specialize in concussion management of athletes. You will need to make sure an ENT, ear nose throat physician, or specifically called an otolaryngologist, oversees your case too.
If you take a step back, everyone in pain has some form of physical tension. You might variations of this definition of tension. Stiffness. Discomfort. Limited range of motion. This is where there is a disconnect between your family General Practitioner, Orthopedist, or Spine Surgeon’s ability to understand the value of adding an otolaryngologist to your rehabilitation program.
We are going to make an assumption that you do not have immediate dizziness or vertigo. If you do, just scroll down to Vestibular Rehab 101 and we will help you understand more about your condition. For many of you, please read on how Vestibular Rehab will make you run faster, lift heavier, or hit better.
If you have arthritis, one would say you have tension more at your joints.
When you have a muscle strain or ligament sprain, you have local tension to your muscle or connective tissues. You get a massage and hope it takes this tension away.
What happens if it does not? What happens if it feels good, but for minutes?
It has been long recognized that a tighter a muscle, the weaker you are. This is based on the stress-strain curve. The keyword to note is “tighter”. There are many reasons for having tight muscles.
Muscle and joint tension is dictated by your nerves. Your nerves react based on your brain and brain stem. The brain and brain stem filters and makes decisions based on your senses.
Your senses impact whether you can relax or not!
Touch. Sight. Sound. Smell. Taste.
For the sake of this article, we will focus on one sensory system that is not talked about enough and the role of the inner ear system. The vestibular system helps to keep up balanced and know where our body in relationship to space.
Basically, the vestibular system helps us know when we are laying down, looking up, walking sideways, and upside down. This is crucial for many athletes. Imagine if you are skateboarding and cannot tell which direction you and your body are in.
Now imagine, you have a hyper ability to sense directions and how to move better on the skateboard. Why wouldn’t you want to get this ability? It is a skill.
Okay. So what is vestibular rehab?
Vestibular Rehab 101
The vestibular system is a sensory organ. It is made up to the Cochlea and the Labyrinth organ. The system is encased in the bone called the bony labyrinth. The inner workings are made of the membranous labyrinth.
The cochlea organ is what helps us to hear. The vestibular side of the labyrinth organ is what we will focus on in this article, as it is the system that will help you to possibly improve mobility, strength, posture and to move better.
The Vestibular labyrinth organ consists of the three semi-circulatory canals and the otoliths of the ear.
There are two parts to the otoliths: utricle and saccule. Each has a specific role.
The utricle helps you to sense vertical acceleration. This is fancy for how much up and down movements are happening. Common examples include squatting, going up and down the stairs, or the small bumps while driving.
The saccule connects to the cochlear duct. Its role is to sense linear acceleration of side to side or front to back movements. An example of this is the act of cutting, skating forward, or the side to side movement that happens when skiing.
The semi-circulatory canals help to detect angular movements. The best way to describe angular movements is where your ears move along with your head. If you notice with the utricle and saccules’ example, the ear stays in the same axis of motion.
YES! Explaining this in words is not easy.
At the ends of the canals are dilated crista endings called ampulla. Within the crista is embedded cupula within the membrane material of the labyrinth. As you can see nerve fibers and hair cells. The cupula and the canals have fluid called the endolymph.
As you move your head, the fluid bends away or to the canals. The direction of hair cells movement tells your inner ear and brain which direction your head is going. Your eyes will stay on target based on this input. If this is not happening, your eyes will follow the direction of your head movement. Your eyes tell your vestibular systems how to move your spinal core and neck muscles athletically.
They are called vestibular-ocular, vestibular-colic, and vestibular-spinal reflexes. They respectively tell your eyes, neck, and body-posture how to react.
These communication pathways happen fast.
There is a 90-100 pulse/second resting tonic contraction.
The hair cells of the cupula are the same weight as the endolymph. What this means is that vestibular input is not dependent on gravity or position. All vestibular symptoms that are coming from the semi-circular canals must be from accelerated movements!
An interesting trivia fact is that alcohol impacts the weight of the cupula. Because of this, the cupula becomes lighter than the surrounding endolymph. The cupula becomes displaced easily. The end feeling is the dizziness one will feel when consuming alcohol.
On top of the hair cells within the otolith organs are otoconia. The otoconia are called “crystals”, and have greater gravity weight than the endolymph. This is important for the management of a specific vestibular disorder called Benign Paroxysmal Positional Vertigo. The otoconia within the utricle become broken into smaller crystals and migrate into the cupula or canals. The medical terminology is respectively called based on where the otoconia reside: capulolisthiasis or canalisthiasis.
You use gravity to move the crystals back into the utricle.
A common sign that we use to know what is happening in your inner ear is called nystagmus. Nystagmus is a subconscious movement of the eye based on the inputs of your inner ear and brainstem.
a.
In this picture, your right vestibular system is overstimulated or in a state of excitation. You turn your head to the right. Your eyes counter-rotate towards the far left so you can stay on the target directly in front of you. The brainstem realizes this and resets the reflex. Your eyes drift back to the right.
What you get is a fast-twitch of the eyes to the side of dysfunction and a slow-twitch of your eyes returning. This repeats from 10-60 seconds. You feel dizzy and crummy during this time. There is a time period at the beginning of the head movement that you do not get nystagmus. This is called latency and is due to the time of the otoconia drifting into the cupula or canals.
Based on other factors, in addition to the direction of nystagmus, we have to determine if you have a dysfunctional central or peripheral vestibular system. A central vestibular problem stems from the big brain itself, like a concussion.
Either way, the body is amazing at compensating to allow you to move to survive. This ancestral survivor adaptation makes it easy to suppress vestibular symptoms. It feels like you grow out of it.
Unfortunately, you are suppressing what needs to be optimized. The common lingering side-effects of a suppressed vestibular problem include vision deficits and/or muscular tension, tightness, or discomfort. The mild and constant tension reduces circulation and vital nutrients to the muscle.
The muscle works at less than 100%. This leads to strain or muscle tears when overworked and overwhelmed. An example is poor eye-hand or body-brain connection late into a basketball, football, or end of the day.
You feel tension so you stretch out more. Sometimes you can shake it off and there are times where you cannot. If your vestibular symptoms get suppress fast, it may feel like you are healthy and strong. You go back to your workout routine to feel the pain in a few months later.
We revealed, to many that seek our expertise in Holistic Sports Medicine Physical Therapy, that there is a vestibular dysfunction at play.
a
Each organ has a nerve that helps to communicate what it senses to the big boss aka the brain and brain stem. The brain tells your body how to move your neck and spinal “core” muscles. This is how neck or lower back pain can improve with vestibular rehab.
The cranial nerve 8, vestibular-cochlear nerve splits into the vestibular branch and cochlear branch. Hmmm… You can guess which nerve goes to which organ.
The Vestibular nerve further splits into superior and inferior branches. The superior part of the vestibular nerve connects and communicate what is happening at the utricle, anterior and horizontal semi-circular canal. The inferior branch communicates the input from the saccule and posterior part of the semi-circular canal.
For bonus trivia, the inner ear gets blood supply from the basilar artery. The importance of this is that if you have any vascular insult to the back of your head, it can impact your inner ear. The Basilar artery also keeps your brainstem alive and splits into an anterior and posterior branch. The posterior Vestibular artery supplies the posterior semi-circular canal, saccule, and cochlear organ. The anterior Vestibular artery supplies and keeps the anterior and horizontal semi-circulatory canal, and utricle healthy and functioning. A stroke to the latter artery cannot impact your hearing.
What you may not be aware of is the connection of every organ to yourself. Today we will highlight the liver-heart-lymphatic system’s connection. As Long Beach’s only Sports Medicine and Orthopedic Physical Therapy that emphasizes healing from within, we preach that there are two ways to getting any little tension or discomfort to go away FOR GOOD.
1. Do more “good”. 2. Do less “bad” or get rid of the “bad”.
The lymphatic system works closely with your circulation system.
Why should you care?
You can do tons of “good” stuff like stretching and strengthening, but if you are getting little rewards or not lasting gains, you must look at the lymphatic system.
You have lower back pain and it does not feel good. You need a professional that can help makes sure you feel better and that it will not come back. Your family or friend have told you about their amazing Physical Therapy experience so you are looking for your perfect lower back pain rehabilitation experience. This article will help you in choosing a Physical Therapy clinic for your lower back pain needs.
There is a reason why Medical Doctors and insurances prefer Physical Therapy over Chiropractic care. The profession of Physical Therapy has been accepted by their medical peers due to their involvement in bringing high-quality research to the topic of lower back care. However, many people are not familiar with Physical Therapy.
The majority of the public understands that chiropractic is the professionals that can provide “quick neck and lower back pain fixes” and “manipulation”. The experience of getting Physical Therapy for lower back pain is much different.
Physical Therapy looks at the causation of your lower back pain. When you understand why your lower back pain is not going away, you can squash it for good.
Running successfully requires two things: the ability to absorb shock well and to have mental stamina. Whether you are new or have been running for some time now, you truly need a mind-body connection during your run. We will teach you how to help your lower back pain when running.
The design and nature of your musculoskeletal and fascia system allow your body to absorb and release shock, called kinetic energy. We like to start to compare this phenomenon to a spring coil.
The power of the spring design comes from the ability to load to explode. Running is the same. The beauty is the kinetic chain transfer. The explode happens from what the other leg does. How well your left leg can push and pull comes from the right leg, and vice-versa.
We did think for some time to make the first paragraph of this article to include “absorb shock and produce raw power”. If you think about the spring coil analogy, you explode based on how well you recoil. Right?
You push on the spring lightly. You get a light bounce. If nothing at all.
You push on the spring so the top coil is the closest to the ground, and you will have to watch yourself. The spring might bounce high up towards you!
Load to explode.
If you watch people run, the amount of leg lift can tell you how well they are pushing force into the ground. They are loading lightly. The muscle stabilizers and movers are working more than they should. Yes, there are two types of muscles.
You have lower back pain. You are looking to determine what condition do you have and how do you help yourself. Sacroiliac joint dysfunction should be one on the list for you and your Spine Specialist to rule out or in. We will end with a few stabilization exercises for your sacroiliac joint pain.
Here is what you will get from this short article. Many articles will go over the “what” and “how”. We will give you the down and dirty secrets that you need to know about your sacroiliac joint dysfunction.
What is sacroiliac joint dysfunction?
How do you know if you have a sacroiliac joint dysfunction?
What are two things that your medical doctor, chiropractor, or physical therapist might not know or share to you?
Five commonly prescribed exercises and what to do if they do not work?
Your pelvis consists of three bones: 2 ilium and 1 sacrum. There is a meniscus-like disc called the pubic symphysis. The pubic symphysis consists of cartilage that has more type 1 collagen called fibrocartilage.
1. What is sacroiliac joint dysfunction?
Your sacroiliac joint is the transition between your lumbar spine and your long thigh bones called femur. Your sacrum acts more like your spine. The two ilium acts more like your hips (coxa-femoral joint). Your pubic symphysis helps to absorb this back-and-forth reciprocating force from your legs that happen as your walk, run, or sprint.
The primary function of your sacroiliac joint is to help transmit and coordinate the kinetic chain force from your legs to your upper body and vice versa. The elaborative explanation is the sacroiliac joint’s role is to take and spread the shock that comes with your leg hitting the ground to your trunk, neck, and opposite arm.
Our swing of the arm causes your opposite arm to whip the other direction. Just like the use of a whip, the snapback whip of your arms brings the kinetic force back down the trunk, sacroiliac joint and opposite leg to swing forward. We hope you realize that the kinetic chain force of walking has a rythmic flow from right to left to right and up to down to up.
In short, your sacroiliac joint dysfunction happens when you lose the ability to move the kinetic force from your legs to your arms. The same occurs from a top-down movement of kinetic force.
5 Foundational Phase 1 out of 5 exercises for Sacroiliac Joint Pain
There are TWO types of sacroiliac dysfunctions: Moving too much (hypermobility) or moving too little (hypomobility). The motion at the sacroiliac is controlled by two types of tissues: active or passive tissues.
Active tissues include all the surrounding muscles that expand over the sacroiliac joint. Passive tissues include all the surrounding connective tissues that are not controlled by the brain, per se. The list includes ligaments and capsules.
Phew! The first question was a longer explanation than you may hope for but that was the most condensed version!
Our philosophy is that everyone can get better and stay active. If you can get all of your body parts to work the way it is designed, you can do amazing things. This is possible in the face of arthritis, age, or whatever you may have been told. YES YOU CAN!
There is no clinical test that is reliable in diagnosing you with sacroiliac joint dysfunction. Research emphasizes practitioners to use a collection of tests that targets the pelvis (which includes the sacroiliac joint) to determine if you have a sacroiliac joint dysfunction.
2. How do you know if you have sacroiliac joint dysfunction?
There is one very accurate test that can help you know if you DO NOT have sacroiliac joint dysfunction. The test is called Fortin finger test. If your pain is very specific to the junction where your ilium and sacrum connects, you have a POSITIVE Fortin finger test. If your pain is not in the region of your sacroiliac joint region, you have a high chance that you do not have sacroiliac joint dysfunction.
You maybe like the many people we see with lower back pain and have pain around or at the sacroiliac joint region. Unfortunately, this makes things still clear as mud.
Your Spine doctor may inject directly to your sacroiliac joint to determine if your pain goes away immediately or not. If you get relief, then the assumption is that you have sacroiliac joint dysfunction.
There are still clinical debates and best practices when it comes to the subject of sacroiliac joint dysfunction! New (and frequently old) clinicians tend to favor going to educational courses revolving around this subject, as it is a source of clinical frustruation in the management of sacroiliac dysfunction.
3. What are two things that your medical doctor, chiropractor, or physical therapist might not know or share to you?
The two things that you need to know about your sacroiliac joint dysfunction are: there is no such thing as treating the sacroiliac joint only AND you cannot manage one ilium without the other ilium.
The main reasons for this dilemma is due to the clinical idea that we have to determine whether it is a local tissue source of problem: sacroiliac joint, hip joint, or lumbar spine joint, lower back muscle, or lower back ligament.
The first question that goes through many people’s head when we hurt our lower back is “What did I just injure?” We understand that our minds want us to believe that it is simple to look for that one thing.
The body works together. Walking requires all muscles to work in coordination with each other. The sacroiliac joint role is to move forces around so the body works well together.
The dilemma is being perpetuated with the question of “chicken-or-egg”. Is the lumbar spine muscle, facet, or disc injury causing the sacroiliac joint dysfunction OR the other way around?
In our opinion, and based on helping 1000’s of lower back pain recover and get back to their activities, we rarely see a patient with only sacroiliac joint dysfunction without lower spine dysfunction.
If you believe in the idea of kinetic chain movement and the idea that your whole body needs to work together to move, you need to address the lumbopelvic-hip unit.
-Dr Danh Ngo
We have a slogan that goes by the statement of “Never chase the pain. Find the source and treat the source.” If you limp or alter your gait due to pain, both legs are not moving optimally. If you cannot run because your lower back and pelvis are hurting on one side, you have to address the mechanics and functionality to both left and right sides.
If you have a left leg that is over-compensating (working too much), then the other side is working too little.
Orthopedic Physical Therapist Specialists are mechanics of the human body. We focus on addressing any mechanical limitations and use a precise form of exercise prescription to ensure you know how to manage kinetic chain forces well. The categories of human movement include mobility, stability, strength, coordination, endurance, reactive control, and power/explosiveness.
You can have a sacroiliac joint dysfunction if your lifestyle requires a mixture of a certain human movement capability but you are not training in that certain mixture.
Lastly, the idea of left and right needs to work well together means that a Sacroiliac Joint Fusion will always lead to over-compensation to the other side. The compensation may happen at the sacroiliac joint, hip, knee, or lumbar spine. The weakest joint(s) will be the next place to scream dysfunction or pain. We never recommend getting a sacroiliac joint fusion.
4. Five commonly prescribed exercises and what to do if they do not work?
The 5 exercises program is design to help if you have either a hyper or hypomobility sacroiliac dysfunction. We focus on making sure you address the mechanical component of most sacroiliac joint dysfunction with a self treatment reset. The next phase will be to ensure both joints are stable and well supported by your muscle-brain connection. Lastly, we end with coordination and staggered stance strengthening for your short stronger sacroiliac joint protocol.
If you are interested in 10 additional exercises (video and written instructions), fill out the short form below. The 10 additional exercises will include regressive and progressive exercises to the 5 exercises listed in this article. It will include soft tissue or mobility exercises to support the 5 exercises in this article.
A. Sacroiliac joint reset.
Lay down and bring one leg up. Try to pick up the side that does not hurt up first. Place a stick on the top of that leg and the back of the bottom back thigh. Gently push your thighs in the direction of the stick for a count of 10 seconds.
Your legs should be moving in opposite directions. If that does not aggravate your symptoms, you can ramp up the intensity of your push.
Perform 5 reps for 10 seconds contraction.
End by placing your fists between the ends of your inner thigh. Push your thighs together slowly and increase intensity. You may hear a “pop” to your front bone and that is typical, but not necessary for success.
Get up and walk or go up and down a few steps. If you feel like there is still discomfort, you can try another set of 5 reps.
If that does not relieve some discomfort, repeat with the opposite leg pushing pattern. 1-2 sets maybe necessary.
B. Bridging.
Lay on your back on a flat and firm surface. Raise your hips and chest up towards the ceiling. Make sure your elbows, wrist, and hands are flat on the table and tuck closely towards your trunk.
Flex and contract your gluteals or buttock region so you can emphasize supporting your Sacroiliac with the strongest muscles that surrounds the back side of your Sacroiliac joint region.
You should feel your glutes working only. If you do not feel your glutes working, you may need to regress to progress.
Hold for 30-60 seconds. Repeat for 5 reps. Do daily for 4 weeks.
C. Active Straight Leg Lift.
Lay on your back on a flat and firm surface. While keeping both legs and knees firm. Raise your legs up to a vertical position. If you cannot reach this height, remain focus on keeping a straight leg. You will get there with time and practice.
If you happen to feel your groin or front thighs tensing instead of your abdominals, brace your abdominals muscles. Practice timing your leg raise with a prolong exhalation.
You should feel your abdominals working only and never tension to your groin or front thighs. If you do not feel your abdominals, you may need to regress to progress.
Repeat for 10 reps and 2 sets.
D. Table assisted elbow to elbow tap.
Place your hands on a firmly secured that is about the height of your thighs. Keep your spine firm and straight. Tense up the back of both thighs.
Alternately, touch your elbows with one hand. Switch. Perform 20 reps. Make sure you try not to rock side to side or twist. This is important for your Sacroiliac Joint stability.
If you notice that you keep swaying or rocking, you may benefit from out additional 10 exercises comprehensive approach.
Perform 2 sets. Do daily for 4 weeks.
E. 1/2 kneel.
Kneel down and support your knees with a sofa cushion or a few thick blankets. Bring one leg forward. Make sure both feet are aligned straight. This is important, but work your way towards this ideal if you have discomfort. Raise both arms up high if you have good balance. Practice safely and use your best judgment.
If you are not swaying and you are practicing with good judgement, close your eyes. Practice improving your single leg balance.
Spend 2-3 minutes working each leg. Do daily for 4 weeks. This is one of the most important exercise out of the five.
If you notice that you keep swaying or rocking, you may benefit from out additional 10 exercises comprehensive approach.
Enjoy and practice daily with our suggested protocol.
If you desire a more elaborate 10 Sacroiliac joint dysfunction exercises and self care (includes video and written instructions), please fill out the form below. If you are in need of immediate Specialist Sacroiliac Joint solution AND live in the surrounding city of Long Beach, California, get a FREE consult with Dr Danh Ngo.
He is in the 1% of Physical Therapist with TWO SPECIALTY: Orthopedic and Sports Medicine. Click on the Blue button for your special chat and time with Dr Danh Ngo.
