Maisonneuve Fracture Treatment Information

Maisonneuve fracture is a disruption-bony or ligamentous- of the medial ankle and proximal fibula and is usually caused by external rotation of the ankle. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament. This type of injury can be difficult to detect. Maisonneuve fractures and syndesmosis injuries occur most often in athletes. The foot is planted on the ground and the lower leg rotates around it. The force of the injury is translated through the interosseus membrane, travels up the leg, and exits through the top of the bone. The result is a proximal fibular fracture.With a Maisonneuve fracture, there can even be a fracture of the tibia at the bottom near the ankle. One cause of ankle injury is previous injury; inadequately rehabilitated ankle sprains place the ankle at risk for subsequent injuries. Common sign of maisonneuve fracture is tenderness at medial malleolus and proximal fibula. Maisonneuve fracture need to reaaproximate syndesmosis.The syndesmosis screw will have to be removed in a subsequent surgery. If not removed, the screw’s presence will not allow for normal ankle motion and could break causing more pain. Rehabilitation should proceed as directed.

Another article about the bench press you ask? Whether you agree or not the barbell bench press is one of the most highly regarded weight room exercises period. Have you heard this conversation in the gym lately? “So how much weight can you use for preacher curls?” “I’m moving some heavy weight, how much can you use for kickbacks?” “I’ve been struggling on those and I have a kickback meet coming up in a few months!” I’ll take a wild guess and say this conversation has never and will never take place. The truth is the vast majority of individuals measure their strength and even their manhood based on how much they can bench. You could be at the gym, or even at a bar having a beer but when the topic of working out comes up people are almost certain to ask the infamous question, “How much you bench?” If you don’t care how strong you are then I don’t know why you’re lifting weights anyway. The bench press is a benchmark of your strength plain and simple. Back to the conversation we didn’t hear at the gym. What our friends above should have been asking each other isn’t how much weight they use when doing kickbacks but rather how much weight they use when they’re performing a lower pulley external rotation exercise. Did I lose you there? I know, I know we declared the bench press is the true measure of our strength not all these isolation and stabilizer exercises right? This is true, but have you ever heard the expression, you’re only as strong as your weakest link? When you bench press there are four tiny muscles that play a major role in whether your bench press takes off or if you’re going to suffer from a bench press blowout. Build these muscles up and you can dramatically decrease the chance of blowing out your shoulder. If you’re benching heavy weight and not paying attention to these muscles you run the risk of muscular imbalances, shoulder pain, and getting stuck in a serious plateau. When bench pressing it essential to have stability and strength in the shoulder. The four relatively small muscles predominantly responsible for stabilizing the shoulder - teres minor, infraspinatous, supraspinatous and sucscapularous - are known collectively as the ‘rotator cuff’. When these muscles contract they pull on the rotator cuff tendon, causing the shoulder to rotate. While bench pressing you may experience some rotator or shoulder pain, during part of the movement. This is likely due to weak muscles in this area. Weak muscles are often but not always the cause of rotator cuff impingement syndrome and associated rotator cuff tears. If you have the rotator cuff strength of a little girl, your body has no choice but to limit the amount of weight you can stabilize and move to prevent injury. It’s not uncommon to see an individual break through a bench press sticking point simply by incorporating direct rotator cuff training. OK maybe now I have your attention. So how do you make sure your rotator cuff isn’t the weak link in your bench press? Or even more importantly how will you prevent a bench press blowout where you damage the rotator cuff? Like we discussed you need to strengthen the muscles, so let’s take a look at this workout routine. Remember if you already have an injury you should not use this routine as a rehab program but rather visit a sports medicine physician. If you want to prevent a future injury and break past a bench press sticking point then follow this routine twice a week. If you’re not in pain now, that’s an even better reason to follow my advice. Trust me if you have a nagging injury you’re not going to be growing or getting any stronger. Train smart, so that you can hit the weight hard when you do bench. The first thing you need to do is stretch the muscles you are about to train. Make sure you have warmed up for a good five minutes on the bike or treadmill before you start stretching. This will help you acquire greater flexibility. You already know stretching is important so just do it. You don’t need any equipment for this stretch. You can do it one arm at a time or with both arms at the same time. Extend your arms out from the torso at a right angle. Now bend your elbows at a 90-degree angle. Place your forearms on the frame of the doorway and lean forward. You will feel the stretch in your pecs and the back of your shoulders. Hold the stretch for 20-30 seconds. Next I want you to hang from a pull up bar for 20-30 seconds. This isn’t a grip strength test so no you don’t have to hang on for the full 30 seconds. Cuban Press Rotation Grab an EZ Curl bar and perform a wide grip upright row until the bar is a few inches below your collar bone. Now keep your elbows stationary while you externally rotate the bar as if you were trying to tap your forehead. Next you will press the bar overhead. Lower the weight along the same plane and repeat for ten reps. You will not be able to use the same weight you use for standard overhead presses due to the external rotation. This exercise won’t build your ego right now, but you’ll be thanking me when your bench press increases. Cable External Rotation Raise the pulley until it is even with your elbow. You’ll be standing sideways next to the weight stack so if your right hand is holding the handle, your left foot should be closest to the weight stack. Grasp the cable attachment with your far arm while keeping your elbow close to your side and forearm across your stomach. Your palm should be facing in. Pull cable attachment away from body by externally rotating your shoulder. Return and repeat. Turn around and continue with opposite arm. Cable Internal Rotation Again raise the pulley until it is even with elbow. You’ll be standing sideways next to the weight stack but this time if your right hand is holding the handle your right foot should be closest to the weight stack. Grasp the cable attachment with the closest arm. Keep your elbow close to your side with your palm facing in. Pull the cable attachment across your body by internally rotating your shoulder. Return and repeat. Turn around and continue with opposite arm. 90-Degree Dumbbell External Rotation To finish off the infraspinatus, hold a dumbbell in each hand, and perform a lateral raise to 90-degrees while keeping the elbows bent at 90-degrees. Once your upper arms are parallel to the floor, externally rotate your arm so that your forearms are perpendicular to the floor. It will look like starting point of a dumbbell military press. Now lower and repeat. Remember to use light weight. The infraspinatus is a tiny muscle so it can’t handle a heavy load. The shoulder horn is a great piece of equipment that keeps your arms in place while you perform this motion. Do three sets of ten repetitions for each exercise. Perform the routine once a week in conjunction with your current workout. This is important so listen up. The last thing you want to do is pre-exhaust your rotator cuff before training the bench press. Never do this workout prior to a heavy bench press or shoulders session or you run an even greater risk of aggravating the area. You can give these exercises a try at the end of your workout, but be sure you always give your rotator cuff muscles 48-hours rest after a workout before training chest or shoulders. Points To Remember: The muscles of the rotator cuff are very small. Even if you’re pushing five bills on the bench press you’ll still be using five-pound dumbbells for many rotator cuff exercises. So leave your ego at the door! Avoid lat pulldowns and military presses behind the head as they place the shoulder in a poor biomechanical position which enourages impingement. Training your rotator cuff muscles can help you avoid pain, prevent future injuries, and fix muscular imbalances. It’s not uncommon for a trainee to add 20+ pounds to their bench press simply by strengthening the rotator cuff muscles. Never perform a rotator cuff routine prior to bench pressing or overhead pressing movements. If you feel serious pain in your shoulder it may be too late. Go see a sports medicine physician. We all know people who were really into bodybuilding/powerlifting and looked forward to bench pressing only to eventually drop out after a few years of hardcore training. Why? In many cases nagging injuries especially those of the shoulder, simply took the fun out of it. This doesn’t have to happen to you so you’re ahead of the game. The best thing you can do to keep your shoulders healthy, and make sure your bench press continues to improve is strengthen your rotator cuff muscles so that they will never be your weakest link! After all your bench press will be going nowhere fast if you’re injured. Pick up the girlie weights for a few sets once a week so you’ll experience a bench press blastoff instead of a bench press blowout. Mike Westerdal is the owner of http://www.criticalbench.com. Visit his site to receive two free PDF reports entitled, “31 Days To Bigger Arms” and “Boosting Testosterone Levels for Big Muscle Gains.”

Best Ways to Injure Yourself in the Gym

This article has a sarcastic tint to it, but it’s educational and gets it’s point across well. If you really want to injure yourself while working out be sure you’re doing the majority of the following:

1)Perform latt pulldowns heavy, behind your neck with a very wide grip, causing excessive external rotation on your shoulders. Then do several sets and keep increasing the weight.

2)Do some aerobic or jogging type activity in the same shoes you wear around the house. It does wonders for shin splints, knees and back problems.

3)Do not warm up at all before lifting heavy weights. Lift “cold”.

4)Attempt squats with heavy weight before you can squat your own body weight. Squat with your knees bent inward and the back flexed.

5)When you finish the squats in number four add more weight and do it again.

6) Workout really hard daily, especially if you’re lifting. Never take a day off for recovery.

7) Do a set of back hyperextensions holding a 25 lb weight close to your chest. Perform the movement going as far up and down as possible. The more weight and range of motion the better.

8)Do a set of dynamic (walking) lunges with your waist bent forward and all your weight over your knees. Even better hold some hand held weights. If your knees hurt, you know you’re doing them right.

9)Leg press as many 45’s as possible with no proper warm-up. The heavy leg presses will impressively load and flex the position of your lower back.

10)Join an advanced aerobics class when you are a beginning level student.

11)Pick up a new peice of equipment you’ve had no instruction on and really give it a go. Work it hard and furious.

12)Watch the “hard core lifters” for tips and then try them. These are the guys who lift heavy with poor technique and spend a lot of time sitting between sets. Model these guys and you’ll learn all sorts of unique ways to weight train.

13) Take an aerobics class with a high level of choreography when you have two left feet. This encourages tripping on both your left feet and maybe a sprain too.

14)Hire a personal trainer and do a lot of the stuff mentioned above. After all, they are experts, right?

Remember, the above list is simply an eye opener. Everthing on this list is something you should not do. Unfortunately, these items are still commonly seen in gyms and many people are not aware they are not safe practices. If you are not sure what constitues a safe workout practice ask a staff member at your health club. Beware, however, that not all staff are properly educated, even the personal trainers.

Lower back pain is commonly due to irritation of the L5 and S1 nerve roots. Hip pain may result secondary to pain and spasm muscles of the lower back and all muscles that cross the hip.

Patients may have trouble with external rotation of the hip due to pain and spasm of muscles that perform external rotation or from pain and spasm of muscles that perform internal rotation and thus limiting the performance of the external rotators.

This week, we shall talk about muscles that perform external rotation. To test these muscles, the patient should lie on his stomach and bend the knee up. The patient then turns the leg and foot in toward midline. This motion produces external rotation of the hip. To test the strength of the external rotators, the examiner must try to push the leg outward away from the midline.

The hip external rotators are:

* gluteus maximus lower fibers (inferior gluteal nerve L5, S1 primarily S1)

* obturator internus (L5, S1, S2)

* superior gemellus (L5, S1, S2)

* inferior gemellus (L4, L5, S1)

* quadratus femoris (L4, L5, S1)

* obturator externus (obturator nerve, L2, L3, L4)

* adductor magnus, lower portion (sciatic nerve, L5, S1)

* adductor brevis (obturator nerve, L2, L3, L4)

* piriformis (S1, S2)

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