The tuck jump is a useful and practical evaluation and return to sport test. Many people forget about the tuck jump when going through their return to sport criteria but I think it is an undervalued test. Lets go through some of the things the tuck jump helps with....
- Looking at valgus of the knee's before, during, and after the jump
- Control- Are their thighs parallel during jump? Do they favor one side?
- Foot contact: Shoulder width apart, foot placement, foot timing, How hard are they landing?
- Plyometric: Technique and power- is their a pause? Are they landing in same spot each time? What do they look like in the flight of the jump?
I recently went through four different return to sport cases with my patients this past month. Three were ACL and one was an internal impingement case. Each time I make decisions about return to sport I consider the patients characteristics. While the research tells us certain tests are good, they don't always apply to our patients. Digging deeper to make sure you take each case on an individual basis is more important.
Take an ACL patient that is very low tone for example. They are going to have a very difficult time gaining strength throughout their rehabilitation. Furthermore, imagine if they were a mechanical mess. Clearly this is an example of a patient who may need some extra work and a much longer recovery time. So how would I approach one these patients? First I would look at the time frame and their requirements for the sport. A patient who is low tone and an MMA fighter would be out for at least 9-10 months due to the extreme positions their sport requires. But a patient who is low tone and baseball player may be able to return sooner depending on his position and mechanics. Again, it's all patient dependent. Another thing I might look at for a low toned patient is how their strength is transferring to both mechanics and power. Often times I've seen these low toned athletes get strong but struggle with controlling that strength. Spending additional weeks and months on mechanics can make all the difference. Lastly, how is their psychological state? I recently had an athlete that did well with his return to sport testing but was not confident in returning to game action. Did I return them? No, I didn't because mentally they needed to feel confident. This is where referring out to a sports psychologist can be useful. Furthermore, my approach with that patient has changed to provide additional encouragement and show them how good they have performed in the clinic.
Returning athletes back to their sports can be difficult. We must take into account so many variables (fatigue, strength, pain, psychology, mechanics, biomechanics of sport, power, etc). Most importantly though we must individualize it and understand the characteristics each patient presents with.
How many of you have dealt with a baseball player who has had shoulder pain? And out of those who have did you see a lack of core control, loss of shoulder flexion, or ribcage flair? If you did chances are you also noticed that the lats were very stiff and dysfunctional. It's a common occurrence with baseball players. So why is this? What is the fix?
The lats are a big muscle group that have many functions that influence everything from rotation to flexion. With their insertion via the low back/pelvis they also affect the core function. Often we see a lumbar lordotic posture with overhead posture as a substitution when the lats are unable to control or the core is not stable. This being said, working the core can sometimes fix the lat problem vs just working on the mobility of the lats. Motor control of the core is vital when re-teaching lat control in baseball players (and any athlete). Make sure to look at whether the lats are the problem or the core is when working with patients.
Some thoughts on assessing the lats:
- Is it hypertonic? If it is- why? Hypertonic muscles can present as a shortened OR lengthened muscle.
- Is it truly "short"? - Use the lat muscle length test
- Brian Schwabe, PT, DPT, SCS, CSCS
Board Certified Sports Clinical Specialist in Physical Therapy/Strength & Conditioning Coach/Fitness & Medical Writer
Sports Physical Therapist in Los Angeles, CA