Expert Panel Responds: Ask a Sports Medicine Expert

by | November 29, 2012, 4:00am 0

Last week, Skyd introduced our panel of training professionals and elite level athletes (Anna Bucher, Jaime Wolf and Jamie Nuwer) for our training topic of the month. If you have follow up questions, please ask them in the comments. We have encouraged our panelists to respond there.

Question 1

Jesse Kummer asks “I tore my right ACL in 2010. After surgery and ~9 months of strengthening/physical therapy, I started playing competitive Ultimate again. I played full college and club seasons with no major setbacks.  However, around August I started getting a sense of weakness in my left knee (the non-torn one). I don’t know a better way to describe it, It just feels weak. At Club Regionals, it buckled a little during a point. I have done some more single leg weight strengthening and both legs can lift the same amount. Any advice on what to do?”

ANNA BUCHER, Doctorate of Physical Therapy


This question leaves me to wanting to know more about the knee itself.  What bothers it both during and outside of frisbee? How does the knee hold up to ligament and meniscus testing? What does it look like when they move (i.e. single leg stance, step down, squat, rotatory stability)?  How does the rest of the leg move? I would specifically want to investigate the knee a little further to make sure that the integrity of the joint is okay prior to attempting a strength program.  I know it is a pain sometimes to get into seeing a doctor or PT, but it is worth the investigation to get a clean slate of health and make sure that you aren’t setting yourself up for risk of further injury.

From there I would focus on adding power to the program.  It looks like you have it covered as far as single leg weight strengthening (making sure it is all functional strengthening i.e. not machines, but single leg dead lifts, rear foot elevated split squats, lunges, step ups).  You can start with some basically non impact activities such as kettle bell swings and treadmill pushes aka deadmills to develop some linear power where you still have some of the support of the other leg.

kb swings

Make sure it is the hips that are driving the motion and not back or arms.  It is all about accepting the load and then exploding out of it.  It is as if the weight is a pendulum.  If you don’t have a kb you can use a dumbbell by holding onto one end of it at the plate with a hand on either side.  As you get into heavier loads, you might need to stand on two steps to give you some clearance.  Nothing like smacking the weight into the ground on your down swing.  Typical starting weight can be ~15 pounds, 2 sets of 15 just to get the groove.  I would also focus on only bringing the kb up to shoulder height for less chance of back involvement.


Typically you’re doing 3 sets of 15-20 steps on each side with about 30 seconds rest between.  Focus on staying on your toes, driving your knees up, and keep your legs underneath you.  I love doing these between circuits.  Great way of working anaerobic and power when your legs are tired.

From here you can progress towards more basic single leg power by doing skipping, speed skaters, and hop and stops.  With any kind of plyo program you do not want to do a ton of reps and make sure you have adequate rest to maintain good form.  Typically I would recommend 2 sets of 5/side for each activity to start off.  At first focus on good control and stability and then progress into making the movement faster, still making sure that you have control of course).  Here are some videos.


speed skaters (aka lateral bounds)

As you get the hang of it you can emphasize distance and height

hop and stops

This is the best video I could find.  It is basically a lateral bound at a 45 degree angle and you will not only be going forwards, but also backwards, bounding from right to left and then backwards to your right leg

Often power is a missing component of a basic strength training program.  Plyometrics can be used to transition your foundational strength that you have achieved through your basic lifting program to functional, sports related performance improvements. With plyos, remember to not sacrifice form and give adequate rest when doing plyos.

JAIME WOLF, Physical Therapy Student


Good thinking by looking at single leg lifts, but I would be just as interested in form and control as being able to lift a certain about of weight. I would assume that in your ACL rehab you learned about proper form for double and single leg squats. Key form points: feet hip width apart, toes forward, knees stay in line with 2nd toe, and think “butt back” as you squat down. Can you maintain good form on both sides? Is it harder to maintain this form and control on one side compared to the other?

The exercises to look at here would be single leg skater squat, step up, single leg dead lift, and single leg swissball hamstring curl. We are looking for control and endurance here, not maximum weight lifted, 3×10-12 reps.

If you are unable to maintain good control of the knee position (knee valgus) then you likely need to work on hip abduction and external rotation strengthening and control. Some good exercises for this include:  clamshells, superclams, and double or single leg bridges. Work on these consistently for a few weeks and then try to return to the single leg exercises listed previously.

Make sure you are doing some static stretching for the quads, hamstrings, and calves to make sure that a lack of flexibility isn’t leading to poor running form and earlier fatigue.

Links to exercise pictures
squat form, bad squat with knee valgus
skater squats, single leg squat (left good, right bad)
step up
single leg deadlifts
double leg swissball hamstring curls
single leg swissball hamstring curls
clamshell (prefer this exercise as an isometric hold)
super clam (use a band for resistance like the regular clamshell)
double leg bridge
single leg bridge

JAMIE NUWER, Sports Medicine


I’m sorry to hear about your bad knee luck. You should get your left knee examined by a sports medicine doctor. The sensation of weakness could be from a muscle imbalance, a nerve issue, or a knee injury.  Rehab will depend on which of these it is.

Question 2

Pooh wants to know, “After playing ultimate since 1995, I’m lopsided from doing thousands and thousands of right leg lunges (to pivot to throw forehands mostly), what are some exercises to rebalance especially my hips and mid/back area?”

ANNA BUCHER, Doctorate of Physical Therapy


A good lifting program will help counter the patterns we fall into during sports.  In rotational sports, it is especially important to make sure you rotate in the other direction as well.  Your mid/back area will be incorporated into lower body and upper body work.  That area is designed to help control movements, make the connection from legs to arm (huge for rotational power), and set a good foundation to jump, throw, push, pull, bend, and lift from.  Focusing on single leg work (once again our friends single leg dead lifts, rear foot elevated split squats, lunges, step ups) as well as including some single arm strength will help balance your time spent playing ultimate.  You can break up arm exercises into horizontal push/pulls and vertical push/pulls.  Using the cable column is a great way for doing single arm work that will also help incorporate a little bit of trunk and hip rotation with it as well.  Chops and lifts are also another great way to create core and hip stability.

cable column pull

You can start in the split legged stance, but make sure that you get a little weight shift to involve your hips, trunk and scapula while rowing rather than just expecting your poor little arm bone to do all the work.

cable column push

He only does the right arm portion of this, but notice how he is driving from hips and trunk to go forward and then controlling the weight, stopping by your chest when going back.

chops & lifts

With chops and lifts it is not about rotating in your trunk to create the movement, but pushing/pulling across the midline on a diagonal while maintaining a stable, upright base (i.e. no arching back or leaning forward).

JAIME WOLF, Physical Therapy Student


The key is here is having a comprehensive training program in which throwing and playing is only a portion for your overall fitness activities. A good well-rounded program should include static stretching, active warm ups, foam rolling, weight lifting, conditioning, and agility training. Even in a game, except maybe an o-line handler, you spend much more time running, cutting, and marking than you do with the disc in your hand pivoting. The issue is most prominent during dedicated throwing practice. Hopefully you have at least a short “off-season” that involves lifting or maybe other sports but not as much throwing.

My favorite throwing drill was probably the worst for creating this problem but I really liked what it did for my throwing: super slow throwing. Basically step out and get low for a forehand, pause at full reach, then fake, full pivot to back hand full reach, get balanced there and then finally throw. I would do a round of 20 each side, which would leave me feeling sore and unbalanced for sure. I usually would follow this up with 20 side lunges and 20 forward lunges with my opposite leg, a little bit of core work (planks and bicycles), and then a few minutes of static stretching. The kung fu throwing program has a little bit of opposite hand throwing and pivoting, which felt really foolish the first time but seemed reasonable during future attempts. Obviously a few opposite side lunges or pivots doesn’t completely undo the imbalance but it’s a good place to start and I think
you would be surprised how much it does.

If the issue is more chronic than you need to have a look at your total flexibility differences (hamstring, quads, groin, glutes, and hip flexors). You are going to have differences but the goal would be to minimize them. Also try some of the exercises I mentioned in the previous section for single leg strength and control.  Finally core exercises I like would be front and side planks and in the gym using cable column or resistance bands to do standing rotational core work.

JAMIE NUWER, Sports Medicine


This is a very interesting question that has been receiving a lot of medical attention lately in other sports.  Imbalances are common in many sports because of various one sided demands. This leads to overuse injuries and eventually to strength and flexibility imbalances that can affect the entire kinetic chain.  The kinetic chain is for example your lower back to hips to legs to knees to ankles to feet. They are all connected and influenced by one another.

The best way to treat a perceived imbalance is to get evaluated by a specialist. This could be a sports doctor, athletic trainer, or physical therapist. The person must be knowledgeable in how to test strength and flexibility of all the muscles and joints in the kinetic chain. They also need the right measurement tools to show your progress. There are multiple means to do this. Find someone you trust to work with you on measuring your body and coming up with a plan tailored to you.

There is not a one size fits all solution to this problem; I wish there were. In general when you’re training try to do exercises and stretches symmetrically.

Question 3

Max Herrmannsfeldt asks, “How should warming up after a two-hour bye differ from warming up for the first game of the day?”

ANNA BUCHER, Doctorate of Physical Therapy


I actually treat the warm up portion after a bye very similarly to what I do prior to the first game.  In the morning, it is important to get our throws, cutting patterns, and defensive movements primed and ready for action.  However, by the time a bye occurs, all of these should be pretty ready, so the drills is where I would actually cut back on time for the warm up after a bye.  The drill can focus on what specifically you need to do to prepare against the next team and be used as the final transition to get people’s legs moving underneath them.

Injuries happen after being cold and not properly warming up again, and even more so when we are tired.  Warm ups should consist of movement prep exercises to get our core, glutes, and stabilizers activated, dynamic stretching in all directions and planes, transitional movements, and accelerators.  The warm up after a bye is not only used to prepare us for the next game, but to also clean the slate of the damage and work that we put on our bodies in previous games.  It is important to take our bodies through full functional movements, proper movement prep, and get our legs moving again in good patterns.  When we are tired, it is even more important to focus on form, reminding our bodies how to move correctly rather than what is easiest and making sure we stay mobile so that we can access bigger muscles in order to move correctly.

JAIME WOLF, Physical Therapy Student


Before my first game I foam roll, whole body mobility, and then dynamic warm ups. Later in the day I usually just go right into dynamics. On Sundays or cold mornings, I’ll jog 5 minutes or throw around to warm up prior to any of this. This largely depends on how you respond to these breaks and how your body is feeling that day. There is not really any research out there that I’m aware of directly relating to this matter.

There is some research out there that suggests vertical jump test performance decreases with prolonged static stretching immediately beforehand. These studies have led many people against static stretching. The same has been said about foam rolling, but the information is less reliable. However, you need to consider information like this in the context that you actually play in. First off very few people at tournaments or practice (league and pickup is different) go directly from stretching or foam rolling into their first point. Even if these activities decrease your vertical jump by 1 inch, if you decrease your risk of cramping or pulling a muscle then it is well worth it.

Really just be aware of what is feeling tight or too loose at any part of the day and work on it. Also think about what bothered you late in the day or the weekend at your last tournament and try to address those mobility issues.

JAMIE NUWER, Sports Medicine


Warm-ups should be focused on priming your body to play Ultimate. Most of the team warm-ups that I see while coaching are way too long. There are several important elements to warming up. My teams don’t change our warm-ups much between the beginning of the day and after a bye. If you or your teammates are feeling tight add a short (30 seconds max per muscle group) static stretching component between 1 and 2. I usually have people stretch whatever they need to stretch on their own during that time.

1) Sweat – one lap, jumping jacks, dance party, whatever gets you sweating without hurting yourself

2) Dynamic stretching – work from your feet up to your hands, start with small and focused muscles then move to big multi-muscle movements

3) Accelerators – priming your muscles and joints for full speed, these need to mimic all direction changes in Ultimate. For example: side to side shuffles, 45 degree angle turns, back pedaling, drop-step turning on defense, plant and turn, chopping steps to turn, etc.

4) Confidence building drill work – you can add any drill you like. It should be one you do all the
time, works on O and/or D, and gets people fired up. This is mostly for the mental game.

Bonus Question!

Jackson writes, “Had surgery for a chronically dislocating shoulder (popped it ~10 times) in April 2012. Worked hard to rehab it, took six months off, was cleared by my surgeon (and physio, who i’d spent much more time with and was far more in tune with my body and my needs as an athlete) and it had been feeling strong until recently during a drill, while chasing a disc too far in front of me, I reached my arm out and felt that old slip-out feeling of the bone leaving the joint slightly, and sliding right back in. For the next couple days, i experienced a weird feeling of friction inside the joint when I would rotate (as in internal and external) my arm. It’s my non-throwing arm.

Is my shoulder toast? Can i save it? What do I do to stop this from happening to my other shoulder (which would be way worse)? Should I go to a doctor, or is the friction issue not a big deal?

Lots of people in Ultimate have shoulder problems, dislocations are common, and maybe by answering this some people will take some steps to protect themselves cuz it’s really been a shitty injury that’s kept me from the highest competitive level on and off since I did it originally”

JAIME WOLF, Physical Therapy Student


While I have known a few people forced to quit Ultimate due to chronic shoulder dislocations and rotator cuff tears, I cannot really tell you the status of your shoulder just based on a description. It really takes a combination of an evaluation for an orthopedic MD, an MRI, and 6-8 weeks of physical therapy to even attempt to make that type of fatalistic decision. I would however like to talk briefly about the common shoulder instability issues.

While multi-directionally and posterior instability problem do exist, the vast majority of dislocations, and instability problems, are anterior in direction. This means the head of the humerus (arm) moves forward relative to the socket in the scapula (shoulder blade). Therefore, general rehabilitation involves stretching the muscles of the chest and front of the shoulder while strengthening the muscles of the back, the scapula, and rotator cuff. The absolute last thing you would want to do would be push-ups or bench press. Start with good posture of the spine and with the scapula pulled back (and possibly a little bit down), from there work on rows and shoulder external rotation.

If your general posture involves shoulders rounded forward (probably 90% of the population), then you increase your risk for shoulder problems. Sit up straight and get those shoulder blades down and back on your rib cage. Also, a little bit more mobility for your thoracic spine can do wonders for improving the alignment and reducing the stresses at your shoulder joint.

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