Preventing Injuries for Football – Knee Injuries

If you’re getting injured, you’re not on the field. If you’re not on the field playing, you’re not getting better. If you’re not getting better, Nick Saban and Bo Pelini aren’t sending you letters asking you to have dinner with them and their family, their football family that is. Make sure your doing everything you can to prevent those football injuries. They can happen after a huge hit or from making a cut. Although either one can knock you out of the game or season, non-contact injuries are some of the most frustrating injuries. These occur due to poor mechanics or weakness in a muscle group that stabilizes a joint. We’ll touch on a couple ways to help prevent these injuries from happening.

Preventing Knee Injuries

Take a look at a running back taking a cut as he’s changing direction. Is he using his outside or inside leg to push off with? In most cases its his outside leg that he’s using to make the initial cut with. If its the inside leg, chances are he’s not running anymore. Many non-contact knee injuries occur this was as the knee is put under more force and torque than it could handle when its under the body.

As you go through drills, focus on pushing with your outside leg. This puts your knee in its strongest and most powerful position, protecting it from possible ligament damage.

EP-706079875There are several prehab exercises that will help prevent injury by activating the muscles that support the knee. One exercise is the terminal knee extension (TKE), which targets the vastus medialis oblique (VMO). Other exercises such as a single leg hop and hold the landing will help target the quadriceps and increase stabilization. While performing any of the knee exercises, keep your knee tracking in the direction of your foot and don’t allow it to fall inward or outward. This facilitates proper mechanics trains the muscles to perform this movement when needed most, in the game.

Injuries that occur from contact are hard to prevent from the prehab exercises above but the severity of the injury can be decreased.

What Supports the Knee

The ligaments that support the knee include two (medial and lateral) collateral ligaments and two (anterior and posterior) cruciate ligaments. The medial and lateral collateral ligaments prevent the knee from buckling inward and outwards and is often injured from being hit from the outside of the knee. As for the anterior and posterior cruciate ligaments, they prevent rotation and front to back movement of the tibia under the femur and are located with in the joint.

The knee joint moves over two menisci that act as a cushion for your upper leg (or femur) on top of the shin (tibia). Injuries and complications to the meniscus often occur with rotation of the tibia under the femur as with ACL and PCL injuries and often at the same time. Some symptoms might include the feeling of instability, swelling and stiffness.

Decreasing Recovery Time

Recovery from injuries to these ligaments often take 6-12 months. Going through physical therapy prior to surgery greatly decreases the length of therapy after surgery. It increases range of motion and prepares your quad for post-surgery strengthening. Through out the process, rest, ice, and elevation will help decrease the swelling that will also help decrease the recovery time, getting you back to the playing field faster.

Don’t assume the time you put in at physical therapy is all you need. Be sure to follow the home exercise program your physical therapist has prescribed to stay on track.

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An easy transition from traditional to minimalist shoes.

The first thing you want to do after you purchase your first pair of minimalist shoes is to use them as you would if you bought a normal pair. Throw them on and go for the same run or walk you did the day before. That is where most people go wrong. The transition from traditional shoes to minimalist shoes is a long process but can


A pair of Vibram Five Finger minimalist shoes.

The debate of using shoes for any mode of transportation, whether its walking or running, has been going on for decades if not longer. Barefoot (minimalist) shoes, such as the vibram’s, have been popular in the fitness community as a replacement to the highly supportive traditional running shoes. Being barefoot is natural and strengthens the muscles that support or feet. The benefits are numerous but takes time to achieve.



A pair of ASICS stability running shoes, model...

A pair of ASICS stability running shoes, model GEL-Kinsei (Photo credit: Wikipedia)

What many people do as they switch from traditional running shoes to minimalist shoes is they don’t ease into them. As we come from the traditional shoes, our muscles and joints have not been used to absorbing the force that comes with minimalist running. The amount of time it takes to adjust to the barefoot or minimalist shoes varies from person to person. Start by using them to walk around the house a little each day and slowly increase the time you use them to walk in. As you start to run in them, try softer surfaces such as a track or grass.

Jeff Gaudette, from, gives a great tip on how you should transition into your minimalist shoes. “Begin with some short 20 to 30-second accelerations in your minimalist shoes after an easy run in traditional trainers. Once you’re comfortable in your new kicks, progress to 3 to 5 minutes of minimalist running every other day and slowly add 3-5 minutes each week, focusing on landing softly with an efficient midfoot strike.”

Another thing that may change as you switch from traditional shoes to barefoot or minimalist shoes is your gate pattern or landing style. This typically occurs without you thinking about it to help absorb much of the increased force that the cushioned shoes took for you. Those who use traditional shoes usually run with a heel strike compared to minimalist runners who are usually mid- to fore-foot strikers. Although the point at which your foot contacts the ground changes from heel to mid- or fore-foot, there isn’t any research confirming the estimated increase in injury when running with a heel strike.

Minimalist shoes aren’t for everyone. Different gate patterns or biomechanical characteristics may need the support of a traditional shoe. These supports and shoe styles are dependent on the need of the person and a physical therapist or foot specialist can point you in the right direction.

What to look for when backpack shopping.

Here is a link to our BACKPACK SAFETY tips. Take a look at them before you go shopping for a new backpack or before the first day of school. These things are often overlooked and can have long lasting effects on our kids.

If you’re having a hard time viewing the pdf above here are some of the tips.


•           Two wide padded shoulder straps

•           Lightweight fabric

•           Padded back

•           Multiple compartments

•           Waist belt

These features not only make it more comfortable to wear a backpack,

but helps evenly distribute the weight



•           Wear both straps. Backpack should sit evenly on the middle of the back,

two inches above the waist.

•           Weight of the backpack should not exceed 10-15% of child’s body weight.

•           Be aware of your posture when standing or walking with book bag.

•           Pick the backpack up by bending at the knee, instead of throwing it over

the shoulders.



•           Use desk or locker more frequently

•           Do not carry around unnecessary items

•           Lighten the load! Bring home only the books needed for homework/ studying each night. Organize the heaviest contents so they are placed near the back.



•           Child struggles to get the pack on and off

•           Complaints of back pain arise

•      Child’s standing posture is altered due to the weigh and fit of pack

Traumatic Brain Injuries in football

Summer is almost over and high school football teams are starting camps all over the country. Whether the players have been training to make the varsity team, preparing for a state championship, or trying to impress college scouts, it now comes down to how they perform. Their training may help prevent non-contact injuries to the knee or ankle, but what about the head? Injuries to the head can cause far worse damage then one might think. Anything from experiencing no symptoms at all to life-altering traumatic brain injuries (TBI).

What used to be the most overlooked part of the body (in terms of training) until recent NFL lawsuits is starting to become a focus point of companies around the country. Companies are claiming that their products might help reduce the chances of sustaining a head injury or speeding up the diagnosis process. Are these products worth the money? It’s hard to say but something that might help player safety that doesn’t cost a penny is awareness.

The more we know about traumatic brain injuries the better we can prepare our athletes and the faster we can diagnose an injury to ensure that they aren’t playing through it. According to the CDC, older adolescents (15-19 yrs.) are some of the most at risk age group to sustain a TBI. What does this all mean in terms of football?

What kind of hits can cause a TBI? It can be anything from major hits that cause unconsciousness to a normal tackle or block to the helmet. It is still difficult to determine the amount of force and direction from which the blow comes from that causes these brain injuries. When these injuries occur, specifically in football, they may cause symptoms that players can often point out but don’t want to admit to the coaching staff in fear of being benched. Besides those symptoms that appear right away, other symptoms might not arise for days to weeks after the initial injury. This makes it difficult to pinpoint the cause.

Sustaining a traumatic brain injury during football, specifically youth football, can have long-lasting effects. We’re hearing more and more that kids are hiding their symptoms to be able to keep playing either out of fear or competition. Doing this can have life-long effects on their health, and it’s not just a knee that can be repaired, it’s their brain. This can be enhanced by the fact that football players are continuing to hit harder at younger and younger ages while the brain and skull are continuing to develop.


Nothing. After being diagnosed with a concussion or TBI the best thing to do is nothing. The obvious things to refrain from include physical contact and activity but some of the other not so obvious are limiting the amount of time that your brain is being used. That may include time home from school, studying, etc. Continue to stay in contact with your doctor or physician as every person is different in how they recover and are effected by a brain injury.


Trying to find ways to reduce the risk of your son sustaining a brain injury while playing football besides abstinence? Be sure that their helmet they are using fits correctly and continue to check the fit after games as it may loosen.

If you have further questions as training camps continue and the season nears, please contact us at or give us a call at 402.934.0045. Do everything you can to prevent a traumatic brain injury.

Balance problems or at risk of falling?

Balance in Every Day Life

Has it been hard to stand or walk without feeling like you’re going to fall? Do moving objects in your visual field mess with your balance? We often take our balance for granted until we experience trouble getting out of a chair, walking, bending over to tie your shoes, or holding your kids or grandkids.

There are a few different systems that help tell us where our body is in relation to our environment that gives us a stable stance whether we’re standing or walking. We like to think of these systems as the three legs of a tripod. They all work together to keep us from falling or feeling like our balance is off.

Feel like you could benefit from physical therapy just for symptoms like these? Visit us at

Visual System

One of them includes our visual system (our eyes) and tells us what the environment around us is like and what obstacles we may encounter. Often taken for granted, the eyes provide a large amount of information and takes into account what we are focused on as well as what is in our peripheral field (ambient vision).

Proprioception/Somatosensory System

Another system includes the proprioceptive/somatosensory system that tells us where our body is in space. The proprioceptive system uses sensory information that come from within the body. For example, if we hold our right arm above our head and close our eyes, we still know that the right arm is raised from information sent to our brains from sensory nerves. So if you think about walking or standing, we don’t really look at our legs when we’re walking but rely on the proprioceptive information from our legs to tell us where they are.

Vestibular System

The third one is the vestibular system, which has a lot to do with balance portion of our movements or stance. This system resides within our inner ear and as our head moves (along with our body) we receive information as to what direction and how fast or slow we’re moving. It doesn’t just help us with posture or stance but tells our eyes what they should be looking at and where to look next. Can you imagine how this might affect our balance if it were somehow “off” or not working right?

Typically these three systems are healthy as we’re young and can diminish in acuity as we grow old. Injuries to the head that we might sustain during sporting events or car accidents can also have an impact on these systems. These injuries are known as traumatic brain injuries (TBI) and sometimes can be tough to diagnose as they may not present themselves right away.

Balance and Vestibular Therapy

Some of the conditions that may be treated by balance and vestibular therapy include:

  • Movement Disorders
  • Chronic Mobility Disorders
  • Neuro Degenerative Disease
  • Fall Risk Identification
  • Dizziness/Disequilibrium/Vertigo
  • Vestibular Disorders
  • Orthopedic Injuries
  • Cerebral Vascular Accident (CVA)
  • Migraines
  • Head Injury/Concussion
  • Spinal Cord Injury
  • Worker’s Compensation

If you feel that you could benefit from physical therapy that is designed to treat these problems in balance then please give us a call or stop by any one of our locations below. Ask for Erin Bryant as she is one of our physical therapists that specializes in the different balance and falling disorders.


Location: 4201 North 90th Street
Omaha, NE 68134
Phone: 402.934.0045
Fax: 402.934.6562
Click here for directions.


Monday through Friday
7:00 am – 6:00 pm


Location: 3830 North 167th Court
(northeast corner of 168th and Maple)
Omaha, NE 68116
Phone: 402.502.2290
Fax: 402.505.3922
Click here for directions.


Monday through Friday
7:00 am – 6:00 pm


Location: 8419 S. 73rd Plaza, Suite 104
Papillion, NE 68046
Phone: 402.991.2745
Fax: 402.991.2748
Click here for directions.


Monday through Friday
7:00 am – 6:00 pm


Location: 1021 S. 178th Street, Suite 101
Omaha, NE 68118
Phone: 402.933.3036
Fax: 402.933.3163
Click here for directions.


Monday through Friday
7:00 am – 6:00 pm


Location: 6909 S. 157th Street, Suite E
Omaha, NE 68136
Phone: 402.933.5448
Fax: 402.933.5449
Click here for directions.


Monday through Friday
7:00 am – 6:00 pm

Preventing and Recognizing Heat Related Injuries

We were able to sit down with Pete Crane, PA-C from  Urgent Care of Papillion to talk about how we can prevent the onset of heat related injuries and illnesses due to the increase in temperature that we see during the summer months.
On days where the temperature is up in the 90’s, be sure that you are hydrating yourself well throughout the day and not just when you’re outside. It’s better to prepare than to react to something like a heat stroke.
Pete couldn’t emphasize enough the importance of “hydration, covering up and limiting your exposure time when it comes to dealing with temperatures in the 90-100 degree range like we’ve seen recently.” Try to plan outdoor activites earlier in the morning or later in the evening if possible. If this is not an option then be sure to stay hydrated by drinking plenty of water and electrolytes and take frequent breaks in the shade or air conditioning.
Serious problems could develop very quickly, so listen to your body and look for these symptoms:
  • Confusion
  • Dark-colored urine (a sign of dehydration)
  • Dizziness
  • Fainting
  • Fatigue
  • Headache
  • Muscle cramps
  • Nausea
  • Pale skin
  • Profuse sweating
  • Rapid heartbeat
By the time you begin to feel the symptoms of Heat Exhaustion it is extremely important to take the initiative in treating yourself or the person experiencing the symptoms as this will help limit the damage.
You should hydrate and cool yourself as soon as possible at the first sign of any of these symptoms. “Get out of the sun, use cold towels, fans or a cool shower” to help decrease the effects of a heat related injury. Medical advice should be sought immediately if you’ve fainted, felt feelings of light headedness, blurred vision, dizzy, or nausea. If you are unable to reach your medical professional either call 911 or come talk to Pete at their location off 72nd and Giles.
A good source for more information can be found at: and WebMD to check your symptoms.
Urgent Care of Papillion
8419 South 73rd Plaza, Suite 101
Papillion, NE 68046
Open 7 days a week.
Monday – Friday – 8:00am – 8:00pm
Saturday -Sunday – 9:00am – 5:00pm

Staying injury free in the garden!

The summer months are upon us and that means more planting, weeding, mulching, and raking. These repetitive movements may seem harmless but can have us raking through the theraband drawer at physical therapy in no time. You can do a few simple things before you start to reduce the risk of injury and will keep your garden from becoming abandoned.

  • Warm-up: This sounds rudimentary but a proper warm-up can get your muscles and joints ready for the task at hand. Whether that is just getting out for a quick walk before and/or stretching, it will help prepare you.
  • Listen to your body: If you start to ache, cramp, or feel pain in your neck or shoulders, take a minute and stretch. Your body is trying to tell you that you are in a wrong position or overworking your muscles/joints so switch up your position or hand that your using.
  • Don’t knee on both knees: This will help give your back more stability.
  • Stretch: When you’re all done, stretch and go for a little walk. This will help prevent soreness the next day.

Contact one of your local Makovicka Physical Therapy clinics if you have questions on mechanics to prevent injury.


Positive effects of stretching.

At Makovicka Physical Therapy, we believe that stretching has a major impact on the outcome of our patients’ rehabilitation programs. Not only will it help after surgery, but stretching will also decrease the risk of a chronic injury that arises from either repeated motions or work habits. We will be focusing on some simple stretches that will decrease muscle tightness that often leads to chronic pain.

Sitting at a desk for 8 hours can benefit from a stretching protocol the same way someone who is physically fit benefits from stretching after a workout. The stretches we will be going through can be done standing up or even sitting at your desk and should become part of your daily routine.

Wrist stretches may be the most simple and can be done sitting at your desk. As we use our hands and wrists for day-to-day activities, it is very important to relieve some of the muscle tightness that may come with that. The stretches below can be held for 20-30 seconds with a straight or bent arm.

Our physical therapists at Makovicka Physical Therapy have treated these chronic injuries in athletes at Papillion-La Vista, Bellevue East and West, Millard, and Omaha school districts and would love to answer any questions you may have.