Don't Let an Injury Sideline Your Workout

According to the Consumer Products Safety Commission, over 50,000 people across the US visited the ER in 2011 as a result of injuries they sustained in the gym.  These are injuries that are sustained from wide range of factors including; falling off a treadmill, exercise ball, dropping weights on their foot or tripping over jump rope.  Although the majority of these are the result of accidents and required an ER visit, the majority of injuries we see in the clinic are not as dramatic and do not require an ER visit.  However, figure 1 shows the rise in workout related injuries from 2009 to 2011 and although they may not be as dramatic, they are very common and in most cases avoidable. 

Figure 1 - Shows rise of injuries by Sport from 2009-2011 - Amongst 20-40 year olds

So how do you avoid a workout related injury and what do you do about if you suspect you have one?  This is often a very difficult question to answer as exercise itself does cause some musculoskeletal pain or discomfort.  So, how do you know if it is an injury or simply a result of your last workout?  In this 2 part series, we will attempt to help you determine that.  First, we will indentify some of most common workout related injuries and common mechanisms that cause.  In the second series, we can talk about what early intervention you can do to prevent from becoming something that puts your workout on temporary or permanent hold. 

Most of the workout injuries we see would fall into the following general categories:

·        Low back pain.  This is definitely one of the most common we see and easily avoidable.  This type of pain or injury is commonly associated with:

o   Squats, leg press, bent over rows and dead lifts

§  Usually result of poor technique or using a weight that that is beyond person’s capability.

§  Ensure you are using proper form and when form is compromised, decrease intensity.

o   Running on the treadmill

§  Usually result of poor running technique, poor shoe wear, some underlying movement dysfunction or tightness in the lower quarter or core.

§  If you are having back pain with, try running on incline.  Doing this decreases spinal extension and can aid in reduction of pain.

§  If continues or progresses, have someone do a running assessment on you.  A qualified PT, DC or ATC can often aid in assuring proper foot wear and addressing underlying issues.

·        Shoulder pain.  This is definitely one that we see more and more in males and can be prevented.  The underlying pathology is numerous but commonly associated with:

o   Bench Press, shoulder press, bicep curls, lat pulls, push-ups

§  Usually result from underdevelopment of the rotator cuff, serratus anterior, poor posture during and range of motion beyond what is “shoulder healthy”

§  Ensure you are using proper form and if you feel like you have a “nagging” shoulder problem, you should have it assessed.  It can mean the difference between ice and a labral surgery.

o   TRX

§  A lot of the band work places the shoulder in extremely compromising positions.  Need to be cautious with as we have seen a lot of labral tears as a result of.

§  Ensure you are doing proper form, under proper instruction and if you have pain in the shoulder with, discontinue.

·        Knee pain.  We see this a lot in men and women but more commonly in women.  The underlying pathology is numerous but commonly associated with:

o   Step-ups, squats, box jumps, lunges, etc.

§  Last month’s blog was on a research project we are doing on these movements and the association with knee pathology.  If your knee moves in those predicatable patterns during the above exercises, you should talk to your personal trainer or see our onsite PT.

§  These movement result in a lot of stress to the knee/hip and low back.  If you do them while you train, you are training to do them with everything else you do.

Please keep in mind these are not all the injuries we see are listed nor all the mechanisms that cause these injuries.  This is simply a list of some of the most common and some simple things you can do to prevent.  A little bit of knowledge can prevent a whole lot of pain.

About the author:  Trent Nessler, P.T., D.P.T., M.P.T., is a physical therapist, and CEO of Accelerated Conditioning and Learning.  He is the researcher and developer the Dynamic Movement Assessment™, author of the textbook Dynamic Movement Assessment and Correction: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.

References:

1. Consumer Products and Safety Commission.  www.cpsc.gov
2. Jones, B; Knapik, J.  Physical Training and Exercise Related Injuries.  Sports Med.  1999; 111-25.
3. Baby Boomer Sports Injuries, U.S. Consumer Product Safety Commission, April 2000
4. Fiatarone M et al.  High intensity strength training in nonagenarians.  JAMA 1990, 263 (22):3029-3034.
5. Withrow, T; Huston, L; Wojtys, E; Miller, J.  “ The relationship between quadriceps muscle force, knee flexion, and anterior cruciate ligament strain in an in vitro simulated jump landing”.  Am j sports med.  34:269-274, 2006.

Are You Ready For Some ………Lacrosse?

Taking You From Conditioning to Rehabilitation

The excitement of seeing your child participate in sports is something that is beyond description.  Seeing your child injured while participating in those sports is devastating.  Often, this will lead parents to question, was there something I could have done to prevent this?  The simple answer is yes and no.  Spotting Sports Injuries. Obviously, if you knew the injury was going to occur then you might have been able to stop it.  But unless you are in the fortune telling business, that is not plausible.  But, educating yourself about potential injuries can lead to decreasing the potential for your son or daughter from suffering from an injury. 
 
Did you know that the injury rate for Lacrosse players is 2.89 per 1000 athletic exposures for boys and 2.54 for girls?  An athletic exposure is defined as one athlete participating in 1 practice or competition.  So if you have 20 players, 2 practices and one game a week that equals 60 athletic exposures.  The average team (20 players) has 640 – 700 athletic exposures a year.  When considering that over 100,000 girls and boys play on high school teams and another 150,000 are involved in recreational leagues, year round play is more common place.  As such, you can see that 1000 athletic exposures is quickly obtained during the course of one year in the sport.
 
That being said, over 50% of the injuries are the result of non-contact mechanisms (meaning no contact with another player or object).  The most common non-contact injuries were knee and ankle injuries.  Male players tend to have higher incidence of shoulder, neck and back injuries.  Although low, the concussion rate for Lacrosse players was .30 per 1000 athletic exposures which is second only to football.  Knowing this is important, because the proper training can have a direct effect on preventing or decreasing the potential for these types of injuries.  Not only do you reduce the potential for these injuries, but you also improve athletic performance. 
 
For example, proper strengthening of the core has not only been show to drastically reduce low back injuries but has also show to improve athletic performance.  We also know that proper strengthening and proprioceptive exercises for the ankle not only reduce ankle injuries but also have an impact on sprint speed.  Most amazingly, is that current research is also indicating that proper strengthening and conditioning of the neck can reduce the potential and severity of concussions.  So, aligning yourself with a performance coach who not only processes this knowledge but also skill set to develop an individualized program cannot only drive performance but also reduce the potential for injury.
 
Once an injury does occur, early intervention is key to success and aids in rapid return to sport.  Early onset of physical therapy has not only been shown to reduce the severity of the injury but also expedite return to sport as quickly and safely as possible.  Getting with the right therapist is essential to having a program that will not only rehabilitate the injury but which is also specific to your sport and one that will drive your performance.  Not all therapists are created equally.  Ensuring your PT has the experience in sports medicine, experience in working with the athletic medicine continuum of care (MD, ATC, PT) and extensive knowledge of exercise and biomechanics ensures you’ll be on the field in no time and in top notch condition.

About the author:  Trent Nessler, PT, DPT, MPT.  Trent is a practicing physical therapist with 14 years in sports medicine and orthopedics.  He has a bachelors in exercise physiology, masters in physical therapy and doctorate in physical therapy with focus in biomechanics and motor learning.  He author of a textbook “Dynamic Movement Assessment: Preventing Injury and Improving Performance", is the associate editor of the International Journal of Athletic Therapy and Training and Member of the USA Cheer National Safety Council.

References:
 
1.     US Lacrosse. 2003 US Lacrosse Participation Survey. Available at: http://www.uslacrosse.org/pdf/ParticipationSurvey_03.pdf. Accessed August 3, 2004.

2.     Andrew E. Lincoln, Shane V. Caswell, Jon L. Almquist, Reginald E. Dunn, Joseph B. Norris and Richard Y. Hinton.  Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study.  Am J Sports Med 2011 39: 95.

3.     2001-02 National Collegiate Athletic Association. Injury Surveillance System: Men’s Lacrosse. Indianapolis, Ind: National Collegiate Athletic Association; 2002.

4.     Mayer NE, Kenney JG, Edlich RC, Edlich RF. Fractures in women lacrosse players: preventable injuries. J Emerg Med. 1987;5:177-180.

5.     Richard Y. Hinton,*† MD, MPH, Andrew E. Lincoln,‡ ScD, MS, Jon L. Almquist,§ ATC, Wiemi A. Douoguih,† MD, and Krishn M. Sharma,† MD. Epidemiology of Lacrosse Injuries in High School–Aged Girls and Boys: A 3-Year Prospective Study.  AM J Sports Med 2005. 1305:14.

6.     Butcher, S; Craver, B; Spink, K.  The Effect of Trunk Stability Training on Vertical Takeoff velocity. JOSPT. May 2007.

7.     Hewitt, T; Reeves, P; Goldberg, G.  The Effects of Core Proprioception on Knee Injury.  Am J Sports Med 2007.

Concussions in Athletics: Are they Preventable?

If our child or athlete plays a contact sport, then you have most likely been aware of the recent increase in media attention on concussions.  In sports medicine, this is not a new phenomenon but rather an old lingering problem with a new resurgence in awareness.  In the state of Alabama, for example, if an athlete is “suspected” of having a concussion, then they “legally” cannot return to play until they are cleared by an MD.  Is this overkill and society being too cautious?  We think not.  Consider the following case study.

Billy (not real name) is a 17 year old high school football player.  Billy was a straight “A” student and exceptional athlete.  In 2007, he sustained a concussion during a high school football game.  He had a typical sideline presentation following his concussion and after a few days “appeared” to have returned to baseline.  Without being cleared by his MD, he was returned to sport and within a week suffered a second concussion.  This one was more severe and he was unable to return to play for the season.  During the course of the following year, Billy continued to have migraine headaches, bouts of vertigo, difficulty with concentration, short term memory loss and some personality changes.  Billy also, as a result of his vertigo, suffered 2 more concussions.  One concussion resulted from falling in his room and hitting his head on his dresser and the other from hitting an overhead bin in an airplane.  2009, Billy was having extreme difficulty in school, continued with migraine headaches 1x/day or more, loss of short term memory and moderate change in personality (depression, easily agitated, etc).  Billy was also unable to walk up an incline or do any light physical activity (where his heart rate was elevated about 40% of target heart rate) without getting increase in his concussion symptoms.  Good thing to know, is that Billy, by receiving the proper medical care and rehab (yes there is “concussion rehab” you can do - see following news story Concussion Rehabilitation), he was able to resume a normal life and resume participation in moderately non-contact physical activity.  Will he return to contact sports?  No.  But he will be able to return to an active lifestyle with modification and be able to go to college.

Understanding this is an extreme case, it is not as “uncommon” as you might think and hence why the increased focus on.  So, as a parent and athlete, are there things that you can do?  Yes.  First educate yourself of concussions.  What are the signs and symptoms, what is the recovery, what are the complications and what is the proper course of care for the concussed athlete?  Dr. Collins, founder of Impact and Executive Director of the UPMC Concussion Program provides great resources  at UPMC Concussion Program.  Knowing the signs and symptoms allows you to make informed decisions. 

Some experts even suggest adding a concussion preventative program to your pre-season and in-season routine.  What is a concussion preventative program?  They believe adding a neck strengthening program to your routine will reduce the potential for sustaining a concussion.  However, according to recent research in Clinical Journal of Sports Medicine, neither the severity nor probability of sustaining a concussion is dramatically impacted with the implementation of a cervical strengthening and exercise routine.  According to the biomechanical studies, the torque that occurs with a rotational force (as occurs with boxer being hit with round house) nor the magnitude of force that the brain sustains with an impact is influenced in any way with increased strength of the cervical spine.  Hence, according to the studies, the probability of sustaining a concussion is not impacted with a cervical strengthening program. 

However, that said, there are several flaws with these types of studies.  First of all, it is an extremely difficult to study rotational forces and magnitude of force in live subjects.  In Birmingham, sports medicine physicians are attempting to do just that.  To see if there is a peak force that is achieved that result in concussion sign and symptoms in athletes.  Secondly, the cervical strengthening programs implemented are not well defined and not ones that we would traditionally do.  Researchers conclude that this is an area that needs to be further analyzed and which there needs to be further investigation into the benefits of a neck/cervical strengthening program.  Knowing the above, is there a place for neck/cervical strengthening?  Absolutely.

In theory, a program which emphasizes strength and endurance of the cervical musculature (traps, scalene, paraspinals, etc) and emphasizes multi-planar strengthening would not only result in decreased incidence of concussions but also decreased severity of concussions when one is sustained (due to the decrease in force and torque).  By improving strength and endurance, the neck musculature is able to attenuate greater forces and loads and therefore reduces the magnitude of, not only the cou, but the contra-cou injury that occurs within the skull during these traumatic brain injuries.  Researchers agree with this hypothesis but to date, no one has put together the appropriate research methods to be able to test this hypothesis.  So will this type of program prevent a concussion?  No, but it may decrease the athlete’s chances of sustaining one and is something that most athletic programs are implementing as a result.  The key is to ensure you are getting a program that addresses the appropriate musculature, emphasizes strength and endurance and includes multi-planar strengthening.  If this is combined with educating one self, proper head and neck gear, a well defined protocol for dealing with the concussed athlete and a team athletic trainer and physician versed in concussion, then the risk is dramatically improved.

About the author:  Trent Nessler, P.T., D.P.T., M.P.T., is a physical therapist and CEO/Founder of Accelerated Conditioning and Learning.  He is the researcher and developer the Dynamic Movement Assessment™, author of the textbook Dynamic Movement Assessment: Enhance Performance and Prevent Injury, and associate editor for International Journal of Athletic Therapy & Training.

References:

1.      Mansell, J; Tierney, R; Sitler, M; Swanik, K; Sterne, D.  Resistance Training and Head-Neck Segment Dynamic Stabilization in Male and Femal Collegiate Soccer Players.  J Athletic Training 2005.  40:310-19.

2.      Mihalik, J; Guskiewicz, K; Marshall, S; Greenwald, R; Blackburn, T; Cantu, R.  Does Cervical Muscle Strength in Youth Ice Hockey Players Affect Head Impact Biomechanics?  Clin J Sport Med 2011. 21:416-421.

3.      Tierney, R; Sitler, M; Swanik, B; Swanik, K; Higgins, M; Torg, J.  Gender Differences in Head-Neck Segment Dynamic Stabilization during Head Acceleration.  Med & Sci in Sport and Ex 2005.  272-279.