Monday, October 9, 2017

Injury, Recovery, Movement Enhancement - A Guest Blog

Enhancing recovery and improving movement efficiency is critical in the treatment and performance enhancement training of our athletes.  The balance of bringing our athletes back to the field following injury is always a delicate balance of training hard enough and yet not over training.  This is where recover is truly key.  I am truly humbled to have one of the leaders in this field Lenny Parracino, CMT, FAFS from the LA Clippers willing to give his thoughts on how he addresses and some of the tools that he uses.  
Injury, Recovery, Movement Enhancement - A Guest Blog
By Lenny Parracino, CMT, FAFS

Injury, recovery, and movement enhancement are all common characteristics of an athlete.  It’s the balance of these three characteristics that becomes tricky.  Lets start with injury.  Injury by definition is a disruption of unity.  The reality is that all athletes during their career will experience some form/degree of injury.  Even soreness after training is technically an injury!  In fact, muscle soreness is muscle damage.  Recently, BYU research shows immune system cells help to repair muscle damage after a workout, a normal response to injury, which is great, BUT do we want our immune system always activated after working out?  What does this reaction do to our movement enhancement?  Knowing soreness is an injury and chronic soreness decreases movement performance, learning a process to optimally recover should be a critical part of everyone’s plan if long-term healthy movement is the goal!

As for the recovery, regardless of the level of injury, we need a safe/pain free environment for optimal adaptation.  All techniques can be categorized into either 1) pain control or 2) conditioning.  Pain science has taught us that the solution for pain is 1) change the sensitizing agent(s) and/or 2) build tolerance to the sensitizing agent(s) or the structural change.  Pain is a sensation of a perceived threat.  Perceived being the key word.  Pain, regardless of how one describes it can no longer be directly correlated to the degree of tissue damage. A great example is a paper cut hurts “big-time” yet a cancerous tumor may not hurt at all.  We can only imagine the cancerous tumor displaying much more tissue damage! 

The solution to enhance movement after an injury is to first decrease sensitive tissue regions followed by building up tissue tolerance.   This leads me to what I refer to as Soft Tissue Hygiene.   We are all taught how to apply a hygiene approach to our dental structures, but what about the rest of our tissues?   Teaching athletes DAILY soft tissue hygiene, utilizing tools that improve soft tissue resilience/tolerance, is key to mitigating chronic damage – just like brushing and flossing.  We don’t brush only when we think we need it, we learn to create a HABIT.  The only way to make a chronic change to your tissues is to implement a chronic habit.  Research has demonstrated tools that compress the tissues SLOWLY change the internal fluid matrix in a beneficial way[1].  When there is increased viscosity (thickness) in the internal fluid matrix it can adversely affect many mechanisms in our body.  Free nerve endings and other mechanoreceptors can be altered, leading to chronic soreness, pain and/or stiffness, and altered motor control.[2] In addition, if the tool exhibits vibration with compression (such as with the Hyperice Vyper vibrating roller or Hyperice Hypersphere vibrating ball), there is a greater benefit than just massaging over the skin or using an implement to roll up and down body parts.  Since the change occurs in the viscoelastic components of the soft tissue complex, SLOW compression/shear/vibration and heat tends to bring positive benefits in the conditioning phase.  If one is in the pain phase I would suggest ice/compression (such as Hyperice) and client/patient pain free micro-movement.

In summary, chronic soreness (injury) should be avoided at all costs if the intention is movement enhancement.  Although there are MANY factors that can contribute, far more than just mechanical, the physical aspect can be assisted by proper soft tissue hygiene.  Although research is now available on this subject, results will speak for themselves. I recommend assessing, applying, and reassessing to adjust variables for optimal adaptation.  By sharing this process I hope I have spurred thought to yours.  By using your intelligence and not memorizing protocols we shift from a master-mechanical-technician to a creative-humble-facilitator.   Lets teach people soft tissue hygiene!

[1] Roman, M., Chaudhry, H.,Bukiet, B.,Stecco, A., Findley, T.W., 2013. Mathematical analysis of the flow of hyaluronic acid around fascia during manual therapy motions. J. Am. Osteopath. Assoc. 113 (8), 600-610.
[2] Stecco C., Stern R., Porzionato A., Macchi V., Masiero S., Stecco A., De Caro R. 2011. Hyaluronan within fascia in the etiology of myofascial pain.  Surg Radiol Anat. 33(10):891-896. 

Lenny Parracino is a former author, hands on instructor, and clinician for The National Academy of Sports Medicine. Currently, he serves as a faculty member of the Gray Institute of Applied Functional Science, is the Soft Tissue Therapist for the LA Clippers, and operates a manual/movement private therapy business. Lenny has recently authored seven manual therapy manuals (Functional Soft Tissue Transformation) and the Gray Institute’s Certified Applied Functional Science (CAFS) curriculum for manual/movement practitioners of all levels.
Lenny has spent over 25 years serving the health industry as an international lecturer and a manual/movement therapist. Lenny has performed over 300 lectures/workshops and has written educational materials and consulted/lectured in the fitness/therapy industry and for various medical organizations around the world. Lenny has earned his degree in Health Science, is a Fellow of Applied Functional Science, holds a California certification/license to practice soft tissue therapy, is a Certified Functional Range Conditioning Practitioner, and holds a certification in nutritional therapy. Lenny continues his studies under the world-renowned physical therapists, Dr. Gary Gray, and Dr. David Tiberio.
Lenny has worked with professional sport teams and/or players from Phoenix Suns, LA Clippers, San Francisco Giants, Philadelphia 76ers, Philadelphia Phillies. Minnesota Twins, LA Kings, and Seattle Seahawks and Buffalo Bills. 

As a full time practitioner, Lenny integrates an eclectic approach of Manual/Movement Therapy with the intention of optimizing individual client function.

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 


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