Monday, January 30, 2017

Innovations in Movement - Blending Movement Science with Technology - Part V

Over the course of the last several weeks we have been discussing how to leverage technology for the assessment of movement and treatment of movement dysfunction.  Most of the technologies we discussed can be easily implemented into treatment and are relatively inexpensive.  Those that are used for the assessment of movement dysfunction can, many times, also be an additional billable service that can be added to your athlete’s episode of care.  To conclude this series, we will be discussing the use technology for HEPs and tracking of compliance with the athlete.

One of the first we will discuss is the ACL Play It Safe Program.  In full transparency, this is one that I have been personally involved in but have no financial tie to.  This is a program I developed to address the preventable non-contact lower limb injury epidemic in sports.  Although the name suggest this is ACL specific, this program is movement specific.  This means this addresses the biomechanics and movements that are associated with non-contact lower kinetic chain injuries, one of the most recognized of which is the anterior cruciate ligament (ACL) injury.  In addition to mitigating injury risk, these same movements are also associated with a decrease in athletic performance.  So, this program is specifically designed to improve the efficiency of athletic movement which results in reducing injury risk and improvements in athletic performance (specifically vertical jump and sprint speed). 

This program was developed in conjunction with Theraband® and Cramer®.  The ACL Play It Safe program is a comprehensive program that can be implemented with an athlete as a part of their home exercise program.  This program includes:

·       Gender specific kit – There is variance in the male and female athlete based on the peer reviewed literature.  The research indicates there are variances in strength and proprioception among the male and female athletes which is accounted for in the male and female kit.

·       Standardized equipment - This standardized kit is designed for the individual athlete.  Having standardized equipment ensures that the athlete is using the same equipment each time and has the equipment available for every exercise.  This improves outcomes since the athlete will not be using different equipment each time and/or skip an exercise because the equipment is not available. 

·       Equipment included – each kit includes the following:
o   CLX – this is the latest development in resistance band technology and was developed by Theraband®.  Use of the CLX allows us to perform very creative exercises like the spiral technique.  This particular technique allows us to perform single limb training while increasing Gmed recruitment during this activity. 

Spiral Technique

o   Padded Cuffs – allows us to perform closed kinetic chain gmed and core strengthening.
o   Stability trainer – allows us to work on single limb proprioception and core stability training
o   Biofreeze – to do the aggressive nature of this program, this allows us to control muscle soreness and irritation that may develop as a normal part of an athletic season.

·       Standardized program – the ACL Play It Safe Program is a progressive program that is designed to be implemented as a part of your team’s practice or training.  This program includes two very distinct parts.
o   Pre-practice routine – Neuromuscular resetting – this is designed to prep the system for movement or participation in sport.  This only includes three movements but are full lower kinetic chain movements that add in improving lower kinetic chain mobility while at the same time initiating the proper movement patterns.  This routine takes 3-5 minutes.
o   Post-practice routine – Fatigue state training – we know that most injuries occur later in the game and that athletic performance is negatively impacted by fatigue.  What the literature tells us is that training in a fatigued state will have a better carry over and impact to the athlete’s movement in a fatigued state.  This means they move better, are at reduced risk for injury and they perform at a higher level.  This routine takes 15 minutes. 

·       ACL Play It Safe App – as a part of the ACL Play It Safe Program, we have developed the ACL Play It Safe App.  Knowing the importance of proper instruction in movement and corrective exercises, we have found that providing this in a comprehensive video was one of the most effective means of doing so.  The ACL Play It Safe App was developed in conjunction with Theraband® and Cramer® and is an easy way to provide a video for every exercise included in this program in an app.  The ACL Play It Safe app can be found on IOS or Android by searching “PhysioSports” and is free.   The ACL Play It Safe app provides:
o   Level I – IV exercises
o   Specific order in which the exercise should be performed
o   Specific technique for each exercise
o   Number of sets and reps for each exercise

*Note – it should be noted that this is a web-based app due to the number of videos included.  This means that you will need access to the internet or cell service in order to run this app.*

In addition to the ACL Play It Safe App, another technology that is being used in home exercise programs for correcting of movement dysfunction is Fusionetics.  Fusionetics was developed by Mike Clark, DPT.  For those in athletics and familiar with movement assessment, Dr. Clark has been an innovator in the area of movement assessment, corrective exercise and technology.  Fusionetics is his latest innovation and is quickly becoming a great platform for distribution of quality research based content and provides a tool by which we can track the athlete’s progress and compliance. 

Fusionetics is a web-based platform that that provides some very unique features.  Once the athlete’s movement has been assessed, the athletic trainer, physical therapist or personal trainer can then build a profile in the software for the athlete.  This allows the provider to assign or prescribe exercises and the frequency at which these are done.  The athlete is then provided with a link that allows them to set up their individual profile and to access the Fusionetics App.  When the athlete logs into their individual profile on the app, they are then provided all the exercises the provider has prescribed to them along with comprehensive videos of each exercise.  Once the athlete performs the exercises, they then log in the app that the exercises were performed and how they are progressing with the exercises, the level of difficulty and if they experienced pain with.

For the provider, once they log into their account, they can instantly see all their athletes, which ones are doing the exercises, who they are progressing and whether or not they should be progressed on
their exercises.  This is an invaluable tool, especially for those of us who need to track multiple athletes or for athletes that we are only able to see occasionally or who travel with their team.  The Fusionetics platform provides the provider with some invaluable information and a way they can continue to engage the athlete throughout their training and season. 

As we have seen, there is a rapid progression of technology in the area of sports medicine.  The technologies that have been mentioned throughout this blog series is only a small portion of the technologies that are available.  In addition to the aforementioned technologies, there are additional telemedicine technologies emerging on the market.  One such technology is Player's Health, which is a mix between an athletic training EMR and telemedicine platform.  This technology allows the provider to have a much more robust engagement with the athlete, team physician, coach and manager/athletic director.  With the integration of their app, this allows:

·       Communication of information to the athlete about their care or physician appointments
·       Team physician to quickly see where each athlete is in the health care continuum and get updates
·       The coach to see which athletes on are on the DL, where they are in the process and their anticipated RTPlay date
·       The athletic director/manager to see what athletes are injured, how long they have been on the DL and their anticipated RTPlay

With the emergence of technologies such as this, it creates a greater level of transparency of care and improved communication.  For those of us involved in treatment of the athlete, we know how challenging this can be and how vital consistent and clear communication is.  These technologies simply allow us to do what we do but even better and with improved efficiency. 
We hope you have enjoyed this blog series and thank you for sharing the passion for movement and prevention.

Dr. Nessler is a practicing physical therapist with over 17 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 >3000 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. 

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