I had a conversation with a coach earlier this week who was asking me about ice. He had conversations with other coaches who had read the book, Iced by Gary Reinl, and he wanted to get my opinion. Since I have not read the book I felt that in order to give an informed opinion I should do some research. I looked at an interview with Gary about his take on ice and then searched medical journals to see whether ice had been tested and what the outcomes were. I was a little surprised at the lack of studies that specifically study ice in the many applications that it has been prescribed for.
In school we are taught that ice has an effect on the inflammation process and that the inflammation process is a problem and should be decreased as soon as possible in order to speed recovery. When tissue is damaged, the body sends microorganisms to the injury site to fight the inflammation and part of that process is tissue swelling. Ice helps to decrease the blood flow to the area in order to slow this process down. One of the main arguments against ice in the acute inflammatory process is that this inflammation is actually beneficial to the body. Inflammation is the body’s way of breaking down tissue and laying the groundwork for recovery and an interruption to this process can be potentially detrimental. Acute sprains: Ice has been the mainstay of treatment, along with the remaining letters of the acronym, RICE, for years. When I reviewed the effectiveness of RICE on outcomes, there are very few well controlled studies and the main conclusion is that more needs to be done to study the effect of RICE on treatment outcomes and return to play decisions. Pain control: Ice has an analgesic, or pain relieving, effect on injuries. Applying ice to an acute injury can help to decrease the pain associated with the injury in the first couple days. Ice does appear to aid in recovery the first 48 hours post surgery. Tendon injuries: Chronic tendon injuries are characterized by a breakdown and a change in the tendon itself, without the presence of inflammation. Ice is used for pain associated with the condition, but should not be used for inflammation. Delayed onset muscle soreness: Ice may have an effect on the pain associated with DOMS as a result of activity, but it does not shorten the time of discomfort. The main treatment for DOMS is light exercise. During the course of the research I learned that rest and immobilization can cause the collagen fibers that repair an injury to align themselves in a haphazard manner and that moving the joint post injury can get these fibers into better alignment. I want to stress that this is for sprains and strains and not fractures or dislocations, which need different management. It appears that immobilization for a day followed by movement can also help improve healing in the hamstrings that are more significant than a mild strain. In light of this research review I will make some changes in how I recommend athletes manage an injury: I will recommend ice as a pain modifying treatment to be used for 10 min to decrease pain in the first 48 hours following an injury and to move the joint as they are able. I will still recommend compression and elevation for swelling in conjunction with movement. I will recommend that athletes lightly exercise if they are sore. For chronic conditions I will recommend soft tissue work and eccentric exercise.
0 Comments
With baseball season starting soon, we can start to expect to have some throwing related injuries affecting the elbow and shoulder.
Before experiencing pain, decreasing performance and frustration, take the time to review this blog from Mike Reinold discussing his throwing warm up. The video is only a couple of minutes long and explains his entire warm up process before starting a throwing program. This information is invaluable for throwing athletes and will help keep their shoulders healthy throughout the season. As with most injuries, the main problem is increasing activity too quickly and not giving your body a chance to adapt. Take the time to strengthen, warm up properly and limit your hard throws early in the season so you can throw hard at the end of the season. http://www.mikereinold.com/2015/02/how-to-prepare-your-body-before-you-throw.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Mikereinold+%28MikeReinold.com%29 New research came out today touting the effects of the FIFA 11 exercises. These exercises were developed to address ACL injury prevention in young female athletes and have been validated a few different times. This latest research confirms the efficacy of incorporating this type of training into your routine.
The key to injury prevention is neuromuscular training, which is the fancy way to say performing exercises properly. Learning how to move correctly improves your efficiency, decreases energy leaks, improves performance decreases risk of injury. Typical ACL exercises involve strengthening the hamstrings through Nordic or Russian Hamstrings, Straight leg deadlifts and ball curls, learning how to squat properly with your hips back and knees over toes, not coming together, single leg squatting and lunging, core strengthening through planks and side planks and cutting drills that focus on keeping your foot under your base of support and not outside of it. To learn more about ACL prevention talk to an athletic trainer or strength coach with experience in developing ACL exercises. Further information: http://f-marc.com/11plus/home/ http://www.sportsmedres.org/2014/12/fifa11-improves-performance-and-reduces-injuries.html#more Should you stretch? If so, when should you stretch? This depends on what type of stretching, when you are stretching and why you are stretching.
The different stretches are static stretching, which involves taking a muscle to a slightly uncomfortable length and holding it for 30-60 seconds. Dynamic stretching involves reciprocal inhibition (contracting one muscle to relax its opposite) in order to improve the range of motion at a joint. Ballistic involves a quick contraction past the point of comfort and is not recommended. Prior to performing an activity it is important to promote blood flow and excite the nervous system. This is best accomplished by doing some sort of calisthenics, dynamic stretching, jogging or body weight exercises to engage your neuromuscular system. The purpose of this is to prime your body prior to the activity it is about to undertake. Doing exercises that stimulate your body will prep it for the work that is to come. Static stretching prior to activity is not recommended since it can decrease performance. This makes sense since static stretching is meant to be relaxing and calming to your nervous system. This is the exact opposite of what you want when it comes to exercise and competition where the goal is to excite your nervous system to perform well. At the end of a workout, it is ok to static stretch. It may not decrease the change of being sore, but if it feels good, then go for it! You can also static stretch throughout the day if you have muscles or regions that are chronically tight, such as hip flexors and shoulders if you are sitting all day long. Stretching like this can help alleviate that tension in your body. Static stretching may also be used if you are recovering from an injury that has caused some muscle tightness and restrictions. You may need to stretch that area in order to improve your health and functioning at that joint. You can also try a yoga class if you are trying to improve general flexibility. Different types of yoga have different goals, but they each involve holding varying degrees of positions in order to strengthen your body (and your mind). By holding the positions you can reset your muscle tension and improve general flexibility. Athletes who tear their ACL and want to return to their sport usually opt for surgical reconstruction. This is primarily done with either using the patient’s patella tendon or hamstring tendon to graft a new ACL. After surgery, patient’s need to perform rehabilitation in order to regain their range of motion, strength and function. Some reviews have been performed that can help guide the rehab and return to sport process. Interestingly, even though there has been a lot of research performed on ACL’s in general, there is not a lot of information on return to sport criteria.
For rehabiliation, the following has been recommended: 1. Forgo the brace. Post operative bracing is not effective for improving pain, range of motion or preventing a potential re injury and is not necessary. 2. An accelerate rehab is safe for patients and they can begin early weight bearing exercise, range of motion from 0-90 degrees and close chain strengthening exercising. Adding in eccentric quad strengthening after 3 weeks was also beneficial in recovery. 3. Focus on strength and range of motion. Adding neuromuscular strengthening is somewhat helpful, but the focus for rehabilitation should be on improving strength and range of motion. Once this is restored, neuromuscular training can be helpful to relearn movement patterns. 4. Single leg cycling can be performed in order to maintain cardiovascular fitness. Returning to sports? 1. Many athletes do not return to their previous level of sport participation, in fact, only 50% may return. 2. The decsion to return is multifactoral, but there is a general lack of evidence to determine the best testing criteria to signal return to play. In general, the decision to return is based on the following; a. Higher quadricep strength b. Less swelling c. Less pain d. Fewer episodes of instability e. Low kinesiophobia (fear of moving) f. Higher athletic confidence g. Higher motivation 3. Part of the challenge is the psychological componenet of returning to sport. The fear of moving (kinesiophobia) may prevent some patients from returning. Patient’s that have more confidence have a greater chance of returning to their sport. The current research shows plenty of gaps in following a standard program for rehabilitation and return to play, but patient’s and their providers can use what we do know to customize a plan. Patient’s should start moving as tolerated shortly after surgery. They can walk as they are able and perform range of motion exercises and strengthening as tolerated progressing the intensity as they heal. When their graft is healed and they have regained strength and motion they can add in neuromuscular training to improve movement patterns. This is also a good time to work on building up their confidnce in a controlled setting. Allowing them to get into a position can improve their confidence as the speed and force of the movement is increased. Consistently working on the psychological aspect of rehab should not be ignored. Rehab is a chance to control the environment so that patient’s can gradually tolerate the load. As they improve, their rehab should adjust to mimic the functional tasks they will need to perform in life and on the field. Once they have reached their healing, they should re-integrate into their sport (once again in a controlled setting) and progressively increase their activity. While there is a lot of flexibility in these guidelines, this can serve as a framework for the rehabilitation and reintegration process. Discussing the steps with the patients, their support groups and providers can help to get everyone on the same page and understand the steps required to resume their active lifestyle. Czuppon, S., Racette, B., Klein, S. & Harris-Hayes, M. (2014). Variables associated with return to sport following anterior cruciate ligament reconstruction: a systematic review. British Journal of Sports Medicine, 48 (5). 356-364. Kruse, L., Gray, B. & Wright, R. (2012). Rehabilitation after anterior cruciate ligament reconstruction. Journal of Bone Joint Surgery, 94 (19). 1737-1748. New media, which includes social platforms, the internet and blogs, have changed the way that consumers access content. Understanding how they consume content is important for engagement and marketing to increase brand awareness.
73% of internet users actively engage on social media with the vast majority of the younger demographic being active. A research review on social media use was published in Sport Management Review and they describe three impacts that social media has: brands use social media strategically to build relationships with customers, brands seek to cultivate and sustain relationships operationally and users co-create content. When brands use social media strategically they are seeking to engage with fans, communicate and develop relationships in order to build the brand. Brands use social media to promote the sport, rather than market promotions. By engaging in conversations with fans, brands can generate more ‘likes’ and increase users. Twitter can be used as a tool to disseminate information and promote messages and different platforms have different values: twitter is used for real time information and facebook enriches the consumer experience. While the platforms may differ, the use is to create relationships with users. Opportunities and challenges exist through strategic social media use. The opportunities are enhanced knowledge of consumers, advanced interaction, effective engagement, and efficient use of resources. The challenges include lack of control, concerns about credibility, concerns of effectiveness, difficulties identifying true consumers and allocating organizational resources. I have written previously that activity on social media is expected among users, but may not transfer into direct revenue. Operational use of social media consists of how brands utilize differing platforms on a day to day basis. Athletes posting about their personal lives allow fans to connect with the person behind the player and leads to more engagement. Brands engage their fans by offering behind the scenes looks into the daily routine of the players and staff. Social media use allows for a personal connection between the brand and the fan. Users of social media vary depending on the brand. NCAA users are predominantly male, educated, affluent and older. Younger fans of the NCAA used facebook and youtube to connect and that twitter is not heavily used by college sport fans. Fans use social media to gather information regarding their favorite teams, players and organizations. There are gender differences in fan consumption based on the sport with women more likely to pay more attention to informational, commercial and social functions of the team’s social media. Fans are also more likely to follow those teams and programs that are more successful. This article leaves us with some increased knowledge regarding social media use and allow brands to use these platforms more effectively. Strategic use allows the brand to communicate with fans, build relationships and promote activities. Operational use of social media by brands shows that they use social platforms to interact daily with fans, share behind the scenes footage, share news and information and promote the brand. Users of social media tend to be younger, educated and more male than female. Information that they are interested tends to be gathering information, entertainment and connecting with other fans. These conclusions are useful when evaluating your social media presence and content development. Filo, K., Lock, D & Karg, A. Sport and social media research: a review. Sport Management Review (18) 2015. 166-181 The IOC released a position statement on youth athletic development that can be found by visitinghttp://bjsm.bmj.com/content/49/13/843.full. This comprehensive statement has a lot of recommendations for youth sports and practitioners and can help serve as a foundation for those involved with youth sports.
While prepubescent males and females show similarities in movement, strength and fitness there is a vast difference post puberty. The implementation of a neuromuscular and strength training program is vital to improve balance, proprioception and strength as athletes go through puberty. The committee acknowledges the importance incorporating strength and conditioning into the development of youth athletes. Some of the other recommendations regarding youth development is a lack of awareness and understanding of adequate nutrition by athletes and coaches. Educational material should be developed and disseminated to those that work with young athletes in an effort to educate them on what a proper diet looks like and how to get the necessary nutrients. Coaches are also encouraged to adopt a 4 C approach to coaching consisting of competence, confidence, connection and character. This should serve as the framework for coaches to develop relationships with their athletes and the adoption and implementation of long term, realistic outcomes. Coaches following this can decrease the chance of psychological overload, or burnout, by making sure that they keep the long term health (physical and mental) and wellbeing of the athlete in mind. As discussed in previous blog posts, there is a concern for overuse injury in single sport, specialized athletes that should be taken in to consideration when working with young athletes. The decision to choose to play one sport is a personal one and efforts should be made to discuss the pros and cons of that decision. Athletes, parents and coaches should understand that playing a single sport is not a guarantee for future success, since so few athletes hit the elite level, and that other sports allow for the development of new motor patterns and tissue adaptation. They can still participate in their main sport with skill acquisition while playing other sports or completing a strength and conditioning program. Athletic development is a complex process with intrinsic and extrinsic factors that interact with each other and the athlete. The goal for the IOC is to “develop healthy, capable and resilient young athletes, while attaining widespread, inclusive, sustainable, and enjoyable participation and success for all levels of individual athletic achievement.” As athletic trainers we are in the perfect position to assist young athletes in making good decisions regarding participation by practicing evidence based medicine. We can develop educational materials for athletes, coaches, parents and administrators, discuss the benefits of strength and neuromuscular training programs and how to appropriately overload and recover for success. Our understanding of youth sports helps to ensure that they are able to engage in safe, long term participation in the sport they love. I worked a volleyball tournament over the weekend weekend and got to observe quite a bit of skilled play at different age groups.
One of the things I noticed was the lack of height on the jumping approaches. This translated into the ball trajectory being flat and going long and not angled down resulting in a kill. This also means that the athletes are using more rotational force and shoulder momentum to hit the ball which can turn into shoulder pain over the long term. The long standing opinion that girls don't need to lift weights or strength train needs to end. The truth is that all athletes need a strength training program that compliments their sport and prepares them for competition. It is also not true that this program requires a lot of time. Developing functional strength for volleyball that will translate directly to on court performance can be done with a few exercises twice a week. The first thing is to introduce the exercises to the athletes, teach form and develop neuromuscular control. Once this is acquired, a simple periodization model to increase resistance and decrease repetitions will suffice in building the necessary strength. The final step is to add in some plyometric activity to transfer this newly gained strength into power. Power is what will give the girls a boost when they elevate at the net to block and spike. A simple program may look like this: 3 sets of 15 progressing to 4 sets of 4 Squat Dumbbell lunge complex Romanian deadlift Kettlebell swing Horizontal press Horizontal pull 3 way shoulder for additional stability For power (teach proper landing) Box jumps Weighted vertical jumps Short sprints/stair sprints This simple program can have profound results if the athletes put in the effort to develop their strength. With concussions in the news, athletic training has gotten a lot of press recently. I hope that this positively reflects on the profession and provides greater opportunities for growth, new generations coming in and improved salaries and benefits.
Athletic training is a unique profession that deals with several facets of health care including injury evaluation and diagnosis, rehabilitation, fitness and acute care of injuries including first aid and emergency response. With such a broad skill set, athletic trainers are perfect for the collegiate and professional settings that so many people associate them with. Aside from the traditional realm, athletic training is a great back ground for working in other industries; manufacturing managing the work related conditions that repetitive motions cause, health care and athletic management, high school, club and recreational sports leagues and dance including the performing arts. If you are serious about a career in athletic training, there will hopefully be plenty of opportunities to do so. If you are involved in the physical activity then consider working with an athletic trainer to get the most out your body and stay healthy during your participation. http://www.athleticbusiness.com/athlete-safety/awareness-driving-athletic-trainer-student-aide-programs.html?eid=277204494&bid=1304170 Reply Forward |
AuthorI write on sport management, fitness, sports medicine and business topics to help you reach your goals Archives
January 2024
Categories
All
|
Home
About Contact |
To learn more about what services we offer, to schedule an appointment or to get prices please contact me at
timkoba@fingerlakesathletics.com (607)279-6791 *This site is for educational purposes only, it is not meant to diagnose, treat or replace medical advice. Before starting an exercise program always make sure that you are healthy and able to do so safely.* |