Aggressive conditioning

Cal recently admitted that negligence of the school contributed, in part, to the death of a football player who died during a conditioning drill. As unfortunate as this event was, it forces us to keep in mind the potential dangers that exist when conditioning athletes.

Dr. Casa out of the Korey Stringer Institute at Connecticut has been very vocal that death due to heat stroke is 100% preventable. If the right policies are in place and adhered to, athletes can have their core temperatures brought under control in adequate time. And, while, the death of this young man seems to be heart related, the same principles apply. Aggressive conditioning with heavy individuals who have not been training adequately can be a deadly combination. The goal of training and conditioning is to apply a load, then recover from that load in order to progress. This means that gains are made over time in a planned manner. Varying the intensity of workouts is a very appropriate mechanism to change that load, but when workouts for any sport or competition significantly exceed a person's ability to handle it, a dangerous situation may exist.

There have been a few deaths in past years that have been the result of excessive conditioning of athletes, not to mention the other issue of rhabdomyolysis. Athletes want to be pushed and many of them excel with the pressure to achieve, but coaches, athletic trainers and fitness professionals need to remember that acute overload can lead to disastrous outcomes and plan accordingly.

http://www.athleticbusiness.com/civil-actions/cal-admits-negligence-in-football-player-s-death.html?eid=277204494&bid=1297447

Assessment of dysfunction

I saw an athlete today complaining of ongoing hamstring tightness and strains that I have seen in the past. Based on the exam I noticed he had very tight hamstrings and restricted movement. He also displayed a quad dominant squat pattern with patellofemoral overload and some instability with single leg squats. 

Based on his presentation we discussed a multi faceted program to improve his mobility and decrease his constant strains. We started doing 1 leg drops for movement and stability ball curls for hip and hamstring strength. We reviewed squatting and single leg squatting to engage his glute muscles to alleviate knee pain and we perform multi directional lunges for hip mobility. As an added bonus we worked on planks to strengthen his core and ensure that he can maintain adequate alignment. 

Since his hamstring is the main link between the pelvis and lower body it is easy to get tight and strained. In order to combat this we need to build a strong stable base for the pelvis and core muscles. When these are stronger the hamstring his not under the same amount of tension trying to provide stability. 

We will recheck his progress but this program should improve his strength and improve his motion leading to less recurrent strains. 

Observations in gymnastics

As a way to burn some energy, interact with peers and participate in physical activity we enrolled my 4 year old in gymnastics. The facility runs classes for many age groups and as I was watching I noticed a few things based on my experience as an athletic trainer and strength coach. 

Some of the older girls were working on their springing and jumping and they struggled with landing appropriately. Typically, gymnastics and dance overload the patellafemoral joint based on the inherent movements in their sport, but landing with a valgus knee or overly externally rotated foot is easily corrected. 

The valgus landing is the mechanism for suffering an ACL injury and there are proven exercises to decrease that risk. The externally rotated foot is how the girls gained stability when they landed off balance and this is another easily corrected movement by working on balance. 

Based on my observations, I would recommend that the athletes do some lateral hip strengthening, core stability, squatting and lunging patterns as a way to activate the appropriate muscles and reinforce movement patterns. Then, during practice the instructors can make verbal cues to remind the girls how to land. 

As an interesting note, some of the girls were landing in poor patterns because they lacked the strength to pop up high enough to complete the maneuver before landing. Time spent on developing strength, power and spring would help them gain enough height so they weren't landing off balance. 

While gymnastics is full of grace and strength, the opportunity exists to improve the motion of the girls to lessen the force generated in joints and lead to longer, healthier participation. 

Relative age and injury risk

The ACSM released a study investigating the risk of injury based on their relative age. During sports, athletes are generally grouped together based on age with an arbitrary cutoff. This study looked at whether those 'younger' athletes were more at risk compared to their 'older' peers.

The study assessed how many injuries were sustained and where the athlete fell in the age range. Their results demonstrated that those athletes whose birthdays were closer to the cutoff and thus were younger, chronologically, speaking were more prone to injury.

I think this study is pretty interesting in that it is demonstrating that just because athletes are the same age, does not mean that they are equal. It is important to remember that an athlete's birthday falls in one of twelve months and their may be pretty large physical differences for those that are on opposite ends of that age spectrum.

When working with youth athletes it is important to match them based on maturity and skill in practice. This is not easy to do in games, depending on the sport, we have all seen those enormous size mismatches on opposite ends of the field. But, every effort should be made to allow kids to have fun, learn a new sport and play safe.

I will be looking forward to seeing if they expand on this initial study to ascertain the effects of chronological age in sport on a larger scale and what ramifications it has not only for injury, but skill development, drop out and long term success.

http://journals.lww.com/acsm-msse/pages/results.aspx?txtkeywords=relative+age

Concussion research

The news on concussions keeps on coming. It is quite the hot study topic these days, and for good reason; we do not know as much about their prevention and treatment as we should.

Stanford researchers have been criticizing the helmet tests that determine their safety by pointing out the fact that they may not be accurately testing for concussions. Helmets do a great job at dissipating force that can cause blunt force trauma and fractures, but they are not capable of decelerating the brain on the brain stem. The researchers looked at the cause of injury and noticed there was a rotational force component that was not being accounted for in standard tests and they recommend that future tests take this into consideration. While this is a great summary of the causes of concussions, I am still skeptical at the ability of a helmet to effectively control the acceleration and deceleration of the brain. I think the biggest factor in preventing concussions is to properly train kids how to play.

http://www.athleticbusiness.com/athlete-safety/study-football-helmet-tests-may-need-a-change.html?eid=277204494&bid=1133043

This is also born out in another study that looked at the causes of concussions in soccer. Heading the ball is typically blamed for the injuries sustained, but the actual results show that individuals are more likely to have a concussion in a collision. An aggressive play style increases the risk over heading alone. Along with player education and training in football, soccer athletes should be taught how to protect themselves and referees should work to ensure that the play stays within the laws of the game. Keeping the game under control can help to decrease the risk of sustaining a head injury.

http://www.athleticbusiness.com/more-news/study-rough-play-riskier-than-heading-in-youth-soccer-br.html?eid=277204494&bid=1122209

When an athlete does suffer a concussion, it is not fully clear why some athletes heal faster than others, until now. Researchers looked at the brains of children with head injuries and compared them to their non-injured counterparts and noticed that those who have a head injury have slower electrical activity. This may be a result of damage the coating that surrounds nerve fibers and aids in conduction. This lining may be injured in a concussion and may help explain why some athletes take longer to heal. When this lining is damaged, nerve impulses are not effectively transmitted which can cause some of the common symptoms related to a concussion such as headaches, confusion, vision trouble and difficulty concentrating. They may not return to normal until this lining is healed. 

 http://www.athleticbusiness.com/athlete-safety/brain-injury-study-suggests-why-some-children-recover-faster.html?eid=277204494&bid=1123452

Overall, lots of interesting new news on the head injury front. Hopefully, in time we will have a better picture of what is happening when the brain is injured so we can effectively work to decrease injuries and improve healing.

Balancing for ankle strength

A new research study was published that showed the benefits of balancing for treating chronic ankle instability. If you have ever injured your ankle, rehabilitation is of vital importance. The simple act of balancing on your foot can help strengthen the muscles that support your ankle and decrease feelings of instability.

Incorporating a balance routine into your exercise program can help keep your ankles strong and decrease the chances of suffering an ankle sprain. To make it harder, add in different exercises to change the stimulation.

Overuse injuries in high school

There was a recent article in the Journal of Pediatrics that looked at the rates of overuse injuries in high school athletes. The results will not come as much of a surprise to those working with high school athletes: girls had higher rates of overuse injuries than boys and the most commonly injured sites were the lower leg, knee and shoulder. The sport played largely determined the injury site, swimming and baseball for shoulders, gymnastics for backs, track and field for lower leg. The really interesting finding was that rates of injuries changed during high school with boys having more overuse injuries as they got older and girls have fewer overuse injuries as they got older. The authors are not sure why that is occurring, but it is probably related to growth, intensity, competition and neuromuscular control. 

 

Since girls and boys have differences in neuromuscular control when they mature, it makes sense that the younger girls would be at increased risk of injury during that time until they got stronger and had improved mechanics. Why the boys got injured more as they got older is an interesting finding to keep track of in the future.

 

I think that these studies are interesting in that they confirm what we suspect, but it also gives us an opportunity to utilize the findings to create better programs aimed at decreasing injury risk. If you work with young athletes then understanding  these results can help you be a better coach. If your team is younger females then spend more time on neuromuscular training, strength training and controlling the volume in practice. If your team is older boys then continue to strength train, but control the volume and intensity in practice. 

 

Participation in athletics carries an implicit risk of injury that cannot be fully mitigated, but it can be better understood. Knowing your athletes, your sport and the common injuries can help to create better programs. If you are not sure the best way to structure a conditioning or training program talk with your school’s athletic trainer (if you have one) or a certified fitness professional.

 

You can find the study here: http://www.jpeds.com/article/S0022-3476(14)00888-9/pdf

 

 

Understanding overuse injuries in high school and college

The American Journal of Sports Medicine published a recent article examining overuse injuries in high school at collegiate sports. Overuse injuries account for the vast majority of injuries suffered in these groups (70%). Of those injuries, running was the common cause. The most commonly involved lower extremity joint was the knee and predictably, baseball, softball, swimming and diving had more shoulder involvement.

This study confirmed what practitioners have been observing when working with their athletes and the comparison between groups is helpful in identifying trends. College athletes have higher incidences that result in more time lost, women have more overuse injuries than men, and lower extremity injuries are prevalent in sports that involve running. While the conclusions are not surprising, I think the important point to remember is that repetitive loading results in tissue breakdown that causes injury without adequate time for adaptation.

Coaches and those that work in coach education can use this information to better develop pre-season and off-season training plans that take overuse injuries into consideration. Instituting programs that have athletes gradually start running or throwing in the off season to adjust to forces can decrease the injuries once the season starts. Too often, not enough is done in the off season and too much is done in the pre-season and early season. This jump in activity increases the tissue load beyond what it can absorb and leads to an injury. Utilizing a periodized program can make sure that loads are applied more thoughtfully to reduce the stress while still attaining the goal of greater skill and fitness development.

Understanding that overuse injuries are prevalent can also help strength coaches and athletic trainers come up with preventative programs. For those athletes that do a lot of running, controlling the volume is helpful, but so is making sure that there are no weaknesses in the kinetic chain. Spending time working on improving hip and core strengthening along with running drills can improve the ability to absorb force and decrease tissue overload. Similarly, making sure that the shoulders are strong and stable prior to swimming or throwing can decrease the overload that they sustain once the season begins. Continuing to monitor athletes and noticing deficits or changes can be an early warning sign that the athlete is experiencing too much strain.

Once athletes start to have pain, early intervention and volume control may be undertaken to decrease the load applied and allow the athlete to continue with participation. Knowing what the common injuries are in a sport can assist with ways of modifying the known risk factors.

http://ajs.sagepub.com/content/early/2015/04/30/0363546515580790.full.pdf+html

Being safe on ice

As I was going skiing today I slipped on some ice that was covering the sidewalk. Normally, I would be upset and continue on my way, but after doing a sport management degree I looked at it in a different light; was the ski area doing all they could to provide a safe environment for their customers and employees? From a risk management standpoint, the answer is no. 

After getting up I continued to walk, carefully, to purchase my ticket I noticed that the entire sidewalk was covered in a layer of ice. When I got my ticket I let the seller know about the ice and was told that they would look into it, but they didn't seem too interested in addressing it. 

Now, luckily I am young and reasonably fit so I just got a bruise on the ice, but what if I was older? The ski area was aware of the ice and yet did not do anything about it. They have options at their disposal to either help or warn: use salt or sand, put up signs warning of the ice or station employees to warn customers. They did not employ any of those methods. 

As it turns out I was talking to a patrol men who told me that they had to put stitches ino someone after they fell on the ice. I hope, for the sake of the ski area, that is the extent of the injuries. 

Was this situation completely avoidable? No. But they could have taken steps to make it safer or caution people; and they chose not to do it. This lack of preparation leaves them open to potential litigation. Don't make the same mistake. 

Benefits of Kinesiotaping

If you watch athletic events, you have undoubtedly seen athletes with different color tape on various parts of their body. This type of taping is called kinesiotaping and it is applied with the goal of being able to support muscles by helping them move appropriately.

 

Injuries can be caused by imbalances that change how a joint moves. When these ‘abnormal’ motions occur, more stress is placed across the joint and supportive structures that can lead to pain. Part of the appeal of kineseotape is that it helps to activate the muscles by placing them in the correct position and reminds the athlete to engage those muscles. In other cases, it is believed that enough pull can be generated that it can actually change joint position and assist with minimizing those imbalances.

 

There have only been a few studies assessing the effectiveness of kinesiotaping and more are needed. The one review that I found states that there is not enough evidence to support the use of kinesiotaping, but it does mention that it has not caused any negative effects.

 

Kinesiotaping may or may not work, but there is not a downside to using it. The true mainstay of injury prevention and conditioning is to use corrective exercises and neuromuscular training to change poor postures and recruitment patterns that lead to injury. If the underlying factors are not corrected, then no amount of tape is going to help.

 

Morris, D, Jones, D, Ryan, H and Ryan, CG. The clinical effects of KinesioTex taping: A systematic review. Physiother Theory Pract.2013 May;29(4):259-70.

 

Safety of Synthetic Turf Called Into Question

How safe is synthetic turf? For years, there has been debate on the risk of injuries from playing on synthetic vs. natural turf. Then, the safety of synthetic turf was questioned when athletes who spent a lot of time on the turf started being diagnosed with cancer. The major question for the physician's and researchers has been what role, if any, turf played in cancer. Now, there is concern that the pellets in synthetic turf contain lead and could be problematic for children.

 

The concern is enough that it is listed on the CDC website as known lead containing substances, but research into how much lead is being absorbed is lacking.

 

As of right now there are a lot of unanswered questions concerning the safety of synthetic turf. It has been installed in many schools and municipalities across the country because of its ease of use, decreased cost of maintenance, life expectancy and durability. Now, everyone who has a turf field is waiting to see if it is safe for the users.

 

Before making any determinations, we need a lot more controlled studies that can identify the true risk of synthetic turf. In the meantime, it might be wise to limit amount of time spent on turf to decrease exposure until we know more.​

 

http://www.athleticbusiness.com/more-news/feds-promote-synthetic-turf-use-continued-research-br.html?topic=6,500&eid=277204494&bid=1031271

Throwing warm up

With baseball season now underway 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

Heads up Football

There is some good news regarding the safety of youth football: coaches that have completed the ‘Heads up football’ training have decreased concussions on their teams than untrained coaches.

Since concussions, and especially concussions in football, are such a big concern right now, it is great to see that there is some training being done to address the issue.

From my personal observation of covering football the last 8 years I have noticed that there is a lack in a systematic approach to training athletes how to tackle properly. When athletes have a helmet and shoulder pads on they tend to use them as a way to initiate their tackle, instead of getting themselves into a proper tackling position. This contrast is very evident when I watch rugby, who do not wear pads and are therefore forced to tackle differently.

I hope that more research is performed evaluating the effectiveness of this type of training for football coaches and that it becomes a part of the mandatory curriculum in order to be eligible to coach at any level.

I will make sure that any coaches who work with my boys, when they are older and if they choose to play football, have had this training.

http://www.athleticbusiness.com/more-news/study-tackle-training-tied-to-safer-football-play.html?topic=2,200&eid=277204494&bid=1014894

Throwing prep

This is a great article on the steps that a high level sport Physical Therapist uses to get his athletes ready for throwing both pre-season and in-season.

He breaks down the routine into different components that are time efficient and effective at breaking up soft tissue adhesions and prepping the musculature for throwing. The components are soft tissue release, stretching, and muscle activation.

Putting this into practice with yourself, or your own athletes, can maintain the health of the throwing shoulder during 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

Concussion risk

The NFL posted its injury rates for the 2014 season and there was a drop in the number of concussions.

 

I will not get into the specifics of the article, but what is important to highlight is the fact that the VP of player health and safety said that teams were focusing on ‘heads up tackling’. The number of concussions suffered by players from head to head or shoulder to head was 50% of 2013’s numbers.

 

The take home point for athletes, coaches, fans and athletic trainers is that while concussions will always be a part of the game (and sports in general) it is possible to decrease the risk of injury. By learning proper technique of tackling with the head up, concussion injuries can be decreased.

 

Neurosurgeon’s have now weighed in on their thoughts about concussions and youth sports: the risk of sustaining CTE through sports is far lower than the risk of sustaining heart disease, diabetes and cancer through inactivity.

Proper training, rules and awareness should encourage younger individuals to join team sports, get active and adopt a healthy lifestyle.

 

If your team is not being taught how to tackle appropriately, it is time to speak up. Play safe and have fun. 

 

http://www.athleticbusiness.com/more-news/nfl-reports-significant-drop-in-concussions.html?topic=5,100&eid=277204494&bid=1004478

 

http://www.athleticbusiness.com/athlete-safety/neurologists-weigh-risk-to-kids-of-contact-sports-br.html?topic=4,100&eid=277204494&bid=1004478

Anterior pelvic tilt and hip impingement

A study by the American Journal of Sports Medicine found that having an anterior pelvic tilt contributed to the presence of hip impingement. This is not too surprising given that being tilted in that position will decrease the amount of flexion and internal rotation available at the joint. It does, however, help clinicians with evaluating and determining treatment protocols to decrease hip pain.

 

When evaluating clients it is helpful to assess the amount of pelvic tilt that they are experiencing. This observation, coupled with their mobility and individual activities can help improve the understanding of how they use their hips and how they have adapted over time. Treatments can then be developed to address the pelvic tilt, muscular tightness and weakness and functional activities that they need to perform.

 

We know that athletes that play soccer and hockey have impingement due to their sport and the movement patterns inherent to their sports. Now we know that the orientation of the pelvis can contribute to impingement. Knowing these items helps us to improve out outcomes by developing preventative programs and effective treatments.

 

In order to help decrease the possibilities of hip impingement we can work with clients to move their body in multiple planes to recruit different muscles. We can also have them perform soft tissue work on their hip flexors and lumbar muscles and corrective exercises to train a neutral spine like planks, bridges and bird dogs. This approach can help our clients to decrease their chances of getting hip pain and improve their performance by becoming more agile.

 

 

Benefits of ankle taping

A new study came out evaluating the effectiveness of ankle taping on soccer players.

The results are not supportive of taping; at the end of 45 min, the range of motion of the ankle had actually increased over the baseline testing, even while wearing the tape. Since taping is meant to reduce motion of a joint, this is not encouraging.

 

For those of us that use preventative taping of athletes as a means to support the ankle, we may want to consider bracing instead. It is also important to note that this study was evaluating taping and not the effect of preventative exercises on increasing ankle stability to decrease the risk of injury. Our efforts may be better spent focusing more effort on preventative neuromuscular and proprioceptive strengthening rather than prophylactic taping.

 

http://cjsmblog.com/2014/02/22/the-effectiveness-of-ankle-taping/

ACL prevention

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

Helmets do not prevent concussions

This is a nice article that discusses the fact that helmets do not prevent concussions.

The type of helmet worn did not have an impact on sustaining a concussion, or the amount of time lost in the case of sustaining a concussion.

 

This reinforces the fact that helmets are not able to prevent a concussion, although they can prevent other head and facial injuries.

 

A lot of concussion prevention is strength, awareness and proper technique training. Focusing on those aspects of prevention may be more beneficial than strapping on a new helmet and thinking you are safe.

Baseball presentation yesterday

Yesterday, I had the opportunity to work with a youth baseball team for speed and agility. The coaches asked me to show them some skills that they could incorporate into practice and during the off season.

Since the kids were younger pre teens or early teenagers my goal was to show some basics and not overwork them.

Our focus was on a warm up and speed drills, full speed sprint work and base stealing techniques for shuffling and transitioning to a sprint. We also did some shuffles and runs into a fielding position in order to prepare for the season. 

The kids worked hard and were pretty tired by the end. 30 min sessions over 2 hours is a lot to stay focused on and theywere struggling by the end. 

It was a good workout and prepared them for when they get outside in a couple weeks.