Archive for the ‘Athletic Trainers in the News’ Category

2017 NFL Pro Bowl Concussion Symposium and Health Screening

Tuesday, February 21st, 2017

Desi Rotenberg
MS, ATC

Posted February 21, 2017

Desi Rotenberg, MS, ATC

The 2017 NFL Pro Bowl is a tradition that stems back to its inception in 1938. While the teams have changed drastically since then, the NFL Pro Bowl has become a tradition of competitive fun and entertainment for players, NFL front offices and fans. 2017 was the first year since 1980 (minus 2009) that the game was held within the continental United States. This venue change hoped to bring more fans, more attention and enhanced exposure of the game itself.

One of the attention grabbers for me during the Pro Bowl weekend occurred off the field. This year, The University of Central Florida (UCF) hosted the 2017 Pro Bowl Concussion Symposium and Health Screening. The purpose of this symposium was two-fold. First, retired NFL players were invited to partake in health screenings for free to help identify any neurological, cardiovascular or other issues plaguing them due to their playing time in the league. Second, the NFL Players Association partnered with the UCF Psychology Department to present all of the latest research and treatment options related to concussions in the world of sports, and more specifically, the game of football.

Here are a few of the highlights:

Following the U.S. Supreme Court settlement regarding previous NFL players and head injuries, the science has gained a significant amount of traction. As new empirical data emerges and technology continues to develop, more funding is becoming available to allow athletes to have increased access to neurological assessment and professional evaluation following head trauma. Interestingly, the Supreme Court settlement included a 65-year plan that will give retired NFL players and their families financial support if they experience symptoms of amyotrophic lateral sclerosis (ALS), dementia or any other life-altering behaviors or symptoms that may arise secondary to traumatic brain injury.

Furthermore, baseline testing is being made available to all retired NFL players and will be done immediately upon retirement. This will allow the players’ medical teams to identify any behavioral, cognitive or neurological changes that may arise over the remainder of the individual’s life.

The overarching goal is to have every college, high school and middle school offer some form of baseline testing in at least one sport for all student athletes. We are slowly, but surely, making our way towards that goal. However, there still remains room for improvement when it comes to baseline testing.

The areas of deficiency that were identified was a lack of baseline testing within recreational sports and ease of administration within middle schools and high schools. If we want to ensure the safety of all athletes, we must do what we can to have concussion education, a concussion protocol and return to play protocol in place.

At the academic levels, we must also ensure that we have a return to learn protocol in place. The question that acts as a defense for medical professionals responsible for the return to play decision is, “If you cannot learn new information, should you be returning to play?”

Emerging Technology

To this point, there are 2 questions that remain: 1) How do we diagnose Chronic Traumatic Encephalopathy prior to death, and 2) How do we avoid the high cost of imaging when it comes to concussion diagnostics?

There is by no means an answer to the first question as of yet, but I am hopeful due to the emergence of Diffuse Tensor Imaging (DTI). DTI has been around for roughly 20 years and has been mainly used in the diagnosis of strokes and other ischemic disorders of the brain.1 Within the past 10 years, research has shown that DTI can also be used to assess the integrity of the white matter in the brain.2 The goal of physicians at the symposium was to make DTI more streamlined and allow patients access to this form of diagnostic following head trauma.

In the image below, the varying colors represent the orientation of various white matter within the brain. In the second image, neurological specialists have the ability to zoom in on a specific location and can visualize a physical abnormality or disruption in neuronal activation due to a disturbance in neuronal integrity.

Images Obtained from Journal of Neuroradiology

So how do we lower the cost of imaging?

We start by locating private medical companies that offer this type of imaging. There were several speakers at the symposium who owned businesses that focused on the neurological diagnosis and treatment of individuals who suffered traumatic head injuries. The businesses offer consultations and diagnostics at a fraction of the cost of normal imagining techniques.

Cognitive and Behavioral Effects of Head Trauma 

Neuropsychologists want to make one thing very clear to all health practitioners: There is no such thing as the average TBI patient. While there are several concussion treatment protocols, it is paramount that each case be treated on an individual basis according to the needs of the patient and the underlying symptoms present. Cognitive changes following head trauma occur on a varying spectrum, and can include, but are not limited to: changes in vigilance, reaction time, mental tracking, verbal retrieval, mood and information processing.

Common symptoms that can be seen are the emergence of anxiety, depression, inability to focus and difficulty sleeping. Each symptom can lead to frustration, impatience and social disconnect. There is one congruity with all of these cognitive and behavioral changes: a concussion is a physiologic injury of the brain, where normal cerebral flow has been altered and the normal “algorithm” of information input and output has been compromised.

Unfortunately, head injuries cannot be cured; however, there is hope for individuals seeking refuge from this life-alerting injury. There are many clinics that exist, such as the UCF Psychology Clinic that can help patients learn to cope with the inhibiting effects of head trauma. Treatments include consultations with neuropsychologists, who walk patients through cognitive rehabilitative exercises and various forms of talk therapy. These treatments can help an individual compensate for the mental, emotional or physical deficiency that has arisen. The goal of treatment is to help the individual learn how to live within this new reality, and how to improve their overall quality of life.

The central message of the symposium is concussion research and concussion management are constantly changing. Unfortunately, policy change happens at an even slower rate. Due to this constant evolution, this is a topic All medical, fitness and cognitive specialists need to stay up to date on this topic due emerging information and the constant evolution of the topic. This can be accomplished by staying up to date on the latest research and emerging trends, in order to be able to follow “best practices” and avoid liability.

Resources

1. Hagmann, P., Jonasson, L., Maeder, P., Thiran, J. P., Wedeen, V. J., & Meuli, R. (2006). Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond 1. Radiographics, 26(suppl_1), S205-S223.

2. Le Bihan, D., Urayama, S. I., Aso, T., Hanakawa, T., & Fukuyama, H. (2006). Direct and fast detection of neuronal activation in the human brain with diffusion MRI. Proceedings of the National Academy of Sciences, 103(21), 8263-8268.

3. Rutgers, D. R., Toulgoat, F., Cazejust, J., Fillard, P., Lasjaunias, P., & Ducreux, D. (2008). White matter abnormalities in mild traumatic brain injury: a diffusion tensor imaging study. American Journal of Neuroradiology, 29(3), 514-519.

About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 

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Exercise Intervention for Post-Traumatic Stress Disorder

Tuesday, November 29th, 2016

Posted November 29, 2016

Desi Rotenberg
MS, LAT, ATC

By Desi Rotenberg, MS, LAT, ATC

Since 2000, there is emerging evidence that exercise can and should be used in the therapeutic treatment plan of patients with Post-Traumatic Stress Disorder (PTSD). Before understanding how therapeutic exercise can be used as a modality for PTSD, we must identify a working definition of the disorder.

The National Center for PTSD defines trauma as “a shocking or anxiety-inducing event that a person witnesses or experiences.”1 It is reported that 6 out of every 10 men and 5 out of every 10 women will experience at least 1 traumatic incident in their life.1 While these traumatic experiences can cause acute forms of PTSD, the effects tend to be short lasting and asymptomatic. However, 8 out of every 100 individuals in the United States will suffer from PTSD at some point in their life.1

PTSD is described as an “anxiety disorder that is triggered by witnessing or experiencing a traumatic event.”2 PTSD is most commonly associated with veterans; however, it can also frequently affect survivors of “violent, personal assaults.” These include rape, mugging, domestic violence, childhood abuse, natural disasters, accidents and life threatening illnesses.

It is important to note the athletic population is not exempt from PTSD. Traumatic events that athletes have suffered either in their past or that are related to an athletic injury can cause substantial hindrances in their return to play. The consequences of traumatic stress can interfere with both an athlete’s rehabilitation as well as their return to play status. Furthermore, sport-related trauma can be a result of over-training or violence within sports.3

The main symptoms of PTSD are generalized anxiety, depression, insomnia, dysphoria and general fatigue. While depression is a common consequence of some of life’s most strenuous occurrences, there are physical and physiological benefits to utilizing exercise as a therapeutic intervention.

There have been several studies that have shown positive outcomes on patients with PTSD, and more data is emerging.  In 2009, Cohen and Shamus noted, “Low-to-moderate intensity exercise can elevate mood and reduce anxiety.”2 Additionally, Tsatsoulis and Fountoulakis determined in 2006 that exercise can “act as an overall stress buffer” which in effect can have a positive impact on the symptoms of depression and PTSD.2 Non-randomized controlled studies using physical activity and exercise as an intervention for patients with PTSD showed improvements in body image, prevention of eating disorders, alleviation of anxiety and depressive symptoms and decreased substance abuse.4 Cross-sectional studies have had high self-reports of a correlation between habitual exercise and better mental health.5

In the athletic population, habitual exercise is the activity that is done outside of organized team activities. Other longitudinal surveys have shown that exercise habits early on in an individual’s growth and development, between ages 18-28, can predict freedom from depression later on in their life.6

Farmer et al. surveyed 1,900 adults in 1988 with preexisting depression (causes were variable, some unknown). They determined that individuals who took part in physical exercise ranging from low intensity to rigorous training, successfully made it to the 8-year follow up, and confirmed the researchers’ ability to predict freedom from depression.7 Additionally, the Journal of Clinical Epidemiology published a study in 1994 looking at 1,758 adults with a variety of physical and chronic health problems and self-reported exercise time during a 2-year study period. The majority of these individual reported improvements in well-being, anxiety levels and reported low levels of depression and fatigue.8

There is extensive data on the efficacy of corrective exercise strategies for individuals who are suffering from PTSD as well as any residual behavioral symptoms that are associated with exposure to a traumatic event. While the occurrence of PTSD and injuries from blunt force trauma to the head are only growing in the United States, it will be up to behavioral specialists, occupational therapists, physical therapists and fitness professionals to facilitate an atmosphere that allows individuals to return to their normal activities of daily living.

Resources

1. National Center for PTSD. http://www.ptsd.va.gov. Date Accessed: October 20, 2016.

2. Kim, L. H., Kravitz, L., & Schneider, S. (2012). PTSD & Exercise: What every exercise professional should know. IDEA Fitness J, 9, 20-23.

3. Wenzel, T., & Zhu, L. J. (2013). Posttraumatic Stress in Athletes. Clinical Sports Psychiatry: An International Perspective, 102-114.Lawrence, S., De Silva, M., & Henley, R. (2010). Sports and games for post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev, 9.

4.  Lawrence, S., De Silva, M., & Henley, R. (2010). Sports and games for post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev, 9.

5. Salmon, P. (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical psychology review, 21(1), 33-61.

6. Krause, N., Goldenhar, L., Liang, J., Jay, G., & Maeda, D. (1993). Stress and exercise among the Japanese elderly. Social science & medicine, 36(11), 1429-1441.

7. Farmer, M. E., Locke, B. Z., Moscicki, E. K., Dannenberg, A. L., Larson, D. B., & Radloff, L. S. (1988). Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up Study. American Journal of Epidemiology, 128(6), 1340-1351.

8.  Stewart, A. L., Hays, R. D., Wells, K. B., Rogers, W. H., Spritzer, K. L., & Greenfield, S. (1994). Long-term functioning and well-being outcomes associated with physical activity and exercise in patients with chronic conditions in the medical outcomes study. Journal of Clinical Epidemiology, 47, 719–730.

About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 


Adopting Injury Prevention Programs in High School

Wednesday, November 16th, 2016

Posted November 16, 2016

Tim Koba, MS, ATC
Twitter: @timkoba
Blog: www.timkoba.blogspot.com

By Tim Koba, MS, ATC

Participation in high school athletics carries an intrinsic risk of injury, but that doesn’t mean certain types of injuries can’t be decreased. There has been a proliferation of injury prevention programs. These programs have the ability to improve performance and decrease risk of sustaining certain injuries, especially ACL injuries and ankle sprains. While this information is readily available, there has been some hesitancy to adopt these and similar programs.

In an Oregon survey of high school soccer and basketball coaches, many of the coaches were aware that injury prevention programs existed, but they were not adopting those programs for their own teams.1 Some of their reasons included the belief that what they currently did was similar to the program; their program was superior to the researched program; or they were not aware of how much actual sport performance gains occurred as a result of these programs. Those concerns have validity and merit further discussion.

Many injury programs have similar features that are easy to adopt and implement such as squatting, jumping, cutting and using a balance apparatus. The key with any of these exercises is to focus on form and ensure the athletes are appropriately performing the required task and not going through the motions. Some of the programs are definitely more involved and time consuming and may cut into the limited time available for training. However, before changing or eliminating exercises, it is important to understand the mechanics and rationale behind those exercises and why they were included in the first place. Arbitrarily eliminating exercises can invalidate the program resulting in a failure to achieve the intended prevention outcomes.

A relatively new option for reducing injury risk, improving fitness and performance is to adopt a training program in physical education (PE) classes.2 This exercise vehicle may be a great way to teach fundamental movement skills to adolescents who carry on to their chosen sport. In a study out of Canada, researchers compared a typical PE class with a specific training PE class. The specific training PE class was geared toward the improvement in movement, reduction in injury and had significantly fewer injuries than the control group. The exercises regimen they chose was similar to the FIFA 11+ and included squats, jumps, lunges, planks and running drills. The inclusion of this, or a similar program, in middle and high school may help to decrease on field injury rates during athletic participation.

The potential for injury will always be a part of athletics, but accepting that there is nothing to help prevent injury is not accurate. At this point there are many options to keep players healthy and participating safely. Knowing the common injuries in your chosen sport and available resources are essential for successful participation in athletic endeavors.

Conclusion

- Injury prevention programs can decrease risk for certain injuries and improve performance

- There is hesitancy to adopt these programs despite their proven effectiveness for a variety of reasons

- Implementing a school wide program can help to bridge the gap between player safety in athletics, exercise, fitness and movement

References

1. Norcross, M.F., et. al. (2016). Factors influencing high school coaches’ adoption of injury prevention programs. Journal of Science and Medicine in Sport, 19: 299-304.

2. Richmond, S.A., et. al. (2016). A school based injury prevention program to reduce sport injury risk and improve healthy outcomes in youth: A pilot cluster randomized controlled trial. Clinical Journal of Sports Medicine, 26(4): 291-298.

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

 

 

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Would ECHO testing during the PPE prevent sudden cardiac death?

Wednesday, November 2nd, 2016

Mike McKenney, MS, ATC

Posted November 2, 2016

By Mike McKenney, MS, ATC

During the pre-participation examination (PPE), many healthcare practitioners employ a traditional cardiac questionnaire and physical examination to detect potential abnormalities and other serious medical conditions that may impact safe participation in sport. However, a physical examination and history are not always sufficient to detect abnormalities of the heart that can result in sudden cardiac death (SCD). More recently, there has been increasing support for broader implementation of electrocardiograph (ECG) testing at all levels of sport. This includes attempts to mandate ECG testing for all high school athletes. Barriers to mandatory ECG testing typically revolve around cost, but there are other factors to consider before requiring this form of screening in an athletic population.

The intended purpose of an ECG is to assess electrical activity of the heart and assist clinicians in determining if a cardiac abnormality is present, whether it be genetic, structural or conductive in nature. However, only 3 percent of cases that result in SCD are of conduction-related causes.1, 2 In young, competitive athletes, structural abnormalities represent the largest percentage of SCD, 84 percent of reported cases,1 which includes conditions such as hypertrophic cardiomyopathy (HCM). Simply put, mandating ECG testing in sport may not be the best step forward due to the test’s limitations in screening for the primary causes of SCD.

The difficulty in utilizing ECG to detect structural abnormalities is reflected in a high false-positive rate due to detection of cardiac adaptations regularly found in trained athletes,1, 3 and other variations that are common with normal cardiac rhythm.3Furthermore, ECG lacks the specificity to reliably detect HCM,3 which is a condition that is largely asymptomatic until an SCD event occurs.2 Additionally, results can be interpreted differently between physicians if consistent standards are not being applied.4 Due to the aforementioned factors, athletes are often subject to unnecessary referrals for further screening that often turn out to be of no concern,4 and add further cost to the evaluation process.2

Echocardiograms (ECHO) are the gold standard for visualizing the heart and are what athletes typically receive when referred to a cardiologist for advanced evaluation. Traditionally, the ECHO is performed in a cardiologist’s office. However, with advances in portable ultrasound technology, there is an emerging application for ECHO testing to be conducted by a front-line physician at a school’s sports medicine facility.2 At Northeastern University, a study5 was conducted utilizing this procedure and found that referral to a cardiologist was reduced by 33 percent. There were no differences between measurements obtained by the school’s physician and an outside cardiologist. In addition, research currently in review found the portable ECHO procedure to be significantly quicker than a traditional history and physical or ECG.2 This finding could potentially lead the way to a more thorough and efficient PPE process.

The costs associated with cardiac screening will always be a point of contention, but results of the previously discussed research are going to shift the discussion in a new way. It is not yet known if on-site portable ECHO testing will be a cost saving measure.  However, in theory, a reduction in unnecessary referrals should reduce the overall cost of screening. Moreover, clinicians will have the added benefit of being able to visualize conditions that can result in SCD, instead of trying to infer their presence from electrical activity alone. If we are to continue advocating for access to advanced cardiac screening, future efforts should be focused on methods and services that provide a more efficient and accurate assessment.

Resources

1. Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. 2007;115(12):1643-1455.

2. Kerkhof D, Gleason C, Basilico F, Corrado G. Is there a role for limited echocardiography during the preparticipation physical examination?. PM & R: The Journal of Injury, Function, And Rehabilitation. March 2016;8(3 Suppl):S36-S44.

3. Maron B, Friedman R, Thompson P, et al. Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation.2014;130(15):1303-1334.

4. Hainline B, Drezner J, Thompson P, et al. Interassociation consensus statement on cardiovascular care of college student-athletes. Journal Of The American College Of Cardiology. 2016;67(25):2981-2995.

5. Yim E, Basilico F, Corrado G. Early screening for cardiovascular abnormalities with preparticipation echocardiography: utility of focused physician-operated echocardiography in preparticipation screening of athletes. Journal Of Ultrasound In Medicine: Official Journal Of The American Institute Of Ultrasound In Medicine.2014;33(2):307-313.

About the Author

Mike McKenney is an Athletic Trainer (AT) at Northeastern University in Boston, Massachusetts, where he is the Medical Coordinator for their Division I men’s ice hockey program.  Prior to Northeastern University, he served as an AT in multiple settings including secondary schools, Division I athletics and professional cycling; additionally, he worked as an AT who extends the services of a physician for a large orthopedic group.  He has also provided services for many organizations to include the Boston Marathon, USA Cycling and USA Volleyball.

McKenney is a hydration and electrolyte replacement consultant for the Atlanta Hawks of the NBA.  His professional interests include hydration, electrolyte replacement, thermoregulation in sport and postural restoration.  McKenney completed his athletic training education at Gustavus Adolphus College in Saint Peter, Minnesota and master’s degree at North Dakota State University in Fargo, North Dakota.  His graduate research was published in the February 2015 edition of the Journal of Athletic Training.

 

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Is Cupping the New “Fad” Therapy?

Friday, October 14th, 2016

Posted October 14, 2016

By Mackenzie Simmons, ATC

If you watched the Olympics this summer, you likely saw many Olympic athletes covered in perfectly circular red spots. These red spots are left by a therapeutic tool, known as cupping. Cupping is an ancient therapy, most prominently used in Middle Eastern and Asian countries.  Cupping has recently started to become popular in the United States over the past few years.

The process of cupping involves heating glass suction cups and placing them on the treatment area. The suction cups are usually left on the skin for around 5 minutes before they are removed. As the suction cups cool down, a partial vacuum is formed with the skin. The number of cups that are used is dependent upon the size of the treatment area; the bigger the area, the more cups that are used.

Cupping is believed to relieve pain by stimulating the muscles while increasing blood flow. It has also been shown as a form of deep-tissue massage that helps with the relaxation of sore muscles. Unfortunately, there has not been much research conducted that shows the positive effects of cupping.

Cupping might be the new “fad” therapy for Olympic, professional and collegiate athletes. Over the past 10 years, Kinesiotape, cryotherapy chambers and power bands have all become well-known and are used by professional athletes. With the limited research on cupping, time will tell  if this therapy will be around in 4 years for the next Summer Olympics.

Reference

http://www.cnn.com/2016/08/08/health/cupping-olympics-red-circles/

 

 

Medical Therapeutic Yoga Series: A New Movement in Healthcare

Monday, October 10th, 2016

Posted October 10, 2016

Desi Rotenberg
MS, LAT, ATC

By Desi Rotenberg, MS, LAT, ATC

Medical therapeutic yoga is a new movement within the rehabilitative realm that is quickly becoming more widely accepted as a pragmatic route to improving physical, emotional and mental well-being. There has been a paradigm shift within the medical field, as yoga therapy becomes more and more integrated into healthcare. Furthermore, yoga therapy is becoming more popular in the treatment of musculoskeletal injuries.

The core premise and philosophy behind medical therapeutic yoga is to understand your own limitations to be able to deliver the safest and best care possible. This includes a comprehensive understanding of the human anatomy and the treatment of specific diseases, disabilities or disorders. Additionally, in order to become a yoga therapist, a medical professional must have knowledge of indications and contraindications for safe breathing practices, as well as a strong knowledge base in various yogic practices to ensure patient safety.1

In 2012, the International Association of Yoga Therapists (IAYT) advisory board approved the educational standards for the training of yoga. This approval opened the door for medical therapeutic yoga to be held to competency-based educational standards. Although, Yoga Therapy is not governed nor regulated by the IAYT. The focus is on entry-level requirements for the training of yoga therapists and includes a definition of yoga therapy and training requirements. The goal for any organization when developing competency-based standards “is to define the foundational knowledge and skills required for the safe and effective practice of yoga therapy.”2

The Scope of Practice for yoga therapy can be found here: http://www.iayt.org/news/308692/IAYT-Updates-Scope-of-Practice.htm.3

The Professional Yoga Therapy Certification can be a post-certification option for Athletic Trainers who are interested in furthering their knowledge base. The Professional Yoga Therapy Institute (PYTI) is one of several institutes who offer both continuing education courses and a full professional certification.

The PYTI defines medical therapeutic yoga as “the practice of yoga in medicine, rehabilitation, and wellness settings by a licensed health care professional who is completing or has graduated from the Professional Yoga Therapy Institute program and has been credentialed as a Professional Yoga Therapist-Candidate or Professional Yoga Therapist.”4

Becoming a medical yoga therapist is not for everyone. While knowledge is essential to a medical professional’s success as a practitioner, the journey of accruing wisdom holds an even greater weight. The uniqueness of this new field focuses on the well-being of the patient, while also ensuring the individual who practices medical therapeutic yoga is able to achieve a balance within every aspect of their life, both professionally and personally.

More information on medical yoga therapy and becoming a professional yoga therapist, can be found at the following websites:

International Association for Yoga Therapy- http://www.iayt.org/

Professional Yoga Therapy- http://proyogatherapy.org/

Medical Therapeutic Yoga- http://www.gingergarner.com/therapies/medical-yoga/

Resources

1. Garner, G. (2007). The Future of Yoga Therapy and the Role of Standardization. International Journal of Yoga Therapy, 17(1), 15-18.

2. Educational Standards for the Training of Yoga Therapists. (2016). http://www.iayt.org/?page=AccredStds. Accessed September 27, 2016.

3. Scope of Practice for Yoga Therapy, (2016). INTERNATIONAL ASSOCIATION OF YOGA THERAPISTS. http://c.ymcdn.com/sites/www.iayt.org/resource/resmgr/docs_certification/scopeofpractice/2016-09-01_IAYT_Scope_of_Pra.pdf. Revised: September 1, 2016.

4. Professional Yoga Therapy Institute, (2016). http://proyogatherapy.org/about-pyts/. Accessed September 27, 2016.

About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 

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Return to Sport Post ACL Reconstruction

Wednesday, September 21st, 2016

Posted September 21, 2016

Tim Koba, MS, ATC
Twitter: @timkoba
Blog: www.timkoba.blogspot.com

By Tim Koba, MS, ATC

ACL injuries continue to be a hot topic in the sport world. A big reason is that even though they are still not very common, percentage wise, they have a large impact on long term joint health, recovery, cost and ability to return. As reconstruction techniques continue to evolve, athletes are able to return to play, but how successfully?

After surgery, the treatment consists of rehabilitation to regain motion, function, proprioception strength and control. Once athletes have completed about 6-9 months of rehab, they return to sport. Here’s the sobering news: Of those who suffer an ACL reconstruction, only 65% return to their pre-injury level of sport, with only 55% returning to competitive play. Even more discouraging is the fact that of those who return to sport, up to 1 in 5 will suffer a tear to their reconstructed knee, or the ACL on the non-reconstructed side.

In order to determine what risk factors existed, and ways to modify them, researchers looked at elite soccer players who had their ACL reconstructed and then followed them. They looked at the type of surgery they had, their rehabilitation process and their return to sport. What they discovered was that athletes who did not meet certain bench marks in rehab were 4 times more likely to have another ACL injury. The following table shows the exercises and the discharge criteria that were deemed successful.

Discharge tests and criteria used during the study period

6 part return to sport tests Discharge permitted when criteria was met
Isokinetic test at 60, 180 and 300 degrees/sec Quadriceps deficit <10% at 60 degrees/sec
Single leg hop Limb symmetry index >90%
Triple hop Limb symmetry index >90%
Triple crossover hop Limb symmetry index >90%
On field sport specific rehab Fully completed
T test <11 sec

In addition to the tests above, athletes who had lower hamstring-to-quadriceps strength ratios were also more likely to injure their ACL. Since strong hamstrings act as an assistant to the ACL, weakness there can mean more stress on the ligament.

Conclusion

This study highlights a couple of key points when rehabilitating ACL injuries.

- Prior to return to play, athletes should be fully recovered with equal strength bilaterally

- They should be able to seamlessly perform multidirectional drills

- Athletes should have adequate hamstring strength. Most of us do not have access to isokinetic testing, but spending time having athletes perform hamstring strengthening during their rehabilitation is essential.

Reference

Kyritsis, P. et. al. (2016). Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50. http://bjsm.bmj.com/content/early/2016/05/23/bjsports-2015-095908.abstract

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

 

NSCA position on Long Term Athletic Development

Thursday, August 25th, 2016

Tim Koba, MS, ATC
Twitter: @timkoba
Blog: www.timkoba.blogspot.com

Posted August 25, 2016

By Tim Koba, MS, ATC

The National Strength and Conditioning Association (NSCA) has released a position statement on long term athletic development. With the rise in youth sport participation, injury trends, sport specialization and long term inactivity of today’s adults, it is important to encourage youth to participate in physical activity. This tenet forms the cornerstone of the position statement.

While long term athletic development is generally taken to mean the development of athletes, the NSCA broadened the term to include all youth and to consider all youth athletic. In this manner, they address the concern and health implications of physical inactivity and they believe that all youth should be encouraged to be active.

There are 10 pillars for successful long term athletic development (LTAD):

1. LTAD pathways should accommodate for the highly individualized and non-linear nature of the growth and development of youth.

2. Youth of all ages, abilities and aspirations should engage in LTAD programs that promote both physical fitness and psychosocial wellbeing.

3. All youth should be encouraged to enhance physical fitness from early childhood, with a primary focus on motor skill and muscular strength development.

4. LTAD pathways should encourage an early sampling approach for youth that promotes and enhances a broad range of motor skills.

5. Health and wellbeing of the child should always be the central tenet of LTAD programs.

6. Youth should participate in physical conditioning that helps reduce the risk of injury to ensure their on-going participation in LTAD programs.

7. LTAD programs should provide all youth with a range of training modes to enhance both health and skill related components of fitness.

8. Practitioners should use relevant monitoring and assessment tools as part of a LTAD strategy.

9. Practitioners working with youth should systematically progress and individualize training programs for successful LTAD.

10. Qualified professionals and sound pedagogical approaches are fundamental to the success of LTAD programs.

When working with youth, it is important to remember they grow and mature at different rates. Customizing a program specific to each individual is preferable to implementing a general one size fits all approach. Programs also need to take into consideration each individual’s specific movement patterns and volume of activity. Many individuals are not engaging in free play prior to organized activity and, as such, are not prepared for the volume of training that occurs. Coaches, Athletic Trainers, personal trainers and strength coaches need to understand that fatigue and recovery are important aspects of a successful long term plan. By engaging in a well-rounded movement based training plan, youth can become acclimated to the rigors of sport and physical activity.

It is also of vital importance to maintain physical and mental health of young individuals. Programs should incorporate neuromuscular control, movement training and injury prevention exercises to reduce the risk of injury. Programs should also strive to be inclusive and foster a community of acceptance for all the participants, regardless of age or physical ability.

Due to the long term health consequences of physical inactivity, we need to encourage all youth to participate in some form of physical activity. Programs that encourage movement, play, control and strength can be an enjoyable experience for all those who participate.

Reference

Lloyd, R.S, et. al. (2016). National strength and conditioning association position statement on long-term athletic development. Journal of Strength and Conditioning Research, 30 (6). https://www.nsca.com/long-term_athletic_development_position_statement/

 About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

 

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Limiting Pitch Counts to Reduce Injury: Is the Formula that Simple?

Wednesday, August 24th, 2016

Posted August 24, 2016

By: Claudia Curtis, MS, LAT, ATC

As a heavily media influenced society, we’ve become hyper aware of some of the major injuries of sports. For example, we frequently note concussions in contact sports such as football and ulnar collateral ligament (UCL) tears leading to Tommy John surgery in baseball.

Football’s answer to reducing the concussion risk in young athletes has been to limit contact practice time on a weekly basis.1 Baseball has been following suit as of late, as many high school associations have adopted stricter rules on pitch and inning counts.2,3 These counts allow associations to place quantitative restrictions on a problem that is far from black and white. The intent is honorable, knowing that most elbow and shoulder injuries in baseball are chronic and related to overuse. However, if we set forth guidelines to reduce the risk of overuse, do we reduce the risk of injury?

According to Dr. James Andrews, a name synonymous with youth sports injuries and UCL reconstruction, he’s seen a five to sevenfold increase in UCL injuries requiring surgical reconstruction in high school athletes since 2000. He cites the top reasons for UCL injury as poor mechanics and overuse, noting the combination of the two is lethal to the UCL.4 Instituting the previously mentioned pitch count restrictions addresses the second risk factor of overuse, but not the first.

Imposing these limits on contact time, instituting pitch counts and limiting the age soccer players are allowed to head the ball are all designed with the noblest of intentions. The goal is to find ways to control injury risk and impose less harm on young bodies and brains. All of the aforementioned actions are technique based. My question for injury prevention personnel is, are we doing enough to address technique issues at a young age? Would we see a larger drop in injury if technique was a larger focus? With the current coaching structure in the United States, is this a reasonable approach to consider?

Resources

1. Jones, Brandon. “States Adopt Plans to Limit Contact in Football.” https://www.nfhs.org/articles/states-adopt-plans-to-limit-contact-in-football/

2. Unruh, Jacob. “NFHS Mandates Member States to Adopt Pitch-Count Rule.” http://newsok.com/article/5509251

3. Mercogliano, Vincent Z. “Why Haven’t More States Implemented High School Pitch Count Rules.” http://usatodayhss.com/2016/why-havent-more-states-implemented-high-school-pitch-count-rules

4. Berra, Lindsay. “Force of Habit.” http://espn.go.com/mlb/story/_/id/7712916/tommy-john-surgery-keeps-pitchers-game-address-underlying-biomechanical-flaw-espn-magazine

Injuries in Gymnastics

Monday, August 22nd, 2016

Tim Koba, MS, ATC
Twitter: @timkoba
Blog; www.timkoba.blogspot.com

Posted August 22, 2016

By Tim Koba, MS, ATC

If you’ve been watching the Olympics, you may have been mesmerized by the physical abilities of the gymnasts competing. Their ability to run, jump, leap, twist, twirl and flip is awe-inspiring. It may also leave you wondering how prone to injury they are given the skills they need to perform and the training required to reach this elite level.

Different studies cite different overall injury rates, but gymnastics generally has a greater risk of injury than many other sports.  Injury rates differ between male and female gymnasts, the events and the various apparatus.

Female gymnasts are more likely to suffer lower extremity injuries while their male counterparts have higher levels of upper extremity injury. Due to the upper body dominant skills of the male events, they are much more likely to suffer wrist and hand injuries. Women are more likely to have ankle and foot injuries. For female gymnasts, the most commonly suffered injury is an ankle sprain on 3 out of 4 apparatus, except for uneven bars which is upper body injury of the shoulder or wrist.

As young gymnasts progress in skill and hours training, their risk of injury goes up since they spend more time under load practicing higher level skills. As they produce more force with their maneuvers, the risk of having an injury increases. Younger athletes are also prone to wrist injuries at the growth plate. As their wrists extend under a load, the forces are transmitted to the growth plate and can result in pain and injury. This is most pronounced in athletes aged 10 to 14. Care should be taken to assess total volume and pain at this level to avoid wrist injury or manage it early.

Injuries in competition are more common as a result of performing the high level skills at higher speeds and greater heights without the benefit of crash pads and landing pits utilized in practice. Unfortunately, traumatic knee injuries, including ACL tears, are the most common cause of long term time away from the sport, surgery and medical disqualification from participation. Injuries as a result of floor routines are the most common mechanism for ACL injury in gymnastics.

Because of the nature of the sport, and the extreme flexibility needed to perform, gymnasts also sustain other injuries. Rates of back pain differ, but low back pain is one of the top 5 most common injuries. The main concern with gymnastics is developing a stress related fracture from constant extension. With the extreme range of motion in the hip, there have been case reports of hip instability and impingement syndromes of that joint. The hours required to learn and master a maneuver can lead to gradual overload and overuse injuries.

Conclusion

• Rates of injury in gymnastics differ, but the most commonly injured areas are the ankle and foot for females; wrist and hand for males

• Knee sprains are the most common cause of time lost from sport and injuries requiring surgery

• Injuries are more likely to occur in competition than in practice and when progressing from one level to another

• There are some unique injuries as a result of participation including wrist growth plates, low backs and hips

Understanding common injuries associated with participation and specific apparatus can help to develop prevention and rehab programs geared toward helping gymnasts successfully participate at their desired level.

References

Kerr, Z. et. al. (2015). Epidemiology of National Collegiate Athletic Association women’s gymnastics injuries, 2009-2010 through 2013-2014. Journal of Athletic Training: 50(8).

Kox, L. et. al. (2015). Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes; a systematic review. British Journal of Sports Medicine: 49.

Saluan, P. et. al. (2015). Injury types and incidence rates in precollegiate female gymnasts. Orthopaedic Journal of Sports Medicine: 3(4).

Tirabassi, J. et. al. (2016). Epidemiology of high school sports related injuries resulting in medical disqualifaction: 2005-2006 through 2013-2014 academic years. American Journal of Sports Medicine: 20(10).

Weber, A. et. al. (2014). The hyperflexible hip: managing hip pain in the dancer and gymnast. SportsHealth: 7(4).

Westermann, R. et. al. (2014). Evaluation of men’s and women’s gymnastics injuries: a 10 year observational study. SportsHealth: 7 (2).

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.

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