• heat map of knee

    Posted on 3/27/2018 by Bryce Vorters, M.S., ATC, LAT

     

    A couple weeks ago, I got the chance to dust off my golf clubs and go to the driving range. I hit 100 golf balls with four different clubs, and all of them went the same distance. I know that isn’t how it’s supposed to work, but hey, I never said I was good at golf. I just have the dream of hitting a hole in one, so I looked up the odds and it is about a one in 3,500 chance. Given that I can’t hit the ball like a pro, or even a good amateur, my dream will probably never happen, but I’m always going to prepare for the day by striking the ball whenever I get a chance.

    From an odds standpoint, one in 3,500 is about .02 percent, which is a long shot, but accounts for approximately 100,000 people this year in the United States. These odds are the same as the possibility of tearing your anterior cruciate ligament (ACL). For the same reasons I go out year after year and practice hoping for a par, I’d encourage you to make a small effort to work on lowering your chances of tearing an ACL with an ACL prevention program.

    ACL prevention programs have been created and mixed into teams warm-ups, cool downs and off-season lift programs and have been shown to be helpful. Research shows 75 to 85 percent less ACL injuries happen when athletes are on an ACL program. Programs are usually three-times per week and take about 30 to 45 minutes to perform or, in my experience, about 15 to 20 minutes of additional work onto the normal warm-up and cool down of a team sport. It’s no guarantee that you won’t tear your ACL, but if you can practice for your sport to get better, why not make a small investment in making sure you can potentially avoid a nine- to 12-month rehabilitation process, too?

    A simple ACL program looks something like this:

    Warm-up
    Jogging – Two minutes forward, two minutes backward and two minutes of side shuffling
    Stretching – Thirty seconds on each of these muscle groups:
    Calf
    Quad
    Hamstring
    Groin
    Glute
    Hip flexor
    This should look similar to a basic high school gym class warm-up.

    Agility Drills – During agility drills, look to maintain your balance. Have your knee stay behind your toes and do not allow your knee to sway toward the opposite side of your body.

    Bend over and touch a ball on the ground in front of you 10 times.
    Balance on one leg in a mini squat for 60 to 90 seconds while dribbling a basketball, playing catch or trying to kicking a soccer ball.
    At this point, we added approximately five minutes to your warm-up, and you should be ready to perform your normal practice, pick-up game or workout.

    Strength Portion – After your workout, perform strength exercises that reinforce proper mechanics of jumping and landing and help you control your body while you’re tired. Most injuries happen to people when they are tired or near the end of a game because they lose focus on controlling their body.

    During this strength portion, you should be looking to stay focused, keep your knees from going toward each other during the landing and land softly and on the balls of your feet.

    Squat jumps with two second hold at the landing 10 times
    Tuck jumps 20 times
    Lateral jumps 10 times each side
    Lunge 10 times each side
    Plank two times for 30 seconds front and each side
    Cool Down – Perform your normal cool down or a nice foam rolling session.

    An ACL prevention program doesn’t guarantee you won’t tear your ACL any more than me hitting the driving range three times per week to help fix my golf swing will guarantee me a hole in one, but it doesn’t mean I’m not going to go out and try. I encourage you to take a few extra minutes to help prevent an ACL injury, and I hope your extra work is fruitful to your sports performance and ACL injury prevention.

    For more information concerning ACL injury prevention and NovaCare Rehabilitation and Select Physical Therapy’s ACL Play it Safe Program, please click here.

    By: Bryce Vorters, M.S., ATC, LAT. Bryce is the head athletic trainer with NovaCare Rehabilitation for Conwell-Egan Catholic High School in Fairless Hills, PA.

  • Snow Shoveling

    Posted on 3/21/2018 by Dorothy Lehr, DPT, OCS, Cert. MDT

     

    Major snowstorms have already hit many parts of the country this winter, and the fourth nor'easter in three weeks is currently battering the East Coast, drowning out any hopes of spring. There is lots of fun to be had with the fluffy white powder, but removing snow from sidewalks and driveways is an unenviable chore and one that can cause a plethora of physical problems.

    With that in mind, below are a few tips and stretches to keep you safe and healthy while out in the winter wonderland:

    Choose an ergonomically correct shovel, one which has a curved handle and an adjustable handle length. As opposed to a straight line shovel, a shovel which is small, lightweight and curved will allow you to carry a manageable load of snow and keep your back straighter, reducing spinal stress.
    Proper shoveling technique is just as important as the correct shovel. Keep your back straight and bend at your hips and knees. When moving the snow to a new location, avoid twisting your body. Instead, turn your whole body by pivoting your legs.
    Avoid slipping on slick areas or black ice by wearing shoes or boots with good tread. Applying pet-friendly salt, sand or kitty litter will also increase traction and decrease the risk of slipping.
    Snow shoveling can be as physically demanding as a gym workout and should be treated like a day in the gym. Don’t overexert yourself, especially when the snow is wet and heavy. In deep snow, take a few inches off the top and tackle the job by dividing it into thirds, with one-hour rest breaks.
    Snow shoveling is a cardiovascular and weight-lifting exercise, and just like you would stretch before working out at the gym, performing the stretches described below before, after and even during snow shoveling can help in preventing an injury.
    Lumbar Extension – This stretch will help in balancing any forward bending that may occur during shoveling. While standing or lying on your stomach, bend back as far as is comfortable and hold for three to five seconds. Perform 10-15 repetitions.

    Lumbar Extension - Step 1  Lumbar Extension - Step 2

    Quadriceps Stretch – While standing, use your right arm to pull your right leg up toward your buttocks. Make sure to keep your trunk straight and use your other arm to hold onto a sturdy object to maintain your balance. Hold each stretch for 20 seconds and perform five reps on each leg. This will help stretch out your quad muscles that you’ll be using to lift while shoveling.

     Quad Stretch

    Hip Flexor Stretch – In a half-kneeling position and while maintaining an upright trunk, lunge forward until you feel a stretch in the front of your hip. Hold this position for 20 seconds and perform five repetitions on each leg. This stretch will help to stretch the muscles you’ll be using while moving snow and helps to keep your spine in a neutral position.

     Hip Stretch

    Sometimes, there will be a winter storm where a snow shovel simply isn’t enough. While a snow blower can certainly help with snow removal, hand injuries such as burns, lacerations, fractures and even amputations can occur if proper techniques aren’t practiced. Here are a few tips to keep you safe while operating a snow blower:

    While it sounds simple, never put your hands down the chute or around the blades of a snow blower.
    Use a broom handle, clearing stick or another tool to clear any clogs. Wait 10 seconds after the engine has been turned before you attempt to unclog the chute; blades could still be spinning even though the machine has been turned off.
    Generally, keep your hands and feet away from all moving parts of a snow blower.Avoid wearing scarves and loose fitting clothing which could become tangled in the moving parts and pull you into the machine.
    Never direct the discharge chute toward you, other people or areas where any damage can occur. The blower can also discharge hard objects, such as salt, sticks and ice further and faster than snow.
    If you are feeling some unwanted aches and pains or suffered an injury during your clean-up efforts, we’re here for you. Contact the center nearest you to schedule a complimentary consultation. Stay safe and keep thinking spring – it’s coming!

    By: Dorothy Lehr, DPT, OCS, Cert. MDT. Dot is a physical therapist and center manager with NovaCare Rehabilitation in Willingboro, NJ. A treating clinician for 12 years, Dot is a board certified orthopaedic specialist and McKenzie credentialed therapist, specializing in spine treatment.

  • athletic training on football field with student

    Posted on 3/16/2018 by Stephanie Wilkins, MSEd, ATC, and Leah Friedland, M.S., ATC

     

    Concussions are a great concern throughout the world of sport and especially in the high school setting. They can impact the student-athlete not only on the field, but also in the classroom and their daily lives. As athletic trainers in the high school setting, when a concussion has occurred, we are involved in the entire process, including:

    Baseline testing
    Evaluation
    Diagnosis
    Follow-up
    Return-to-play
    We help with education, implementation of proper concussion protocols and serve as an advocate for the student-athlete in their sport, classroom and life.

    Education – Despite the growing awareness and concern that is present in the media over concussions, we find that coaches, parents and athletes are often still uninformed about the seriousness of concussions and the proper way to handle them. A concussion is a traumatic brain injury that is caused by either a direct force/blow to the head or a force transmitted through the body to the head. As high school athletic trainers, we find ourselves explaining to coaches that “getting your bell rung” is the same as sustaining a concussion, and that it is not something that can be ignored. “This wasn’t a big deal back when I played sports, and I turned out fine,” is not an acceptable way of viewing this issue.

    We are seeing now that, decades later, people are experiencing abnormal brain function and lasting damage as a result of previous head trauma that might not have been managed properly. Concussion education is not intended to scare people, but rather to inform and stress that concussions should be handled appropriately and taken seriously.

    We must also work to change the team attitude around concussions and urge athletes and coaches to take responsibility for their well-being and the well-being of their teammates. The culture of not reporting concussions for fear of sitting out or being made fun of must not continue. High school athletic trainers are in the unique position of helping create this cultural change within sports programs and we strive to do this by forming relationships with our coaches, parents and student-athletes that are based on trust and compassion.

    Baseline Testing – Every concussion is different; even in one person, different concussive episodes can present in different ways. Symptoms of a concussion include:

    Headache
    Appearing dazed or confused
    Nausea and vomiting
    Difficulty concentrating
    Imbalance… and more
    There are few objective measures available to diagnose concussions, so it’s important to have a baseline evaluation for each athlete to help determine return-to-play.

    We perform this evaluation at the beginning of the season to obtain a baseline score, i.e. an athlete’s “normal” level of functionality. If the student-athlete sustains a concussion during that season, a second test will be administered. This second test occurs when they are symptom-free and have completed the return-to-play progression.

    In our high school, we implement two different tools for baseline testing. With more than 800 student-athletes, we prioritize the high risk contact sport athletes (like those participating in football or soccer) and administer baseline tests to those sports. The first test is ImPACT®, a computer neurocognitive exam that tests word and image recall, reaction time, motor speed and symptom report. The alternate test we use is C3 Logix. In addition to a neurocognitive exam, C3 Logix includes a balance and vision component. It is more comprehensive and time intensive, whereas the ImPACT® Test is more easily administered to a large team all at once.

    We don’t use ImPACT® or C3 Logix to diagnose concussions, but rather as a tool to monitor their healing process and identify any potential problem areas. 

    Evaluation and Diagnosis – The most important aspect of concussion management in the high school setting is communication. We’ll discuss concussion management with both the student-athlete and parents/guardians to discuss next steps and answer any questions they may have

    Next, we communicate with our Concussion Oversight Team (COT). The COT is a multidisciplinary group of individuals who help manage the student-athlete’s post-concussion care. It includes the athletic trainers, team physician, school nurses, athletic director and school counselors. We also email the coach and physical education teacher. This is our opportunity to provide athletic and/or academic accommodations as needed. The counselors and nurses are vital for helping communicate with the student-athlete’s teachers.

    Occasionally, a student-athlete will require academic accommodations. These are specific to each individual and can include wearing sunglasses to help with sensitivity to light, postponing quizzes or tests, limiting use of computer work or leaving class early. Most students don’t require academic accommodations, but all are excused from gym class and athletics until their symptoms have resolved and they have completed the return-to-play progression.

    Follow-Up – Oftentimes, parents will ask, “Does my son/daughter need to go to the doctor or the emergency room?” The emergency room is rarely indicated unless there are signs and symptoms of a brain bleed. This will be evaluated at the time of the injury and, if there is concern, a referral to the emergency room will be made.

    Research shows that most concussions resolve within 7-14 days. Our protocol recommends following up with a physician if the symptoms have not resolved within 7-10 days. And, referral to an appropriate health care provider is essential. When possible, we will refer to a concussion specialist who works with these cases on a normal basis. The average primary care physician will not have expertise in concussion management. We will sometimes recommend following up with an ophthalmologist if the student-athlete is having difficulty with vision or physical therapy due to vestibular problems.

    As athletic trainers, we take care to be as best prepared to diagnose and treat concussions as possible. We put a strong emphasis on communication with the athlete, parents, coaches and school in order to return the student-athlete safely to school and sport. Concussion research will continue to evolve over the years to come, just as we will continue to adapt and update our management protocols to keep student-athletes safe and active.

    By: Stephanie Wilkins, MSEd, ATC, and Leah Friedland, M.S., ATC. Stephanie and Leah serve certified athletic trainers for NovaCare Rehabilitation in Chicago, Illinois, and currently work at York Community High School. Stephanie also serves as the sports medicine program director and helps manage other sports medicine contracts around the Chicago-land area.

  • collage of exercise

    Posted on 3/8/2018 by Joshua Cramer, DAT, LAT, ATC, CES, CSCS

     

    Injuries can happen at any time to anyone. Whether playing your favorite sport, working on the job or living your daily life, it’s important to get the proper treatment when an injury occurs, and that starts with the evaluation process.

    During an evaluation, a clinician will discuss a patient’s medical history, discuss goals and specific needs, inspect for abnormalities, tenderness or deformities and test musculoskeletal health. All of these components are essential to making a proper diagnosis, but they rarely provide the whole picture. These evaluative techniques focus on the area of the patient’s chief complaint, but what if the issue is in a different region or system in the body?

    To design more effective treatments, it is important to look at the body as a whole – the upper and lower body, the front and back of the body and the limbs. This is where postural and functional assessments come into play.

    Functional movements are essentials movements found in activities of daily living. They usually involve multi-joint movements in numerous directions, which place demand on the body's core muscles. Our clinical team frequently include functional movement screens in the evaluation process, which are designed to examine these daily essential movements and help identify limitations and dysfunction, reduce the risk of injury and improve efficiency and performance. Functional movement screens also include a detailed report and customized corrective exercise program.

    There are a handful of functional movement tools available to clinicians. Some of the more popular are through the Functional Movement System, which is divided into two main parts: the Functional Movement Screen (FMS) and the Selective Functional Movement Assessment (SFMA). Another popular functional movement tool is Fusionetics.

    The FMS is a screening tool which takes the patient through a series of basic movements with the intention of determining if the patient is at risk for injury. Its role is to impose minimum standards on movement patterns. The movements include:

    Squatting
    Stepping over a hurdle
    Lunging
    Reaching behind the back
    Leg raises
    Push-ups
    Core test – the patient starts on his/her hands and knees and touches the elbow to the knee
    The SFMA is a full-body assessment broken down into two parts, the top-tier and the breakouts. The top tier helps determine if movements are functional versus dysfunctional and painful versus non-painful. The breakouts determine the type of dysfunction a patient may suffer from. The movements consist of:

    Various neck movements
    Reaching behind the back
    Hip flexion (bending forward)
    Hip extension (arching backward)
    Hip rotation (twisting)
    Single leg stance
    Squatting
    The SFMA will help define what type of dysfunction exists, whether that’s stability and motor control dysfunction, joint mobility dysfunction or tissue extensor dysfunction. Once the clinician determines which dysfunctions exist, he/she will set up an individualized treatment protocol to correct the faulty movement pattern and treat the injury and prevent future occurrences.

    Fusionetics is designed in the same manner, but is web-based. It is a series of 10 exercises that determine whether someone is susceptible to certain injuries due to form and body mechanics. At the end of the Fusionetics assessment, the system will provide patients with corrective exercises. Each patient can create a free account with Fusionetics and access the results and corrective exercises from any computer, tablet or smartphone.

    These screenings and assessments can be done on both injured and healthy individuals to identify movement and stability deficits. As you continue to play your respective sport or go through your daily routines, keep in mind that proper functional movement is a necessity. It is just as important to treat your body properly when you’re healthy as it is when you’re injured.

    By: Joshua Cramer, DAT, LAT, ATC, CES, CSCS. Josh has been with NovaCare Rehabilitation for five years and serves as the head athletic trainer for Germantown Academy and the Philadelphia Freedoms. He is certified in various manual therapy techniques and has treatment expertise in shoulder injuries and concussion.