Month: March 2014

Ice: Friend or Foe?

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If you played sports or ever hurt anything I’m sure you have heard the phrase, “throw some ice on it”. Why is that the case? It decreases/prevents swelling? Decreases pain? May help you recover faster? What if I told you this may not be the case at all? You would probably think I was crazy. Even I have told my athletes that this is the case. But my recent reading and research (because when you think you know it all, you know nothing at all) has caused a bit of a shift in my beliefs and treatment styles. I just recently completed Gary Reinl’s book ICED! The lllusionary Treatment Option and it really challenged a lot of my beliefs on ice.

Now, when we put ice on an injury, whether it be acute or chronic, the first goal is to prevent or limit inflammation and swelling. Lets first talk about inflammation. Inflammation is a key component of how the body heals itself. It helps bring in the substances and materials needed to repair the injured area. The body has a magical way of healing itself, so why would we want to prevent or limit it?? Also, it has been shown that ice does not limit nor prevent swelling. Think back to an significant injury you may have had, mine happen to be ankle sprains (I have tissue paper for ankles). The firs thing you may have done was slap an ice bag on it or put it in a bucket of ice water. But what happened soon after taking the ice off the injury?? You still swelled correct? That is because the body is pretty stubborn and will still try to heal itself the way it was intended to do, through inflammation. The ice only delayed the inflammation process. So why delay the inevitable? Why not let the body do what it does best and repair itself? While reading ICED!, I was having an internal struggle with myself about this aspect. Everything I was taught in school was to ice acute injuries but looking back this was totally disregarding our body’s natural biology. Now for all the good that inflammation causes, swelling is the enemy of returning back from injury. It is the waste and byproduct of the healing process that must be removed to allow for healthy movement and function.

For years medical professionals, and myself included, as well as the lay person (coaches and parents) have recommended to ice a swollen area. The thought as been that it constricts the areas that are swollen causing an evacuation of the swelling. This may be the exact opposite. Ice may be causing a back flow of swelling from the lymphatic drainage system(or the path in which the swelling is removed) therefore causing even more swelling. Also, think about what ice or cold does to liquid. The analogy that best describes this is toothpaste. Cold toothpaste becomes hard and difficult to squeeze out of the tube. Think of swelling in the same light, the ice we use may actually make it more difficult to remove the swelling. Also, think back to when you last iced an injury, did it feel stiff or did the athlete report it feeling stiff after the icing? This may be due to the ice causing an increase in viscosity of the fluid. So how does one remove the swelling??

The lymphatic drainage system is a passive system, therefore it needs help to remove the excess swelling. This is where compression comes into play. There are two ways to create compression on the lymphatic system. Either through compression units (Normatec) or activation and contraction of the surrounding muscle tissue. Gary Reinl describes this as reverse milking of a cow. The muscles will help push the swelling back towards the midpoint of the body. The best way to remove this swelling is through contraction of the muscles around the injured area, for example the muscles that control the toes and foot with an ankle injury. The idea of an active pump may also shine some light into better recovery methods after tough workouts.

Ice baths have been the dreaded tool of coaches and sports medicine professionals to help with post workout recovery. The thought behind it is you may be flushing the waste products in the muscle that can lead to muscle soreness and fatigue. We all know this can hinder our workouts and cause a decrease in performance. Ice bathes were said to decrease the metabolic activity there for leading to less waste that the body must remove. Ice baths have since been shown by the NSCA to actually delay recovery from muscle damage caused by exercise. In fact, creatine kinase MB levels were significantly increased in people who used topical cooling compared to people who did not ice. Creatine kinase is a blood marker used to determine how much breakdown of muscle tissue is occurring.

So what is the best method for recovery?? MOVEMENT! I am a huge believer of active warm downs after workouts, as well as the next day. For delayed onset muscle soreness a light workout of the affected tissues is actually much more effective. So next time you are sore, try doing some body weight movements to help “flush” the trash that is left over in the muscle.

Has anybody else begun to move away from the use of ice in their treatments? Good or bad results? This is all pretty new for me and I am interested to see how it works in the long run.

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Is it effective to find a 1 rep max on adolescent athletes?

Yesterday I saw a great statement from @EricCressey about 1 rep maxes(RM) in adolescent athletes.

“1RM testing a 14-year-old is like driving in Daytona 500 on first day of driver’s ed.”

I got quite a chuckle when I first read this statement. When I further analyzed the statement and tried to truly understand the statement, I found it to be absolutely genius. Think back to when you were 15 years old, and in drivers ed, do you think you were ready to be full throttle at 200 MPH racing 3 wide at Daytona International Speedway? Now look at a 14-year-old athlete whose exercise movement patterns may not be fundamentally correct. There are two possible outcomes to these situations:

1. Failure due to injury
The lack of fundamentals will lead to the proverbial crash into the wall. In the case of the athlete, undue stress will be placed on joints that may not be able to handle the “maximal load”. You may end with back injuries due to improper core bracing or anterior knee pain due to poor knee stabilization techniques.

2. Improper form leads to lower performance
Take another look at the racing example, if you don’t know how to drive the car properly, you will probably fall way behind from the rest of the pack. You may not be able to drive at the average 200 MPH needed to keep up. This same scenario of poor performance can occur while trying to achieve a 1RM with a 14 year-old. The proper form in lifting will allow for greater performance as it is the most efficient path from point A to B.

If you are working with young athletes, quit worrying about the numbers. Start focusing on the fundamentals. You will see greater gains in performance in the long run if you focus on the fundamentals early on and establish good movement patterns.

Rest: It won’t kill you

About a year ago Dr. James Andrews, famous orthopedic surgeon to the pros, was quoted as saying young athletes need rest. In summary he says that the rise in youth athletic injuries is due to the year-round sports and training that is occurring at an earlier age. He specifically mentions baseball as a big culprit of this. I would even broaden this to sports such as softball, softball, and basketball. Club and AAU sports have become more and more influential and are seen as the only way to make it to the next level. I feel much of this play all year mentality comes from the club/AAU coaches. I once heard that a young male baseball player played upwards of 162 games one summer…that is the equivalent of a Major League Baseball season. Look at an MLB injured reserve, even the developed and well conditioned bodies of adults cannot sustain that level of volume without some sort of injury.

I think we as a sports culture need to take a step back and re-evaluate the “right” way to make it to the next level. I would recommend to these young athletes, take some time off. Let your body heal from your grueling high school season or club season. I have always been under the impression, if you are good enough, college coaches will find you but if you’re hurt, they’ll never see you play. Now taking time off does not necessarily mean you completely stop training, it means taking a step back, lowering your volume and working on the fundamentals. I think practice and conditioning the body are just as important as playing, but the fundamentals are the foundation to playing great. So athletes, coaches, and parents slow things down for a bit, work on the little things and let your daughter/son/athlete rest. They will be better for it in the long run.

My Lent Challenge: Pulling your weight!

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Today being Fat Tuesday, the greatest day to live or be in New Orleans, I figured I’d set my goal or what I’d give up for Lent. Then I thought about it and I said why should I give something up…why not challenge myself?? So I began to consider my strengths and weakness in the weight room. Pulling or my upper back has never been my strong point. So I have set a challenge for myself, to do some sort of pulling whether it be pull-ups, rows, or a variation of deadlift, everyday for the 40 days (not including Sundays). My starting point or gauge of the progress seen will be the number of pull-ups I can do in one maximal set. I also think I may see an increase in core lifts of the bench, squat, and deadlift. Excited to see where this challenge will take me both physically and I am even sure mentally.

What better time to set a challenge to make yourself better?? Let me hear how you may challenge yourself physically or mentally over the next 40 days!

Saving athletes from themselves and their coaches

That title may tick some people off, especially coaches. The title is not calling out all coaches or athletes. There are some coaches who do the right things in doing whats best for the kid over what is best for the team. This is where we as athletic trainers come in. We always have the best interest of the individual over the interest of the team. Of course we want the teams we work for to win, but not at the expense of one athlete’s well being.

This subject came to mind as me and my brother (who is in his last clinical rotation before becoming a DPT, or in other words a physical therapist), were having a conversation about concussions. There was a story he shared of a young man(not a patient at his clinic), who had received a concussion some weeks ago. The young man, who is a high school wrestler, is still suffering from headaches and nausea and vomiting (and I’m sure suffering from other concussion symptoms). The disheartening part of this story is the coaches of this team having been getting on to him for not practicing and showing complete disregard for the well being of this young man. Now I do not know if this school has an athletic trainer or not, but from the facts that I received, I would highly doubt it. Any medical professional with a clue about a concussion would see this athlete is not ready for any kind of physical activity. I would even recommend to the parents and the school that the young man should be at home resting and not stressing his brain during school.

In the case of the young man, the athletic trainer would be protecting the athlete from the coach. But the coach isn’t the only person athletic trainers and other medical professionals who deal with injuries should be protecting the athlete from. Sometimes the athletes worst enemy is themselves. I hear too many times, “Mitch, I’m fine I can go back in!” I quickly explain why I can not let them return whether it be a concussion or some sort of orthopedic injury. I also hear the, “If I have a concussion, I’m not telling you!” This scares me to death and keeps me on high alert and paranoid. With these kids, I explain that I am not trying to hold you out, my goal is to protect them and allow them to play as soon as possible as safely as possible.

As I have moved from the college to the high school level, and as I am currently waiting on my own little one, I have become much more protective and will do whatever it takes to protect them. I think this is the goal of most athletic trainers and other medical professionals.

My charge to parents, demand that your school has an athletic trainer in your school! They are there to protect your child. Athletes, please be truthful and upfront with your athletic trainer as they are only trying to help you! And coaches, care more about the individual than the team. These young men and women look up to you and your actions toward them can have far reaching repercussions.

Athletic Trainer: Saving lives everyday

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Everybody body has heard the term “trainer”. It is a very ambiguous term. Some people use it for the big buff guy who makes you do 100 crunches at the end of your workout. Some people use it for a person leading a training. And then there is the “trainer” who we see on tv taking care of the big time athletes. I want to talk specifically about this “trainer”. These educated and highly skilled medical professionals are actually called Athletic Trainers.

What is an athletic trainer?
An athletic trainer is a medical professional who collaborates with a physician to provide care to patients. These services include evaluation, treatment, rehabilitation and emergency acute care. Athletic trainers are also not only in athletics. Athletic trainers can be found in clinics, both rehabilitation and physicians offices. Athletic trainers are also utilized in the performance arts (cirque du soleil), military, and industrial settings.

What does an athletic trainer do?
As said before there are so many different fields to the athletic training profession, but I will speak on what I know best, the more traditional field of athletic training which is athletics. Every professional team and college athletic program has 1 or multiple athletic trainers providing medical care to their athletes. Where the coverage is lacking but has increased is at the high school level of athletics. Many school districts and even state school boards are beginning to require an athletic trainer at home athletic events. Where the coverage is lacking is in the less affluent areas, such as rural and some inner city areas. This is a shame as these athletes deserve the same amount of medical care as the rich kids. Many deaths in athletes at the high school level could’ve been avoided had an athletic trainer been on site to provide emergency care. The single most important job of the athletic trainer is preventing/treating an emergency situation. Athletic trainers have been trained to handle life-threatening events such as asthma, cardiac events, and head and neck injuries. We have been drilled over and over on these situations and are prepared to act when needed. This is the primary reason parents should be beating down school board doors if their school does not have an athletic trainer at the school for sport activities. I have heard the quote, “if you can’t afford an athletic trainer, you can’t afford to have football”. I think this is a very true quote, but I would even extend this into the entire athletic department.

Athletic Trainers are all also skilled in the realm of exercise and movement. This could include everything from strength and conditioning, rehabilitation, movement assessment. This particular area has become a huge area of interest for me. This is the “fun” part as it takes a bit of problem solving to treat an orthopedic injury or a movement dysfunction. Athletic trainers, under the direction of a physician, can take an injured person from day 1 of the injury and safely return them to play through rehabilitation and treatment. For me, this may be the most satisfying aspect of my job, to see that athlete go from devastated because an injury has ended his/her season and be back at their top level of physical shape playing like they were never hurt. It is one of the big reasons I am excited to walk in to work each day.

This is what sets us apart from the “trainer”. Athletic trainers are saving lives and allowing for a better quality of life for athletes as well as the “retired athlete”. I am proud to be called an athletic trainer because I know I am helping people do what they enjoy safely.