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Archive for the ‘Journal of Athletic Training’ Category

Here are some items that I came across recently that I thought may be of interest to you:

  • The standard Pallof press (or cable press) is probably one of my favorite exercises. Well, Nick Tumminello has taken this exercise and added to it. He has taken the traditional exercise and added a frontal plane component and a sagittal plane component making this a tri-planar exercise. Check the links out for great stuff from Coach Nick.
  • Here is a blast from the past – this was my review of a phonophoresis study that has been one of my more popular posts.
  • Another blog that you may not have checked out yet is Charlie Weingroff’s blog. Charlie is a DPT, ATC, CSCS and he always has thought provoking material on his blog. Make sure the check it out.
  • Barefoot running seems to be a raging topic everywhere you turn. Here is a blog post on Mike Reinold’s blog discussing this topic. With this topic, and seemingly every other trend in the field of sports medicine, people have a tendency to go overboard. I don’t remember the exact quote from Alwyn Cosgrove but he talked about a pendulum and how people have a tendency to go to the extremes of one side or another and the answer is probably somewhere in the middle.
  • If you are a baseball fan, I am sure you have paid attention to Stephen Strasburg’s injury. What a shame. And yet, do things like this curb the way our youth train and participate in sport – even though they head down a similar path. Eric Cressey has a good write-up on his thoughts about this case.
  • Finally, here is an article that was posted in the local paper this past weekend concerning concussions. I was disappointed in the article to say the least. There were some signs and symptoms and precautionary measures sandwiched between an account of a former player who reportedly played in a game after suffering a concussion and a poll (not a study as indicated) of coaches and how they handle the situation of concussions.  The most shocking thing about the article is that the player said that if they had to do it over again, he would have done the exact same thing. Kids reading that are going to disregard the experts and even the coaches and listen to what a fellow student-athlete says. Please take a read of the article and give me your comments. Am I overreacting or is this a pretty irresponsible piece?

Thanks again, enjoy the great resources, and please share your comments on the concussion article.

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A little over a year ago, I wrote a blog post reviewing a study that compared crushed ice, cubed ice, and wetted ice and their effect on tissue cooling. The conclusion of the study was that wetted ice was the most effective in providing both surface temperature and tissue cooling.

So, if the goal was to produce the most tissue cooling – the choice would have been to use cubed ice and add about a cup of room temp water to get your wetted ice treatment.

Now, let’s fast forward to phase two that will help us even make better evidence-based decisions when we choose ice as a treatment modality.

The most recent edition of the Journal of Athletic Training published a study entitled: The Magnitude of Tissue Cooling During Cryotherapy With Varied Types of Compression.

This study compared the use of no compression, Flex-i-Wrap, and an elastic wrap as compression methods when applying ice. The study looked at both surface temperatures and intramuscular cooling. An interesting side note was that this study utilized crushed ice. (This is not a criticism – simply an observation that we can take into account at the end of the study when developing some take home points of note).

Going into the study we would probably surmise that an ice bag secured with any type of compression would produce greater tissue cooling than no compression. This was largely true but there were some additional interesting findings.

In respect to surface temperature cooling, there was a statistically significant difference with compression using an elastic wrap and no compression. However, there was no statistically significant difference between using Flex-i-Wrap and no compression or Flex-i-Wrap versus the elastic wrap. So, from this we can conclude that compression with an elastic wrap provides the greatest amount of surface temperature cooling. (Although we must also note that skin temperature is not necessarily a direct reflection of what is happening intramuscularly).

When comparing intramuscular tissue temperature at approximately 2 cm below the skin, again compression with an elastic wrap produced greater intramuscular tissue cooling than both the Flex-i-Wrap and no compression.

This to me was a bit of a surprise. I would not have expected much difference in means of compression. Many athletic trainers utilize Flex-i-Wrap or similar type product for several reasons. Apparently, the elastic wrap adds a level of insulation that is not necessarily provided with the Flex-i-Wrap.

Another point that was also driven home in the study I reviewed last year, was that tissue cooling continues after the ice is removed. Ice, in this study, was applied for 30 minutes and the coldest tissue temperatures were measured at 40 minutes post treatment. So the tissue cooling continues for approximately 10 to 15 minutes following ice treatment.

Please read the study in depth – it was well done and again helps us toward more evidence based practice.

So when we look at this study and compare it with the previous study, what sort of best practices can we establish when using ice as a treatment modality?

  • Cubed, wetted ice is the treatment of choice – crushed ice is probably the least “effective” in comparing the methods of cryotherapy using ice
  • Use compression over no compression – so instead of simply laying an ice bag on an ankle, calf, knee, etc – make sure to secure it with a compression wrap
  • Use an elastic wrap as the choice of compression – This method is more effective than using other plastic wrap methods
  • Both studies utilized treatment times of 30 minutes so this probably serves as a great reference point as well

Following these evidence-based parameters will help athletic trainers provide their athletes and patients with proven methodologies that will ultimately provide more effective treatment. If you have these elements at your disposal, the research shows these are more effective.

Thanks again to the authors of this study and to David Tomchuk, MS, LAT, ATC, CSCS who took extra time to answer questions that I had about this study.

What are your thoughts? Do this studies change the way you think about the application of ice?

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The 2010 Supplement to the Journal of Athletic Training has a vast number of abstracts contained within. Today I want to discuss the abstract entitled The Effects of Ultrasound Transducer Velocity on Intramuscular Tissue Temperature Across a Treatment Site.

Ultrasound is a commonly used, yet maligned modality. As a result, it is important to have studies that speak to it’s efficacy (or lack thereof for that matter) as a treatment and also help to determine parameters for use.

This study aimed to determine if transducer velocity (how quickly the soundhead is moved over the surface) affected intramuscular tissue temperature. Now the authors stated that the general recommendation for soundhead velocity is 4 cm/s and the recommended treatment area is twice the size of the soundhead. Whether the velocity recommendation or whether there was uniform heating within the treatment area were points of interest for this study.

The researchers had 12 subjects and performed continuous ultrasound treatment for 10 minutes at 1 MHz frequency and 1.5 w/cm2 intensity. Intermuscular temperature changes were assessed via sensor probes at 2.5 cm below skin surface. The researchers used velocities of 2 cm/s, 4 cm/s, and 6 cm/s and compared the results.

The study concluded that sound head velocity had no effect on temperature rise during treatment. The other finding in this study was that tissue heating was not uniform across the treatment area. The further away from the center of the treatment area, the less the increase in tissue heating.

Here is an alternate, yet very similar study from 2006 that yielded very similar results. The parameters of this study were very similar. The treatment area was twice the size of the soundhead. This study measured transducer velocities of 2-3 cm/s, 4-5 cm/s, and 7-8 cm/s. Muscle temperature for this study was measured at 3 cm below one-half of the skinfold thickness. Overall, this study showed very similar tissue temperatures between the three tested treatment velocities.

Overall, the one abstract reveals some compelling evidence regarding ultrasound as a treatment. Both studies when looked at together are even more convincing.

So here are some conclusions that we can come to about ultrasound as a treatment based upon both of these studies:

  • There were no significant changes in intermuscular temperature from transducer velocities of 2 cm/s to 8 cm/s.
  • The further away from the center of the treatment area, the less the intermuscular temperature increase
  • Continuous ultrasound at 1.5 cm/2 x 10 minutes in two separate studies produced tissue temperature increases of 4 to 5 degrees celsius
  • Intermuscular tissue temperature was shown to increase during treatment from 2.5cm to approximately 3cm below the skin.

So at the end of the day:

  • Transducer head velocity plays little role in the elevation of intermuscular tissue temperature
  • Treatment parameters of 1.5 cm/2 x 10 minutes of continuous ultrasound seem to be good starting points to deliver muscular tissue temperature increase
  • Using the above treatment parameters, you can expect approximately 4-5 degrees Celsius of temperature increase
  • The larger your treatment area is, the less the tissue temperature increase at the outer rims of the treatment area.

So as we try to become more evidence-based in our approach, these findings can help us to make more appropriate choices in the use of ultrasound as a treatment modality.

What are your thoughts? Did you find any other conclusions from these studies?

Photo Credit here

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I received the Journal of Athletic Training in the mail yesterday along with it’s accompanying Supplement to the Journal of Athletic Training.

Now, I’ll admit – in the past, I have paid little mind to the Supplement. Call it ignorance. For whatever reason, I never paid much attention to it. The fact that it simply contained abstracts and not full studies may have contributed to my lack of interest.

So yesterday, as I perused the more than 400 submissions, I realized that this supplement is a worthwhile read. Unfortunately, I have missed out on some great research and information in the past. So in order to not repeat mistakes of the past, I went through and highlighted all of the abstracts of interest. Needless to say, there is research here that will give insights into the prevention, evaluation, and treatment strategies that I maybe did not have previously.

I read a few of the abstracts this morning during my morning reading time and there is some great information inside those pages that flies under the radar a little bit.

So if you have been inclined to discount this issue in the past as I have, I’d encourage you to not repeat that mistake and make an effort to read the abstracts contained within. They’ll challenge your thinking, reaffirm some of your current practices and possibly fly in the face of current strategies you are using. Nevertheless, you’ll be a better professional for taking the time to glean from the hard work of others.

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