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Archive for the ‘sports medicine’ 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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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 ordered my copy of Optimal Shoulder Performance yesterday. I attended the course in November and look forward to reviewing the material and relearning some of the great information that may have passed me by initially.

One comment about this product and other multimedia presentations in regards to Athletic Trainers and CEUs that most people in our profession have a poor handle on.

Most ATCs are misinformed about what educational materials they can actually utilize in order to acquire their CEUs. They simply think that if an educational course does not have CEUs assigned to it or is offered by a non-approved provider, that they can’t get CEUs for it. So they pass the opportunity by and miss out on a potentially great learning experience.

Unfortunately, this is incorrect. Educational materials such as DVDs or seminars sponsored by non-approved providers can count toward your CEU total under Category D. Each ATC can acquire 20 CEUs in this category every three years.

I wrote a detailed post on this subject previously and you can also check out the BOC guidebook for Continuing Education here.

So don’t disregard those Category D opportunities.

And make sure you order a copy of the Optimal Shoulder Performance DVD as well – you won’t be disappointed.

Take care and have an awesome Easter!!!

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Staying on top of all of the research that is out there is important. It shapes why we do what we do with those in our care. It reaffirms some of the things that we are doing right and rightfully calls into question some of those things that may need to be questioned.

The trick is to be able to access and efficiently navigate through the research that particularly applies to our profession and the settings we work in.

Last week in a post, I mentioned a free site that allows access to various studies. Today, I’ll bring the Physiospot.com site to mind.

Here is a brief overview of the site:

“Physiospot is a resource where physiotherapists (and other health care professionals) can easily keep up to date with current affairs related to the physiotherapy profession. It presents featured articles, new research, recent news, courses and jobs in one easily accessible place. Not only does this resource provide a wealth of current and archived information for health care professionals, it also provides a great place for self directed continuing education and professional development.”

This site provides summaries of some of the latest research and links to the accompanying abstracts. This site is a great place to visit if you have some spare time to review some of the latest research. Take a look – Rachel Lowe and the team do a very nice job with the site.


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Sports Health published a meta-analysis in the January-February 2010 issue. It was entitled: Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Autograft Versus Allograft Tissue.

Although autografts are much more commonly used for ACL reconstruction, the comparative studies of the two are very limited. The research team searched exhaustively to find studies to qualify for inclusion. After reviewing 5000 studies, the researchers found 576 studies that warranted further review. When all was said and done, 56 studies were deemed to meet every aspect of their criteria, one of which directly compared both autograft and allograft reconstruction.

The meta analysis compared the following outcome measures: positive Lachman test, positive pivot-shift test, IKDC grade C or D, graft failure, and joint laxity as measured by a KT-1000 arthrometer.

In a comparison of all the studies, the only statistically significant difference was that allograft patients presented with increased joint laxity when measured by the KT-1000 arthrometer compared with autograft patients.

While the other negative outcome measures proportions were larger for autograft than allograft, statistical analysis revealed that these differences were not statistically significant.

So based upon the available data, the researchers concluded that patients who undergo allograft ACL reconstruction may have more joint laxity as measured by the KT-1000 arthrometer compared to patients who undergo autograft ACL reconstruction. They go on to further recognize that a large multicenter randomized clinical trial comparing both is warranted and would be beneficial.

On a final note, I found this particularly interesting – the researchers had this to say in the discussion:

“Furthermore, data suggest that the incidence of osteoarthritis is similar for patients who have sustained an ACL rupture 15 years following injury, regardless of whether or not they undergo reconstruction. 40 It would be important to ascertain if graft type has an influence on the incidence or progression of osteoarthritis following ACL reconstruction.”

This was a significant undertaking and the researchers should be applauded for their efforts to help provide us with the information needed to more accurately instruct and educate those who face the prospect of ACL reconstruction.


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Over the Christmas and New Year holidays, I read the book Born to Run by Christopher McDougal. I heard about this book while listening to a webinar and gave it a read. This best-selling book has obvious appeal, but as an athletic trainer, I found the book to be a very interesting read.

On the heels of that, I came across the following study yesterday: The Effect of Running Shoes on Lower Extremity Joint Torques published in the December 2009 issue of Physical Medicine and Rehabilitation.

If the book hadn’t caused me to pause and re-evaluate what I think I know about running injuries and their subsequent causes, the study certainly does.

The book, Born to Run, takes us on Christopher’s journey to answer the question that he had: Why does my foot hurt? Throughout the book, the reader is challenged to re-evaluate what we “know” (or think we know) about running. Probably the most fascinating part of the book was Christopher’s discussion of the advent of footwear and how the incidence of injury has not significantly decreased despite the latest technology and latest models of running shoes currently available. In fact, the notion that the more expensive the running shoe, the more likely a runner is to sustain injury is offered in the book.

The study is challenging as well. It combined barefoot runner with runners shod with shoes and measured lower extremity joint torques in both scenarios. The study showed that there were indeed increased joint torques at the hip, knee, and ankle in those with running shoes compared with those running barefoot.

“An average 54% increase in the hip internal rotation torque, a 36% increase in knee flexion torque, and a 38% increase in knee varus torque were measured when running in running shoes compared with barefoot.”

The authors did go on to list some limitations with the study but the results of this particular study do cause us to reassess the role that running shoes potentially play in contributing to lower extremity injuries.

While I am not suggesting that you start telling everyone to run in leather sandals or run entirely barefoot, these two literary pieces should at the very least get us to reevaluate what we think about running, running related injuries, and footwear.

As we take the research and meld it with our experience, maybe our opinions will remain unchanged – maybe not. But don’t be afraid to reassess what we “think we know” and challenge yourself to think critically.

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As 2010 is now here, I have several books on the proverbial wish list to purchase this year.

One of those – The Men’s Health Big Book of Exercises by Adam Campbell, MS, CSCS – I picked up yesterday. This book just came out and comes in both a men’s and women’s edition. (A quick look through – both appear nearly the same in terms of exercise selection although the tips vary from each book dependent upon the male and female population. You can’t go wrong with either. )

The book is chocked full with over 600 exercises. The exercises are laid out by muscle groups being targeted and is also laid out by progression as well.

The photography is really outstanding as each exercise is laid out in full color and is extremely easy to see how to perform. (By contrast, I perused several other exercise books yesterday just for comparison and the photography and exercise demonstration wasn’t even close). The exercises have tips on form and proper execution. There are additional tips that are sprinkled throughout this book in addition to other nuggets such as workout regimens, nutritional information, and more.

So if you are looking for a pretty exhaustive encyclopedia of exercises, this is a great resource to add to your professional library.

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