Monthly Archives: November 2017

Specialization in Youth Sports

Specialization in Youth Sports

Dr. Ken Charleston PT, DPT

It has been a growing trend for youth athletes to specialize in a single sport. I believe this trend has become popularized by the notion that by funneling all energy into one set of sport specific skills will develop an elite level athlete. The hard truth is that a very small percentage of high school athletes will achieve collegiate level athletics and an even smaller number of athletes will ever play at the professional level. There is also growing evidence that suggests single sport specialization leads to more negative outcomes than it does positive. Athletes that participate in one sport only are at an increased risk for overuse injuries, psychological stress and burnout.

Of course there are several other factors that contribute to injury risk in athletes, however the most important risk factor was exposure.  Single sport athletes are at an increased risk for overuse injuries such as patellofemoral pain syndrome, Osgood Schlatter and Sinding Larsen-Johansson compared multi-sport counterparts.

Psychological stress and burnout should also be of concern.  Single sport athletes may experience dropout due to stress, decreased motivation and lack of enjoyment. Youth athletes that specialized too early also show increased rates of physical inactivity as an adult.

My recommendation to youth athletes is to participate in multiple sports throughout the year.  Injuries can happen in any sport, however, by shifting from single sport focus to adopting other athletic endeavors, the athlete is at a reduced risk for developing overuse type injuries.  By participating in a single sport year round, you may be missing out on other athletic experiences in which you enjoy. There is a time and a place for specialization, however this should be reserved for athletes after puberty and when at higher levels of competition. Participate in your favorite sport, but explore others as well. Become a better overall mover and athlete in the process.

How to Deal with Calf Muscle Injuries

How to Deal with Calf Muscle Injuries

Written by Jordan Stone

As an athlete you deal with aches and pains throughout a season. Some of those are part of the game while others can easily be prevented. The purpose of this article is to help you prevent calf injuries.  If your calf is already, hurt do not hesitate to come and see a physical therapist who can further assist you.  These are just basic identification and prevention tips!

What most people typically refer to as the calf is actually made up of three separate muscles (the gastrocnemius, soleus, and plantaris) that all come together to form the achilles tendon. The most common of these to be strained is the gastrocnemius. The mechanism of injury is often a rapid extension of the knee accompanied with the foot being in dorsiflexion (think trying to touch your toe to your shin). If the strain is in the gastrocnemius, it is likely that the individual will be tender in the belly of the calf. The gastrocnemius muscle originates above the knee and this means in order to be stretched or strengthened the knee must be extended. To stretch it try lunging into a wall and with your back leg keep it straight while pressing your heel into the ground. To strengthen the muscle try getting just the balls of your feet on a stair with your heels hanging off and raise your body as high as you can and lower yourself all the way down. The Plantaris is rarely injured and even if it is hurt, it is typically treated similarly to the gastrocnemius, so there is not much need to differentiate it from the gastrocnemius.

Lastly, injuries of the soleus are often misdiagnosed as gastrocnemius and therefore under reported. Most often the symptoms of a soleus strain are calf stiffness, tightness, and pain that worsens over time. If the strain is in the soleus it is likely that the individual will be tender towards the outside of the calf. The soleus muscle originates below the knee and this means in order to be stretched or strengthened the knee must be flexed. To stretch it try getting into the same lunge position as the stretch for the gastrocnemius. Now,  move your back foot closer to the wall and bend your knee while still pressing your heel into the ground. To strengthen the muscle move to a seated position with one flexed (knee towards chest). With the bent leg place a band around the ball of your foot and use both hand to hold/ stretch the band toward your body. Push your foot down toward the ground and slowly let it rise back up and repeat.

If you are already hurt the above will not be enough nor is it intended to replace proper rehabilitation. Please seek out help from a medical professional if you are concerned about already being injured, the above is meant to help spot and prevent an injury before it occurs.

Backpack Safety Tips

Backpack Safety Tips
Dr. Katie Poole, PT, DPT

Did you know that how you wear and pack your backpack can have an impact on your health? According to the American Physical Therapy Association, backpacks should weigh no more than 10-15% of your body weight. So for example, if you weigh 100 pounds, your backpack should not weigh more than 10-15 pounds. Unfortunately, many of you carry backpacks much heavier than this, causing your body to have to adapt to the heavy load. You do this by arching your back, leaning forward, or leaning to the side if only one strap is used. These changes in posture can cause strain and fatigue in the muscles of the neck, shoulders, back, and abdominals, leading to possible neck, back, and shoulder pain, headaches, and tingling in the arms.

Now that you are a few months into the school year and I’m sure your backpack is getting heavier as you get more projects and homework, here are some tips for wearing your backpack correctly:

  • Proper fit. Your shoulder straps should fit comfortably and allow your arms to move freely. The bottom of the backpack should be at your waist, not sagging towards your buttocks, as this puts more pressure on your back and shoulders.
  • Use both straps. Wearing both straps helps to distribute the weight of the backpack evenly and promote symmetrical posture. Find a backpack with padded shoulder straps if possible.
  • Wear the waist strap. If your backpack has a waist strap, wear it to help distribute the load of the backpack to your pelvis.
  • Both the shoulder straps and the part of the backpack against your back should be padded.
  • Lighten the load. Take frequent trips to your locker, only carry necessary items home, and carry books in your arms if necessary.
  • Balance the load. Especially if your backpack has multiple compartments, put the heaviest items (textbooks, laptop, etc.) closest to your body.

In addition to making sure that your backpack fits and is not too heavy, it is also important to watch your posture while carrying and lifting your backpack. When picking up your backpack, your back should be straight and neutral, not rounded, and you should lift with your legs, using good squatting mechanics. If your backpack is hard to lift, it is probably too heavy.

If you have any questions about your specific backpack, how heavy it is, and your posture, call your Physical Therapist and they can help you adjust your backpack, improve your posture, and increase your strength so you stay pain free.

Truth or Myth? Sports Related Concussions

Truth or Myth?  If You Sustain a Sports Related Concussion You Should Sit in a Dark and Quiet Room Until All Symptoms Subside…..MYTH!

Dr. Daniel Luczka PT, DPT, CSCS

More and more evidence is strongly supporting that an early return to physical activity, within 1 week, may reduce persistent symptoms of a concussion.   The Journal of the American Medical Association published a study that involved over 2,400 children and adolescents between the ages of 5 and 18 years old who sustained a concussion.  The findings showed that out of those who participated in early physical activity, only 28% still had persistent post-concussion symptoms compared to those who did not participate in early physical activity, over 40% of them continued to have persistent post-concussion symptoms at 28 days post injury.

The benefits of aerobic exercise on the brain have been documented for years.  Protocols such as the Balke or Buffalo Concussion Treadmill Test have been proven to be safe and effective in finding the proper dosage and intensity of physical activity post-concussion to help speed up the recovery of the athlete.

Do not fall into the out dated protocol of being told to “sit in a dark room and do nothing.” Make sure you are seeing a medical professional who is up to date on the most current research for Post-Concussion Syndrome.  Call your Physical Therapist as soon as you suspect a concussion to help ensure the best medical care is being provided!

Rehabbing the ACL, Both Physically AND Mentally

Rehabbing the ACL, both physically AND mentally
Dr. Lisa C. Clark, PT, DPT

The last time I wore the number 17, I was carried off the field. I had experienced the dreaded “pop”, the horrifying buckle, my worst fear. I had torn my ACL in double overtime, halfway through my senior lacrosse season. My college career was over and I was devastated. In the last 4 weeks of that season, I watched my teammates play the game I loved while I worked my hardest to prepare for a surgery I never wanted. The emptiness that I felt was overwhelming and lonely. I felt like my identity had been stripped from me. Being an athlete was all that I knew and, suddenly, it was just over.

Now, as a physical therapist, I treat athletes like me all the time. Luckily, many of them are young enough to return to their sports and find plenty of success, like receiving athletic awards and commit to colleges. The amount of joy that we both feel is tremendous. Many of these kids didn’t think they’d ever get back to sports, but they did and it took a lot of work to get there.

Tearing the anterior cruciate ligament (ACL) is, perhaps, the most feared diagnosis in all of sports. Physical symptoms include significant joint pain and swelling, loss of range of motion, quad weakness, difficulty walking, feelings of instability. In most cases, a reconstruction is the best option for anyone who would like to return to sports involving a change of direction. The rehabilitation process can take anywhere from 6-12 months. Many people staring this prognosis in the face are understandably overwhelmed. For athletes, though, this is an entire year of sports. Maybe 3 or 4 competitive seasons or a recruiting year that they’re missing out on. While they see their friends trying to make college decisions, they are just trying to walk, run, and squat properly.

Along with these physical symptoms comes the mental and emotional response, which is not often discussed, but is very prevalent. Perhaps even more important than rehabilitating the knee is rehabilitating the mind. Research shows that psychological responses, such as depression, anxiety, fear, and anger, are significant in cases where an athlete has suffered a severe injury. These emotions are shown to have a large effect on the rehab process. Athletes with depression, for example, are less likely to adhere to their treatment and home exercise programs. They struggle with returning to their sport, may experience a social withdrawal, and are at an increased risk for suicide. Literature suggests that athletes with depression are more likely to demonstrate poor functional and orthopedic outcomes and report a lower quality of life.

Even more significantly vulnerable for negative responses to injury are those who already have a history of depression. Athletes between the ages of 15-25 are the most at-risk group for ACL tears. This age group is also most vulnerable to suicide. Thus, depression following an injury is even more problematic in our adolescent and collegiate athletes. In general, injured athletes who gain self-worth and self-esteem from performance have been shown to be at risk for negative responses in comparison to their peers who are uninjured.

While this information is intimidating, it is worth mentioning that research indicates that most athletes return to their sports with minimal complications following proper rehabilitation. Therefore, as a clinician, I do all that I can to help ensure my patients that I thoroughly believe they will return to their pre-injury status. The hardest part is convincing them of the same thing, which can be an uphill battle. I always discuss the mental portion of ACL tears, like fear, discomfort, frustration, and grief. I let them know that these feelings are normal and encourage them to talk with teammates, coaches, family, friends, or even me. Sometimes just acknowledging these emotions and talking about them can take away their power. We also set goals and try to accomplish them one-by-one. I also try to schedule my ACL patients together so that they form a comradery with each other. That is sometimes more helpful than anything – strength in numbers and emotional support. If that isn’t enough, though, I encourage my patients to utilize the many resources we have to ensure our athletes are making a complete physical and mental recovery: primary care or mental health practitioner, sports psychologist, cognitive behavioral therapy, counselors or wellness professionals (to name a few).

If you are a PT/ATC/MD or any clinician reading this: please take the time to educate your ACL patients about how much mental health affects their outcomes and their return to athletics. Understand that depression can make it difficult for patients to be consistent with visits and remain compliant with home exercises, especially with time spans of 6-9 months. Instead of being frustrated, be encouraging. Show that you care and use what you know to help to motivate them. Increase their number of visits as they get closer to their return-to-sport to make sure they are sticking to their programs. Rehab compliance can help to improve their physical and mental ability. Prove to them why that is the case.

If you are an athlete who has suffered an ACL tear and are in any stage of recovery: your mental health is a HUGE factor in your return to what you love. Your PTs and the people working around you want what is best for you. These are some symptoms of depression: sadness, isolation, irritation, lack of motivation, anger, frustration, changes in appetite or sleep, and poor concentration.

If you experience any of them, please talk to someone about it. These feelings are perfectly normal and can be dealt with in whichever way is most appropriate. If any of these symptoms are interfering with your rehab process, it must be taken care of. As I mentioned above, remember that depression will make it difficult for you to stick with your exercises, but the more effort you put in, the better you will be both on and off the field. Stay involved in team activities. Go to practices and games and team functions. Do whatever fundamental drills you can participate in (stickwork, ball handling, hand-eye reaction drills, etc). You are still part of a team, even if you’re not putting on the uniform every day.

Treating patients with ACL injuries is my passion, not just because I’ve been down that road, but because I love getting to know and understanding the whole person. Not just their knee, but their emotions, their goals, their passions, and their motivations. It would be a mistake for me and all of my colleagues to not address the most important part of ACL rehabilitation: the mental recovery.