Treatment for ACL Injury

Anterior Cruciate Ligament (ACL) Injury

What is an anterior cruciate ligament (ACL) injury?
The anterior cruciate ligament (ACL) is one of the major ligaments in the middle of the knee. Ligaments are strong bands of tissue that connect one bone to another. The ACL connects the thighbone (femur) to the shin bone (tibia). This ligament, along with the posterior cruciate ligament, helps keep the knee stable and protects the femur from sliding or turning on the tibia. A sprain is a joint injury that causes a stretch or a tear in a ligament.

Sprains are graded 1, 2, or 3 depending on their severity:

•grade 1 sprain: pain with minimal damage to the ligaments
•grade 2 sprain: more ligament damage and mild looseness of the joint
•grade 3 sprain: the ligament is completely torn and the joint is very loose or unstable

The ACL may be completely torn or partially torn. Most injuries are complete tears.

How does it occur?
The anterior cruciate ligament is frequently injured in forced twisting motions of the knee. It may also become injured when the knee is straightened further than it normally can straighten (hyperextended). It sometimes occurs when the thigh bone is forcefully pushed across the shin bone, such as with a sudden stop while you are running or a sudden transfer of weight while you are skiing.

What are the symptoms?
There is usually a loud, painful pop when the joint is first injured. This is often followed by a lot of swelling of the knee within the first several hours after the injury. This swelling is called an effusion and is made up of blood in the knee joint. You may find it difficult to fully bend or straighten your knee.

If you have torn your anterior cruciate ligament in an injury that occurred months or years ago and you haven't had reconstructive surgery, you may have the feeling that the knee is giving way during twisting or pivoting movements.

How is it diagnosed?
Your healthcare provider will examine your knee and may find that your knee has become loose. If you have swelling in the joint, he or she may decide to remove the blood in your knee with a needle and syringe. You may need X-rays to see if there is an injury to the bones in your knee. An MRI (magnetic resonance imaging) scan may also be done and should clearly show the condition of your ACL (as well as that of other ligaments and cartilage).

How is it treated?
Treatment includes the following:

•Put an ice pack on your knee for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain goes away.
•Keep your knee elevated whenever possible by placing a pillow underneath it until the swelling goes away.
•Take an anti-inflammatory medicine or other drugs prescribed by your healthcare provider. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.
•Do the exercises recommended by your healthcare provider or physical therapist.

Your provider may recommend that you:

•Wrap an elastic bandage around your knee to keep the swelling from getting worse.
•Use a knee immobilizer initially to protect the knee.
•Use crutches.

For complete tears, you and your healthcare provider will decide if you should have intense rehabilitation or if you should have surgery followed by rehabilitation. The torn anterior cruciate ligament cannot be sewn back together. The ligament must be reconstructed by taking ligaments or tendons from another part of your leg and connecting them to the tibia and femur.

You may consider having reconstructive ACL surgery if:

•Your knee is unstable and gives out during routine or athletic activity.
•You are a high-level athlete and your knee could be unstable and give out during your sport (for example, basketball, football, or soccer).
•You are a younger person who is not willing to give up an athletic lifestyle.
•You want to prevent further injury to your knee. An unstable knee may lead to injuries of the meniscus and arthritis.

You may consider not having the surgery if:

•Your knee is not unstable and is not painful and you are able to do your chosen activities without symptoms.
•You are willing to give up sports that put extra stress on your knee.
•You are not involved in sports.
If a growing child tears an ACL, the healthcare provider may recommend that surgery be postponed until the child has stopped growing.

How long will the effects last?
When you tear your ACL you will have pain and swelling for several weeks. You need to stop doing the activities that cause pain. If you continue doing activities that cause pain, your symptoms will continue.

If you have a completely torn anterior cruciate ligament the effects will be chronic. Your knee may feel loose and feel like it will give way when you are running and making quick turns. Rehabilitation exercises and a special brace will help improve these symptoms.

When can I return to my normal activities?
Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your knee recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your normal activities when, starting from the top of the list and progressing to the end, each of the following is true:

•Your injured knee can be fully straightened and bent without pain.
•Your knee and leg have regained normal strength compared to the uninjured knee and leg.
•Your knee is not swollen.
•You are able to walk, bend and squat without pain.

How can I prevent an anterior cruciate ligament sprain?
Unfortunately, most injuries to the anterior cruciate ligament occur during accidents that are not preventable. However, you may be able to avoid these injuries by having strong thigh and hamstring muscles and maintaining a good leg stretching routine. Practicing coordinated jumping and landing may help prevent ACL injuries. In activities such as skiing, make sure your ski bindings are set correctly by a trained professional so that your skis will release when you fall.

Written by Pierre Rouzier, MD for RelayHealth.
Published by RelayHealth.
Last modified: 2009-01-09
Last reviewed: 2009-01-07
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Kinesio Tape for Sports Injuries

What is Kinesio Tape?



For over 25 years, Kinesio has provided comfort and stability to our loyal users. Kinesio Tape offers patients a more gentle approach to rehabilitation than those provided by conventional athletic tape. On the heels of our unprecedented publicity and positive feedback from the 2008 Olympic Games in Beijing, we here at Kinesio would like to invite you to experience what athletes and medical practitioners around the world are calling the rehabilitative and enhancement tool.

Kinesio Tape is a Latex free, non-medicated, thin, porous cotton fabric with a medical grade acrylic adhesive. The tape is comprised of elastic qualities which are designed for a 30-40% longitudinal only stretch when applied. Our bodies were designed to move and the Kinesio Taping Technique promotes movement and motion. With Kinesio Tape, we are not only limited to supporting and stabilizing musculature, but allowed to provide rehabilitation while encouraging movement!

How it Works:
The technique relies heavily on insertions and origins of muscles. The built-in stretch of the tape can help stabilize injured muscles, support fatigued, weakened and/or strained muscles, and can also help facilitate a stretch for those muscles in spasm.

In addition to muscle support, Kinesio Tape can lift the skin to increase the space between the skin and muscle. This reduced localized pressure in the affected area helps promote circulation, lymphatic drainage, and lessen the irritation on the subcutaneous neural pain receptors. As an end result, the Kinesio Taping Technique reduces pain and inflammation.

Since the introduction of Kinesio Tape in the United States, medical practitioners such as PTs, ATCs, OTs, DCs, MTs and MDs have recognized and embraced this effective, safe and best of all, easy-to-use modality. The method and tape allow the individual to receive the therapeutic benefits 24 hours a day with both comfort and ease because it can be worn for several days per application. Currently, Kinesio Tape is being used in hospitals, clinics, high schools, colleges, professional sports teams, and even at the Olympic level!

For more information, please visit www.kinesiotaping.com or consult with one of our health care professionals!


Chiropractor Fairfax VA, 22031

Testing New Exercise Technique

Testing New Exercise Technique


A year ago, Michael Bemben, professor of health and exercise science in the University of Oklahoma College of Arts and Sciences, was invited to the National Press Club in Washington, D.C., to formally announce the partnership between the American College of Sports Medicine and Sato Sports Plaza of Japan. The partnership is an effort to facilitate independent research projects around the country to examine the efficacy of a new type of training technique.



Bemben's lab at the university is currently only one of four labs outside of Japan that has been working with the KAATSU-Master training system, testing the effectiveness of reducing blood flow to exercising muscle. This technique allows for a reduction of the external loads that need to be lifted from a traditional high load of 80 percent of a person's strength down to 20 percent while maintaining all the benefits of the high-intensity programs. KAATSU-Master has been in development for more than 40 years in Japan and now is working on building research abroad regarding the many benefits and uses for the equipment.



KAATSU-Master may be used by both professional athletes and older adults in need of activities that limit physical stress to the body, giving them both similar benefits of weight training without having to lift heavy loads and deal with high joint stress. Other advantages may include faster rehabilitation or physical therapy for orthopedic problems, reduced hospital stays, and reduced muscle and bone loss during space flight. Both NASA and the Japanese space agency JAXA are working with KAATSU-Master for use in space exploration.



OU's lab has completed several different studies on men and women of various ages, including 18- to 25-year-olds and 50- to 64-year-olds, using KAATSU-Master to compare both the acute and chronic responses of muscle and bone to traditional high-intensity weight training and muscle endurance weight-training interventions.



In general, they have found an increase in markers for bone formation; a decrease in markers of bone resorption; increases in hormones responsible for muscle growth; increases in muscle strength and size; no changes in inflammatory markers; and increased muscle activation that are similar to or enhanced when compared to traditional high-intensity resistance training programs.



If this training technique is confirmed to be safe and effective by this new research initiative by the American College of Sports Medicine, then it is hoped that a program ultimately could be established that would certify trainers worldwide to use this equipment in a variety of settings with many different populations.



The Department of Health and Exercise Science is the third-largest department in the OU College of Arts and Sciences. Faculty, graduate students and undergraduate students have multiple ongoing research projects that involve different aspects of exercise physiology and health promotion. For more information, visit their Web site at http://hes.ou.edu.



Source: Michael Bemben

University of Oklahoma

Treatment for Medial Meniscus Tear

A great summary from the Sports Injury Clinic...

What is a medial meniscus injury?
The medial meniscus is more prone to injury than the lateral meniscus as it is connected to the medial collateral ligament and the joint capsule and so is less mobile. Hence, any forces impacting from the outer surface of the knee, such as a rugby tackle, can severly damage the medial meniscus. In addition, medial meniscal injuries are often also associted with injuries to the anterior cruciate ligament. Other mechanisms of injury may be twisting of the knee or degenerative changes that are associated with age. Any of these circumstances may lead to tearing of the medial meniscus, which in serious cases may require surgical intervention.

Symptoms of medial meniscus tear
A history of trauma or twisting of the knee
Pain on the inner surface of the knee joint
Swelling of the knee within 24-48 hours of injury
Inability to bend knee fully- this may be associated with pain or a clicking noise
A positive sign (pain and/or clicking noise) during a "McMurrays test"
Pain when rotating and pressing down on the knee in prone position (video).
"Locking" of the knee
Inability to weight bear on the affected side

Types of meniscal injuries:
Degenerative Changes: This may lead to edges of the menisci becoming frayed and jagged
Longitudical Tears: This is a tear that occurs along the length of the meniscus
Bucket- Handle Tears: This is an exaggerated form of a longitudical tear where a portion of the meniscus becomes detached from the tibia forming a flap that looks like a bucket handle

Treatment of medial cartilage meniscus injury

What can the athlete do:

Apply RICE to the injured knee.
Wear a heat retainer or support.
Gentle exercises to maintain quadriceps strength, although care should be taken not to aggravate the symptoms.
Take a glucosamine / joint healing supplement.
Consult a Sports Injury Specialist.

A Sports Injury Clinician May:

The first aim of the sports injury specialist will be to correctly diagnose the injury. He/she may do this by utilizing specific tests for meniscal tears such as a "McMurrays" test. Once diagnised the practitioner may consider two different modes of treatment depending on the extent of the injury.

1. Conservative Treatment
This may be indicated in the case of a small tear or a degenerative meniscus and may involve:

Ice, compression and recommendation of NSAIDs e.g. Ibuprofen.
Electrotherapy i.e ultasound, laser therapy and TENS.
Manual therapy
Once pain has subsided, exercises to increase range of movement, balance and maintain quadriceps strength may be prescribed. These may include: squating, single calf raises and wobble-board techniques.

2. Surgical Intervention
In the event of more severe meniscal tears such as a bucket handle tear, arthroscopic surgical procedures may be necessary to repair the lesion. The aim of surgery is to preserve as much of the meniscus cartilage as possible. The procedure itself will normally invlove stitching of the torn cartilage. The success of the surgery depends not only on the severity of the tear but also on the age and physical condition of the patient. Younger and fitter patients are known to have better outcomes.

Following surgery a rehabilitive exercise program will be outlined for the patient which may include strenghtening and balance training. Full co-operation with the rehabilitive technique will be necessary to maximise recovery.

Treatment for Pulled Hamstring

Hamstring Injury - Pulled Hamstring Muscle
How to treat hamstring injuries, pulls, and strains
By Elizabeth Quinn, About.com Guide
About.com Health's Disease and Condition content is reviewed by the Medical Review Board

Hamstring injuries are common among athletes who play sports that require powerful accelerations, decelerations or lots of running. The hamstring muscles run down the back of the leg from the pelvis to the bones of the lower leg. The three specific muscles that make up the hamstrings are the biceps femoris, semitendinosus and semimembranosus. Together these powerful knee flexors are known as the hamstring muscle group. An injury to any of these muscles can range from minor strains, a pulled muscle or even a total rupture of the muscle.

Symptoms of a Hamstring Injury
A hamstring injury typically causes by a sudden, sharp pain in the back of the thigh that may stop you mid-stride. After such an injury, the knee may not extend more than 30 to 40 degrees short of straight without intense pain. Like most sprains and strains hamstring injuries are usually caused by excessive stretching (tearing) of muscle fibers or other soft tissues beyond their limits.

Severity of a Hamstring Injury
Hamstring strains are classified as 1st (mild), 2nd (moderate), or 3rd (severe) degree strains depending on the extend of the muscle injury.

Mild (Grade I) Hamstring Injury
•Muscle stiffness, soreness and tightness in the back of the thigh.
•Little noticeable swelling.
•A normal walking gait and range of motion with some discomfort.
•Flexing the knee to bring the heel up

Moderate (Grade II) Hamstring Injury
•Gait will be affected-limp may be present .
•Muscle pain, sharp twinges and tightness in the back of the thigh.
•Noticeable swelling or bruising.
•Painful to the touch.
•A limited range of motion and pain when flexing the knee.
Severe (Grade III) Hamstring Injury
•Pain during rest which becomes severe with movement
•Difficulty walking without assistance.
•Noticeable swelling and bruising.

Common Causes of Hamstring Injuries
Hamstring pulls or strains often occur during an eccentric contraction of the hamstring muscle group as an athlete is running. Just before the foot hits the ground, the hamstrings will contract to slow the forward motion of the lower leg (tibia and foot). Less commonly, a hamstring injury is the result of a direct blow to the muscle from another play or being hit with a ball. Some of the factors which may contribute to a hamstring injury includes:

•Doing too much, too soon or pushing beyond your limits.
•Poor flexibility.
•Poor muscle strength.
•Muscle imbalance between the quadriceps and hamstring muscle groups.
•Muscle fatigue that leads to over exertion.
•Leg Length Differences. A shorter leg may have tighter hamstrings which are more likely to pull.
•Improper or no warm-up.
•History of hamstring injury.

Treating Hamstring Injuries
Treatment for hamstring injuries depends upon the severity of the injury. Due to the pain and limited ability to use the muscle, a third degree strain usually results in a visit to a physician for evaluation and treatment. Less severe hamstring strains may be treated at home. These general treatment steps are commonly recommended for mild or moderate hamstring injuries.

•After an injury it's important to rest the injured muscle, sometimes for up to two or three weeks before you can return to sports after your injury.
•R.I.C.E - Rest, apply Ice and Compression. Elevate the leg if possible.
•An anti-inflammatory can be helpful to reduce pain and inflammation.
•A stretching program can be started as soon as the pain and swelling subsides.
•A strengthening program should be used to rebuild the strength of the injured muscle in order to prevent re-injury. Make sure you increase this gradually.
•A thigh wrap can be applied to provide support as the muscle heals.
Preventing Hamstring Injuries
•Warm up thoroughly. This is probably the most important muscle to warm-up and stretch before a workout.
•Stretching after the workout may be helpful.
•Try adding a couple sessions per week of retro-running or backward running which has been should decrease knee pain and hamstring injuries.
•Follow the "Ten Percent Rule" and limit training increases in volume or distance to no more than ten percent per week.
•Other ways to prevent injury are to avoid doing too much, too soon, avoid drastic increases in intensity or duration, and take it easy if you are fatigued.


Chiropractor, Fairfax VA

Patellofemoral pain syndrome Runners Knee

From professional athletes to weekend warriors, the condition known as "runner's knee" is a painful and potentially debilitating injury suffered by millions of people - although until now, it has been unclear just what causes it.

But new research from the University of North Carolina at Chapel Hill has zeroed in on what appear to be the main culprits of the condition, formally known as patellofemoral pain syndrome.

The study is believed to be the first large, long-term project to track athletes from before they developed runner's knee, said study co-author Darin Padua, Ph.D., associate professor of exercise and sport science in the UNC College of Arts and Sciences.

"Earlier studies have usually looked at people after the problem sets in," Padua said. "That means that while previous research has identified possible risk factors related to strength and biomechanics, it's been unclear whether those caused the injury, or whether people's muscles and the way they moved changed in response to their injury."

The research appears in the November issue of the American Journal of Sports Medicine.

Runner's knee - the bane of many types of exercise, from running to basketball to dance - affects one in four physically active people. If unchecked, it can lead to more serious problems such as patellofemoral osteoarthristis.

"Patellofemoral pain syndrome can be devastating," said Padua. "The pain can severely curtail a person's ability to exercise and the symptoms commonly reoccur. That said, athletes often have a high pain threshold and may ignore it. But if they do, their cartilage may break down - and if that gets to the point of bone on bone contact, nothing can be done to replace the damaged cartilage."

Padua and his colleagues studied almost 1,600 midshipmen from the United States Naval Academy. Researchers analyzed participants' biomechanics when they first enrolled at the academy, then followed them for several years to see if they developed patellofemoral pain syndrome.

A total of 40 participants (24 women and 16 men) developed the syndrome during the follow-up period. The study found:

- Participants with weaker hamstring muscles were 2.9 times more likely to develop the syndrome that those with the strongest hamstrings
- Those with weaker quadriceps muscles were 5.5 times more likely
- Those with a larger navicular drop (a measure of arch flattening when bearing weight) were 3.4 times more likely
- Participants with smaller knee flexion angle (those whose knees bent less on landing during a jump test) were 3.1 times more likely

Padua said the pain associated with the condition could be explained by those different factors coming together to create a focal point of pressure between the kneecap and the underlying bone.

"Overall, these people generally have weaker quads and hamstrings. As a result, they don't bend their knees as much when doing task, such as running or jumping. That means the contact area between the kneecap and the femur is smaller, so pressure is focused and pinpointed on a smaller area.

"Also, the more a person's arch falls when bearing weight, the more their whole leg may rotate inwards. That will mean their kneecap won't track properly, leading to yet more pressure and more potential pain."

Padua said the good news is that the study appears to confirm that if people can change the way they move and improve their leg strength, they can prevent or correct the problem.

Everyday athletes can also spot for themselves whether they are at risk: if their knee crosses over the big toe when squatting; the arches of their feet collapse when landing from a jump; and if they do not bend their knees much when they land, they stand a greater chance of developing the syndrome, Padua said.

The researchers are now looking into which exercises are best for improving the biomechanics involved. They have also developed a simple screening tool, called LESS (Landing Error Scoring System), for identifying people most at risk of runner's knee and similar conditions, and of suffering ACL (anterior cruciate ligament) injuries.

The study's lead author was Michelle C. Boling, Ph.D., a UNC doctoral student at the time of the study, now an assistant professor at the University of North Florida, Jacksonville, Florida. Other co-authors are Kevin Guskiewicz, Ph.D., professor and chair of the UNC exercise and sport science department; Stephen W. Marshall, Ph.D., associate professor of exercise and sport science, and of epidemiology and orthopedics in the UNC Gillings School of Global Public Health and the UNC School of Medicine, respectively; Scott Pyne, M.D, United States Naval Academy, Annapolis, Md.; and Anthony Beutler, M.D, Uniformed Services University of the Health Sciences, Bethesda, Md.

Source
University of North Carolina at Chapel Hill

Promising Pharmaceutical Agents Emerge As Sports Doping Products

Researchers from the German Sport University Cologne in Germany found that non-steroidal and tissue-selective anabolic agents such as Selective Androgen Receptor Modulators (SARMs) are being sold on the black market for their performance enhancing qualities. The availability of authentic SARMs was recently demonstrated for the first time by the detection of the drug candidate Andarine in a product sold via the Internet. Full findings of the study appear in the latest issue of Drug Testing and Analysis published by Wiley-Blackwell.

SARMs represent a promising class of therapeutics for the treatment of various diseases such as sarcopenia, osteoporosis, benign prostatic hyperplasia (BPH), and cancer cachexia. While none of these agents have yet been approved for therapeutic use, SARMs are gaining popularity in the sports doping community because they are believed to provide the benefits of traditional anabolic/androgenic steroids such as testosterone with fewer unwanted side effects.

In 2008, the World Anti-Doping Agency (WADA) prohibited the use of SARMs in sports due to their potential for misuse. WADA closely cooperates with pharmaceutical and biotechnological companies, as well as medicine agencies and drug evaluation bodies on the issue of therapeutics being misused in sports. WADA's preventive approach was validated with the recent finding of a commercially available, non-approved arylpropionamide-derived SARM termed Andarine. This product, declared as green tea extracts and face moisturizer to pass customs, was available on the Internet at a discount price of $100 USD.

To prove that SARMs lacking clinical approval are distributed and potentially misused in sports, Mario Thevis, Ph.D., and colleagues, analyzed the advertised substance using state-of-the-art mass spectrometric approaches with high resolution/high accuracy (tandem) mass spectrometry. "One unit (30 mL) was purchased online and delivered in a box labeled to contain face moisturizer and green tea extract. The sealed bottle did not declare any content and no further documents accompanied package," said Dr. Thevis. He went on to explain that LC-MS(/MS) analysis of this solution revealed the presence of S-4 at approximately 150 mg/mL with equal amounts in each container, yielding a total of 4.5 g of the SARM. The active ingredient was identified and characterized by a) its elemental composition (as determined by high resolution/high accuracy mass spectrometry, b) comparison to synthesized reference material regarding retention time and product ion mass spectrum, and c) elucidation of its mass spectrometric behavior. Besides the detection of the active ingredient S-4, a significant amount of byproduct was observed.

"Major concerns result from these findings," explained Dr. Thevis. "This product with considerable anabolic properties is readily available without sufficient research on its undesirable effects; this is especially significant where uncontrolled dosing is applied and drug impurities with unknown effects are present in considerable amounts as observed in the studied material."

The issue was recently addressed at the Conference of Parties to the International Convention against Doping in Sport, held October 26-28, 2009 at the United Nations Educational, Scientific and Cultural Organization's (UNESCO) headquarters in Paris. WADA President John Fahey said that government agencies will need to adopt laws and regulations to combat the trafficking and supply of illegal substances in order to rid sport of doping.

The ease of purchasing SARMs as a performance-enhancing drug supports the need to make early implementation of screening for emerging therapeutic compounds a routine part of sports drug testing. "Our study demonstrates once more that the misuse of therapeutics without clinical approval by athletes cannot be dismissed," Dr. Thevis concludes.

Full Citation: "Detection of the arylpropionamide-derived selective androgen receptor modulator (SARM) S-4 (Andarine) in a black-market product." Mario Thevis, Matthias Kamber, and Wilhelm Schanzer. Drug Testing and Analysis; Published Online: November 19, 2009 (DOI: 10.1002/dta.91:).

Source: Dawn Peters
Wiley-Blackwell

Cheerleading related injuries.

New National Study Finds More Than Half Of Cheerleading Injuries In U.S. Due To Stunts

Whether rallying the crowd at a sporting event or participating in competition, cheerleading can be both fun and physically demanding. Although integral to cheerleading routines, performing stunts can lead to injury. Stunt-related injuries accounted for more than half (60 percent) of U.S. cheerleading injuries from June 2006 through June 2007, according to a new study conducted by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital.

Published as a series of four separate articles on cheerleading-related injuries in the November issue of the Journal of Athletic Training, the study focused on general cheerleading-related injuries, cheerleading stunt-related injuries, cheerleading fall-related injuries and surfaces used by cheerleaders. Data from the study showed that nearly all (96 percent) of the reported concussions and closed-head injuries were preceded by the cheerleader performing a stunt.

"In our study, stunts were defined as cradles, elevators, extensions, pyramids, single-based stunts, single-leg stunts, stunt-cradle combinations, transitions and miscellaneous partner and group stunts," said author Brenda Shields, research coordinator in the Center for Injury Research and Policy at Nationwide Children's Hospital.

The most common injuries were strains and sprains (53 percent) and injuries occurred most frequently during practice (83 percent). The top five body parts injured were the ankle (16 percent), knee (9 percent), lower back (9 percent) and head (7 percent).

The study also showed that nearly 90 percent of the most serious fall-related injuries were sustained while the cheerleaders were performing on artificial turf, grass, traditional foam floors or wood floors.

"Only spring floors and 4-inch thick landing mats placed on traditional foam floors provide enough impact-absorbing capacity for two-level stunts," explained Shields. "There is a greater risk for severe injury as the fall height increases or the impact-absorbing capacity decreases, or both."

Data for the study were collected using Cheerleading RIO™, an Internet-based reporting system for cheerleading-related injuries.

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children's Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research as its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy and advances in clinical care.

Source: Nationwide Children's Hospital

Tayshaun Prince Back Injury

Prince has ruptured disc in lower back

AUBURN HILLS, Mich. -- The Pistons say forward Tayshaun Prince will be out of the lineup indefinitely due to a small rupture of a disc in his lower back.

The team said Saturday that the injury was confirmed following an MRI exam and evaluation by team doctors this week. The Pistons say Prince will continue to receive treatment for the injury.
Prince had been sidelined since earlier this month with a back injury.

The 6-foot-9 Prince has appeared in three games this season averaging 12.3 points, 5 rebounds and 2.3 assists. (www.espn.com)

Treatment Options for a Lumbar Herniated Disk
By: Peter F. Ullrich, Jr, MD

Introduction to Lumbar Herniated Disk Treatment

The care of a patient with a lumbar herniated disk is far from standardized and, to a certain extent, needs to be individualized for each patient. A lumbar herniated disk usually causes leg pain (sciatica or a radiculopathy) and is often referred to as a pinched nerve, bulging disk, ruptured disk, or a slipped disk.

The treatment options for a lumbar herniated disk will largely depend on the length of time the patient has had his or her symptoms and the severity of the back pain. Generally, patients will be advised to start with 6 to 12 weeks of conservative treatment (such as physical therapy or chiropractic care).

Surgical Treatments for a Lumbar Herniated Disk
If conservative treatment for the lumbar herniated disk does not provide pain relief after 6 to 12 weeks it is reasonable to consider surgery. At times, if there is severe pain and the patient is having difficulty maintaining a reasonable level of functioning, surgery may be recommended prior to completing a full 6 weeks of conservative care for the herniated disk.

Most patients will heal a lumbar herniated disk on their own, but it may take a prolonged period of time. While there are no hard and fast guidelines for how to heal a herniated disk, this article outlines some general guidelines for conservative treatment options and surgical treatments.

Conservative Treatments for a Lumbar Herniated Disk
There’s a wide variety of conservative treatment options for patients to try for treatment of a lumbar herniated disk. The primary goals of treatment are to provide relief of pain and to allow return to a normal functional level.

The most common conservative treatment options for a lumbar herniated disk include:
Rest, followed by slow mobilization
Pain medications
Chiropractic/osteopathic manipulations
Physical therapy
Epidural steroid injections

The recommended amount of conservative treatment for the herniated disk needs to be individualized for each patient. For those patients who are not in severe pain and can function well, a longer period of conservative treatment is reasonable (e.g. 12 weeks). For those patients with severe pain that is not responsive to conservative treatment, surgery to decompress the nerve is a reasonable option to treat the lumbar herniated disk.

Surgery for a Lumbar Herniated Disk
If a patient does not feel better after 6 to 12 weeks of conservative care, then surgery may be considered to treat the lumbar herniated disk. The goal of surgery is to help alleviate the pain faster. If a patient has severe pain and is unable to function at a satisfactory level, surgery may be a good option even before six weeks of symptoms.

Any patient who has progressive neurological deficits, or develops the sudden onset of bowel or bladder dysfunction, should have an immediate surgical evaluation as these conditions may represent a surgical emergency. Fortunately, both of these conditions are very rare, and most surgery for a lumbar herniated disk is an elective procedure.

In recent years, the morbidity (such as post-operative pain) of surgery for a lumbar herniated disk has decreased and the results have improved, so surgery is generally considered a very reasonable option to get better quicker.

Surgical treatment options for the lumbar herniated disk include:
Microdiscectomy (the most common procedure)
Lumbar laminectomy
Chymopapain injections
Arthroscopic lumbar discectomy
Microendoscopic surgery

A lumbar microdiscectomy (also called a lumbar micro-decompression) is considered the gold standard and is the most common surgery to alleviate pain from a lumbar herniated disk. (www.spine-health.com)


Chiropractor, Fairfax VA

Basketball, ACL and Biomechanical Sports Injury Prenvention Training

Effects of Sports Injury Prevention Training on the Biomechanical Risk Factors of Anterior Cruciate Ligament Injury in High School Female Basketball Playersfrom The American Journal of Sports Medicine current issue by Lim, B.-O., Lee, Y. S., Kim, J. G., An, K. O., Yoo, J., Kwon, Y. H.1 person liked this
Background
Female athletes have a higher risk of anterior cruciate ligament injury than their male counterparts who play at similar levels in sports involving pivoting and landing.

Hypothesis
The competitive female basketball players who participated in a sports injury prevention training program would show better muscle strength and flexibility and improved biomechanical properties associated with anterior cruciate ligament injury than during the pretraining period and than posttraining parameters in a control group.

Study Design
Controlled laboratory study.

Methods
A total of 22 high school female basketball players were recruited and randomly divided into 2 groups (the experimental group and the control group, 11 participants each). The experimental group was instructed in the 6 parts of the sports injury prevention training program and performed it during the first 20 minutes of team practice for the next 8 weeks, while the control group performed their regular training program. Both groups were tested with a rebound-jump task before and after the 8-week period. A total of 21 reflective markers were placed in preassigned positions. In this controlled laboratory study, a 2-way analysis of variance (2 x 2) experimental design was used for the statistical analysis (P < .05) using the experimental group and a testing session as within and between factors, respectively. Post hoc tests with Sidak correction were used when significant factor effects and/or interactions were observed. Results A comparison of the experimental group’s pretraining and posttraining results identified training effects on all strength parameters (P = .004 to .043) and on knee flexion, which reflects increased flexibility (P = .022). The experimental group showed higher knee flexion angles (P = .024), greater interknee distances (P = .004), lower hamstring-quadriceps ratios (P = .023), and lower maximum knee extension torques (P = .043) after training. In the control group, no statistical differences were observed between pretraining and posttraining findings (P = .084 to .873). At pretraining, no significant differences were observed between the 2 groups for any parameter (P = .067 to .784). However, a comparison of the 2 groups after training revealed that the experimental group had significantly higher knee flexion angles (P = .023), greater knee distances (P = .005), lower hamstring-quadriceps ratios (P = .021), lower maximum knee extension torques (P = .124), and higher maximum knee abduction torques P (= .043) than the control group. Conclusion The sports injury prevention training program improved the strength and flexibility of the competitive female basketball players tested and biomechanical properties associated with anterior cruciate ligament injury as compared with pretraining parameters and with posttraining parameters in the control group. Clinical Relevance This injury prevention program could potentially modify the flexibility, strength, and biomechanical properties associated with ACL injury and lower the athlete’s risk for injury.

Exercise Keeps Dangerous Visceral Fat Away A Year After Weight Loss

A study conducted by exercise physiologists in the University of Alabama at Birmingham (UAB) Department of Human Studies finds that as little as 80 minutes a week of aerobic or resistance training helps not only to prevent weight gain, but also to inhibit a regain of harmful visceral fat one year after weight loss.

The study was published online Oct. 8 and will appear in a future print edition of the journal Obesity.

Unlike subcutaneous fat that lies just under the skin and is noticeable, visceral fat lies in the abdominal cavity under the abdominal muscle. Visceral fat is more dangerous than subcutaneous fat because it often surrounds vital organs. The more visceral fat one has, the greater is the chance of developing Type 2 diabetes and heart disease.

In the study, UAB exercise physiologist Gary Hunter, Ph.D., and his team randomly assigned 45 European-American and 52 African-American women to three groups: aerobic training, resistance training or no exercise. All of the participants were placed on an 800 calorie-a-day diet and lost an average 24 pounds. Researchers then measured total fat, abdominal subcutaneous fat and visceral fat for each participant.

Afterward, participants in the two exercise groups were asked to continue exercising 40 minutes twice a week for one year. After a year, the study's participants were divided into five groups: those who maintained aerobic exercise training, those who stopped aerobic training, those who maintained their resistance training, those who stopped resistance training and those who were never placed on an exercise regimen.

"What we found was that those who continued exercising, despite modest weight regains, regained zero percent visceral fat a year after they lost the weight," Hunter said. "But those who stopped exercising, and those who weren't put on any exercise regimen at all, averaged about a 33 percent increase in visceral fat."

"Because other studies have reported that much longer training durations of 60 minutes a day are necessary to prevent weight regain, it's not too surprising that weight regain was not totally prevented in this study," writes Hunter. "It's encouraging, however, that this relatively small [amount] of exercise was sufficient to prevent visceral fat gain."

The study also found that exercise was equally effective for both races.

About the UAB Department of Human Studies

The UAB Department of Human Studies, housed in the School of Education, offers programs in counselor education, health education, community health, physical education, exercise science and fitness leadership.

Source: University of Alabama at Birmingham

Blake Griffin Knee Injury

Clips’ Griffin out 6 weeks with broken kneecap
By GREG BEACHAM, AP Sports Writer
Oct 28, 1:38 am EDT

LOS ANGELES (AP)—Blake Griffin is about to add patience to his repertoire of basketball skills while his broken left kneecap heals.

It’s a vital quality for somebody trying to turn around the Los Angeles Clippers.

The NBA’s No. 1 overall draft pick will be out for up to six weeks with the stress fracture, likely delaying his debut until mid-December—and creating one more reason to believe there’s a curse on this star-crossed franchise.

“It’s disappointing, especially when it happened, but I’m not going to feel sorry for myself,” Griffin said Tuesday at the club’s Playa Vista training complex. “Everybody plays with a certain amount of pain, but it is a fine line, because you do want to take care of your body and make it easier on yourself.”

Griffin watched the Clippers’ 99-92 season-opening loss the Lakers on Tuesday night from behind the bench in a three-piece suit and blue tie, waving to fans shouting encouragement from the stands. The former Oklahoma star won’t be allowed back into practice until his fracture has healed in several weeks.

Griffin wore shorts and no knee protection while watching the Clippers’ morning shootaround. He will undergo bone stimulation and special blood treatments that will limit his activities for at least a month, and he plans to swim for exercise.

Coach Mike Dunleavy believes the process will be frustrating, but hopefully instructive for a power forward whose relentless work ethic sometimes leads him to rush his recovery time and even play through pain unnecessarily.

“He needs to be more honest with his body and with our medical personnel,” Dunleavy said. “There are times when he’s telling us he’s fine, he’s good, and he’s feeling some pain. … He understands better the potential consequences now. Give us the information, and we’ll decipher it and figure out what you should play through, but I think he understands now.”

Griffin was hurt during a preseason game last Friday, wincing in pain as he came down from a dunk late in the third quarter. He claimed as recently as Monday afternoon that he would play through the discomfort, but an MRI revealed the stress fracture Monday.

“He could play on it, but it won’t get better,” Dunleavy said. “Once that became apparent, there was no question: Let’s shut it down. Him playing at a lesser level isn’t going to do us much good.”

While he’s out, the Clippers will move on with a fairly solid roster. Marcus Camby(notes), Chris Kaman(notes), Rasual Butler(notes), Craig Smith(notes) and Al Thornton(notes) all are capable of playing significant frontcourt minutes.

Dunleavy isn’t sure whether the broken kneecap is related to the bruise that Griffin sustained on the same knee in late September. That injury didn’t keep him from playing in the preseason, when he averaged 13.7 points and 8.1 rebounds while appearing fully ready for the NBA challenge.

Griffin’s short tenure with Los Angeles already has been dotted by injuries, starting with a strained right shoulder during summer league play in Las Vegas.

Clippers fans wish they could say they’re shocked by the latest development, but few still doubt the power of the Clipper Curse.

Los Angeles has just two winning seasons in the last 30 years and just one playoff series victory since moving to town in 1984. The Clippers also have a long history of disappointing draft picks, including a pair of No. 1 overall choices that didn’t dazzle.

Danny Manning played just 26 games in his rookie season in 1988-89 after tearing his knee ligament and undergoing surgery, though he eventually became an All-Star before fleeing town on his broken-down joints. Michael Olowokandi(notes), the top pick in 1998, played just 45 games in his rookie season, and he wasn’t much help even when healthy during five underachieving seasons.

Griffin insists his injuries and his franchise’s past have nothing to do with each other.

“It’s not something that requires surgery,” he said. “It’s not something where I’m going to be out for six months, half a year.”

Griffin was the consensus college player of the year with 22.7 points and an NCAA-best 14.4 rebounds per game last season for the Sooners. Shortly after arriving in Los Angeles, he announced he didn’t believe in any Clipper Curse— and he hopes to prove he’s right when he’s finally healthy.

“It’s a setback, but it’s not major,” Griffin said. “It’s something that I can work through, and hopefully use this to work on other things to get better.”


Chiropractor, Fairfax VA

Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans

Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans


Foundation for Chiropractic Progress commissions landmark report delivers incremental impact on population health and total health care spending

Carmichael, CA - October 20, 2009 - A report, prepared by a global leader for trusted human resources and related financial advice, products and services, finds that the addition of chiropractic care for the treatment of low back and neck pain will likely increase value-for-dollar in US employer-sponsored health benefit plans. Authored by Niteesh Choudhry, MD, PhD, and Arnold Milstein, MD, the report can be fully downloaded at:

Full Report Download

Accordingly, this report was commissioned by the Foundation for Chiropractic Progress (www.f4cp.com) to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US.

According to Gerard Clum, DC, spokesperson for the Foundation for Chiropractic Progress and President of Life Chiropractic College West, ?While some studies reflect cost efficiencies and others clinical efficiencies, these findings strongly support both for chiropractic care of neck pain and low back pain.?

Executive Summary:

Low back and neck pain are extremely common conditions that consume large amounts of health care resources. Chiropractic care, including spinal manipulation and mobilization, are used by almost half of US patients with persistent back-pain seeking out this modality of treatment.

The peer-reviewed scientific literature evaluating the effectiveness of US chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments. However, US cost-effectiveness studies have methodological limitations.

High quality randomized cost-effectiveness studies have to date only been performed in the European Union (EU). To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU.

The results of the researchers' analysis are as follows:

-Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain.

Total cost of care per year:

-For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care.

-For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care.

Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.

These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorable to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health benefit plans will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve.

###

About F4CP

A not-for-profit organization, the Foundation for Chiropractic Progress (F4CP) embraces a singular mission to promote positive press for the profession in national, regional and local media. Through effective and ongoing initiatives, the Foundation?s goal is to raise awareness to the many benefits provided by doctors of chiropractic. The F4CP relies upon strategic marketing campaigns that span prominent spokespersons, monthly press releases, public service announcements, and advertisements in high-profile media outlets. To learn more about the Foundation, please visit us on the web at www.foundation4cp.com or call 866-901-f4cp.

Female Atletes and ACL Injuries

Female Athletes More Prone To ACL Injuries
By Simeon Margolis, M.D., Ph.D.

One of my granddaughters is a high school long-distance runner and another granddaughter plays just one sport (soccer) almost year round. So I was interested in an article by Michael Sokolove in the May 11 issue of The New York Times Magazine titled, "The Uneven Playing Field."

The greater involvement of American women and young girls in athletics largely stems from an important federal law, Title IX, which was enacted in 1972 to guarantee equal opportunities in sports for both men and women.

The downside of such participation is that now girls, like boys, may suffer ankle, back, and head injuries. Of particular concern to young athletes, however, is a tear or rupture of the anterior cruciate ligament (or ACL), 1 of 4 major ligaments of the knee, and the one most commonly injured.

Football fans hear of ACL injuries to their favorite players, often the result of a direct blow to the knee. But these injuries can occur without any contact or unusual happenstance. For example, the ACL can be damaged when the knee is twisted on landing, or when a foot is firmly planted on the ground but the player's body is forced to rotate.

An ACL tear or rupture is not only quite painful but often ends up needing a surgical repair or reconstruction, followed by a rehabilitation period of 6 to 9 months before a return to competition.

Researchers have determined that girls rupture their ACLs 5 times more often than do boys, even when competing in the same sports — soccer, basketball, and volleyball. This difference may be due to hormonal changes at puberty, when testosterone causes boys to add muscle and grow stronger, though less flexible. By contrast, increased estrogen in girls tends to add more fat than muscle, so that their ligaments, although more flexible, are surrounded by less protective muscle.

Based on what I hear from the parents of our 12-year-old, soccer-playing granddaughter, young girls are apparently getting pressured more and more to play longer and harder, in more and more tournaments. The result is that these youngsters have too many opportunities to get hurt and too little time to recuperate from their injuries.

Just as worrisome, youngsters are urged to concentrate on one sport, so as to increase their chances of standing out. This specialization means that the same groups of muscles and ligaments will be getting the punishment throughout the year. When I was growing up, we played different sports each season, and the muscle stiffness on switching from one sport to another made it apparent that each sport puts the greatest strain on its own particular muscle groups.

What can be done to prevent ACL and other injuries in young girls?

They need:

-to start at a young age with vigorous exercise to gain muscle strength
-to be taught proper stretching and balancing exercises
-to receive less pressure from coaches and parents to spend excessive time and effort on a single sport
-to be given more freedom to try as many sports as they want, so the same group of muscles and ligaments will not be subjected to stress year after year

Increasing Severity Of Bicycle Injuries Leads To Concerns About Cycling Infrastructure

Record-high gasoline prices, the slowdown in the economy, and increasing environmental sensitivity are leading more people to bike to work or for play. But an adequate infrastructure may not be in place to protect cyclists from serious injury according to surgeons who presented a new study on the issue during a scientific paper session at the 2009 Clinical Congress of the American College of Surgeons.

The researchers found that the severity of injury and hospital length-of-stay for bicycle injuries at one trauma center has increased significantly over the past 11 years. Despite the wide-spread attention paid to the importance of wearing helmets, helmet use did not change during the time period of the study, and more than 33 percent of 329 bicycle injury victims had a significant head injury. Even more alarming, the number of chest injuries increased by 15 percent and abdominal injuries rose three-fold over the last five years. "We were astounded by that data," said Jeffry Kashuk, MD, FACS, associate professor of surgery at the University of Colorado School of Medicine and senior attending surgeon at the Rocky Mountain Regional Trauma Center at Denver Health Medical Center, Denver. "We're talking about injured spleens and livers, internal bleeding, rib fractures, and hemothorax [blood in the chest]. Those kinds of injuries are reflected by an increase in injury severity score," he added.

The study was conducted in Denver, which has one of the most well-developed bicycle path networks in the country. "Denver is very much a bicycle community. If we are seeing an increase in injuries in a metropolitan area that has fairly mature bike infrastructure from the standpoint of bike pathways, there's reason for concern about what's happening in metropolitan areas that don't have that level of maturity. There seems to be a significant increase nationally in the use of the bicycle for urban transportation. If our data is a microcosm of what is going on nationally, we may be on the cusp of an injury epidemic," Dr. Kashuk said.

Researchers at the University of Colorado hope to obtain funding so they can expand the study nationally and generate data that will support better safety standards and raise community awareness about the lack of cycling infrastructure. "On a local and national level, people need to be aware of the fact that a push for bike transportation for the sake of health, the environment, and lower transportation costs has real potential to raise medical costs because our infrastructure may not be ready for it," Dr. Kashuk said. "Look at all the safety factors that have been incor-porated in automobiles and streets and highways. If even a percentage of that kind of investment went into safety vis-a-vis bike paths and community infrastructure, we would protect people from major injury."

Zachary Hartman, BA; Ernest E. Moore, Jr., MD, FACS; Walter L. Biffl, MD, FACS; Catherine C. Cothren, MD, FACS; Jeffrey L. Johnson, MD, FACS; Carlton C. Barnett, Jr., MD, FACS; and Angela Sauaia, MD, participated in the study.

Source: American College of Surgeons (ACS)

Preventing Sudden Death In Sports By Means Of Genetic Testing: Study Launched

The BBVA Foundation and the Cardiology Service of Madrid's Hospital Clínico San Carlos have launched a new study aimed at detecting DNA alterations linked to sudden cardiac death in sports. Genetic testing is vital if the condition is to be caught in time, since most cases are asymptomatic and hard to diagnose by other means.

The Foundation has donated a latest-generation gene sequencer to the hospital's Cardiovascular Research Unit for use in its research project "Genetic testing in cardiovascular pathologies linked to sudden cardiac death among young athletes". The device is already operating all day round in the Madrid hospital, from Monday to Friday, analyzing 16 samples per hour. It is equipped to detect the Brugada syndrome - the cause of unexpected sudden cardiac death in apparently healthy hearts - in just two hours, compared to the 25 hours needed by preceding technologies.

Although similar gene sequencers exist in Spain, this is the only device devoted exclusively to the study of alterations linked to sudden death in sports.

The donation was made in the frame of the ongoing agreement between the Hospital San Carlos Cardiology Service and the BBVA Foundation spanning basic and clinical research, healthcare and epidemiological analysis.

Seizures and pre-seizures among professional and amateur athletes

Spain, unlike other countries, has no reliable data on the incidence of sudden cardiac death in the general population, although the country has over 6 million registered athletes and over 12 million people engaging in some kind of sport. Estimates suggest that between 30 and 40 sportsmen or women die from this cause each year, though only deaths occurring during official competitions get covered in the media.

"Sudden death is the final consequence, but before that come seizures or pre-seizures, and it is here that we need to detect potential victims and bring them under clinical treatment", explains Antonio López Farré, head of the Cardiovascular Research Unit within the hospital's Cardiology Service.

The research team will keep a record of all cases detected in the course of the study. For the moment, its scope is confined to the Madrid Region, where an agreement has been concluded with ambulance service SAMUR for a special code 33 to be activated in all cases of seizures involving an amateur or professional athlete.

This code indicates that the SAMUR team should transport the patient directly to Hospital Clínico. There, he or she will be treated in the Accident & Emergency Department and offered the choice of taking part in the study. Those who accept will be subjected to genetic tests using the sequencer installed in the Cardiovascular Research Unit in order to detect possible alterations associated with sudden death.

If some such alteration is found, the patient will be placed under the appropriate medical care, and also offered the opportunity to have his or her relatives tested to see if they suffer from the same pathology.

In its first weeks in operation, the sequencer has analyzed the genes of 85 athletes (65 men and 20 women). In each case a series of test were run depending on the possible condition. To date, 4,067 sequencings have been carried out along with 5,523 sequencing reactions.

Source:
Silvia Churruca
Fundación BBVA

Basketball Shoes and Injuries

A great article from AAPSM

Basketball Shoes and Injuries

Too many basketball players overlook the importance of buying a durable and high-quality pair of basketball shoes, which is astounding when you consider how much time they spend pounding their feet into the ground. Bad shoes can lead not only to foot and ankle problems, but leg, hip, and even back pain as well. That's because alignment begins with your feet and moves up to influence the rest of your body. In time, the stress to a certain soft tissue or bone structure will create a fatigue injury which then renders the player unable to participate in his or her sport.

The average high school basketball player can greatly decrease his/her incidence of overuse injury by simply replacing his/her basketball shoes frequently, said Michael Lowe, DPM, team podiatrist of the Utah Jazz of the National Basketball Association. Dr. Lowe presented a study which showed that the average high school basketball player will utilize only one pair of new basketball shoes per season. Dr. Lowe recommends that the basketball shoe be changed monthly during the season. This has been found to greatly decrease the rate of injury to professional players, to the point that they will often replace shoe gear every two to three days or games.

The use of proper shoe gear has a strong relationship to the performance and stability of foot function within the shoe. Those shoes which compliment foot requirements for stability, flexibility and shock absorption, can greatly aid in the dissemination of stress to foot and leg structure. The amount of stress applied to the shoe gear before replacement with a new shoe also has a profound influence upon protecting the athlete. Most runners are encouraged to replace shoe gear every 350 -500 miles depending upon the size of the runner and his or her running environment. The same should be true of the basketball player. The average runner will spend about 66 hours in running to accumulate 500 miles on a pair of shoes ( 8 minute per mile pace times 500 miles). The average high school or collegiate athlete will work out easily 72 hours per month. Basketball shoes are now made of the same types of materials, i.e. eva or polyurethane midsole and a harder outer sole material. These materials all have a fatigue factor which greatly influences function of foot and stress delivered to bone and soft tissue structures. Players in the NBA will rarely use a basketball shoe for longer than 7-10 days before replacing it with a new pair of shoes.

A positive secondary by-product of frequent shoe change is that of a protective influence of shoe gear to foot and ankle stability to external forces. As the shoe is worn over hours of use the leather uppers slowly begin to stretch to the rotational forces applied. Also the midsole material slowly deforms or compresses to repetitive ballistic starting and stopping of play. As these external changes to the shoe continue the rotational movement of the foot within the shoe slowly increases in range of motion. Therefore it can be seen that with newer shoe usage, there will be fewer inversion injuries as compared to injuries due to the lack of support from worn and stretched shoe gear materials which lack the integrity to decelerate foot rotational movement beyond normal positioning.

The use of a high top basketball shoe is still one of the best means for protecting the ankle from inversion sprains. NBA players choose a wide variety of shoe gear styles to play in; 68% of the players utilize a high top shoe, 15% utilize a 3/4 top shoe, and only 10% will use a low top basketball shoe for regular play. Your choice will be tempered by what is available and what properly fits.

Exercise can decrease the incidence of colds

As the weather turns colder, the noses turn runnier - but incidence of colds can be greatly reduced by making exercise a part of daily life, according to an expert from the American College of Sports Medicine.

David C. Nieman, DrPH, FACSM, says that multiple studies have shown a 25- to 50-percent decrease in sick time for active people completing at least 45 minutes of moderate-intensity exercise (such as walking) most days of the week.

"This reduction in illness far exceeds anything a drug or pill can offer," Nieman said. "All is takes is a pair of walking shoes to help prevent becoming one of the thousands predicted to suffer from the common cold this winter."

However, if you're already sick and aren't sure whether to hit the gym or the couch, Nieman offers these tips:

- DO exercise if your cold is confined to your head, such as illnesses with runny noses and sore throats.

- DON'T overdo it. If you have a cold, keep exercise to a moderate-intensity level (i.e., walking). Studies have not shown any negative effects of moderate exercise for those suffering from common colds.

- DO stay in bed if your illness is "systemic" - that is, beyond just the sniffles of a regular cold. Respiratory infections, fever, swollen glands and extreme aches and pains are all good reasons to rest up instead of work out.

- DON'T jump back in too soon. If you're recovering from a more serious bout of cold or flu, gradually ease back into training after at least two weeks of rest.

Nieman also advises exercising prior to receiving a flu shot. Moderate-intensity exercise just before getting the shot has been shown to improve the body's response to the vaccine, boosting immunity.

Nieman's advice aligns with the Exercise is Medicine ™ program, a component of which centers on including physical activity as a standard part of health care, like any other vital sign.

Source
American College of Sports Medicine

L-Arginine Exerts Anti-Inflammatory Effects

Keywords:CARDIOVASCULAR DISEASE, CORONARY ARTERY DISEASE, INSULIN RESISTANCE, ENDOTHELIAL DYSFUNCTION, INFLAMMATION - L-Arginine

Reference:"Oral l-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass," Lucotti P, Monti L, et al, Metabolism, 2009 July 8; [Epub ahead of print]. (Address: Internal Medicine Department, Cardio-Diabetes Trials Unit, Scientific Institute San Raffaele, 20132 Milan, Italy. E-mail: piatti.piermarco.hsr.it ).

Summary:In a randomized, double-blind, placebo-controlled study involving 64 patients with cardiovascular disease who previously underwent autocoronary bypass, supplementation with l-arginine (6.4 g/d) for a period of 6 months (in 32 of the 64 patients found to have a non-diabetic response to an oral glucose load), was found to decrease asymmetric dimethylarginine levels, decrease indices of endothelial dysfunction, and increase cyclic guanosine monophosphate, l-arginine to asymmetric dimethylarginine ratio, and reactive hyperemia. In addition, increases in adiponectin and the insulin sensitive index and decreases in interleukin-6 and monocyte chemoattractant protein-1 were also associated with l-arginine treatment. The authors conclude, "…insulin resistance, endothelial dysfunction, and inflammation are important cardiovascular risk factors in coronary artery disease patients; and l-arginine seems to have anti-inflammatory and metabolic advantages in these patients."

Gilbert Arenas Finger Injury

RICHMOND, Va. (AP)—The Washington Wizards say Gilbert Arenas(notes) has missed scrimmages at training camp because of a finger injury—not because of any problems with his surgically repaired left knee.

Arenas sat out a scrimmage for the second consecutive day Thursday, although he did participate in drills.

He dislocated the middle finger on his left hand in a pickup game before training camp began, then aggravated it this week.

Arenas had three operations on his left knee in 1 1/2 years, and he missed all but two games last season. But Wizards coach Flip Saunders said the knee is not limiting Arenas at the moment, the finger is.

See the short article on Yahoo!

Tai Chi Can Help People With Diabetes Lower Glucose Levels

A regular tai chi exercise program can help people better control their diabetes and lower glucose levels, according to a University of Florida study.

In a study of adults diagnosed with type 2 diabetes, those who participated in a supervised tai chi exercise program two days a week with three days of home practice for six months significantly lowered their fasting blood glucose levels, improved their management of the disease, and enhanced their overall quality of life, including mental health, vitality and energy.

"Tai chi really has similar effects as other aerobic exercises on diabetic control. The difference is tai chi is a low-impact exercise, which means that it's less stressful on the bones, joints and muscles than more strenuous exercise," said Beverly Roberts, Ph.D., R.N., the Annabel Davis Jenks endowed professor at the UF College of Nursing.

Roberts, with Rhayun Song, Ph.D., R.N., of Chungham National University, studied tai chi's effect on older Korean residents. The research was featured in the June issue of The Journal of Alternative and Complementary Medicine.

About 23.6 million children and adults in the United States, or 7.8 percent of the population, have diabetes. It occurs when the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.

Risk factors include obesity, sedentary lifestyle, unhealthy eating habits, high blood pressure and cholesterol, a history of gestational diabetes and increased age, many of which can be reduced through exercise.

"People assume that for exercise to be beneficial you have to be huffing and puffing, sweating and red-faced afterward," Roberts said. "This may turn people off, particularly older adults. However, we have found that activities like tai chi can be just as beneficial in improving health."

Tai chi is an ancient Chinese martial art that combines deep breathing and relaxation with slow, gentle circular movements. This low impact exercise uses shifts in body position and stepping in coordination with arm movements.

Sixty-two participants, mostly Korean women, took part in the study. Half the group participated in at least 80 percent of two supervised sessions one hour per week, with three days of home practice for six months, and the other half served as a control group. Those who completed the sessions had significantly improved glucose control and reported higher levels of vitality and energy.

"Those who participated in the tai chi sessions actually had lower blood glucose at three and six months," Roberts said. "Those individuals also had lower hemoglobin A1c, which means they had better diabetic control."

In addition to improved blood glucose levels, participants also reported significantly improved mental health. This was very encouraging especially since people with less depression are typically more active and independent, Roberts said.

Tai chi has also been used for people with arthritis and disabilities to increase balance, muscle strength and mobility and to reduce the risk of falls. It is worth investigating its effects in other conditions, especially in older people, Roberts said.

"Tai chi provides a great alternative for people who may want the benefits of exercise on diabetic control but may be physically unable to complete strenuous activities due to age, condition or injury," Roberts said. "Future studies could examine if tai chi could similarly benefit conditions such as osteoporosis or heart disease."

Since tai chi is an exercise that involves so many parts of the body and also helps to relax the mind, it is more likely participants will adhere to the exercise, said Paul Lam, M.B.B.S., a lecturer with the University of South Wales School of Public Health and Community Medicine and a practicing family physician in Sydney, Australia.

"This study shows that tai chi can have a significant effect on the management and treatment of diabetes - a significant and growing health challenge for all Western countries," Lam said.

Source
University of Florida Health Science Center

LaDainian Tomlinson on Injury Prevention

To Your Health
Playing to Win: Injury Prevention Is the Key
By Alex Guerrero

With nearly 12,000 rushing yards, San Diego Chargers running back LaDainian Tomlinson is on track to become the National Football League's most prolific runner. He's starting his ninth year in the league and is less than 7,000 rushing yards (four to five seasons) short of the all-time career mark, held by former Dallas Cowboys running back Emmitt Smith. A former MVP of the NFL, LaDainian owns or shares 28 Chargers team records and holds the NFL record for most total touchdowns scored in a single season. And none of it happened by accident.

While LaDainian has suffered his share of injuries over the years (including last year), he's stayed remarkably healthy in a sport (and at a position) that features constant physical contact. After all, he's already played for eight years when the average NFL player's career is only 3.5 years. So, how's he done it? The same way you can do it. It's all about injury prevention. Whether you're an All-Pro running back like L.T. or a weekend warrior, the goal is the same: You undoubtedly want to lower your chances of incurring an injury while participating in your favorite sport. Fortunately, there are some general rules for injury prevention that apply to all sports, which is important because sports scientists suggest injury rates could be reduced by 25 percent if athletes took appropriate preventative action. Here are a few tips on how to stay healthy and reduce your risk of suffering an injury.

The #1 Rule: Don't Overdo It

The amount of training you do plays a key role in determining your real injury risk. Studies have shown that your best direct injury predictor may be the amount of training you completed last month. Fatigued muscles do a poor job of protecting their associated connective tissues, increasing the risk of damage to bone, cartilage, tendons and ligaments. If you are a runner, the link between training quantity and injury means total mileage is an excellent indicator of your injury risk. The more miles you accrue per week, the higher the chances of injury. One recent investigation found a marked upswing in injury risk above 40 miles of running per week. Of course, this can be minimized and often avoided by regular chiropractic and massage therapy treatments, along with getting adequate rest between training sessions. The point isn't to avoid exercise, but rather to appreciate that overdoing it can lead to injury, and that when your muscles are fatigued, they need rest. It's about knowing what your body can handle at any particular point in time.

Says LaDainian: "I know my body real well and I know exactly what I need to do and when to get in shape. I start a couple of weeks after the last game. You get broken down, and you get weak [during the season], so I start with the basics: core, hips, shoulders, and then I move into the more functional stuff, building strength through movement." L.T. and other professional athletes also use an anti-inflammatory cream before and after physical activity to minimize pain and overuse injuries.

If You Can Predict an Injury, You May Avoid an Injury

If you have been injured before, you are much more likely to get hurt again than an athlete who has been injury free. Regular exercises have a way of uncovering the weak areas of the body. If you have knees that are put under heavy stress because of your unique biomechanics during exercise, your knees are likely to hurt when you engage in your sport for a prolonged time. After recovery, if you re-establish your desired training load without modification to your biomechanics, your knees are likely to be injured again. In layperson's terms, that means figuring out why you got injured in the first place and how to avoid it from happening again.

The second predictor of injury is probably the number of consecutive days of training you carry out each week. Scientific studies strongly suggest that reducing the number of consecutive days of training can lower the risk of injury. Recovery time reduces injury rates by giving muscles and connective tissues an opportunity to restore and repair themselves between workouts.

Specific Factors Influencing Injury Risk: Which Apply to You?

Psychological Factors

Some studies have shown that athletes who are aggressive, tense and compulsive have a higher risk of injury than their more relaxed peers. Tension may make muscles and tendons tighter, increasing the risk that they will be harmed during workouts. Try some breathing exercises or visualization before starting your workout to ensure you are as relaxed as possible.

Weak Muscles

Many injuries are caused by weak muscles that are simply not ready to handle the specific demands of your sport. This is why people who start a running program for the first time often do well for a few weeks, but then suddenly develop foot or ankle problems, hamstring soreness or perhaps lower back pain as they add the mileage on. Their bodies simply are not strong enough to cope with the demands of the increased training load. For this reason, it is always wise to couple resistance training with regular training. Your body needs to be stronger before it can handle the "new" demands being put on it.

Muscle Imbalances

Screening for muscle imbalances is the current cutting edge of injury prevention. The rationale behind this is that there are detectable and correctable abnormalities of muscle strength and length that are fundamental to the development of almost all musculoskeletal pain and dysfunction. Detection of these abnormalities and correction before injury has occurred should be part of any injury prevention strategy. Assessment of muscle strength and imbalances, as well as regular chiropractic and massage therapy, can be beneficial in this strategy.

Muscle Stiffness

Technically speaking, muscle stiffness refers to the ratio between the change in muscle resistance and the change in muscle length. Muscle stiffness is directly related to muscle injury risk, so it is important to reduce muscle stiffness during your warm-up. Research indicates that only dynamic stretches (slow, controlled movements through the full range of motion) decrease muscle stiffness. Static exercises (holding a stretch in one position for a period of time) do not decrease muscle stiffness. This suggests that dynamic stretches are the most appropriate exercises for warming up; static stretches are perhaps more appropriate for the cool-down period, as they help to relax the muscles and increase their range of movement.

Trigger Points

When pain syndromes develop, certain locations on the body called trigger points develop. A "trigger point" (TP) is a thick knot in a muscle that is palpable and tender (even painful to the touch). A diagnostic sign of a trigger point is a so-called jump sign. This sign is produced by accurately palpating the TP to produce pain in the area of referral as well as muscle contraction (or a jump) of the involved extremity.

Treatment of a TP (separating the fibers of the muscle knot) can be achieved by applying direct pressure to the point for 10 to 20 seconds, gradually releasing the pressure and repeating the process four or five times. The amount of pressure, which will depend on the sensitivity of the TP, can be applied by using one or both thumbs. A number of treatments may be required but as the sensitivity of the TP reduces it will become harder to find.

Trigger points are an early warning to a potential serious injury, getting checked for TPs is very beneficial. A regular massage is well worth it as the therapist, when conducting a massage, can check for TPs and treat them. I also always use an anti-inflammatory cream when treating TPs to help reduce pain and inflammation, which helps the healing process.

The Value of Sport-Specific Training

Resistance training can fortify muscles and make them less susceptible to injury, especially if the strength-building exercises involve movements that are similar to those used in the performance of the sport. As L.T. says, "Football is a movement game. You don't lie down, like you're on a bench press, and tackle somebody; skill players want to be quick, so you don't need to do a lot of heavy lifting, not all the time."

For example, if you are a thrower, then lots of time should be spent developing muscles at the front of the shoulder that increases the force with which you can throw, but you must also work systematically on the muscles at the back of the shoulder which control and stabilize the shoulder joint.

By following these simple recommendations, you can live an active life and enjoy the sports and other activities that make you feel great. That's what keeps LaDainian Tomlinson going strong, and that's what can keep you doing the same thing when you're working out, playing your favorite sport or just playing with the kids. To learn more about ways to stay in shape and avoid injury, talk to your doctor.

Injury Prevention Tips

-Avoid training when you are tired; you should be strong and ready to exercise.
-Increase your consumption of carbohydrates during periods of heavy training.
-Match increases in training with increases in resting. (Rest is how the body regenerates.)
-Precede any increase in training load with an increase in strengthening.
-Treat even seemingly minor injuries very carefully to prevent them from becoming a big problem.
-If you experience pain when training, stop your training session immediately.
-Never train hard if you are stiff from the previous effort.
-Pay attention to hydration and nutrition (water before exercise, electrolyte drink during exercise and water after exercise).
-Use appropriate training surfaces.
-Check that training and competition areas are clear of hazards.
-Check that equipment is appropriate and safe to use.
-Introduce new activities gradually and make sure you are clear on how to perform them safely.
-Allow lots of time for warming up before your workout/activity and cooling off after your workout/activity.
-Review training and competition courses beforehand.
-Train on different surfaces, using the right footwear.
-Shower and change immediately after the cool-down (after exercise).
-Stay away from infectious areas when training or competing very hard.
-Be extremely fussy about hygiene, particularly in hot weather.
-Monitor daily for signs of fatigue; if in doubt, ease off your workouts for a day or two.
-Get regular massages to keep muscles loose and blood circulating properly.

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Alex Guerrero is a sports therapist who works with many professional and world-class athletes. He specializes in sports injury, rehabilitation, performance enhancement and nutrition.

Supervised exercises are more effective than shockwave treatment to relieve chronic shoulder pain, finds a study published on bmj.com

Supervised exercises are more effective than shockwave treatment to relieve chronic shoulder pain, finds a study published on bmj.com.

Shoulder pain is the fourth most common type of musculoskeletal pain reported to general practitioners and physiotherapists. Treatments often include physiotherapy, non-steroidal anti-inflammatory drugs, and steroid injections. Physiotherapy can include shockwave treatment, ultrasound, exercises and acupuncture.

Several studies have suggested that shockwave treatment may not be effective, but it continues to be used widely.

So a team of researchers based in Oslo, Norway compared the effectiveness of radial extracorporeal shockwave treatment (low to medium energy impulses delivered into the tissue) with supervised exercises in patients with shoulder pain.

The study involved 104 men and women aged between 18 and 70 years attending the outpatient clinic at Ullevaal University Hospital in Oslo with shoulder pain lasting at least three months.

Participants were randomised to receive either radial extracorporeal shockwave treatment (one session weekly for four to six weeks) or supervised exercises (two 45 minute sessions weekly for up to 12 weeks).

Both groups were similar at the start of the study with regard to age, education, dominant arm affected and pain duration.

All patients were monitored at six, 12 and 18 weeks and were advised not to have any additional treatment except analgesics (including anti-inflammatory drugs) during the follow-up period. Pain and disability were measured using a recognised scoring index.

After 18 weeks, 32 (64%) of patients in the exercise group achieved a reduction in shoulder pain and disability scores compared with 18 (36%) in the shockwave treatment group.

More patients in the exercise group returned to work, while more patients in the shockwave treatment group had additional treatment after 12 weeks, suggesting that they were less satisfied.

These results are in agreement with results from previous trials recommending exercise therapy and do not strengthen the evidence for extracorporeal shockwave treatment, say the authors.

They conclude: "Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain."

Link to paper

Source
British Medical Journal