HAMSTRING INJURIES RESPOND BETTER TO EXERCISE, ACCORDING TO APTA

Platelet-rich plasma injections might sound like cutting-edge treatment for hamstring injuries, but according to the APTA, a 2012 systematic review of 10 randomized clinical trials indicates that rehabilitation exercises actually have a superior effect on acute hamstring injuries (“Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis” – July 21, 2015).

Specifically, lengthening exercises and progressive agility and trunk stabilization exercises have been identified in previous studies as appropriate “for daily practice” to treat acute hamstring injuries. However, the authors of the above study discourage the use of platelet-rich plasma injections, in which a patient’s own platelet-enriched blood is injected into an injured part of the body with the intent to promote healing, finding that the injection is ineffective.

Hamstring injuries are one of the most common lower body injuries, particularly affecting athletes participating in sports, such as football, soccer, or track. After tearing a hamstring muscle, a person is 2 to 6 times more likely to suffer a subsequent injury. Participants from the reviewed studies were all associated with sports.

Physical therapists can design individualized treatment programs for hamstring injuries that may include range of motion, muscle strength, manual therapy, and function training.

3 REASONS TO SEE A PHYSICAL THERAPIST EVEN IF YOU'RE NOT HURT

1. You want to boost your ‘athletic’ performance.

We are all athletes. Whether you aspire to play sports in college or just like shooting hoops on weekends, you’re an athlete in my book. Maybe gardening is your thing. If you don't think those dance classes you go to involve athletic ability, just consider how much more clumsy you felt when you first enrolled. Yes, we are all athletes. 

But is your body getting what it needs to move most effectively? Is everything that should be moving moving well? Are the parts that should be nice and stable actually holding things together?

SPJs have the power to keep you running at top speed, no matter what your favorite activities are. They just have to watch you move to see the unseen. It's common to see an SPJ quickly identify a seemingly unrelated part of the body that winds up having a huge impact on your athletic ability – whatever that means to you. SPJs know where to push and pull and allow your body to do the rest. 

2. You don’t want to get injured. 

What if you don't hurt or only hurt "a little?” While it's not always necessary to seek care for the bumps and bruises that come from normal activity, it’s useful to become educated and get answers when small pains begin to stack up and change the way you move normally. 

Our bodies already have a few superpowers. For example, they’re immensely resilient and have an impressive capacity to heal. More often than not, fear of re-injury and compensating for a previous injury by, say, changing your gait slightly, actually leads to more persistent pain. SPJs are great to have around in these cases because they know exactly when and where to apply stress to the body to speed up healing, as well how to help people best understand how to heal themselves. 

3. You want to save money and time. 

Surgery can be expensive, timely and require a frustrating amount of recovery time. But what if I told you that mounting evidence shows that, in some cases, an SPJ’s management is as effective as many surgical treatments for hip, back, shoulder and knee pain? Believe it. Not only can SPJs save people from some unnecessary surgeries, but good SPJs can also be more cost-effective than the many expensive diagnostic tools typically used to "take a look" at those painful areas. Even if surgery is the best option, a well-trained SPJ can guide you along the healing process and get you back to your favorite activities in no time.

TURF TOE

Turf toe injury is an injury to the main joint of the big toe. The formal medical name for the condition is metatarsophalangeal (MTP) joint sprain. This injury occurs when the big toe is forced into extreme positions of hyperextension (where the toe moves back toward the top of the foot past its normal range of motion). It occurs primarily in athletic environments, particularly in football, such as when an athlete pushes off to sprint or is tackled with the front of the foot fixed and jammed into the ground, causing the toe to get stuck or caught in a hyperextended position. In most circumstances, a turf toe injury does not require surgery and can be treated effectively by a physical therapist.

What is Turf Toe?

There are 2 joints in the big toe. These joints allow the toe to move in an upward motion and bend in a downward motion. The big toe plays a significant role in our ability to walk and run; when the foot touches the ground and prepares to take another step, the big toe is the last joint through which the foot pushes off to move the body forward. The primary joint that this motion occurs through is the metatarsophalangeal joint, where the metatarsal, the first long, straight bone of the foot, attaches to the phalange, the first shorter bone of the toe.

If the big toe is forced into an extremely unnatural position, the MTP joint and surrounding structures may be injured. These structures may include ligaments, muscle tendons, or the small bones that sit under the big toe, called the sesamoid bones. All of these structures play a role in maintaining the integrity and function of the MTP joint; they are often grouped together and termed the plantar complex. Sometimes, 1 of the soft-tissue structures is simply stretched when the toe is bent back toward the top of the foot. However, a turf toe injury may involve a subluxation (where 1 bone of the joint slips out of place, but comes back to its normal position) or a dislocation (where the 2 bones of the joint are completely separated).

How Does it Feel?

The most common symptoms associated with a turf toe injury are:

• Localized pain at the MTP joint
• Feeling a "pop" at or around the MTP joint at the time of the injury
• Swelling
• Bruising
• Tenderness to touch
• Cramping in the arch of the foot
• In more severe injuries, a disfiguring of the MTP joint (as in a dislocation)

How Is It Diagnosed?

Turf toe injuries are typically classified into grades 1 to 3 to describe the severity of the injury and to guide treatment:

• Grade 1: stretching of the plantar complex
• Grade 2: partial tearing of the plantar complex
• Grade 3: complete tearing of the plantar complex

Diagnosis of turf toe injury starts with an interview to learn the mechanism of injury and your symptoms. Your physical therapist will perform a gentle clinical examination to assess the toe's movement and muscle function as well as to note any swelling or tenderness in the area. Your physical therapist may ask you if you are able to walk on your foot and, if so, will analyze your gait pattern. If your therapist suspects a fracture of 1 of the bones or a tearing of the muscle-tendon unit, your physical therapist may refer you to an orthopedic physician who specializes in foot and ankle injuries for diagnostic imaging (i.e., x-ray, MRI).

How Can a Physical Therapist Help?

Immediately following a turf toe injury, the RICE protocol is recommended: Rest, Ice, Compression, and Elevation. The goal of the RICE protocol is to decrease pain and swelling and protect the joint from further injury until it can be more thoroughly assessed. Most turf toe injuries do not require surgery and are treated with physical therapy. The treatment depends on the severity of the injury.

• Grade 1. To treat a Grade 1 injury, your physical therapist may use narrow athletic tape to immobilize your big toe with your second toe to restrict painful motion. Your physical therapist may also place a firm insert in your shoe to limit motion and promote healing. In many cases, an athlete may be able to return to sport soon after a Grade 1 injury.
• Grade 2. Treating Grade 2 injuries may require immobilizing the foot in a brace or walking boot, and allowing several weeks of rest.
• Grade 3. Treatment of Grade 3 injuries is dependent on the severity of the damage to the structures of the foot. Surgery may be required if there is a fracture of a bone, damage to the cartilage (the tissue that lines the bones of the joints), a complete tearing of the tendon, or excessive movement of the joint that causes repetitive instability (subluxation or dislocation).

In each case, your physical therapist will work with you to design an individualized treatment program specific to the exact nature of your condition and your goals. Treatment may include:

Range of Motion Exercises. It is important to regain a full range of motion of your big toe. Your motion may be limited after a turf toe injury, particularly one that requires immobilization in a brace or boot. Your physical therapist will teach you gentle stretching exercises to help regain motion.

Muscle Strengthening. It is common to lose strength in the muscles of your leg, particularly around your foot and ankle after a turf toe injury due to the limited weight-bearing and activity that is required to allow the injury to heal. Your physical therapist will determine which muscles are weak and teach you specific exercises to treat them, such as strengthening with resistance bands, balance activities, and functional activities, like stair climbing.

Manual Therapy. Many physical therapists use manual (hands-on) therapy to gently move and manipulate muscles and joints to improve their motion and strength. These techniques can target areas that are difficult to treat on your own. Manual therapy can be especially effective for joints that become stiff following immobilization; with turf toe injury, your physical therapist will use different techniques to mobilize your big toe as well as the other joints of your foot and ankle that may have become stiff during your recovery.

Patient Education. Your physical therapist will educate you on the dos and don’ts following turf toe injury to ensure that your recovery is a smooth one. Your physical therapist will work with you to develop an individualized rehabilitation program, including expected timelines and goals to give you a roadmap for your return to full activity.

Can this Injury or Condition be Prevented?

There are certain external factors that may increase the risk of turf toe injury, such as competing on artificial turf surfaces and wearing shoes with highly flexible soles. Care can be made to ensure that your footwear is supportive and appropriate for the surface on which the sport is being played. Additionally, performing preventative flexibility and strengthening activities for the foot and ankle may improve your body's ability to withstand the stresses placed on the body during athletic activities.

THE DIFFERENCE BETWEEN ACL AND MENISCUS TEARS THAT TELLS ALL

Fall sports have a tendency to have the highest number of ACL and meniscus tears on average compared to any other sports seasons. Between football, soccer, volleyball, cross country, and off-season basketball, physical therapy clinics are swarming with ACL and meniscus tears.

Both, ACL and meniscus, will likely result in a decreased range of motion, excessive swelling, and pain on occurrence; although some people state that they had no pain at the time of the initial tear - simply just heard a "pop". 

The huge difference will be visible at around 24 hours after the tear. Aside from the initial pain, most ambulation impairments (troubles walking) on flat ground are going to be from self-preservation for an ACL tear.  In other words, if you're limping more than 24-48 hours following an ACL tear, it's likely as a result from your being cautious, as opposed to your actual injury causing pain. Many ACL tears we see only have problems ascending stairs, jogging, or walking downhill but can walk up hills and on flat roads without an increase in pain. A meniscus tear, on the other hand, will cause fairly severe pain even just standing on it.

The reason they have this huge symptomatic difference is due to each of their respective anatomical locations. While the ACL is a ligament connecting the backside of the femur (thigh bone) to the front of the tibia (shin bone) helps to support the knee joint by protecting the femur from moving too far forward during deceleration (stopping quickly, ascending stairs, lateral movements), the menisci (2 per knee) sit on the tibia and are used as a form of biological padding to protect the tibia from colliding with the femur.  When a meniscus is torn, putting pressure on it in many forms can cause severe pain, as there is not only a torn tissue, but also there is no longer much support between those two bones when standing, walking, and even sitting, or bending the knees while laying down, depending on where the tear is located. 

This excess in pain is likely going to cause an increase in swelling for a longer period of time than that of an ACL. The process of inflammation takes 7 days to complete, but increases in pain is correlated with increases in bloodflow, with is correlated with increases in inflammation. Essentially, it's a repetitive cycle that typically results in higher levels of swelling for longer periods of time following an initial injury. 

More questions? Come see us at Champion Performance and Physical Therapy at 7510 State Line Road, Suite A in Prairie Village!

TOP TEN MOST INJURED CHILD ATHLETES

Have you ever wondered just how risky your son or daughter's favorite sport is, or whether it was a good idea to allow them to participate at all? While some of these statistics can seem threatening, remember that there are over 30 million students who enroll in some form of organized athletics program every year in the United States, ages 5-14. Below are statistics provided by the Consumer Product Safety Commission and Lucile Packard Children's Hospital - Stanford regarding some of the most common sports children are injured while participating in.

1. Football

As predicted, football leads to around 215,000 trips to the emergency room. As an extremely physical sport, football is widely regarded as one of the few sports that project a higher risk of brain injury or permanent injury - but surprisingly, child football programs do not report the largest number of brain injuries per year.

2. Bicycling

This sport makes a not-so-surprising appearance on this list, as many of the 200,000 injuries that result in an ER visit each year for that age range are as a result of crashes. It's a hard life without training wheels.

3. Basketball

While injuries during a sport like basketball are fairly common in adolescents, around 170,000 children in that age range mentioned above wind up in the emergency room due to a basketball-related injury. At this age, it's much more common to see kids in the ER to treat a badly-poked eye, jammed fingers, broken wrists, and rolled ankles.

4. Baseball and Softball

Although getting hit with a ball or tripping over older brother's old cleats seem like the most common ways children can get hurt while playing baseball, getting hit in the head with a bat or ball can prove to be just as dangerous as football - even at that age. Baseball and softball are responsible for 110,000 visits to an emergency room, and has the highest fatality rate for athletics in that age division per year, at 3-4 deaths. 

5. Soccer

Depending upon the level of competition, soccer can be brutal at any age. It's extremely common for kids to sprain an ankle by getting caught in a hole in the ground, break a wrist landing incorrectly, or get concussions trying to head the ball. Soccer players make up 88,000 of just over 775,000 injuries reported from sports in that 5-14 age range.

6. Skateboarding and Trampolines

Although two very different activities, skateboarding and trampolines lead to very similar statistics as far as number and type of injuries. Both sitting somewhere in the mid-60,000 for number of children sent to an emergency room, they both have an extremely high fall risk that put them both near or at the top of the list of most risky sports for head injuries. Skateboarding sits atop the chart at the most risky for head injuries to occur, resulting in a whopping 50% of all athletic-related injuries in children ages 5-14 each year.

7. In-Line and Roller Skating

It shouldn't be surprising that roller skating follows skateboarding on the list of the most-injury prone child athletes, with a staggering 47,000 injuries resulting in a trip to the ER per year.

8. Skiing and Snowboarding

Because I myself have been injured from snowboarding, I'm not particularly surprised that these adventurous sports ended up on this list, as well. While it's extremely easy fall and land the wrong way leading to upper extremity injuries, such as broken wrists or dislocated shoulders, it's also more than likely a higher risk for children to fracture a bone in their legs, too. The amount of pressure on the joints that are associated with such rigorous sports can lead to hairline fractures that progress in children, as their bones may not yet have solidified. There's also an increased risk of injury due to lack of predicted course, as a child can easily turn down the wrong run and end up on a much more dangerous path than intended. Skiers and snowboarders sit toward the bottom of our most commonly injured child athletes, with over 25,000 emergency room cases per year.

9. Ice Hockey

Last but definitely not least, this sport only increases the risk of injury as children climb through that age division. A notoriously brutal sport, ice hockey is responsible for more than 20,000 injuries per year. 

Look forward to next week's post, Part II, regarding how you can help decrease your child's risk of injury if their passion can be found somewhere on this list. 

RUNNING IN THE RAIN

Since Kansas City is one good rain short of drowning, we figured there's no better time than now to post a few tips as far as being smart when running in the rain.

Many avid runners don't find running in harsher weather conditions to be intimidating, and casual walkers, joggers, and runners are more likely to head outside in the rain when the weather warms back up in the spring and summer. Don't get me wrong - a few of us are all about it, too. We just want to make sure we can help you to stay safe and prevent situations or injuries the rain will increase when you hit the road, outdoors.

1. Wear Your Neon!

On the rainier days, neon is especially important for drivers on the road to see you. Visibility is almost as low as when it's dark outside, but car brakes have a higher flaw ratio when conditions are anything less than perfect.  Bright colors will just help to ensure drivers see you in time to make adjustments and accommodations to runners and bikers.

2. Compression Is Best

If you're not wearing running leggings, wear compression shorts underneath your running shorts.  Not only do they help to maintain body temperature, but they're also great to help wet thighs avoid chafing. 

3. Seal Your Electronics ---

Use workout gear with sealed, zipper pockets, to keep your phone or ipod directly out of the rain. However, since most zipper pockets may not completely keep the water out, you can always put your phone in a plastic bag or plastic wrap, or even find yourself a waterproof case. They're more expensive than a typical case, but I'm sure you'll get more use out of it than just running in the rain (dropping phones in the bathroom, in lakes/pools, etc.)

4. CHECK YOUR SHOES!!!

Take a look at the bottom of the running shoes you're planning to wear. If you've had them for a long time, or they've acquired milage from running on treadmills from over the winter, the tread may be worn down to the point that they no longer have any useful amount of traction. This isn't typically a big problem when it's dry outside, but it does add a significant increased risk of injury in the rain. Use some shoes that have more tread on them to avoid slips, falls, or other injuries.

5. Adapt Your Workout

Firstly, don't plan on beating your personal best when it's raining. Harsh weather conditions can considerably decrease your speed - even if you don't realize it. More importantly, increase your stride rate. If you're one to run with longer strides or you have longer legs, try your best to shorten your stride to decrease your time on a slippery surface. 

6. DO. NOT. RUN. WHEN. IT'S. STORMY.

Rain is one thing, storms are completely different. Water is an electric conductor, and the risk of dangers to your health increase when lightning is near. Make sure to check radar to ensure it's only rain coming in your direction, not hail or lightning. 

THROWING INJURIES

As with many orthopedic injuries, repetitive motion like throwing can create an excessive stress on shoulder and elbow tendons and ligaments. Repeated stress can also tear the ligament and tendon away from the bone and can even pull off tiny bone fragments. In the case of children, normal bone growth can be affected if this condition is left untreated.  As children are starting to play sports competitively much younger and continue to play at a high level throughout their entire career, injury recognition is key to preventing further damage that could potentially lead to career-ending problems. 

Symptoms of Injury

The symptoms of a throwing injury can include shoulder pain or elbow pain, a reduced range of motion and, with the elbow, the tendency for the joint to lock.  Tendonitis or frayed tendons are most commonly caused by, surprisingly enough, a lack of functional strength in certain muscles. 

These athletes have been conditioned to throw using a certain technique throughout the majority of their lives.  The muscles necessary to recreate that technique time and time again are very strong, but the surrounding muscles may not be activated nearly as much as they should be. Muscles insert via a tendon to bone, and will usually cross bony prominences, or bumps on the bones, to get to their insertion point.  For a strong, healthy muscle, tendons have enough slack to reach their insertion point without obstacles, but remain taut enough to keep the tendinous portion from rubbing on the bony prominences they cross. 

When the muscles are not activated regularly (strengthened properly), these muscles will get pulled in whichever direction the strong, frequently-utilized muscles are willing the bones.  For example: if pectoral muscles in the chest are tight and the scapular stabilizers between the shoulder blades aren't fired enough, their weakness will allow the tightness of the pectorals to round the shoulders forward.  This will lead to poor posture, and potentially cervical issues. 

When these weak muscles get pulled in a different direction due to lack of strength, their tendons rub constantly over the bony prominences - and this is worsened by repetitive motion, such as throwing. This will fray the tendinous portion of the weak muscles over time, until eventually there is too much inflammation, causing fairly debilitating pain, or until the tendon tears. 

Treatment Options

The most common treatments include resting and icing the affected area to reduce inflammation. As difficult as it is to pull players out of games and practice at such a high level, it's vital that any injury be treated as soon as possible to prevent further damage.

NSAIDs such as ibuprofen may be helpful to ease pain and inflammation, and physical therapy may be recommended by an orthopedic specialist. Physical therapy will strengthen the muscles around the damage to relieve them from the strain of bony prominences. This can relieve pain, but will likely not repair damages in the tendons. In some cases, surgery may be necessary to repair rotator cuff tendons in the shoulder or ligaments on the inside of the elbow to restore proper function and throwing mechanics and reduce pain.  Surgery is a more common solution for older athletes - high school and up, and most likely due to chronic symptoms and extensive damage over time as compared to a single incident. 

Common Throwing-related Conditions

Click below for further information.

• BURSITIS/ROTATOR CUFF TENDINITIS
• ROTATOR CUFF TEAR
• SHOULDER LABRAL TEAR

ICE v. HEAT

Many people have this question when coming in for therapy - which is better for my injury, specifically - ice or heat? 

The truth is, neither have the research behind them proving that they do much good, longterm. Regardless of whether you ice, your injury will still swell immediately, and regardless of whether you use heat, your chronic pain will return.  Neither are permanent solutions to the underlying problems, but they can, however, be used as short term solutions to help minimize pain. Ice will partially numb a painful area, whereas heat will partially relax the muscles surrounding or leading to pain in a specific area. 

The scientific community still debates on the validity of information reporting that ice and heat will change anything or improve the status of your injury, but heres the deal: it usually doesn't hurt to try.

Below are some simple guidelines, the recommended do's and don't's as far as what injury you  have and whether or not you should ice or heat. Ice is for injuries, and heat is for muscles - in most cases.

Ice is for injuries — calming down damaged superficial tissues that are inflamed, red, hot and swollen. The inflammatory process is a healthy, normal, natural process … that also happens to be incredibly painful and biologically stubborn. Icing is mostly just a mild, drugless way of dulling the pain of inflammation. Examples would include a recently torn ACL, a knee or ankle that hurts from walking in heels all day, or a rolled/strained joint. 

Heat is for muscles, chronic pain, and stress — taking the edge off the pain of whole muscle spasms and trigger points, or conditions that are often dominated by them, like back pain and neck pain), for soothing the nervous system and the mind (stress and fear are major factors in many chronic pain problems, of course).

What are Ice/Heat NOT for?

Heat can make inflammation worse, and ice can make muscle tension and spasms worse, so they have the potential to do some mild harm when mixed up.

Both ice and heat are pointless or worse when unwanted: icing when you’re already shivering, or heating when you’re already sweating. The brain may interpret an excess of either one as a threat — and when brains think there’s a threat, the pain will likely increase. 

But heat and inflammation are a particularly bad combination. If you add heat to an fresh injury, watch out: it’s likely going to get worse. Pain and swelling will double, as the heat dilates the arteries, increasing blood flow to the area.  As inflammation/swelling occurs as the body's natural defense to protect the injured area, the increase of blood from arterial dilation will therefore, increase swelling. 

If you ice painful muscles, be careful: it might get worse! Ice can aggravate sensations of muscle pain and stiffness, which are often present in low back and neck pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain — the very condition people often try to treat with ice. If in doubt, please see the links below in the “More information” section.

What about an injured muscle?

If you’re supposed to ice injuries, but not muscle pain, what do you with injured muscles (a muscle tear or muscle strain)? That can be a tough call, but ice usually wins — but only for the first few days at most, and only if it really is a true muscle injury. A true muscle injury usually involves obvious trauma during intense effort, causing severe pain suddenly. An example would be an achilles tendon rupture in the calf, or a biceps tendon rupture in the arm. In these cases, ice is going to be your best bet.  After surgical repairs or intense therapy in the case of a partial tear, you'll likely continue with ice to help decrease the swelling and numb some of the pain until you're further along in therapy to where the muscle is cramping.  For an achilles tendon rupture and repair, that'll likely be as far as 4-5 months out from the date of the initial injury. If the muscle is truly torn, then use ice to take the edge off the inflammation at first. Once the worst is over, switch to heat.

Which is better?

Ice packs and heating pads are not especially powerful medicine: some experiments have shown that both have only mild benefits, but sometimes, any little bit helps.