PREVENTING SKIING-RELATED KNEE INJURIES

The most common injuries in skiing happen to the lower limb, most commonly the knee. The introduction of releasable bindings has decreased the rate of leg fractures by 90% in the past 30 years, but knee sprains (including ACL and/or MCL tears) are on the rise accounting for about 30% of all skiing injuries.

The most common injury is the medial collateral ligament (MCL) tear, which is typically treated without surgery.  In skiing, the MCL is often torn when the ski tips are pointed toward one another in a snowplow position (the common slow or stop position) and the skier falls down the hill. MCL tears are more common among beginning and intermediate skiers than advanced and elite skiers.  When skiing you may prevent an MCL tear by:

• Making sure that your weight is balanced when you are in the snowplow position.
• Sticking to terrain that is a comfortable challenge but not overwhelming.

The second most common injury is the anterior cruciate ligament (ACL) tear. Given the importance of the ACL to the functional stability of the knee, ACL tears often require surgery (however in some cases patients can avoid surgery). ACL tears are common in sports, but most of them are the result of "non-contact" injuries.

There are two ways that skiers most commonly tear the ACL:

• Landing a jump in poor form. When skiers land from a jump with their weight back, so the back of the boot is pushing on the calf, the force from landing can tear the ACL.  The best way to avoid this injury is to learn to land safely, with your weight forward, by starting with simple jumps and gradually advancing to more difficult jumps.
• The "phantom foot" phenomenon often happens when skiers try to stand up to prevent an unavoidable fall. As the skier falls, all the weight goes on the outside of one ski, and the arms and trunk rotate away from that leg. When a skier falls into this position, an ACL injury is often the result. Avoid this position by never trying to stand up during a fall and accepting an unavoidable fall. Skiers should "go" with the momentum of a fall and maintaining good ski technique.

Preventing injury on the slopes

• Remember the keys to effective skiing technique: hands and weight forward, legs parallel, and hips, knees, and ankles flexing equally.
• Stay on marked trails: Going off trail can take you into ungroomed territory with many possible obstacles (such as trees and rocks) that can contribute to injuries.

Getting ready for the slopes:

• Prepare your body. A few simple exercises (listed below) can prepare your core and lower extremities for skiing. Three to four weeks of aerobic training such as walking, elliptical, or biking can be excellent ways to help you tolerate a full day on the slopes.
• Ensure you have proper equipment: Make sure ski boots, bindings, and ski length are fit and appropriate for your height and skill level. Wear a helmet. Wrist guards are a good idea if snowboarding.
• Learn proper technique: Take a skiing technique class with a professional before you hit the slopes.
• Rest: If you are tired, rest.  Injuries happen more commonly when skiers are fatigued.

Exercises to Condition Core and Lower Extremities

The exercises below are not intended as a substitute for care from a health care professional. If you experience pain or other signs and symptoms of injury or pain, you should seek the advice of a physical therapist or other health care professional.

Double Leg Squats

Place your feet shoulder width apart. Squat down, keeping your heels on the floor. Keep your feet and knees facing forward. Stick your bottom out and don't let your knees go too far forward. Focus on using your gluteal muscles (buttock muscles) to lift and lower your weight. Your shins should be parallel to one another, with your knees no farther forward than your toes, just like in good skiing technique. Do 10-15 repetitions, then hold midway in the squat until you are fatigued. Repeat 3 times.

Single Leg Squats

Stand on one leg. Use a chair or counter to place a hand or few fingers to help you keep your balance at first. Work towards squatting without any help balancing. Keep your pelvis level and squat down. Just like in the double leg squat, keep your heel on the ground with your foot and knee facing forward. Make sure your pelvis is level; that it isn’t dropped down on the leg that is unsupported. Do 10-15 repetitions on each leg, and repeat 3 times.

Side-to-Side Skaters

Stand on one leg and take a large step to the side with your other leg. Stand on that leg, and then take another large step back to where you were. Make sure that your pelvis stays level and that your knee doesn’t buckle inward. You can make this more difficult by wrapping a resistance band around your waist. Work up to doing this for 2 minutes. Don't rush. The slower you go, the more difficult this exercise is.

Side plank

Lie on your side with your knees bent, and prop up on one elbow. Lift up your hips and push them forward, so you make a straight line from your shoulders to your knees. Slightly lift the top leg up. You should feel this working your hip and core muscles on the side that is down. These are the muscles that keep your knee from falling inwards. Make the exercise more difficult by starting with your knees straight so only your forearm and the outside of your foot are touching the ground.

UT COMPENSATION

WHAT IS IT?

UT compensation, or Upper Trap compensation, is the overuse of the upper fibers of the trapezius muscle due to injury or weakness.

WHY DOES IT HAPPEN?

Supraspinatus Injury:

The most prominent injury leading to UT compensation is a rotator cuff tear - most often, the supraspinatus muscle. The supraspinatus is primarily responsible for abduction of the shoulder, and stabilization of the humeral head (top of the arm bone) in the glenoid fossa (socket). Abduction of the shoulder joint is the arm moving out to the side, and away from the body - as if you are doing a jumping jack. Once the arm reaches shoulder height, the deltoid muscle takes over and continues abduction by raising the outstretched arm the rest of the way to get entirely overhead. 

When an injury occurs in the supraspinatus, the deltoid immediately becomes responsible for abduction - however, it still is unable to raise the arm in abduction before it reaches shoulder height entirely on it's own - so the UT raises the entire shoulder, not just the arm, to help the arm reach higher without the supraspinatus muscle. 

Scapular Weakness:

The other common reason for UT compensation is scapular weakness and instability. The scapula is the bone that creates your shoulder blade, as well as the socket portion of the ball-and-socket shoulder joint. Multiple muscles attach to the scapula from all different aspects that work together help to control the strength and mobility of the shoulder. 

When there is weakness present in the elevators (function to lift up) and retractors (function to pull back, like you're puffing out your chest) of the scapula, the UT activates to help the scapula maintain it's range of motion, so as to allow the shoulder joint to maintain it's normal range of motion. 

WHAT HAPPENS NEXT?

It is not uncommon for UT compensation to go unnoticed for weeks, to months, to even years. Some individuals with plenty of strength elsewhere may get away with it for longer, some individuals with less functional strength may notice it immediately. Common symptoms are elevated shoulders, stiff/tight muscles in the neck/upper back, and residual pain in the shoulder.

IS IT CURABLE? 

The longer you wait to talk to your doctor, the longer it will take to reverse the symptoms and retrain your body to activate your muscles properly. With effort and hard work, prognosis is usually fair to excellent. Talk to your physical therapist about performing a screening or evaluation to identify if UT compensations are occurring due to a larger issue in your upper extremities. 

Ask us at CHAMPION today!

PHYSICAL THERAPY AND YOUR INSURANCE

A Patient's Guide to Getting the Best Coverage

The best way to take care of your health is to take an active role in your own health care. To do this, you need to know about your options and your rights as a patient. Patients across the country are becoming better educated and demanding more and better options from their health insurance companies. The right to physical therapist services is an important option, and it is your right as a patient.

Federally qualified HMOs are required to have physical therapy in their benefits packages.

In most states you may see a physical therapist without a doctor's referral, but be sure to check your health insurance plan to see if physical therapist services are covered without a physician's referral.

What You Can Do to Improve Your Physical Therapy Coverage

Talk with your employer/benefits manager. The employers who contract and pay for employee health care plans often have the most influence with insurers. Employers are interested in keeping their employees on the job and their premiums low, so providers who can help employees prevent injuries and avoid recurrence (as well as promote a healthy lifestyle) have particular appeal to them. Arrange a meeting with your human resources director or whoever is responsible for negotiating the terms of the company's insurance plan.

Ask your human resources director or insurance company the following questions to determine if your current benefits package gives you access to appropriate physical therapy services:

1. Is your physical therapy benefit "bundled" with those of other providers of care? Physical therapy services should be listed separately in the benefit language so that access to necessary services is not compromised.

2. Does the benefit language permit access to physical therapists for each condition during the year? Benefit language should permit treatment of more than one condition in a calendar year (eg, ankle fracture in January and low back injury in July).

3. Does the benefit language permit access to physical therapists for each episode of care? A person may require more than one episode of care for the same condition. For example, someone with arthritis may receive physical therapy intervention for knee weakness in an attempt to avoid surgery. While this is often successful, some patients may still require surgery for the knee condition (eg, total knee replacement), which may require post-operative physical therapy treatment. The benefit language should support each "episode of care."

4. Does the benefit language ensure coverage that facilitates restoration of function? Benefit language that restricts physical therapy care to a 60- or 90-day period imposes an arbitrary limit on recovery. In determining an appropriate physical therapy benefit that will allow an individual to return to his or her previous level of function, benefit language should reflect the normal amount of time that it takes to recover from an injury or from surgery.

5. Does the benefit language ensure coverage that promotes functional independence for those with chronic conditions? Someone who has a chronic condition may need to be seen periodically by a physical therapist. The physical therapist will determine if the individual's home program, equipment, or adaptive devices should be modified. (For instance, children requiring orthotic devices will need modifications to those devices as they grow.) Benefit language should ensure that someone with a chronic condition may receive the kind of care that promotes personal safety and the greatest degree of function possible.

Choosing a Health Plan

Millions of Americans are offered a choice of health plans through their employers, but the question is "What makes a good health care plan?" Here are some things to consider when choosing a health plan.

• Are you choosing a plan simply because it is the cheapest? This may not be the best way to go. Some inexpensive plans have a high deductible and no comprehensive coverage.
• Is the plan accredited by the National Committee on Quality Assurance? This is a good indicator of quality.
• Are your current doctors and specialists in the plan? If not, make sure you will be able to see a certain provider or specialist, such as a physical therapist, without too much added expense and difficulty.
• Is physical therapy coverage adequate? If you should have an injury or illness requiring rehabilitation, you will need a plan that offers an unlimited number of visits to a physical therapist or that allows for the number of visits to be extended if needed.
• Are there lifetime limits on benefits? If so, you could face a serious financial crisis if you or a covered member of your family suffers a major illness or injury.
• Does the plan have an out-of-pocket maximum? In this case, once you have paid a certain amount (usually several thousand dollars) the plan would cover the rest.
• How does the plan handle grievances and appeals? The procedure should be simple, timely, and accessible.
• Does the plan permit use of out-of-network doctors, specialists, or hospitals? Called "point-of-service" option, this would allow you to see a provider, such as a physical therapist, who is not in your plan. There may be an additional cost, but it may be worth it.
• What is the plan's disenrollment rate? A high rate of members leaving the plan annually may indicate customer dissatisfaction.

SUMMER BREAK = WEIGHT GAIN IN KIDS?

Summer is associated with children at play, but a recent study suggests it’s also a time when kids are gaining weight at an increased rate compared with during the school year.

The Harvard University systematic review, published in the Centers for Disease Control and Prevention journal Preventing Chronic Disease(Accelerated Weight Gain Among Children During Summer Versus School Year and Related Racial/Ethnic Disparities: A Systematic Review” – June 12, 2014), analyzed 7 studies and found that all but 1 demonstrated evidence of a faster rate of weight gain among some children during the summer months compared with the school year.

The accelerated weight gain was most pronounced among children who were already overweight.

Potential solutions suggested by the authors included “greater access to summer camps and parks and recreation programs” and “increased use of summer food programs, which provide meals outside of the school year.

OBESITY ACCOUNTS FOR WHAT PERCENTAGE OF US ADULT DEATHS

At a time when more Americans are overweight than ever before, a study published in the American Journal of Public Health suggests that obesity is more deadly than previously estimated.

The study, which examined data from 1986 to 2006, when Americans were comparatively lean, determined that as many as 18% of deaths of individuals aged 40- to 85 are linked to obesity.

As NBC News reported ("Heavy burden: obesity may be even deadlier than thought" - August 15, 2013), many factors increase a person's likelihood of weight problems, from income to level of education. And people who are obese are more likely to have other unhealthy habits, such as smoking and poor diets.

"People who are overweight or obese are far more likely than thinner people to have heart disease, cancer, or diabetes, and to have strokes or heart attacks," NBC reported. "Usually, but not always, fatter people are less fit than thinner people, and exercise can clearly protect you from death and disease."

As experts in human motion, physical therapists at CHAMPION can design fitness programs to help you exercise safely. Give us a call for questions, or to set up an evaluation!

PREGNANCY ALTERS RUNNING FORM

A recent study published in The Journal of Orthopaedic & Sports Physical Therapy suggests that pregnancy causes biomechanical changes to a runner's stride that can linger after childbirth.

As reported in the New York Times (How Pregnancy Changes a Runner's Body - June 10, 2013), these changes have the potential to cause injury, although some runners participating in the study reported no pain as a result of the changes.

In an August 8, 2013 episode of Move Forward Radio, physical therapists involved in the study discussed their findings and provided tips for women hoping to run during or after pregnancy.

See a pelvic floor specialist of physical therapy here at CHAMPION to learn how to strengthen the pelvic muscles affected by pregnancy, or an orthopedic physical therapist here at CHAMPION for a running analysis. 

IS IT REALLY NECESSARY FOR SURGERY FOLLOWING A MENISCUS TEAR?

Could 1 of the most popular surgical procedures in the United States be unnecessary many of the approximately 700,000 times it is performed each year?

A study published in the New England Journal of Medicine suggests that might be the case for arthroscopic surgery to repair a torn meniscus—particularly if the tear is a result of wear and aging, as opposed to a traumatic event.

As the New York Times reported ("Common Knee Surgery Does Very Little for Some, Study Suggests" - December 25, 2013), a Finnish study of 146 patients between the ages of 35 and 65 found that those who had arthroscopic surgery had no better level of satisfaction 1 year later than had others in the study who had undergone a mock surgical procedure.

"Those who do research have been gradually showing that this popular operation is not of very much value," Dr David Felson told the Times.

What exactly does that mean? Well, it means that there's essentially a chance that the outcomes of a surgical repair are not significantly greater than that of physical therapy, meaning you can achieve close to the same outcome at a much cheaper cost. Does this concept apply to everyone? No, it absolutely does not. This study is one of a few that are starting to go public that only apply to those in generally good health, not other knee conditions, and no outstanding circumstances - meaning they are low risk patients who wish to get back to moderately stressful (on the body) activities, at the most. High level athletes, young athletes, and professional athletes are not considered in this category, as well as elderly, individuals with other degenerative conditions of the knee, and those with multiple injuries of the knee (like a meniscus tear and ACL tear, or something along those lines.) 

Talk to your physical therapist today, or come see an orthopedic physical therapist at CHAMPION  about whether surgery is a good option for you!  

EXTRA STEPS CAN HELP THOSE AT RISK FOR DIABETES AVOID...

...AND LOWER THE RISK OF HEART ATTACKS AND STROKES.

Individuals at risk for diabetes can cut their risk for heart attack or stroke by 8% by taking an extra 2,000 steps a day—equivalent to about 20 minutes of moderately paced walking—according to a study of more than 9,000 adults performed by researchers at the University of Leicester and published in the Lancet.

"Two thousand steps seemed to be the magic number," TIMEreported ("How Many Steps Does it Take to Avoid a Heart Attack? Researchers Find Out" - December 19, 2013). "Even before the study began, for every 2,000 steps a day one participant tended to walk on average compared to another, he enjoyed a 10% lower rate of heart problems by the end of the year."

EARLY EXERCISE CAN DECREASE DEPRESSION IN INDIVIDUALS WITH PARKINSON'S DISEASE

Exercise is known to offset many physical side effects of Parkinson's disease (PD). A recent pilot study suggests that early exercise also can reduce depression symptoms among individuals with PD.

A study of 31 patients randomized into an early exercise start group and a delayed start group found that patients in the early start group scored "significantly better" on the Beck Depression Inventory, according to the research published in Parkinsonism & Related Disorders ("Effects of a formal exercise program on Parkinson's disease" - January 20, 2014).

While this is extremely relevant in individuals being treated with medications for neurological conditions like Parkinson's Disease and Huntington's Disease, it's equally as important in those who are living with nothing of the sort. Depression and anxiety is not only a side effect of multiple conditions, but also has a high prevalence in adolescent individuals in recent years, and continues to rise. 

Exercise is proven to release endorphins and chemicals related to happiness, and can help improve signs and symptoms along with a treatment plan put in place by your physician. Exercise is for everyone, not just people who go to the gym everyday. 

However, if you are an individual who's being treated for Parkinson's Disease, if you're looking to reap the benefits of exercise surrounded by individuals who are going through the same thing you are, a Rock Steady affiliate may be a wonderful option for you. 

Prairie Fighters, a Rock Steady Boxing affiliate is located just 2 miles from our location on 75th and State Line, at 89th and State Line, and are currently taking new customers. 

Below is the link to their website! 

GUESS WHO IS AT A HIGHER RISK FOR OVERUSE INJURIES DURING HIGH SCHOOL?

According to the APTA, among high school athletes, girls are at greater risk for overuse injuries than boys, according to a recent national study published in the Journal of Pediatrics (“Epidemiology of Overuse Injuries among High-School Athletes in the United States” – March 2015).

In analyzing 3,000 male and female high school athletes participating in 20 different sports, researchers found that overuse injuries represented 7.7% of injuries overall, but rates among girls and boys differed significantly, with overuse injuries representing 13.3% of all injuries for girls compared to only 5.5% for boys.

Girls and boys also differed in terms of when the injuries were likely to occur, with the proportion of overuse injuries decreasing in females from freshman to senior year, while it increased in males.

The highest overuse injury rates for girls were seen in track and field, field hockey, and lacrosse.

"This finding may be solely due to differences between males and females or that these girls’ sports have larger teams with younger, skeletally immature girls who were not physically ready to handle the repetitive motion associated with these sports," the researchers summarized. "Athletes in these sports may benefit most from overuse injury assessment and prevention."

In a video produced by Ohio State University, lead author Thomas Best, MD, also theorized that single-sport specialization could be a contributing factor.

"Many of these youngsters are playing a single sport, and that may in fact be a major risk factor for these overuse injuries because their bodies are seeing the same repetitive blows with one sport," Best said.

What can you do? Preventative measures are your best option. Although there's no guarantee, you can make a significant impact on yourself by working against nature to prevent it.