Why Is Ice So Important for the Treatment of Injuries?

By: Adam Mistr, MSEd, ATC

Just Ice It – Using Ice for Acute Injuries:

Ice is a cornerstone for many injury treatments, especially for acute injuries.  There are 3 phases to a soft-tissue injury: the inflammatory phase, the repair phase, and the remodeling phase.  The inflammatory response causes pain, swelling, redness and warmth to arise around the injured area.  The swelling helps provide stability and protection to the area to prevent painful motion.  The acute inflammatory phase of an injury lasts for the first 48-72 hours after the injury occurs.  Using ice during this phase of the injury is important to help decrease the amount of swelling, bleeding, and loss of motion to the injured area.  The sooner ice is applied to the area, the quicker the inflammatory phase can be completed and the injury can enter the proliferation or repair phase and speed up the recovery process.

During the repair phase of an injury, the body will lay down collagen to replace the damaged tissue structure.  This part of the injury healing process lasts from 72 hours to 6 weeks post-injury.  The new collagen is unorganized at this point and does not reach its full strength until it is molded to replace the damaged tissue.  Ice can still be used at this time, but is usually used after rehabilitative exercises or activities have been performed.  Prior to activity, moist heat may be applied to the injured area to help increase blood flow and range of motion of the affected joint or muscle.  During this phase of injury, there is a lower risk of increasing swelling and decreasing range of motion with the use of heat.

The molding of the new collagen occurs in the remodeling phase of an injury.  The collagen is stressed so it can be molded in certain alignments of the tissue it is replacing in order to properly perform the functional capabilities of that tissue.  This phase can last from 6 weeks to 3 months after the injury has occurred.  Again, as with the repair phase, heat may be used before activities to help with range of motion and increased blood flow.  However it is still important to apply ice to the injured area following activities to prevent swelling from returning and to minimize pain in the area.

Ice 1

Using Ice for Chronic Injuries, Sub-Acute Injuries, and Soreness:

One of the most common chronic or sub-acute injuries experienced by athletes of all levels is tendinitis.  Tendinitis is, by definition, an inflammation of a tendon.  This is a common overuse injury that at one point or another, most athletes will experience during their athletic career.

As tendinitis is an inflammatory condition, it is treated with ice to help reduce the inflammation, reduce pain, and reduce the further breakdown of the involved tendon.  Ice can be applied in the form of an ice bag, freezer gel pack, or via ice massage.  Ice bags or gel packs should be applied for 15-20 minutes to achieve the desired results.  However, an ice massage may be performed for only 7-10 minutes to reach the same goal of anti-inflammation, plus the massaging effect helps alleviate pain from the involved tendon.

Ice is commonly used by athletes who participate in sports that involve a lot of overhead activities (i.e. baseball, volleyball, tennis, swimming).  The nature of these sports places a higher level of stress on an athlete’s shoulders and elbows, which can lead to muscle soreness and aches associated with these joints.  The use of ice after these activities can help an athlete recover quicker and be able to continue performing at high levels with the stresses placed on the involved joints.  Ice may not completely rid the athlete of soreness or pain, but the use of ice after these types of activities can help athletes return to his/her highest level of performance more quickly.

Ice is not the only answer when treating athletic injuries.  However, it is a versatile treatment option that is beneficial in shortening recovery time in a majority of injuries.  Ice should never be applied for longer than 20 minutes, and extreme caution should be used when using freezer gel packs.  These packs should always be wrapped in a clean, dry cloth (such as a hand towel or pillow case) and never applied directly to the skin.  Freezer packs have been known to cause burns and frostbite in cases where they have been applied for too long or applied directly to the skin.

Should you sustain an injury, it is never a bad idea to apply ice to the area and always seek appropriate medical advice from a Certified Athletic Trainer or your physician.  Always remember to consult your physician prior to beginning an exercise program, or before participating in organized athletic activities.

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So how do you become an Athletic Trainer?

By: Christine Minor, MSEd, ATC, VATL

Working around high school aged kids, I am frequently asked about how someone becomes an athletic trainer (ATC) and how I got into the profession.  For me, I was introduced to the profession during my high school sports days after suffering a significant injury that required rehabilitation in order for me to continue playing.  After that, I joined the sports medicine club run by my high school’s ATC where we learned the basics about what an athletic trainer does, first aid skills, and some basic anatomy.  From here, I chose a college that had an athletic training program.

When students ask me about how they can become an ATC, I give them some basic resources that are listed below to look for more information.  I also suggest that they try to spend some time with an athletic trainer to really get to see what we do on a daily basis.  Athletic trainers are educated, trained and evaluated in six main areas of practice:

  1. Prevention
  2. Clinical Evaluation and Diagnosis
  3. Immediate Care
  4. Treatment, Rehabilitation and Reconditioning
  5. Organization and Administration
  6. Professional Responsibility

To become an ATC, you must graduate from an accredited athletic training education program with either a bachelors or a master’s degree and then pass a national board exam.  To keep your certification active, all athletic trainers must take continuing education classes to enhance their knowledge within the profession.  Also, depending on the state that you work in, you may also need to become licensed or register as an athletic trainer.

Below are some good websites to look at if interested in the profession of athletic training:

http://www.nata.org/athletic-training

http://caate.net/

http://www.bocatc.org/

Resources

National Athletic Trainer’s Association (2009) Athletic Training Education Overview . Dallas, TX.

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Register Now for the 8th Annual Pediatric and Adolescent Sports Medicine Update for Primary Care Conference

Registration is now open for the 8th Annual Pediatric and Adolescent Sports Medicine Update for Primary Care which will be held on June 19, 2014 in Norfolk, VA. 

AGENDA

7:30 Registration and Continental Breakfast

8:00 Taking Care of Performing Artists – Chris Koutures, MD

9:10 Welcome/Opening Comments

9:15 All Joint Problems are not Sports Related – Matthew Hollander, MD

9:45 Q & A

9:50 OCD in Young Athletes – Allison Crepeau, MD

10:20 Q & A

10:25 Adaptive Sports: From Disability to This Ability – Aisha Joyce, MD

10:55 Q & A

11:00 CrossFit for Young Athletes: An Introduction – Jeremy Gordon

11:20 Break with Exhibitors

11:30  Workshop 1

A. Movement Impairments of the Knee– Chris Bertani, DPT

B. Respiratory Issues in Young Athletes– Chris Koutures, MD

C. CrossFit: A Hands-on Approach– Jeremy and Nicole Gordon

12:30 Lunch and Panel – Youth Sports Medicine Dilemmas Moderator: Joel Brenner, MD, MPH; Panelists: C. Koutures, A. Crepeau, J. Almquist, A. Joyce, C. Bertani, K. Lesher (Questions submitted by the audience)

1:25 Workshop 2

A. Utilizing Instrument Assisted Soft Tissue Mobilization– Eric McClung, ATC

B. Managing Oculovestibular Problems in Concussions– Jon Almquist, ATC

C. Advances in Adaptive Equipment for Disabled Athletes– Katrina Lesher, MD

2:25 Anne McKim Memorial Lecture: The Role of the Oculovestibular System in Concussions– Jon Almquist, ATC

2:55 Q & A

3:00 What’s Real? New Treatments in Sports Medicine, The Evidence Behind Them, and The Placebo Effect– David V. Smith, MD

3:30 Q & A

3:35 Youth Sports Culture – Joel Brenner, MD, MPH

3:55 Q & A

4:00 Closing Remarks/Adjourn

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Taping- Prophylactic or Kinesio?

By: Sean Burton MBA, ATC, VATA-L

     As long as there are sports, there will be injuries.  As long as there are injuries, there will be athletes who want to get back out to play as soon as possible.  Thankfully, there are tape jobs that allow athletes to get back out on the playing field.  Kinesio Taping is becoming more popular in the athletic world.  While watching sports on TV, you can see many brightly colored tape jobs and may be wondering what it is all about.  Although Kinesio Tape has been around since 1973, it didn’t really become popular until a few years ago.  The most common form of taping is prophylactic taping using white athletic tape.  Today, we will learn a bit about both types of taping and when we would use each.

Kinesio Tape

Kinesio Tape

Prophylactic ankle taping

Prophylactic Ankle Taping

     Prophylactic athletic taping is used for prevention of injuries by many athletes.  Two of the most common uses for this is taping of ankles and wrists to help prevent sprains and for support after sprains. Prophylactic taping is mainly used for ligament sprains.  After an athlete has an injury, using prophylactic taping can allow them to return to play sooner.  Prophylactic taping limits joint mobility; which is its primary purpose. The athletic tape that is used for this type of taping can only be kept on the skin for a short period of time, so after a practice or game it has to be removed.  Although some people are jumping on the Kinesio Taping bandwagon, prophylactic taping has its place in the athletic world and should not be left behind.

Prophylactic Wrist Taping

Prophylactic Wrist Taping

     The Kinesio Taping technique uses a highly elastic therapeutic tape to provide functional correction and circulatory/lymphatic correction.  Kinesio Tape can increase blood flow and lymphatic drainage to the injured area based off of its application.  Both of these help with decreased healing time which allows athletes to return to play sooner.  Kinesio Tape can be used similarly to the prophylactic taping by providing support to joints and surrounding soft tissue.  Kinesio Tape should be worn 24 hours a day for anywhere from 3-5 days.  This allows for the best results.  Regardless of which type of tape you choose, it is best to consult with your school’s athletic trainer regarding proper taping technique to optimize the effects of the tape.

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Preparing for Pointe Work

By: Erica Walters, DPT

On a previous blog, the guidelines for beginning pointe work were discussed along with risk factors associated with beginning too early.  Several tests can be performed in order to determine if the dancer is ready to begin pointe work once they have met all of the guidelines.

Tests to determine if you’re ready:

Pencil test

Point 1

Dancer points her toes while in long-sit.  Place a pencil on top of ankle joint.  If the pencil lays flat and balanced the dancer has sufficient plantarflexion for pointe.

If the dancer does not have enough plantarflexion, have her perform these stretches:

Point 2     Point 3

Balance tests

  • Dancer must be able to maintain single-leg balance with eyes closed for > 30 seconds without movement of stance foot or touching down opposite foot.  If dancer can maintain single-leg balance for > 30 seconds progress the test.
  • Dancer must be able to maintain single-leg balance while maintaining passé-relevé.  Dancer must maintain neutral pelvis and full relevé for > 5 seconds.

If dancer is unable to maintain single leg balance, have dancer perform multiple single-leg exercises on the floor and on uneven surfaces:

    Grand Battements	      Point 5       Point 6

            grand battements          passé-developpé                       single-leg relevé

Topple test

Point 7

Have dancer perform single pirouette en dehors (outward turn) from 4th position.  Dancer must maintain proper form throughout pirouette without any lateral trunk movements or loss of balance.

If dancer struggles to maintain balance, have her perform:

  • Single leg passé with plié to relevé
  • Pirouette preps: have dancer perform single leg passé with plié to relevé for quarter turns
  • Once dancer masters quarter turns without loss of balance progress to half turns then ¾ turns and then full turns

Double-Leg Lower test

Point 8

Dancer lies on back with both legs flexed to 90°.  The dancer lowers both legs (with knees straight) toward the floor while maintaining a flat back.  If the dancers back starts to arch, measure that angle.  If the angle is < 45° the dancer passes this test.

The dancer can perform several core strengthening exercises to improve results with this test:

Point 9  Point 10  Point 11  Point 12

Airplane test

Point 13

Dancer stands on one leg with the opposite leg in arabesque with a level pelvis.  The dancer performs 5 controlled pliés to touch floor with hands.  The dancer must be able to perform 4 out of 5 pliés without knee valgus or loss of balance.

The dancer can practice airplanes on the floor and on uneven surfaces with and without plies:

     Point 14                   Point 15

      Airplane floor touch with knee straight                                Airplane with plié

Single-leg sauté test

Point 16

Dancer performs 16 consecutive single-leg sautés (jumps) while maintaining neutral pelvis, upright posture, and proper toe-heel landing.  The dancer must be able to perform > 8 sautés correctly.

If the dancer is unable to perform > 8 sautés correctly, have the dancer perform ankle strengthening exercises along with double-leg jumps:

Point 17     Point 18       Point 19

T-Band plantarflexion                  double leg sauté                                        échappés

If the dancer passes all of the above tests with good form, good ankle control, and adequate motion she is ready to begin pointe work.  The dancer should now enroll in either a pre-pointe or beginner pointe class if available.  Dancers grab your pointe shoes and get ready to break them in!

References:

Richardson M, Liederbach M, Sandow E. Functional criteria for assessing pointe-readiness. J Dance Med Sci. 2010; 14(3):82-88.

Lin V. When to go en pointe. Rehabilitation Medicine Associates of Eugene-Springfield P.C. website. http://www.rmaeug.com/whentogoenpointe.html. Accessed March 6, 2014.

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