ACL Injuries in High School Female Athletes

By: Kyle Stafford, DPT, CSCS (Certified Strength & Conditioning Specialist)
SUMMIT Physical Therapy

Statistics
According to the American Academy of Orthopedic Surgeon’s, there are approximately 200,000 annual ACL injuries. Roughly 50% of those result in ACL reconstruction surgery and damage to other structures of the knee joint (ligaments, meniscus, cartilage).

A recent study showed that 1 in 100 high school female athletes will injure their ACL at some point. Roughly 70% of ACL injuries by female athletes are due to non-contact situations involving deceleration, planting, landing, twisting, cutting and movements requiring agility. The primary sports involving this type of stress entail soccer, basketball, football, and skiing.

Down the road, approximatelty 50-60% of these patients will show imaging/radiographic results of early osteoarthritis. Osteoarthritis is a big precursor for having a total knee replacement. You see where this trend is heading…

The neuromuscular system
The neuromuscular system is the interaction between your nervous & muscle systems. Your ACL is one of the ligaments in your knee, of which it contains “proprioceptors”. These are receptors that allow your knee to detect where it is in space, and interact with your nervous system to tell your muscles to stabilize your joint. This is crucial in sports that require agility, cutting, jumping, pivoting, etc… When you undergo surgery or sustain an injury your proprioceptors are diminished and must be re-trained to provide your knee with reactive stability. Notice I said reactive, because many times athletes have sufficient stability in a predictable environment such as practice or a rehab facility. Sports are a series of reactions, plays and events that take place where an individual must react to a unpredictable task at hand.

Body mechanics in running, jumping & landing
The change of direction, whether it be running, cutting/pivoting, jumping, landing, shuffling or any other movement, occurs with every player of every play. These repetitive movements place stress on the knee joint. Learning how to move in all of these movements efficiently is similar to installing the appropriate shocks & brakes on your vehicle. Athletes are larger in stature than any time in history. You would not want to head down a hill in a Ford F-350 with the shocks/brake pads of a Toyota Prius. Ignoring mechanics and trying to “strengthen only” is like heading down the hill in the same F-350 but with a truck bed full of bricks and bigger tires installed. “Use proper mechanics. The No. 1 problem in any specific sport is improper mechanics”, as stated by Dr. James Andrews in his recent STOP(sports trauma overuse program.)

Core/lower extremity strengthening
We have all heard the term “core strength”, but understanding what entails the core is critical. Your hips/glutes, abdominals, lumbar/low back, diaphragm and oblique muscles to name a few, all serve as the central band of stability for spine & extremities. Developing core strength along with mechanics/movement patterns will help the individual move more efficiently and reduce stress on the body. Every human on the planet can benefit from core strength, and athletes must demonstrate this to a whole new level. For basketball players, we aim to develop core strength/stability in conjunction with movement or dynamic postures. Training the body to react to provide stability while moving is absolutely critical for injury prevention.

Rest & specialization
I want to inform you that modern medicine is showing that kids specializing in sports early are at a much higher risk for injury. Different sports utilize different muscle groups and movements. In the present day, kids are playing 1 sport year round without proper rest. Less than 2 months of rest per year can drastically increase your child’s chance of injury. So with that being said, I fully advocate and encourage your daughter to rest after basketball season or whatever sport they play. That does not mean or equal doing nothing. It does not mean that it has to be 2 months in a row of rest, as it can be 1-2 weeks here and there. We hate seeing adolescent patients with injuries at such a young age, when the simple solution to help is to play another sport or take a break at times.

Community change
The purpose of this document is to help inform you as parents, and communicate the aim I have to change our community sports programs to help our young athletes. Injury prevention is becoming very significant in large cities and advanced areas of sports training/medicine. It is my intent to help establish this task of helping educate parents, coaches, teams and youth organizations of the importance of injury prevention for the future leaders of our community. If you have any questions, concerns or general comments, please feel free to contact me at SUMMIT Physical Therapy.

Contact Kyle Stafford, DPT at 918.342.3800.

Tennis Elbow. What is it?

Tennis Elbow (Lateral Epicondylitis)

By SUMMIT’s Hand Therapists: Kay Neldon, OTR/L, CHT & Colleen Caton, OTR/L

“I went to the doctor because my arm hurts and the doctor says I have Tennis Elbow. I don’t play tennis, so why does the doctor say I have Tennis Elbow?”

• Tennis Elbow, or Lateral Epicondylitis, is a condition where there is an injury or overuse to one or more of the muscles that straighten your wrist and fingers. Several important muscles have their beginning around the bony area at the outside edge of your elbow and they can be injured or worn out with forceful or repetitive use. Lateral Epicondylitis got its nickname “Tennis Elbow” because many tennis players overuse these muscles with high force and repetition to play tennis. More often, however, the person who is suffering from Lateral Epicondylitis may not play tennis but may be using the arm strenuously in handling tools, homemaking, yard work, extended keyboard use, lifting weight, or participating in sports.

• Signs and Symptoms of Tennis Elbow (Lateral Epicondylitis)
  The stiffness, dull ache, or sharp pain may be sudden or it may increase gradually over a period of time. The discomfort is usually located around the top outer edge of the smaller bony spot of your elbow and may extend down into the muscles on the top side of your forearm. Numbness or tingling is not usually a symptom of Lateral Epicondylitis and should be discussed with your physician.

• Causes of tennis elbow:
  Lateral Epicondylitis is most often provoked by doing activities that require repetitive and/ or stressful hand, wrist, or forearm movements/ positions. Some examples might be:
  -Gripping forcefully and pushing/pulling hand tools
  -Digging in the garden
  -Chopping up large amounts of food
  -Lifting heavy or light objects repetitively (or sometimes just once) with palm-side down
  -Using computer mouse for a long period of time without taking a break

  

• “How do I get rid of Tennis Elbow?”
  Early management might include avoiding the activities that provoke the discomfort, resting the arm, applying cold to the affected area, gentle stretches, and anti-inflammatory medications. After the symptoms improve, continuing treatment might include gentle massage for increased blood flow and gentle stretching to muscles. If symptoms do not go away, you may need to consult a physician. A Tennis Elbow strap may be useful in some cases, but correct placement and adjustment of the strap is extremely important; a badly placed strap may provoke additional problems and make the situation worse.

• At Summit Physical Therapy and Rehab, therapy is provided by either a Physical Therapist or an Occupational Therapist. Treatment may include pre-fabricated or custom wrist orthoses (splints), soft tissue mobilization, nerve gliding, specific and graded stretching, prescribed muscle strengthening, modalities to improve comfort and promote tissue healing, and education to improve your function and reduce your risk of re-injury.

Please feel free to leave a comment or question- our SUMMIT therapists are here to help and educate you!

Core Series: Part III

Core Series: Part III
By: Caitlyn Caldwell, DPT – SUMMIT Claremore Clinic

In the first two parts of our Core Series, we discussed the basics of the core, its revelance in everyday activities and importance in the treatment of low back pain or during pregnancy. Cathey gave us a starting point for working on our core with the TA activation.  So where do we go from there? In Part 3, we will take core training beyond the TA and basic daily activities to higher level training and the athlete.

• The Kinetic Chain
  Our body is a complex machine with many different parts. Each and every one of those parts needs to work effectively for our body to function in the correct and proper manner.  Our arms and legs are made up of a series of joints, and movement at one joint affects movement at the joint above and below. This series of joints is called the kinetic chain. Movement at the ankle will affect the knee, the hip and ultimately– the core!  A weakness at any part of the chain can place stress on another part of the chain. Over time or with greater level of force this can cause injury.
• The Core and Athletes
  Identifying and eliminating weakness in the kinetic chain is important with any patient– but is especially crucial for athletes who will be returning to high levels of function.  Research has shown that core training has an important role in the rehab of athletes with lateral ankle sprains, knee injuries, hamstring strains, as well as throwing athletes.  Take a baseball pitcher for example– he generates momentum all the way from his feet on the ground to releasing the ball from his hand. Researchers have found that pitchers with UCL tears (candidates for Tommy John’s surgery) have decreased single leg stance balance and core control. This is a perfect example of how weakness in one part of the kinetic chain results in overuse and injury in another location.  Studies have also shown that implementing a core program can increase control at the knee and ankle and prevent re-injury for patient’s with ankle sprains, hamstring strains, patellofemoral pain, and ACL tears.
• Core Training Progression
  So how does core training differ for athletes? Well– all core training is based upon the same position and some principles we have already discussed. Here are 3 principles of training:                                                                                            Static –> Dynamic, Single Plane–> Multiple Planes, and Stable –> Unstable
  Core training starts with static stabilization– the TA maneuver. We start with stabilization in one plane in a stable enviroment– a good example is TA activation when lying on your back and marching your legs up and down.  From there, we can add in movement in multiple planes and take the training to less stable positions: sitting, standing, single leg stance, or on top of a ball!    After you have trained your core to stabilize in all planes of movement, it is time to take training in a dynamic direction. This means adding actual movement at the core instead of just stabilizing.   Your core needs to be able to stabilize your spine and pelvis, but also needs to be able to help your body move.
• Sport Specific Training
  The final principle that we need to employ when training and rehabilitating athletes is sport specific training.  I can’t tell you how many times I heard this growing up during many a softball practice– “You play like you practice”.  This is also true during rehab and core training. It is important to train the body doing the specific functional activities the athlete performs in his or her sport.   Don’t get me wrong, for an athlete is important to have a strong stable core in all directions. The athlete is constantly reacting quickly to conditions in his or her sport and will need to be strong and powerful in all directions.  However, it is important to specifically train in the way the athlete plays. Let’s take our example of baseball pitchers– core stability and dynamic strength in single leg stance positions and trunk rotation would be especially important to train for this athlete.
• This concludes Summit’s 3-part series on “The Core”!  We hope you have been able to learn a little about how important the core is in daily function whether you are a competitive athlete or enjoying the relaxing retired life.  Please feel free to leave a comment or question– our SUMMIT PTs are here to help!

Core Series: Part II

Core Series: Part II
By: Cathey Bowling, DPT – SUMMIT Claremore Clinic

If all of this core discussion so far has you thinking you need to start a core program today, then you are not alone. The majority of people could use a “tune up.”

• Your core is the center to almost everything you do throughout your day. Whether you are sitting at work, playing baseball, seven months pregnant, running a marathon, or emptying the dishwasher, your core is functioning. If there is weakness, asymmetry, or imbalance, then abnormal patterns will occur. Core strength can work to reduce low back pain, improve postural imbalances, and improve athletic performance.
• A healthy back makes a happy person. Low back pain can be debilitating and can affect 4 out of 5 Americans. It is also the second most common reason patients seek medical attention. Low back pain can occur due to strain, injury, overuse, repetitive movements such as bending, twisting, and lifting, or even too much sitting at a desk. Chronic low back pain is often associated with core weakness/instability. Stabilization exercise is considered a major component of treatment and effective in reducing long term pain, along with restoring overall daily function.
• Pregnancy is the ultimate strain on the body. 50-70% of women who are pregnant experience low back pain for many reasons including weight gain, postural changes, hormonal changes, and change of the body’s center of gravity. This can increase the amount of force the muscles must generate everyday causing women to have postural changes. Exercise can improve muscle strength/endurance, especially in the hips, back and abdomen. Improving these areas can prepare the body for the physically demanding event of delivering a baby. Finally, therapeutic exercise during pregnancy can assist the recovery after the delivery. Physical therapy can intervene to reduce strain, creating a more positive experience.
• Where do I start?… It is first important to learn to isolate your core muscles in your treatment. The transversus abdominus “TA” creates a “corset-like” structure as it is contracted. A common therapy technique in individuals with low back pain/weakness is to provide neuromuscular education how to first fire the TA. Your deep abdominal muscle can be contracted by bringing the belly button up and in toward the spine, or drawing in the abdominals. Normal breathing is important to maintain throughout the muscle contraction. It is important to maintain a correct abdominal contraction when progressing this exercise by adding arm and leg exercises. 

• Everyday activities. Since we do not perform all of our daily activities lying on our backs, it is important to understand how to incorporate core strengthening in more functional ways. Turning to look behind you while driving, bending over to put on your socks and shoes, bathing, or gardening… these are just a few routine activities, we perform every day, not in neutral positions, that rely on your core. Although your core may go unnoticed, these activities can become painful, or even difficult if your core didn’t exist. Part III will further explain how to strengthen in multi planes and dynamically.
• Part 3… Many injuries, including sports related, are caused from a weak core. Doing a few simple exercises in order to further strengthen the core can keep the entire body working in symmetry. Further core discussion to be posted, focusing on the athletic population!

CORE Series: Part I

CORE Series: Part 1
By: Kyle Stafford, DPT -SUMMIT Claremore Clinic

• What is meant by the term “core”? I can speak for most of us in that we have all heard the term “core”. It could be from that late night infomercial that is going to change your life to the 3 minute DVD workout plan that will get you ripped with some abs. Regardless, most of us have had this term hit our ears at some point. What many may not know is that your core is far from just your abdominals that look good at the beach. It is a working unit ranging from your pelvic floor muscles to the diaphragm for breathing, and many muscle groups in between.
•  Core is critical… As mentioned above, your core entails many parts all functioning as a unit to provide your spine with stability & strength for a low risk of injury and optimal daily function. Think of it like a box that entails your glutes/hip, low back muscles, diaphragm, abdominal muscles, & pelvic floor… Just to keep it simple. In all humans there are tendencies, weaknesses, & compensations we use throughout the everyday routine. The key is finding out that compensation pattern or hole(s) in our core, & correcting them for improved human performance.
• Human performance… performance is not just for the elite athlete or those in sports. Human performance is for anyone needing to move to function in their everyday life. From the construction worker to the office secretary, we all have different movements our core needs to provide stability in order for us to function properly. Sitting at a desk for 8-9 hours a desk is a completely different stress then a person who works in a lumber yard. One is more of a static or stationary stress held for a long period of time. The other is multiple short bursts of heavy stresse(s) & larger movements throughout the day.
• Stability vs Strength… Stabilization is not just tightening your abs. It is a chain reaction of muscle firing/activation that starts with your breathing or your diaphragm. That is why controlling your breathing can really enhance your core’s ability to function properly.  Strength is the ability to use the core to move in spite of resistance. Strength must be trained after stability, otherwise you are just swimming upstream. That would be like driving a vehicle with half of the tires nuts/bolts screwed in properly. It is not a matter of time if you will have problems down the road, but when…  You can hide it for a while, but eventually the instability will be exposed.
•  So what does this mean?… I hate to break it to you, but if you are alive & breathing you have some sort of hole/weakness/instability in your core. The good news is that daily training, awareness, & correction can take your body a long ways if built into the daily routine.  Physical therapists are the human movement specialists and establishing a solid exercise plan for your core can be a discussion that prolongs your health.

•  Parts 2 and 3… stay tuned for the parts 2 and 3 for a look at the core’s function for the athletic and non-athletic population. Pictures for some basic exercises/rationale will be posted!!!

I had knee replacement surgery… Now What?

By: Kyle Stafford, DPT

• You are not alone. There are over 600,000 knee replacement surgeries performed yearly & growing in the United States. In fact it is projected by 2030, over 3 million will have this procedure done. It’s growing, and not going away. Look around in the clinic & at any point, I bet you there will be others going through the same aches & pains. Talk to them, complain together, unite. Just not against the therapy staff please…
•  It’s a process… By the time you reach our clinic or what is known as the outpatient phase, you will know that we (PT’s) want you to walk. (even on the day of surgery…ouch). It will take time to get your walking or “gait” pattern normalized, but with practice you will improve.
• Motion, motion, motion. You can strengthen all the muscles you want, but it’s spinning your wheels until you have functional motion. We will focus on the primary movements of your knee, bending/ “flexion” & straightening/“extension”. Most think the bending is more important, but actually your straightening is more critical. This allows you to walk without a limp, thus keeping your joints aligned for walking/mobility. For a visual think of an axle on your vehicle… Without your wheels rotating on it properly, your car will not drive smoothly.
• Home exercise program= adult homework… And you thought you escaped homework years ago… Nope, it’s up to you to do your program at home as instructed by your PT. If you don’t understand it, just ask your therapist to clarify. You’re in the clinic 3-4 hours at most a week, leaving you at home roughly oh say… 164-165 hours. I know you will leave home to go do something, I’m not that harsh. But you do the math….
• You will have ups & downs… With time, your overall pain, function, stiffness, & general comfort will improve. That doesn’t go without being said you will have good days, & not so good days. See the light at the end of the tunnel, & keep perspective on how far you’ve come.

For more information visit our website: www.ptsummit.com

What is a Women’s Health Therapist?

 Cathey Bowling, DPT -Women’s Health Therapist at Claremore Clinic

 

• I love getting questions on women’s health therapy. It allows me to educate women of all ages on how I can help. Here are several questions/statements I hear on a daily basis: “Physical therapists can treat women? Are you like a gynecologist? Do you perform internal exams? Do you have private rooms? What would a treatment consist of? I thought incontinence was part of delivering babies and aging.”
•  If you were to ask me six years ago during physical therapy school if I would treat women’s health patients, the answer would have been no. When I first learned about women’s health, I was shocked. I had no clue PTs could treat these diagnoses, yet alone, were trained to perform internal exams and treatments. Six years later, here I am, promoting women’s health therapy. I have worked with women’s health PTs and have seen the lives changed through treatments. This is a whole new realm of therapy that is incredibly rewarding as a physical therapist.
•  So to answer your questions- yes, there are physical therapists trained to treat women through conservative interventions. Types of common diagnoses include urinary leakage, pelvic pain (pain during intercourse), and pregnancy/post partum.
•  No, we are not similar to a gynecologist. We are musculoskeletal system experts that focus on diagnoses associated with the pelvis. We are trained to assess the pelvic floor internally. We are looking for muscle weakness, abnormal tone, asymmetry, or any other finding associated with symptoms.
•  Yes, most definitely, we have private treatment rooms. We primarily focus on assessing the pelvic floor and the individual as a whole in private treatment rooms. The treatment is gradually progressed to performing functional and daily activities, symptom free.
•  Carefully pay attention to this last statement: NO, INCONTINENCE IS NOT NORMAL, IT IS COMMON. It does not matter how old you are, or how many children you have delivered. Not one woman should have to think this is part of her life and have to adapt to the changes. Weak pelvic floor muscles are a big part of incontinence. There is more to women’s health than “kegels.” Learning how to properly engage your pelvic floor muscles, in addition to core exercises, can lead to successful changes in your life.

7 things you didn’t know about Posture….

7 things you didn’t know about Posture….
By: Kyle Stafford, DPT at Claremore Clinic

• There is no “bad posture”. We have all had a parent/grandparent say “stand tall, or straighten up, or stop slouching.”  Posture is a word that when said, 99.9% of people straighten up and only hold it for 1-2 min.  Then they go back to slouching and looking at their i-Phone. It’s never permanent, nor concrete.

•  Posture is continuous… Unless you are a guard at Buckingham Palace (which is impressive), you will be constantly moving & changing positions all day. While some move more than others, we are all getting around to some degree.

• We (PT’s) are assessing you from the moment we shake hands/meet. You may not realize it, but a physical therapist or “PT” is analyzing your posture from the waiting room where we meet you. We study posture so much, it’s ingrained in a PT’s brain as much as anything we learn in school. Talk to any PT and they will tell you they have caught themselves analyzing their family members. When we ask you to stand comfortably, just relax we already have a good idea how you operate

• Routine is the enemy…Arrive to work… fill up coffee… sit down… lunch… go home… rinse repeat. For those that do more laborious work, it might be the same but with standing or lifting. Throw some variability into your work day. Take a walk, stretch, do some push-ups or squats… (with your door closed of course).

• Don’t get drastic… We have all seen those people that make a 360 flip & completely change everything. It lasts a couple weeks or a month, and things return to the usual. The smallest of daily changes can make a HUGE difference. Less than 5-10 minutes a day, can go light years in how you feel

• Use a reminder… It can be anything from setting an alarm on your phone to get up, to a sign near your computer screen. We all can get sucked into the “work zone” and forget to change it up.

• Everybody is different… While PT’s study a standard posture in school, the reality is that every patient is an individual. What works for a 15 year old student athlete, might not work for the 52 year old grandmother working as a nurse. Find a series of stretches or exercises that give you relief or consult with a PT for a posture analysis at your local clinic.