Posts tagged injury
Should I Use R.I.C.E. Or Call The P.O.L.I.C.E. After An Injury?
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The acronym R.I.C.E. (rest, ice, compression, and elevation) has been utilized for decades in the clinical and self management of acute injuries. Clinicians have updated RICE to PRICE adding in protection of the injured area, but this acronym needs further updating. In general, the 4 of the components of this self treatment approach have merit for injuries, but rest is being challenged in injury management. Immediate rest, 2-3 days, is required after a ligament, tendon, or muscle injury to facilitate the healing process, but newer research has highlighted the importance of exercise to facilitate an optimal recovery

A clinical commentary in the British Journal of Sports Medicine advocates for a new acronym in acute injury management, POLICE, which includes progressive optimal loading ice compression and elevation (Bleakley et al. 2011). Physical therapists are now utilizing progressive, optimal loading strategies due to research documenting accelerated recovery compared to an immobilization approach. For example, both ankle sprains and tendon injuries respond best to early mobility vs. prolonged rest. Progressive loading of injured tissues creates a beneficial cascade of events in the body through a process called mechanotransduction. Early exercise creates cellular changes in injured tissues allowing them to remodel into stronger, healthier tissues.

Authors state the difficulty in recovering from injury is finding the balance between rest and exercise. Many factors including, but not limited to, the patient, injured tissue, time since injury, severity and irritability of the injury play important roles in this decision making. In many cases, moving from rest into incremental exercise accelerates the recovery process and optimizes a patient’s return to activity. Patient’s are encouraged to work with their local Physical Therapist to determine which progressive, optimal loading interventions are best for their specific injury.

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Pre Season Y Balance Scores Did Not Accurately Predict Future Injury
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Pre-participation movement screens have gained popularity among sports teams and health professionals over the past decade. Their aim is to determine the likelihood of an individual sustaining a future injury by testing them through a battery of movements. Clinicians may utilize a composite of individual tests to identify risk for a specific injury (ex. ACL tear) or use a commercially available stand alone test designed to screen for all injuries (ex. FMS or Y Balance). One of the determining factors in these stand alone tests is examining symmetry of movement patterns, comparing one side of the body to the other or to an established “norm” of movement. These tests have been under scrutiny as recent research has challenged the validity of these tests suggesting these tests may not be able to accurately identify individuals at risk for future injury.

The Y- Balance Test is a common pre-participation movement screen determining lower extremity injury. Individuals are asked to move their leg in 3 planes while in single leg stance on the opposite leg. Previous research has shown a difference in reach distance from side to side may indicate a risk of future injury. A recent article out of the Sports Journal looked at a homogeneous group of 169 male collegiate basketball players over 2 seasons (Brumitt et al. 2019). During the study, all athletes were given a pre season Y balance test and then followed through the seasons. The authors found no association between preseason Y-Balance scores and future time-loss from their sport or lower quadrant non contact injury during the upcoming seasons. These results add to the growing evidence questioning the validity of these stand alone movement screens. Injury prevention for specific injuries such as ACL tears and composite testing of individual tests may provide better risk reduction test batteries.

Eating for Recovery After Injury
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Acute muscle strains and sprains remain one of the most common injuries we encounter at our Boulder Physical Therapy clinic.  In a previous blog post we summarized the findings of new research studies showing how early Physical Therapy accelerates a patient's recovery after these injuries.  In addition, to exercise and sleep, nutrition also plays an important role in recovery.  A healthy, balanced diet is critical in post operative or injured patient.  

Collagen is a key structural protein in many of our body tissues including blood vessels, muscles, ligaments, and tendons.  It remains an essential natural resource utilized by our body during the healing process.  Many factors have been shown to reduce collagen production including smoking, simple sugars (candy, soda), and UV light.  These factors can damage proteins necessary for collagen formation and in turn healing.  

Conversely, collagen production is increased with exercise and may be augmented through nutrition and diet.  Nutritionists recommend a diet sufficient in protein due to its' high content of amino acids especially leucine.  Leucine has been shown to both reduce the breakdown of muscle and enhance muscle synthesis in animal studies.  Key sources of leucine include chicken, cheese, eggs, whey and soy protein powder.  In addition to protein intake, colorful fruits and vegetables also play a key role in recovery due to the abundance of anti oxidents found in berries and vegetables.  The vitamins found in this food group facilitate muscle and soft tissue recovery.

There are numerous supplements claiming to accelerate recovery, but like most supplements many fail to demonstrate statistical significance above a placebo.  Small studies have found an accelerated recovery from injury when collagen and Vitamin C are combined in supplementation, but more research is needed before widespread use.  Outside of supplementation, gelatin and bone broths are found to have high contents of collagen. 

Patients are advised to follow up with a nutritionist and their medical doctor before any significant change in diet or beginning any nutritional supplement.

 

Prevalence of Injury and Illnesses During Ultra-marathon Running

Over the last 5-10 years ultra marathon running has grown in popularity with pavement and trail races popping up throughout the West.  Ultra trail running events are described as distances greater than a marathon, in mountainous terrain, and involving elevation changes.  Authors report a 5200% increase in these events between 1978 and 2008 (Hoffman et al. 2010).  In 2008 alone over 2000 athletes finished 161 km races and many of these athletes finished >3 in a year (Hoffman et al. 2010).  In Colorado, the annual Leadville 100 remains a popular event for Coloradans and American athletes alike.   Due to its' recent popularity not much is known regarding the illnesses and injuries facing these ultra athletes.  

A recent study in the International Journal of Sports Medicine sought to identify the injuries and illnesses among athletes completing a 65 km race involving a total elevation change of 4000 meters (Vernillo et al. 2016).  204 of 234 runners completed the race and of the 204, 85 agreed to take part in the study.  At the finish line athletes were interviewed for injuries and illnesses sustained during the race.  Each illness or injury was considered either major (unable to compete) or minor (able to compete but with limitations).  

A total of 132 injuries and illnesses were documented by the authors with the majority of athletes complaining of > 2 areas of concern.  1 in 2 of these were due to a medical illness including hypothermia, heat illness, dehydration, fatigue, and cramping while 1 in 3 were due to musculoskeletal injury.  The majority of these injuries were documented in the lower extremity including heel pain, knee pain, leg pain, ankle sprains, and knee sprain/strains.  

Thankfully the majority of these injuries and illnesses were minor in nature.  Unfortunately did not capture the major injuries sustained by individuals who were not able to complete the race.  This data will help to develop further evidence on how best to prevent these injuries in the future. 

Marathon Running Injuries

Marathon running is a challenging event requiring substantial amounts of endurance and strength training for optimal performance and injury prevention.  The race distance of 26.2 miles requires high mileage training, often >75-100 miles per week at the elite level, placing the athlete at risk of a running related injury (Saragiotto et al. 2014).  In addition to training volume, athletes with training errors (too much volume too quickly), muscle imbalances, and gait deviations place themselves at greater risk of future injury and lost performance.    

A recent study in the International Journal of Sports Physical Therapy (Carvalho et al. 2016) sought to document the frequency, severity, and location of running related injuries among elite marathoners.  The athletes all met the following criteria: sub 2:35 and 3:00 marathon for men and women, respectively, as well as, enrollment in the "elite" racing category.  The 199 enrolled athletes were asked to assess their prevalence of running injuries over the previous 12 months.  Even at the elite level, 3 out of 4 runners reported a running related injury most commonly experienced in the leg (19%), knee (15%), and achilles (15%).  Among the injured runners close to 40% described at least two different injuries over the last year.  

Athletes preparing for an upcoming marathon are encouraged to work with a local Physical Therapist to reduce modifiable risk factors for running related injuries. 

Age and Running Biomechanics

Last year an estimated 30 million people ran at least 50 days for exercise and health benefits (Running USA).    The fastest growing segment of the running community includes older adults who gain impressive cardiovascular, muscle, bone, and mental health benefits compared to their sedentary peers.   In addition, contrary to popular but incorrect old wives tales about running and arthritis these active older adults experience less pain than their sedentary peers (Bruce et al. 2005).  Our previous posts on the older adult running community detailed specific cardiovascular and gait changes which take place due to aging.   These losses in flexibility, strength and balance increase the already high rates of overuse injuries among runners.  A better understanding of running gait changes through the life cycle may help us prevent future injuries among this population of runners. 

A recent study in the Journal Medicine and Science in Sports and Exercise studied the running gaits of 110 experienced runners between the ages of 18-60  (DeVita et al. 2016).  Consistent with the previous literature the authors noted each age group older than 18 demonstrated a progressive loss of running velocity.  These changes were largely due to decreased stride length vs. stride frequency compared to the younger participants.  Further, older runners ran with decreased ankle power which translated into decreased horizontal and vertical forces at push off.  The presence of ankle changes with age, but the absence of hip or knee changes, indicates the importance of the ankle for both energy absorption and propulsion during running.