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Thursday, 30 January 2014

Working with High Performance Minor Athletes - Part 2

Please check out part one of Working with High Performance Minor Athletes

It does not matter if the athletes are male or females, hormones are going to effect your interactions with them each and every day.  They effect their moods, their body, how they recover from injuries both physically and emotionally, how they react to their teammates, training partners and coaches.  I will break the myth right now, it is not only girls who cry and not only boys who want to hit things.  If you are dealing with young elementary aged children, they are still learning how to deal with disappointment, loss and success.  As the athletes grow older they are starting to discover who they are, and are having more expectations put on them.  Their role in sport can start to define them, if this role is suddenly changed, they may find it hard to cope.  You typically become their ally or enemy. If this role change occurs due to an injury, they see you as an enemy because you are what is holding them back.  If it is a coaching choice that changes their role you become the ally, they see you as someone to turn to who understands what is going on.  Typically at this age their relationships with their parents are changing and they may not feel they can go to them, you become their constant who they can trust.  It is this trust that will help you get through the enemy stage.  If you have built the trust when the time comes for you to remove them from play you remain their ally.  When removing an athlete from activity be prepared for anything.  As I said earlier girls hit and boys cry, you are messing with their identity in their minds, and they each have their own way of showing it.

At times you feel like a glorified babysitter.  You are the first one there, the last to leave, you pick up after the athletes, find out who's parents are always late, and do the room checks because the coaches are having strategy sessions.  Due to all this you become the gate keeper, you learn which athletes like to toe the line, which ones like to step over the edge a little and the ones who will ask you later "what line?"  Many coaches like to think they have their finger on the pulse of their athletes, but truly it is the Athletic Therapist.  We see all, here all and usually end up cleaning up the mess.  With minor aged athletes you try to help them keep the messes to a minimum, you become the teacher again in guiding them as to right and wrong.  You would be amazed at what these young minds can come up with to do on road trips.

For everyone involved in minor sports at a high level, we all must remember that these athletes are still kids.  Even as an Athletic Therapist it is hard.  We are trying to give them the structure and guidance they need to succeed.  Nutrition plans, treatment schedules, and expectations of how to act in the clinic or treatment room.  Let the kids be kids.  They will try to eat poutine before a game, use your athletic tape for their sticks and you will go through about ten sets of nail clippers each season.  It all becomes worth it though when they do something to show they have been listening, or when the truly show they care by carrying the treatment table and medical kit.  No matter the age of your athletes it is important to treat them all with respect and have their long term health and wellness in mind, because at times you will be the only one worrying about that.

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Monday, 27 January 2014

Working with High Performance Minor Athletes Part 1

Continuing with our what is an Athletic Therapist series we will discuss the different settings that we can work in.  This week will be focusing on dealing with high performance minor athletes.  Not all Athletic Therapists work with professional teams, in clinics or in high schools.  Some of us have choose to or worked our way up by working amateur sport with young athletes.  Depending on the sport we have worked with kids as young as five all the way up to those at eighteen.  It may seem simple and cut and dry as you are not dealing with high expectations of the professional spot light,  however the pressure and demands that occur in minor sports is high.

Sometimes I wished I was dealing with adults, it would make life so much easier.  When dealing with players under the age of eighteen so many legal issues come into play.  You become their guardian while on road trips, they can not make their own medical decisions, you at times are their mother, best friend, prison guard and teacher.  You are dealing with hormone changes and mood swings, school schedules, and the pressure of playing high level sports.

One of the major things I found when dealing with minor athletes who were competing at high levels was the amount of time expected of them to participate in sport or sport related activities.  Depending on the sport your athletes are going anywhere from five to seven days a week, with training, practice, film sessions, mental training, oh yeah and school.  At times we treat these athletes who are as young as eight like professionals.  I find it funny that they keep talking about the student athletes in post secondary, every athlete under the age of eighteen is a student athlete, and I will tell you not many junior high schools and high schools are as accommodating as post secondary ones for their athletes.  The number of times I have supervised homework sessions, relearned chemistry and math is beyond me.  I do know I do not want to go back to high school.

You help the athletes with their homework but also educate them on aspects of being an athlete, such as proper nutrition, physical training and injury management.  You become not only a teacher to the athletes but to the parents, coaches, officials and administrators.  Many of these people may be new to the high performance levels and needs that these young bodies require to perform at their best.  You learn how to explain things in about four to five different ways.  Athletes and coaches want to know how to achieve success, but need it explained a bit differently.  Parents generally want what is best for their child, and if they have more than one child you soon become knowledgeable about all of them.  Officials be quite young and just starting out or veterans to the sport who may not be up to date on the newest information on health and injury management.  I have found the best way to educate administrators is to put it in dollars and cents, and liability.  They need to worry about the sum of the whole not just the individual parts, you need to be the one who bridges that gap for them.  

When dealing with injuries and medical issues the most important thing that I always had to remember is that you are making the decision not about how does the injury effect their sport life, but their overall life.  This should be how we treat all athletes but unfortunately it is not.  A fourteen year old has so much life ahead of him and even the smallest decision you make can effect how that life will be.  Consultation with parents is always a must, and their decision is the one that counts on what treatment occurs.  You can recommend what you want, but they can say yes or no to it.  When travelling or if the parents are not present you get to make these decisions but you must do so in the best interest of the athlete.

When starting this topic I knew there was lots to explain, but did not realize how much.  Please check back on Thursday for Part 2 of Working with High Performance Minor Athletes.

Also please check out our website at and follow us on Twitter @EliteInjuryMgmt

Thursday, 23 January 2014

Exercise - What is the Perfect One?

I would like to thank Freakonomics for the inspiration for this article and for Dr. David Geier for introducing me to the Three I's.

For many the desire to improve their health via exercise can be a long, tiresome journey.  One of the reasons is the need to try and find the perfect exercise.  Walk into any gym and you will see line ups for treadmills, ellipticals and bikes, yet not everyone is seeing the same results.

Intensity High intensity work outs are all the rage right now and for good reason.  By increasing the intensity of each individual work out you can decrease the time needed to work out and lets face it the majority of us do not have the time or desire to spend hours of each day in the gym.  A good example of intensity training would be to run for a minute as hard as you can, then rest (key here is active) for a minute.  You complete more work in 15 minutes than you would in double that time by doing continual exercise.

Indvidualized We all move in our own way.  Not everyone is a runner or a swimmer.  Some people have the ability to move gracefully in dance or yoga, were others feel more comfortable hitting a heavy bag.  Due to injury, physiology, anatomy or access to equipment can effect how well an activity works for you.  High intensity training works great for those who do not have access to much more than their running shoes and a pair of shorts.  Exercises such as high knees, bear crawls and jumping jacks can all be done in your living room.  Even those who enjoy running can employ the principals of intensity.  For some traditional exercises such as running, swimming and biking work well for them and produce ideal fitness gains.

I Like to Do It The best exercise for anybody is the one they will do.  If you don't like to run, don't.  Sink like a rock, don't enter the pool.  I quite enjoy Zumba, while my husband has recently discovered DDP Yoga.  Within a 30 minute Zumba session I work more muscles, burn more calories  than I do in a 30 minute jog.

I am adding Inspire even if you love the exercise if it does not inspire you to get off the coach, push your chair away from your desk then it still won't do you any good.  I love swimming but I have no desire to find a babysitter just to go workout for an hour, plus it's hard to get inspired to go into a cold pool during our Alberta winters.  A good test as to whether an activity is inspiring would be this.  If you see someone doing it, and you want to join, I suggest you do.

Not everyone has to start competing in triathlons once they start their journey to better health like TriFattyTri but you may enjoy it.  If you are starting your own journey to better health and incorporating exercise follow the Three I's, remembering that the most important is do you like it.

Please visit our website at www.eliteinjury.con and follow us on Twitter @EliteInjuryMgmt

Monday, 20 January 2014

The Parent Perspective - Having an Athletic Therapist Child

So I asked my mom what its like to have an Athletic Therapist as a daughter, her response "don't understand what you are talking about half the time".  It is also important to note that she was the first person to say I was sadistic.  Apparently getting joy from healing people is wrong, her theory is I enjoy the pain it sometimes takes for the healing to occur.  I will admit I do enjoy doing trigger point therapy and friction massage is great.

I keep prying for her to explain more and this is what I got, "I still don't understand everything that you do".  Okay, apparently I need to do some more work. I have been a Certified Athletic Therapist since 2005 and a member of CATA since 2002.  So 11 years of working towards becoming an Athletic Therapist not including my first few years of university.  This unfortunately seems to be the never ending battle we as Athletic Therapists face.  Our parents don't even understand what we do.

The one thing my mom does enjoy, is that when they do have something wrong I always have suggestions as to ways to get better.  Recently she has been suffering from shoulder bursitis which was greatly affecting her day to day life.  It got to the point where she had trouble lifting her arm, sleeping and her golf game.  As much as she doesn't enjoy the hands on therapy I referred her to a massage therapist and gave her some exercises.  She hasn't tried golf in the last few months, but is able to pick up her grandchildren and gets a massage once a month.  I recently pointed out to someone who couldn't believe that I had done a similar treatment on my mom as I had on them, if I can't or won't fix my family, then whats the point.

I do know that my parents always worry about me career wise.  My dad wasn't so sure he was okay with his daughter working in male sports.  He wasn't comfortable with me being in or around the locker rooms.  My mom worries about the hours, it doesn't matter clinical or field. We work stupid hours.  A colleague who works at a post secondary college recently finished a 13 hour day on a Monday.  Think of what her Friday and Saturday are like with games.  I know my mom didn't like me leaving the rink late at night, but I did get a car starter because of that.

 No matter what happens I know that my parents have my back.  I need to do some more work on getting them to understand what I do.  I expanded my dads understanding by doing some acupressure and trigger point therapy and was able to relieve some of the pain he was experiencing.  So if you are a parent whose child is thinking of going into the field of Athletic Therapy, please encourage them.  They will endure long hours and will constantly be explaining what they do, but they are doing it because they want to help others.

Thursday, 16 January 2014

So You Made a Resolution

How many of us have made to lose weight by exercising more.  A great way to better yourself and improve your health.  We are half way through January and are starting to reach the point where people are faltering with that resolution.

One of the keys to maintaining a lifestyle change such as working out is to ease into it.  Not only will it easier to have this change be a lasting one, it will be more beneficial to the body.  When you push yourself too fast to soon you put yourself at risk of injury and not maintaining your exercise program which can lead to fluctuating weight.  We are going to focus on the injuries that can occur by doing to much to soon.

There is an increased risk of musculoskeletal injury when taking on a new exercise program to quickly.  Moderation is a key when starting out or changing your exercise program.  The exertion that you are putting on your body is more than it is used to which can lead to injury.  Typical injuries that you may experience when starting out with an exercise program are muscle soreness, muscle strains and depending on your choice of exercise you may see ligament sprains.

Muscle soreness is typical with physical exercise and typically is called DOMS - delayed onset muscle soreness.  DOMS is normal with workouts, and occurs one to two days after exercise.  If the pain is severe or lasts for longer than two days, you have progressed from normal muscle soreness to muscle damage.  If the pain is so severe that you our unable to complete daily tasks such as walking or lasts longer than the normal two days, you need to make a change to your program.  This also applies to any time you make a change to your work out.  For treatment of DOMS the best way to reduce pain is to continue with moderate exercise.  Stretching, cryotherapy and massage therapy have not shown to be beneficial in the reduction of pain from DOMS.  One of the best ways to deal with DOMS is to alternate your work out, by giving the muscle groups a day or two of rest before training them again, you allow the body to heal/repair from the prior work out.

Muscle strains occur when the muscle is taken beyond its normal capacity be it load capacity or range of motion.  These typically occur when using too much weight or performing a move that requires flexibility that you have not gained.  If you have taken up strength training, yoga or classes such as Zumba, you may be more prone to a muscle strain if you do not pay attention to your body.  Slow and easy is the best rule of thumb when starting a strength program. When doing exercises that involve flexibility or doing a movement that goes beyond your norm, pain is your guide.  If the movement hurts, stop.  Find a way to modify the movement, but continue to work on building towards completing the movement properly.

A ligament sprain can occur during weight lifting, running, or during activities such as Zumba, dance, soccer or even yoga.  You typically will not see them if you are cycling, running on a treadmill, rowing or using an elliptical machine.

As part of a complete exercise program, you need to have a flexibility and propioception portion.  A full body stretching program will help alleviate any muscle imbalances caused by improper posture.  Propioception is knowing where you body is in space.  By working on balance and proper positioning you reduce the chance of injury. Think of a volleyball player coming down from a block, if as they land their ankle starts to roll, an athlete with propioception training body will notice this and activate the muscles to avoid the injury.

Setting the goal and resolution of losing weight is an admiral one that will only be of full benefit if you are able to continue with it and avoid injury.

Monday, 13 January 2014

So You Only Deal With Athletes, Right?

One of the many myths about Athletic Therapists is that we only deal with athletes and at that only those at the elite level.  Well yes the first word in our title is athletic but we are much broader than that.  As the Canadian Athletic Therapy Association states Athletic Therapy, is a rapid return to work and play.

As an Athletic Therapist I have worked with athletes as young a 8 to those who are still going past 40.  Clinically I have treated patients who have suffered injuries at work, from motor vehicle accidents to seniors looking to maintain their mobility.  No matter who the patient or athlete is they all receive that same care.  The goal for everyone is to get them back to sport or their normal life as soon as possible.

Athletic Therapists use an active model of care that includes contemporary rehab techniques, therapeutic modalities such as ultrasound, IFC, EMS, soft tissue mobilization, physical reconditioning and supportive taping.  We do everything to create an ideal environment for healing so that our patients and athletes can return to activity safely.

You will find Athletic Therapists working in a variety of areas including:

  • Private sports medicine and therapy clinics
  • Professional sports, such as the NHL, CFL, NBA, MLB
  • Elite games, such as the Olympics, Pan Am, Canada Games
  • Teaching or research at universities and colleges
  • Minor, high school, amateur and varsity athletics
  • Professional dance companies
  • Sales and marketing for performance and rehabilitation brands
  • Municipal government
  • Industrial workplaces
  • Insurance industry
So while many of us work with athletes on a daily basis in a field setting, we also deal with the weekend warrior, the new mom recovery from pregnancy, the airport rampee who got hurt at work and the senior recovering after a knee replacement.  No matter your level of activity, no matter your job, no matter your level of sport, Athletic Therapists are there to get you back in the game. 

Thursday, 9 January 2014

Why Ice?

As you can gather from the name of this blog, I fully believe in icing injuries.  Any athlete or patient will tell you that I don't believe in heat only ice when it comes to treatment of musculoskeletal injuries.  There has been a lot of new information coming out saying that icing an acute injury is detrimental to healing.

When dealing with an acute injury the use of cryotherapy (application of cold) to the area is important for the first 24-48 hours.  The use of ice decreases pain and muscle spasm as well as blood flow, inflammation and edema.  This is due to the stop of tissue hypoxia and additional tissue injury.  When managing an acute injury the reduction of all of these aids in recovery and rehabilitation.

Reviews of research done on cryotherapy shows that more detailed studies need to be completed.  The research has proven that the application of ice on acute injuries does decrease pain, which will decrease spasm caused by the pain-spasm cycle.  Since muscle spasm decreases range of motion, this decrease in pain will lead to earlier improvement in range of motion and subsequent earlier start to rehabilitation.

The principle of RICE is still the standard when dealing with acute injuries.  Rest, ice, compress and elevate the injured area for the first 24-48 hours.  When icing on average for topical application the ice should be applied for around 20 minutes depending upon the size of the area needing treatment and the depth of soft tissue.  Topical application will reduce tissue temperature to a depth between 2 - 4 cm.

When applying ice, no matter the mode there are 4 sensations that you will experience.  Starting with cold, progressing to burning, achy/dull and finally numb.  When determining how often to apply the ice, the area needs to come back to normal body temperature before reapplying.

No matter the type of soft tissue injury, be it sprain, strain, contusion or post operative the application of ice is the still the best way to decrease pain and inflammation without the use of medications after an acute injury.

Articles used
Hubbard, T.J & Denegar, C.R. Does Cryotherapy Improve Outcomes with Soft Tissue Injury? Journal of Athletic Training. 2004 Jul-Sep; 39(3): 278-279

Nadler, S.F, Weingand, K, Kruse, R.J. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner Pain Physician.  2004;7:395-399, ISSN 1533-3159;7;395-399.pdf

Monday, 6 January 2014

Injury Prevention - Athletic Therapist at the Ready

To continue on with our What is an Athletic Therapist series, we will be focusing on their role in injury prevention.

Injury prevention is a major role for all athletic therapists, be it for initial injury or re-injury.  There are many aspects to injury prevention.  Two of the most important are physical preparedness and education.

Physical preparedness.  Athletic Therapists play a major role in helping ensure that their athletes can withstand the physical demands of their sport, both daily and from season to season.

Proper strength and conditioning involves everything from ensuring proper muscle balance, flexibility as well as proper aerobic and anaerobic conditioning for sport and position.  Their knowledge of biomechanics, anatomy and physiology enables each Athletic Therapist to work with each athlete on an individual basis to improve their performance.

On a daily basis the preparation for practice, game or event can range from stretching or muscle work, injury rehab, or taping and strapping all help prevent injuries.

Part of physical preparedness is also ensuring that the body is being provided with the proper nutrients and energy.  Ensuring that athletes have readily available nutritious food that will supply them with the proper energy reserves for their sport as well as educating all athletes in the area of nutrition.

Each day Athletic Therapists are educating athletes, coaches, parents and administrators.  Any time that as an Athletic Therapist you get to educate someone you are working towards injury prevention.  Even during the rehabilitation stage the knowledge you are passing on can help prevent further injuries.  From nutrition, injury care, concussion recognition, injury recognition, and beyond your Athletic Therapist is there to ensure that you have the knowledge and skills to stay healthy and in the game.

All Athletic Therapists are prepared to deal with any injury that may come their way, however their goal is to help you prevent those injuries from even occurring or reducing the time you are away due to injury.  Your success is always what every Athletic Therapist wants.

Friday, 3 January 2014

What I Have Gotten Back

To give more of an insight as to why I do what I do, I thought I would give you a glimpse inside.

The athletes have always been my reason?  As an athlete I suffered through injuries that effected my performance and still effect my day to day life.  I had an amazing Chiropractor who helped me through so many of my injuries and led me to becoming an Athletic Therapist.  I wanted to be there for other athletes, to help them achieve their best.

As an Athletic Therapist you are there with your athletes through everything.  We see them at their highs and lows, both on the playing field or in their personal life.  It is not only the physical injuries that can cause devastating blows to athletes.  The loss of a girlfriend or boyfriend, family member or even teammate can effect athletes in so many ways.  Getting to know my athletes both on a physical, mental and personal level has helped me gain a better understanding of what makes them "tick".  Developing these relationships is what makes me good at what I do.  Knowing that I have been there for my athletes in their time of need means a lot.

The relationships that continue after athletes have graduated help me realize that I did make a difference in their lives.  Getting to watch my athletes get married and have babies, graduate from college or university, get drafted into the NHL and even play professional hockey gives me great joy.  Even greater joy is watching my children be able to enjoy the benefits of their mom being away for long hours and for all the time put in before they were born.

Being able to have my 6 week old son meet Nail Yakupov was pretty cool.  I know at the moment this picture means nothing to him but give it a few years and I think he will thank me.  I am also very grateful to Nail for being so wonderful and willing to hold him.  I am also grateful for C being so good at hanging out at the rink with me that weekend for the Stollery event.

The other picture is now one of my favorites.  Jaynen is a former athlete of mine who now plays for the Calgary Hitmen.  Q has decided that he is her favorite player and her Christmas present was getting to meet him.  For so many reasons I am grateful that this could happen.  Being able to watch Jaynen grow into an amazing young man who I am proud that my daughter looks up to is great.  The smile on both their faces says it all.

I hope that I have at helped all my former and current athletes in some way but mostly I would like you all to know that I am thank full for all of you.  You have all taught me something in some way, be it due to an injury, something you were studying on the bus or what music I should be listening to, you have taught me something.  Thank you.

This has been a short list of what I have gotten back because I truly have to be thankful for so many things in my life that I have gotten from sport and being an Athletic Therapist. Being able to help athletes achieve their goals, working through the physical struggles of injuries is just the tip of the iceberg as to what I have gotten back.