What Makes a Great Coach?

Being  a coach in any sport is not an easy task, beyond being technically and tactically sound, what else can you do to become a better coach.  These are  few tips that came from instructing the Hockey Canada Safety Course. 

1) Be a Good Role Model - demonstrate to your athletes good life skills, teach them to win gracefully, learn from their mistakes and failures.  

2) Create a Safe & Respectful Environment - Not only will skills develop better when athletes feel safe, your athletes will achieve more success as those skills develop.  Respect plays a major role in safety be it respect for your competition, team-mates or training partners, the respect you give the athletes and show to other coaches and officials. 

3) Continue Education - Educate yourself. Take courses, be it to improve your technical or tactical repertoire as it is always important to fill your tool box.  It is also important to take courses or seminars that will improve player health, safety and well being.  First Aid, CPR, and injury courses, nutrition, goal setting, anything that can improve you or give you tools to improve your athletes is a benefit. 

4) Take in Account the Whole Athlete - We all at times forget that athletes are not just physical beings.  When we ask how they are doing we need to get beyond the skills, the techniques, the injuries or the performance.  The mental and emotional aspects of athletes can effect all of those.  Events that are occurring with family, friends or at school can weigh on how an athlete performs.  These distractions can also lead to being more injury prone as they aren't focusing on proper technique or tactics. 

While this list is definitely not inclusive these few tips can help you be just a coach who can teach skills and tactics into a coach who truly creates a great environment for their athletes to excel both in sport and life. 

June is National Athletic Therapy Month

June is National Athletic Therapy Month, please see the press release from Sandy Jespersen, Executive Director of the Canadian Athletic Therapy Association (CATA)

National Athletic Therapy Month reminds us that we’re all athletes

While we usually think of sports when we talk about athletic activity, most Canadians engage in some form of physical activity every day. Whether it’s lifting an infant into a highchair, running for the bus, or bending to reach a fallen sock behind the dryer, we move and exert our bodies constantly. And sometimes we feel the pain from those movements.

That’s the idea behind National Athletic Therapy Month this June: an annual reminder that everyone can benefit from the expertise of Canada’s Certified Athletic Therapists. By declaring, “We are all athletes”, the Canadian Athletic Therapists Association (CATA) hopes to educate Canadians who have sustained an injury to their muscles, bones, or joints that a Certified Athletic Therapist (CAT(C)) can help get them back to work and play.

 “While we’re primarily known for our role in helping athletes recover from injury faster and achieve peak performance, our skills can be used to help anyone with an injury,” said Richard DeMont, President of CATA. “Whether you’re a weekend golfer an avid gardener, or a busy soccer mom, moving without pain or discomfort is an important part of our overall health and well being.”

 Being able to translate the knowledge gained from years of treating elite athletes at the highest levels of competitive and professional sports into the needs of all Canadians makes the role of a Certified Athletic Therapist very valuable for injury recovery. 

 "For professional and elite athletes, the sporting arena is their workplace, and we treat workplace injuries,” said DeMont. “Whether that workplace is a playing field or an office tower makes no difference; we help get people back into their game.”

 From injury prevention to emergency care to rehabilitation, Certified Athletic Therapists are committed to assisting all of life’s athletes. 

For more information on Athletic Therapy or National Athletic Therapy month go to www.athletictherapy.org or www.aata.ca

We will be featuring local Edmonton area Athletic Therapists throughout the month to help you get to know your local ATs a little better.

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com for more information on Athletic Therapy and the services we offer. 

Why Proper Injury Management is Important

I recently treated a young dancer who hurt her leg at school.  The story of how she hurt her leg and her subsequent recovery is a perfect example as to why safety recognition and proper injury management is key. 

Now her mechanism of injury is somewhat amusing but totally preventable.  While at school she slipped on a pencil and awkwardly caught her balance.  She was unable to extend her leg fully and was walking around on her tippy toes when I saw her.  She complained of pain in her upper calf.  She had no swelling or deformity.  Her hamstring and calf were in spasm which was causing her pain.  I sent her home with instructions to RICE (rest, ice, compress & elevate).  This is where the story turns ugly.  She went to school the next day feeling better, that was until she was not allowed to ice during recesses and lunch.  When her mother arrived home, her ankle was swollen, bruised and sore.  She was in so much pain, you could not touch her leg without her crying.  Click here to see her ankle.  After one day of ice, elevation and rest the swelling had gone down and by day five full range of motion had returned and she is back to dance.

  

Her injury was totally preventable, making sure that things are not left on the floor and encouraging kids to be aware of their surroundings.  However, kids will be kids and that can't always happen.  What could have happened is the proper management post injury.  As was seen by her recovery once the RICE principle was initiated, if this had been done the day after injury then the swelling, pain and bruising would not have been so severe. 

Basic injury management principles are just that basic and simple.  The RICE principle has been around for many years and does not require much advanced knowledge of injury management.  Correct management obviously creates a more ideal situation for healing, which is in the best interest for everyone.  A similar situation is a friend of mine who hurt her knee during soccer.  Her husband told her to heat it that night.  These two situations show the importance of more education on basic injury management.  

As health professionals we may feel that everyone knows how to deal with acute injuries, but everyday athletes both young and old are getting improper advice which in turn prolongs their injury and taking them away from being active and achieving success. 

For more information on injury prevention and management follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com 

Year Long Sport and Early Specialization

Early sport specialization and year long sport has become a major problem for our young athletes.  There are many reasons and justifications for this by parents, coaches and administrators as there is a perceived success for those who do specialize early.  Some are unaware of the detriment to their athletes bodies and some just choose to ignore what they see and hear.  Athletes can achieve success in their careers even when starting to specialize as late as age of fifteen.  

There are both physical and psychological negatives to the early specialization of young athletes. Overuse injuries and burnout are the most common, which lead to early retirement.  By the age of thirteen 70% of adolescent and child athletes will have dropped out of their given sport or activity.  By encouraging and registering them in a cross spectrum of sports benefits include an increase of joy, talent and the use of the full body.  

By involving your child in sports that involve the full body, you decrease the likely hood of overuse injuries.  Repetitive strain injuries such as Osgood-Schlatter, Sever's disease, Little League Elbow, tendinosis, and stress fractures are all linked to excessive repetitive motions and repetitive training cycles.  Gymnastics, diving and figure skating are the only sports to show some benefit with early specialization due to their use of periodization.  Graded increases in activity, are the most beneficial for the physical and skill development of athletes.  Rest both during the season and off season, is imperative to keeping young athletes engaged and injury free.  

The long term effects of overuse injuries can be seen in the number of baseball players especially pitchers in both the college and professional levels who are suffering ulnar collateral ligament sprains.  The philosophy of no pain, no gain has long been shown detrimental in both coaching and conditioning realms.  By engaging in multiple sports different parts of the body and brain are engaged, making turning the child into a better overall athlete.  People marvel at college athletes who compete and excel in more than one sport.  What we should be doing is using them as an example of how non-specialization actually leads to success.

By allowing our young athletes to engage in more than one sport and delaying specialization we will create not only better athletes but better adults as well.  By reducing overuse injuries and burnout at the younger ages, athletes will continue on being active throughout their adult lives.  That is true success over medals and accolades.

Follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com

Resources used for this post

 Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine, DiFiori et al; Br J Sports Med 2014;48:287-288

Any Given Monday: Sports Injuries and How to Prevent Them for Athletes, Parents, and Coaches - Based on My Life in Sports Medicine, Dr. James Andrews 

http://researchrepository.murdoch.edu.au/4422/1/sport_specialization_in_youth.pdf

Anaphylactic Reaction

Anaphylaxis is a serious allergic reaction to a food or environmental stimulant.  The most common stimulants in Canada are peanut, tree nuts, milk, eggs, fish, shellfish, sesame seeds, soy and wheat.  Insect stings such as yellow jackets, hornets, wasps and honey bees are can also trigger an anaphylactic reaction.  Medications as well as rubber latex can also trigger a reaction. 

Signs and symptoms of a anaphylactic reaction can be categorized into five categories:

• Skin system: hives, swelling, itching, warmth, redness, rash
• Respiratory system (breathing): coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing
• Gastrointestinal system (stomach): nausea, pain/cramps, vomiting, diarrhea
• Cardiovascular system (heart): pale/blue colour, weak pulse, passing out, dizzy/lightheaded, shock
• Other: anxiety, feeling of “impending doom”, headache, uterine cramps, metallic taste

Any sign or symptom should be dealt with immediately as the severity can change rapidly.  Every athlete with severe allergies should have an emergency plan.  Included in this plan should be knowledge of past reactions, location of epinephrine auto injector.  Anaphylaxis policy changes depends on your province and school board, it is important to check what is allowed or not allowed in your jurisdiction.  

In North America there available auto-injectors include Twin Jet, Epipen and Allerject.  The amount of epinephrine comes in two dosage strengths and is based upon weight.  Consultation with your physician and pharmacist as to the appropriate dosage.  

The management plan for an anaphylactic reaction:

1) Give epinephrine auto-injector at first sign of reaction

2) Call 9-1-1

3) Administer second dose of epinephrine if available

Having a well planned out plan for any emergency is important, knowing what to do when that emergency is an anaphylactic reaction is the difference between life and death. 

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 

The Art of Taping

As an Athletic Therapist one of the things that we do on a regular basis and by regular I mean multiple times daily is taping.  Be it an ankle, thumb, knee or wrist we have to know that exact place to put the tape and what way the that piece of tape needs to go to prevent and stabilize the joint.  

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Recently I was instructing a class of high school students on various tape jobs.  There were varying degrees of experience with taping as well as degrees of interest in doing them properly.  One of the first steps we went over was reviewing the motions of the joints we were going to tape.  Before you even can touch a roll of tape you have to know what way the joint your going to tape moves.  It would be very detrimental to tape an ankle inversion sprain and pull the ankle into inversion instead of eversion.

Learning to tear tape is another skill that needs to be mastered prior to applying tape to the body.  Poor tears cause wrinkles and tight spots which are both huge no-no's with any tape job.  The use of scissors or tape sharks to cut regular white taping tape is not efficient nor practical.  

You may be asking by now why is this post called the Art of Taping.  It may seem more technical than artistic.  As much as you need the technical knowledge as to the body and its motions, taping is truly an art.  No body part is the same.  For example no arch in the foot is the same.  Being able to recognize this and know the difference, while taping essentially on the fly is part of the artistic aspect. 

 Many of you may not think so but tape jobs are pretty.  They should be viewed like a sculpture.  The absence of wrinkles and windows (where skin shows through between two pieces of tape) makes for a smooth, flawless tape job.  This combined with the ability of the strength of the tape to prevent injury is beautiful.  

If you still doubt how taping can be art.  Watch an Athletic Therapist at work.  The fluidity of their motions as they move the roll of tape around the body of their athlete or patient is at times as graceful as a ballerina or pianist.  

I hope that after reading this you have gained a little more appreciation for those of us who tape.  It is not as simple as throwing on a piece of tape as though it is a bandage.  Each piece is in its place for a reason and put there purposefully, as a painter puts each brush stroke on their masterpiece.  

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com for more tips and services that we offer in keeping everyone in the sport of life.  

Fatigue in Athletes

Many athletes become fatigued during the season.  With the prevalence of year round sport, young athletes are becoming fatigued more often that before.  As a coach and parent there are two main ways you can help deal with athlete fatigue.  Firstly you must plan a schedule that will help prevent athlete fatigue, secondly you must be able to recognize the signs and symptoms of athlete fatigue.  

Signs to look for when seeing if your athlete is becoming fatigued come as both physical, mental and emotional.  Physically athletes may become more prone to sickness.  Missing practices, games and competitions due to illness more often than normal is an easy sign for parents and coaches to see.  An increase in pain as well as slower recovery from work outs or injuries occur as athletes become more fatigued during the season.  As the body uses its energy to try to keep up with normal daily activities, It finds it harder to find the energy to heal, compete and learn new skills.  Skills that were once automatic become harder to complete.  

Mental and emotional fatigue can end up leading to depression, so it is imperative that early recognition occurs.  Athletes may appear moodier or more emotional.  The happy go lucky athlete who cheers everyone on, soon becomes withdrawn and irritable.  You may notice an increase in irritability.  Snapping at parents, siblings or teachers without cause or over reacting to situations can be early indicator of fatigue.  

Altered sleep patterns, both a increase or decrease in the amount of sleep is a sign of both mental and physical fatigue.  When or wear an athlete chooses to sleep as well.  You may find that an athlete is falling asleep during dinner or needing naps after school.  If this is typically abnormal and becomes more than an occasional occurrence, further investigations as to the cause need to occur.  

One of the major clues or signs to look for is a decreased enthusiasm for their sport.  Not wanting to attend practices or competitions, coming up with excuses as to why they don't want to go or wanting to leave early are all signs of this loss of enthusiasm.  This type of fatigue is associated with burnout and is typical with athletes involved in sports with early specialization and year round sport.  

Prevention of fatigue as with all types of injuries is simpler than dealing with it after it occurs.  When organizing an athletic year follow the principles of periodization.  Both physically and mentally the athlete can not be at peak performance all the time.  There must be highs and lows of training and competition. 

As parents, coaches and teacher-coaches; a balance between school, sport and social life must be achieved.  When scheduling practices and games allow time for both the body to recover as well as time for your athletes to complete homework and spend time with friends and family.  

Communication is pivotal for both recognition and prevention of fatigue.  Talking and listening to your athletes to both verbal and non-verbal actions will allow you to take any steps needed before it is too late.  

Athlete fatigue is more than just being tired and can lead to long term health problems.  Preventing and recognizing this before it becomes severe is important in truly making the athletes health a priority. 

Follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 

Becoming an Athletic Therapist

So you want to become an Athletic Therapist.  Congratulations and welcome to one of the most rewarding careers you can find. If you want more information than provided here please go to www.athletictherapy.org

The first step towards becoming a Certified Athletic Therapist is to attend an accredited institution. We have seven institutions in Canada.  University of Manitoba, University of Winnipeg, Camosun College, Sheridan College and Concordia University all have degree programs in Athletic Therapy.  Mount Royal University offers a post degree certificate as well as a collaborative program with University of Regina, University of Calgary, University of Lethbridge and Trinity Western University.  York University currently has probationary status. 

Upon completion of your education you will continue on the path of certification.  Before attempting the national certification exam you will need to have met the following requirements.  A valid CPR-HCP certification, completed a First Responder course, have your Supervisory Athletic Therapist (SAT) to approve your application and have completed 600 hours of both field and clinical work.  

The national exam consists of two parts.  The written exam consists of 200 multiple choice questions.  The oral-practical portion consists of both field and clinical components.  During the field exam you will face an urgent or non-urgent on field scenario, a sideline return to play scenario and a taping/support scenario.  The clinical component has to scenarios, injury assessment and rehabilitation.  The oral-practical exam is marked live by Certified Athletic Therapists.  

There are 6 domains of competencies that you will gain during your education and will need to demonstrate during your national exam.  

1. Prevention
2. Recognition and Evaluation 
3. Managing, Treatment and Disposition
4. Rehabilitation
5. Organization and Administration
6. Education and Counselling

Once you have completed all these steps you will receive one of the greatest pieces of mail stating you our now a Certified Athletic Therapist and get to use the professional designation of CAT(C).

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com

First Aid supplies

Every team needs to have a fully stocked first aid kit on site during all team, club or sport activities.  Having these supplies at hand, knowing what is available and knowing how to use them are all part of a well organized risk management plan and emergency action plan for your group. 

Not all first aid kits are created equal.  A kit used at home, work or in the car will not meet the needs of an athletic event.  Depending on your expertise you may expand the supplies you keep on hand, but it is very important to only have supplies you are trained to use.  When being given a first aid kit by your organization or club it is very important to go through it.  Knowing what supplies you have on hand or not can mean change how prepared you are for the injury situation. 

Basic supplies that everyone should carry are:

• Barrier protective gloves - non latex is best, but if you have not latex allergies in your athletes latex is fine.
• CPR mask or shield 
• Bandaids - I always recommend butterfly or knuckle as they have more coverage and stay on better.  You may need to pay attention to adhesive allergies. 
• Triangle Bandages - They aren't just for slinging shoulders, in my world the more the better.
• Tensor Bandages - 3" and 4" are best, depending on your knowledge adding a double 6" is beneficial.
• Saline Solution - Used to clean wounds.
• Antibiotic Cream - Keep wounds clean 
• Gauze - Sterile and non-sterile to dress wounds, 3" is sufficient
• Alcohol Sanitizer - You can not always make it to a sink to wash.
• Hypafix or similar product - Keeps gauze on great
• Prowrap - Even if you don't know how to tape this comes in handy for many things
• White Athletic Tape - Zinc Oxide tape is the basic tape used in athletics.  If you have a taping and strapping course carry enough to tape.  If you do not know how to tape still carry some as you can use it to hold on bandaids or gauze. 
• Scissors - Rescue Shears or Utility Scissors can cut through shoulder pads, great to have on hand for emergency or everyday issues.
• Helmet Removal Tool - Depending on your sport having something to properly remove the face mask can be life saving.  An pair of angled pruners or the Trainer Angel work well, a Utility Knife is not safe for either the athlete or person using it. 
• I do not recommend chemical ice packs as they can break and tear.  Leaving the athlete prone to chemical burns or the ice pack has already been activated prior to needing to be used.

A well packed and organized first aid kit can make a huge difference when managing injuries.  By knowing what supplies you have on hand and how to use them will save you time when an injury does occur. Nothing is worse than trying to find gloves and gauze when dealing with a wound.  Always keep your first aid kit stocked and check for expiration dates on any supplies.   Check with your sport governing body or organization as to if there are any restrictions as to what you can carry in your kit. Some sport governing bodies do not allow you to carry anything that has a drug identification number (DIN).  The final step to having an effective first aid kit is making sure you take it to all sport events. Practices, games, training and competitions all require having your first aid kit on site. 

Please follow us on Twitter @EliteInjuryMgmt and check out our website for more information at www.eliteinjury.com.

Emergency Action Plan Part 2

As a continuation from last week we will continue with Emergency Action Plans to continue showing the importance of why all teams, clubs and organizations need to have an effective EAP.  I would like to thank Dr. David Geier, Mike Hopper, ATC and Stop Sports Injuries blog for their posts on EAPs as well in the last couple of weeks as some of the basis for this post will come from them.

Last week we discussed the three major roles that are needed to have an effective EAP, these make up the personnel portion based on Dr. Geier's components.  The second component is communication, both with each member of the EAP, parents, other teams and administrators.  We covered communication within the EAP last week so we will discuss communicating with parents and administrators.

Parent communication is so critical prior to competition, once an injury occurs and after an injury occurs.
Prior to the season starting or competitions inform your parents that you have an EAP, they do not need to know the details, just make them aware that if an injury does occur you have a detailed plan.  It is very important to let them know that the plan includes injury care and contacting EMS as it will help avoid multiple calls to dispatch.  During injury care, it becomes the job of the control person or additional members of the team staff to help calm the parents of the athlete.  Inform them of the degree of the injury, that they are being cared for and that EMS is on route.  This would be the same if you are travelling and the parents are not there, you need to contact them as soon as possible to advise them of the situation.  Post injury stay in contact with the parents to ensure that everyone is on the same page as to severity and rehabilitation of the injury.

When acting as the host for events, you should let the other team know of your EAP as there may be differences as to activating EMS and access to the facility compared to their home venue. When visiting ask the other team or facility these questions, you can not always be reliant on them having an EAP and there maybe the same differences as if they were the visiting team.

Whenever a major injury occurs especially in a school based setting, letting the administrators know can be vital.  In school settings the athletic director, principal and at times the school board must be made aware of the situation.  For minor sports, the club or organizing body will need to know the details of the incident.  In both cases it primarily will be about liability and insurance.  Depending on the insurance plan, there can be time frames for starting a claim and retrieving the information needed.  Usually it will involve paper work from the hospital which can take time to receive and insurance companies usually don't budge on their deadlines.

The third component is ensuring you have proper equipment to deal with emergency situations.  That equipment will vary depending on whether you are a coach, parent, or Athletic Therapist.  The most basic things that everyone in sport should have on the sidelines are:

• Up to date medical information on all participants in your care including coaches
• Face mask removal tool - football 
• Rescue shears for removal of equipment
• CPR mask & other Personal Protective Equipment such as gloves
• Wound supplies - gauze and towels to stop flow of blood
• ICE 
• Triangle bandages
• Splints 
• AED - you may not have a portable one but knowing where it is located at the venue is extremely important

An AED can mean the difference between life and death in emergent situations involving the heart.  The rate of survival increases by 75% when and AED is used.  For every minute that an AED is not used the rate of survival drops by 7-10% and by 12 minutes without defibrillation the rate of survival is only 5%.  Having one on site during any sporting event is a major step towards proper injury management.

You never know what each day at the rink, field or gym will bring.  Hopefully everything goes off fine and no injuries occur, but at some point an injury will happen.  Emergent situations can range from a spinal injury, head injury or an open fracture.  You may have a medical situations such as heat stroke, allergic reactions or an athlete with diabetes who is either hypo or hypoglycemic.  Be it in a school setting, a club or team sport having a detailed documented EAP that fully defines the roles and actions of everyone involved is the critical step in ensuring athlete safety.  Having someone on hand as a first responder, be it a coach with first aid and CPR, an Athletic Therapist or an EMT, without the prior planning of what to do in that emergent situation, no matter what their skills are, the athlete's well being and safety has been put in jeopardy.

For more information on EAP's please contact us at info@eliteinjury.com or visit our website at www.eliteinjury.com.

Resources used

Dr. David Geier - Why are Emergency Action Plans Critical for sports teams?
Mike Hopper, ATC - Sports Emergencies
Heart and Stroke Foundation - Public access to AEDs
Stop Sports Injuries - Why all sports teams should have an Emergency Action Plan

Athletic Therapist as Coach Educator

As much as we all would like to live in a perfect world where every team, school, and club carried or hired an Athletic Therapist, we haven't reached that point and unfortunately never will.  After participating in the #sportssafety chat this past week, it came to my attention that no matter how hard we try to have ATs at all levels of sport it seems that there are obstacles that will never be removed.  So what do we do?  We need to work on educating the coaches on injury prevention, recognition and basic management.

When working with a team or not one of the roles an AT takes on is educating coaches on the above topics.  Injury prevention must be something that all participants buy into.  The coaching staff are the ones that run practices, make tactical plans for competitions and are the overall guardian of what goes on with the athletes. Coaches need to learn about topics such as proper warm up, nutrition, hydration, rest and equipment as they can be a major influence if not the key influence as to athlete safety.

When it comes to injury recognition and management, by no means do I think coaches should know the difference between the laxity of a grade 1 sprain vs a grade 2 nor should they learn how to place players on spine boards.  What coaches do need to know though are basic first aid, CPR and have an understanding of basic injuries.  ATs need to share some of their knowledge with coaches.  Coaches do need to understand the difference between sprains and strains and understand the severity of each.  This knowledge will help them become a better coach, as they will understand why their athletes are out of sport while injured.  Everyone involved in sport should have first aid and CPR, so they can deal with emergent situations and have basic splinting skills.  Where ATs come into the education role is to help coaches take that first aid knowledge and apply it to sport.  

We know that at some point in their coaching career a coach will have to deal with an injured athlete, by educating them as to how to prevent injuries, we can help them decrease the number they will see.  By expanding their skill set when it comes to injury recognition and management, they will feel more comfortable when an injury does occur.  Athletic Therapists have a wide knowledge base, and by no means should coaches be expected to have the same one.  What we as ATs need to do is help the coaches expand their knowledge base, take the fear and uncertainty away when it comes to injuries.  Give coaches the ability to handle an injury until the athlete can receive more advanced care and ensure that the injury is not made worse.  If we as ATs work to empower coaches then coaches will learn that we are an integral part of the sporting community.

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 

Emergency Action Plan

An athlete goes down, they are hurt and not getting back up.  What do you do?

Well no matter if you are an Athletic Therapist/Trainer or coach the most important thing that you have already done is have your Emergency Action Plan (EAP).  The EAP is simply the plan that you as an association, club or team have set out in case an emergent situation may occur.  It is important to remember that not all emergent situations may be an injury.  An athlete may have a medical episode as well as someone in the stands.

It is really simple to think that if an emergency does occur everything will fall into place and there will be no complications.  However during an emergent situation, there is chaos.  No matter the level, no matter the expertise of the medical staff or coaching staff, everything going on is chaos.  If you check back to any of the videos from the post Athletic Therapists/Trainers in Action  even though all the ATs are working in the professional ranks, what goes on around them is chaos.  The biggest thing to notice is that it is organized chaos.  Each person knew their role and that by completing their role, that was what would guarantee the athlete getting the best, quickest care possible.

It is very important to note that if as a coach you are unable to have an Athletic Therapist on staff you still need to have an EAP and may find it more important as you will be taking control and charge of the situation.  You as a coach need to have this written plan that you share with your coaching staff and inform your parent group that you have one.  This will help with efficiency in care and will ease any concerns that your parent group will have in case something were to happen to their child.

So what makes up a good EAP.  There are three major roles.  Charge Person, Call Person, Control Person.  The focus will be on if you do not have an AT on staff and will be managing the emergency as a member of the coaching staff.  Time is of the essence during an emergency, so making sure that everyone knows what to do is very important.

The Charge Person's only concern is the care of the injured athlete.  They are to decide whether or not further care is needed beyond what they are trained to do.  This can include finding someone more qualified in the stands and activating EMS.  It is recommended that this person does possess some level of first aid and CPR training that way they have the knowledge base to know if more care is needed and can do some basic interventions.

The Call Person has at times the most simple job, they need to discuss with the charge person what the extent of the players injury is and if they want EMS contacted.  Never rely on a cell phone during this time as depending on the location service may be intermittent.  The call person should know the location of a land line or pay phone at the venue and have the address for each.  They should also know the best location for the ambulance to come to to ensure adequate access, the closer the ambulance can get to the playing field can at times be critical.

The Control Person can be likened to the bouncer.  They must ensure only the people needed to help with the emergency have access to the athlete.  As much as spectators and parents feel they will be of assistance, the more bodies in the way can impede the care of the injured athlete.

So how does all this start.  Once the charge person enters either the competitive surface, both the call and control person need to be at the ready.  A simple set of easily identifiable signals can get the ball rolling.  You can choose which signals work best for you and your EAP team, but some standard rules should apply.  The signal for activating EMS should be one handed, as your other hand could be stabilizing the head and neck.  All signals should be large ie. arm straight up in the air, hand on the head ect.  That way someone on the sidelines or stands can easily distinguish what is going on.  You can have a signal not only to activate EMS, but to ask for assistance from the sidelines.

Depending on the EAP sample you look at, it can be either the call person or control persons job to talk to the facility staff.  The facility staff are a huge asset during this time.  They know the layout of the venue and will assist in ensuring the ambulance can get to the athlete quickly and uninhibited.  You can also decide who will retrieve the Automated External Defibrillator (AED), it can be the call or control person or you can designate someone who's job is solely to do that.  As soon as the charge person shows the need to activate EMS the AED needs to be retrieved.

Use the officials of the game or event, they can help greatly in dealing with crowd control including the other team.  Once they charge person has decided that EMS needs to be activated they can assist the control person and facility staff in ensuring quick access to the athlete.

Time is of the essence during an emergency, be it your athlete or a spectator or even an athlete from another team, you want to ensure they get the quickest access to advanced medical care.  In rural areas your average time for an ambulance to arrive can be upwards of half an hour, even in the city you may be looking at a wait of ten minutes or more.  The sooner that you as the charge person decide that is what is needed, the sooner that ambulance is on its way.  Never assume that someone else more qualified will be there to make that determination and know that unlike professional sports Paramedics are not waiting in the wings to take over.  A well organized EAP runs smoothly like a well choreographed dance, each person moves independently of each other but all working towards the same goal.  This goal is the safety of the athletes and having an EAP is one of the first steps in ensuring that for them.

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com

The Life of an Athletic Therapist in Junior A Hockey

Thank you to Mat Bonneau, CAT(C) for sharing what it is like to work with in the AJHL. 

I’ve had the pleasure of working this past year for a Junior A hockey team as their athletic therapist/equipment manager. It’s been a lot of fun and I love being able to go to the rink every day and get paid to be there. I have a variety of different tasks but all focusing on keeping our guys on the ice and in the best condition to play that I safely can. On the equipment side, my major duties include ordering and picking up equipment, keeping inventory and sharpening/repairing skates. There’s a lot of long days and a many hours logged on bus trips but nothing beats the feeling of being at the rink on game day. Typically I’m at the rink six days a week, training camp was 2-3 weeks of being there every day so it’s nice to get that out of the way and get a bit of a break once the season starts.

Our boys practice from 2:45-4:00pm each day, so I typically arrive at the arena around 1:00pm. From there I may have a few pairs of skates to sharpen or put rivets in if I didn’t get to it the night before. I try and get water bottles filled and put out sock and stick tape for the guys. I do any brief treating and assessing before practice to see where injured guys are at and to help determine what they are doing at practice that day. This is also usually the time that guys find broken sticks or any other repairs that need to be done before they head out on the ice.

During practice I usually try and keep the water bottles filled and assess anyone that gets injured during practice. Also if we have guys that are out, I try and get them to do some exercises while they are at the rink. This is usually a good time to assess anyone that may be out with a concussion because everyone is out of the room so they can focus on their SCAT without any distractions. We have some bikes in the room as well so guys can ride when they reach that part of their return to play.  After practice I typically get ice ready for anyone that needs it. Also I usually try and the guys to put their skates out and I’ll finish them that night.

Game days run a little different. I’m usually at the rink pretty early. I’ll hang all the boy’s jerseys in their stalls to start. Then usually I’ll fill water bottles for our bench and the penalty boxes. I have to make sure the game day pucks are on ice so that they don’t bounce around too much during the game. Again I’ll set out sock and stick tape for the game and make sure that guys that are playing have their game socks in their stalls. There’s usually a couple guys that need skates done because they didn’t check them or didn’t put them out the night before so I try and get those done while the players are having their pre-game meeting. I also mix the Gatorade and make sure that the visiting team has the game sheet. It’s also a good time to check in with the other therapist and see if they need help with anything or forgot something. After the meeting the guys go for their run and after the run I’ll do any extra stretching or taping/supportive techniques that need to be done. After that’s done I set up the bench with the water bottles, towels, my medical bag and set up the pucks for warm-up as well as make sure the nets are on for both sides. After warm-up I try and help pick up pucks and do any last minute things that need to get done before the game.

The routine for road games looks fairly similar but I also have to make sure that the bus is packed and ready to go. This means making sure we have all our jerseys, socks, extra equipment, tape, skate sharpener,  medical equipment and extra sticks all packed and ready to go the night before so when I get the rink the next day its ready for the guys to load.

During the games I like to run one of the doors to keep me involved and it’s fun to do. I try and look after myself but I’ve still been hit with the odd puck or stick during games. I’ll look after any injuries that happen and deal with equipment issues like broken sticks or skates that lose their edges. Between the periods I’ll refill the water bottles and put nets on if I have time to do it. The odd time I’ll have to sharpen a pair of skates or two if someone stepped on something or slid into a post.

After games I’ll get ice ready and I’m responsible for getting the game socks and jerseys washed. If I’m at a home game I’ll usually do it the same night. After getting back from the road it’s usually pretty late by the time we get back and unpack the bus so I’ll do them the next day we have practice.

It’s been a great year so far and I really hope that I get to continue and maybe move up someday to a major junior or professional team. We have a great staff and team so it’s fun to go to work each day. Like I said there are a lot of long days and weeks but it’s still great to be able to do it at the rink.

So Your the One who Runs Onto the Ice?

First of all I don't run onto the ice, that isn't safe, I walk quickly.  You may be thinking that all our concentration is on not falling, even though that may be part of what is going on in our head, we are already starting assessing the scene.

When you are working on the bench or the sideline as an Athletic Therapist you are always at the ready.  I have heard coaches say it is like we have eyes in the back of our heads we can know something is wrong even if we are not looking at the playing surface.  Adam Oates commented that when he started as a coach in the NHL he noticed one of his players was hurt and turned to Athletic Trainer Greg Smith to point it out and Smith was already moving down towards the end of the bench the player was coming off at.  This is a typical reaction for any AT working with a team.

I have been asked what we do while on the bench.  When working lacrosse and hockey I did work the gate but for me that just helped me see the ice and floor better, it also helped me get to know my athletes.  You could tell what they were like coming off from each shift, what was normal and what wasn't.  You would also be amazed at what they will tell you while you are both standing there.

So a player goes down.  You get an initial shot of adrenaline, I have told coaches who do not have access to ATs on their bench that the first thing you need to do when entering the playing surface is to take a deep breath and calm down, it is because that is what I do. As I am on my way to the injured athlete, many things are running through my head.  I am assessing what position they are in, are they lying still or rolling around in apparent agony?  I am going over what I saw the last few seconds of the play, based on this I already have an idea of what body part might be injured.  I quickly run through their medical history, was that the same knee that they had surgery on two seasons ago?  I may talk to another player or official to see if the noticed anything.

Once I arrive at the athletes side, the hands on work begins.  Always start with A, B, C - Airway, Breathing, Circulation.  Hopefully the athlete is talking to you and that solves A & B, you still need to check their heart rate.  Have them take some deep breaths before you start to assess, what is wrong, what hurts, what happened?  What I saw might not be what they are complaining of, however when I start my physical assessment I am going to make sure we both aren't right.  As long as it is not a suspected spinal injury, a quick physical assessment occurs and once the athlete is ready we move the athlete safely.

The pressure that is on during the on field assessment is huge.  Deciding if it is safe to move the athlete and how to do so.  Officials, other players are over your shoulder trying to help and wanting to get the game moving.  The coaches are wanting you to find out what is wrong so they know if they have lost a player or not.  Then there is the fans.  Parents, grandparents, family, friends, scouts, everyone is watching your every move, at times if feels like they are waiting for you to mess up.

I may not have eyes in the back of my head, but I do use my senses during injury assessment.  Initial injury assessment begins on the sideline, by watching and listening to the game or sport.  Once the physical assessment begins we add the sense of touch but always continue with my eyes and ears.  The use of the 6th sense is almost the most important, however that is a whole other post in itself.

So yes I am the one that goes onto the ice or field, but my job doesn't start or end there.  I've been watching to make sure if anything happens, making sure any of the prevention techniques used are doing their job, checking in with athletes as to their status of a healing injury.  When an athlete does get hurt, getting them off to the sidelines safely is just the start, a further assessment and decision about care must occur prior to anything else.  No matter what the safety of the athlete is key.  Getting them back to play is the goal, that is why we do what we do.

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com

Females and ACL Sprains

In a continuation of our female athlete series we will focus on their predisposition to of suffering ACL sprains.
To start a quick overview of the role of the anterior cruciate ligament (ACL) in the body and why it is important to athletes.  The cruciate ligaments in the knee form an X the ACL starts in the front of the knee while the PCL starts in the back, together they prevent back and forth movement of the knee.   ACL sprains can typically without contact.  A quick deceleration, hyper-extension and typically with a change of direction.
So if we all have ACL why are female athletes more prone to suffer an injury. There are both intrinsic and extrinsic factors.

Intrinsic factors include:

Alignment
Large Q Angle
Q angle is the angle formed by a line drawn from the ASIS to the central patella and a second line drawn from the central patella to the tibial tubercle. In females the average angle is 17 degrees compared to males at 14 degrees.  The increase in this angle puts more stress on the structures of the knee and comes from females typically having wider hips.

Hyper-extension
The alignment of the femur onto the tibia can predispose females to hyper-extension of the knee putting them in a position that is already causing stress on the ACL.  Any further extension pushes the ligament beyond its tensile strength.

Hormones
There are studies showing that joint laxity increases during the pre-ovulatory phase of the menstrual cycle.  The sex hormones estradiol, estriol, and progesterone all rise in this stage causing an increased laxity in the joint.

Extrinsic Factors:

Strength
Females have a tendancy to have a low hamstring to quad strength ratio, meaning their quadriceps are stronger than their hamstrings.

Shoes
The type of shoes and surface playing on can increase the likely hood of an ACL injury.  The proper type of footing is required.  Wearing outdoor soccer cleats during indoor season will more than likely place a female in danger of suffering an ACL sprain.  This is caused by the cleat getting caught on the playing surface causing torsion of the knee.

Combined Factors:

Propioception
This is the body knowing where it is in space.  An example of this is being able to touch your finger to your nose.

Sport Specific Skills
Having the appropriate skills needed to compete at the given level of competition goes along way towards injury prevention.

Prevention:

The use of ACL prevention programs has shown to decrease injuries up to 88%.  These programs typically are around 15-20 minutes long.  They will consist of a dynamic warm up, the use of plyometrics and propioceptive exercises.  These programs can be used as your teams warm up.  The strength portion focuses not only on the lower leg but strengthening the core as well.

Females are 2 - 10 times more likely to suffer an ACL injury compared to their male counterparts.  Intrinsic factors can not be changed, however extrinsic factors such as strength, propioception, and the type of shoes being worn can be dealt with either by implementing an ACL prevention program or by being aware what shoes are appropriate to the surface that participation is occurring on.

Please follow us on Twitter @EliteInjuryMgmt and check out our website www.eliteinjury.com

References used for this post:

William Romani, Jim Patrie, Leigh Ann Curl, and Jodi Anne Flaws. Journal of Women's Health. April 2003, 12(3): 287-298. doi:10.1089/154099903321667627

Clin J Sport Med. 2009 Jan;19(1):3-8. doi: 10.1097/JSM.0b013e318190bddb.

Mandelbaum BR1, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garrett W Jr.Am J Sports Med. 2005 Jul;33(7):1003-10. Epub 2005 May 11.

http://www.aaos.org/news/aaosnow/nov10/research3.asp

Dr. Connie Lebrun, Considerations for the Female Child Athlete

Don't Try This at Home

So you want to be the next Alexandre Bilodeau?  Word of advice, he didn't just strap on the skis one day and win 2 Olympic Gold medals the next.  Sure going down a ski hill at 40 km/hr sounds like fun, but remember they put speed bumps in the way and then ramps that launch you into the air.  Anyone who has tried moguls on a ski hill will tell you it is not a walk in the park.

One of the great benefits of the Olympic Games is that it inspires people to get more active and try something new.  How many little girls wanted to be Liz Manley after the 1988 Olympics in Calgary or skiers that were inspired by Jennifer Heil from 2006?  This is great but success like this does not come overnight.

No matter the sport that you decide to try you must first be realistic and take precautions.  Even what seems like a simple sport such as cross country skiing has its risks.  Taking on any exercise program must be done so gradually.  With many of the winter sports they are outside activities and the elements must be taken into consideration.  If you decide to start cross country skiing make sure you have appropriate clothing is key, as well as not to go to far at first. You will fatigue faster than you expect and my end up stranded on some trail.  Extreme sports like ski-slope, snowboarding and in my mind the sledding events, (who thought it would be a good idea to go sliding down a tube of ice head first) require lots of training and education.  These are not sports you should try without some coaching or supervision.

All sports come with risk and that needs to be remembered.  Do not go into any sport blindly, be aware of the physical demands that will be placed on the body, and enjoy finding something that gives you joy.

Athletic Therapist in an Occupational Setting

We would like to thank Mat Bonneau, Certified Athletic Therapist for giving us this insight as to what it is like to work in an occupational setting. 

So I’ve been working in occupational testing for 2 years now, and it’s something I never thought that I’d be working in coming out of school. The opportunity has been good thus far although the job definitely comes with its own set of challenges.

As an athletic therapist, I am responsible for assessing a person’s medical history to help make a determination if they are able to complete our lifting test. We hold our clients to pretty strict standards to help ensure that they do not injure themselves while doing the test or something that could be potentially harmful on the job site. Occasionally we also run the physical portion of the test depending on how busily our day gets booked up. We see everybody from the lean 18 year old heading out for his first job on the rigs who’s never had so much as a cold to the overweight 55 year old type 2 diabetic, hypertensive operator who’s looking for a job to take them to retirement. We get quite a range of characters coming through. For the most part things run smoothly but occasionally we run into people who are more difficult to deal with. Like any service type job, how our day goes depends a large part on who companies send us each day.

Typically, a client goes through a brief pre-medical screen before coming to see us. We take a few measurements such as height, weight and blood-pressure to make sure there are no concerns with a client taking the test. We then go over their medical history with them, making sure to highlight and talk more in depth about any health conditions that may be red flags. Every once in a while I’ll come across a condition which I’m not as familiar with. We have a medical review team of medical doctors, chiropractors, physiotherapists and athletic therapists that help us to discern what may need to be looked at by another health professional or can continue through our testing without any restrictions. All of our files are reviewed by this team to make sure that everything is covered. Any type of medical clearances or restrictions are take care of by this department.

After going through a client’s medical history, we typically review their injury history looking for dislocations, fractures, sprains and strains. This can be challenging because clients may try to hide or not disclose information that they feel may hinder their opportunity to find a job. We check a client’s joint range of motion, muscle strength and ligament laxity to determine if a candidate is fit enough to not only complete the test, but also safely work at the job site without putting them at risk of further injury. We tend to focus on problem areas such as shoulders, low backs, knees and ankles throughout our assessment, while also keeping in mind common workplace injuries such as medial/lateral epicondylitis or carpal tunnel syndrome. The most difficult part of the job comes when you have to stop somebody from performing the lifting portion of the exam. Sometimes a person understands why we have a concern about the injury or medical condition in question and sometimes they don’t. We see people who have had a rotator cuff tendonitis for years but feel it is just part of getting old and don’t ever seek treatment for it. Other times they've had surgery and we just want proof that a surgeon feels that they are safe to go back to work without any restrictions. It can be a very touchy subject because a person feels if they don’t get through all their testing on the first day that they won’t get the job. It does put us in an awkward situation sometimes but we do our best to try and explain everything to our clients to the best of our ability.

Each physical test is set for a company based on a site analysis done by one of our assessors. The test doesn't change much from company to company but we vary the weight of the test based on what the person will be doing on the job site. The test is always run by a person with an exercise background, whether it’s a PFT, Kinesiologist or one of our assessors to ensure client safety. The test takes about 30 min to run for each group. We start with a brief cardiovascular test and proceed to a lifting test. Throughout the physical test, we are looking for a person’s ability to safely perform the lifting portion of the test using proper lifting technique for each lift. Clients are closely monitored to ensure that we are not putting them in danger throughout the testing. People will try and push themselves past their limits sometimes in order to attempt to secure a position within a particular company, so we do our best to prevent them from causing any injuries throughout our testing.

Overall it’s been an enjoyable experience working in occupational testing. It’s a really good chance to be exposed to different medical conditions and it’s a good chance to work on your assessment skills. On a busy day you can assess 25-30 people so it’s a good opportunity to be hands on with your muscle testing and special tests. I’m grateful for the opportunity to work in this field and appreciate being stretched outside the box of a typical athletic therapy setting.

Please check out our website at www.eliteinjury.com  and follow us on Twitter @EliteInjuryMgmt

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.

Please follow us on Twitter @EliteInjuryMgmt  and our webpage at www.eliteinjury.com

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

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/

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
http://www.painphysicianjournal.com/2004/july/2004;7;395-399.pdf