The Hype Behind Sport Specialization

We recently did a presentation for Ever Active Schools - Shaping the Future conference 

Here is the presentation 

Preparing for the Upcoming Season as a Parent

Well the September long weekend is over, kids are back at school and the fall/winter activities are starting up.  As a parent you are getting the year schedule and are soon finding your calendar is full.  Before you reach for the bottle of wine, take a deep breath, you will get through this.  The following will help you get through this season hopefully injury free, but if an injury does occur with your young athlete, you will be prepared for it. 

Write down the schedule, not just this months, but the whole year.  Put it in a master calendar with everything on it.  Important school dates, holidays, practices, games, tournaments and competitions.  Again before you scream there is a reason for this.  Do you notice any trends?  Are there days off?  If you your child is in multiple activities are there any conflicts?  Is there conflicts between each child's schedule?  By noticing any conflicts now, you have the time to manage them now, instead of last minute.  The stress that you express when something happens is felt by your children and can distract them their task at hand.  Back to days off.  Rest is important, very important.  Both physical and mental fatigue lead to injuries or burnout.  For more on fatigue in athletes go here.  

Proper meal planning is also very important.  Being prepared with lots of meals in the freezer that can be easily thrown into the oven or slow cooker will save you time and the dread of heading through the drive thru.  A supply of healthy snacks in the car can get you through those school to sport moments.  

Being prepared for injuries is like having insurance, you hope you don't need to use it but are glad you have it if something does happen.  Knowing basic injury management principles will help you not only with your child's injuries but are also a good life skill to have.  It is also important to have a health care professional that you trust in case your child does suffer an injury, that way your not searching after the fact.  If the sport your child is involved in is prone to concussions, have baseline evaluations done by a qualified health care professional.  

Asking your child's coach, teacher or instructor as to their qualifications and preparedness for injury situations.  Do they have first aid and CPR?  Have taken an injury management seminar or course?  Do they have an EAP and a risk management plan?  What is their policy on return to activity after injury?  These are all questions you need to ask them.  Most of the time they will be the one responding to your child's injury, not you.  You want to make sure they are prepared for the situation and that there will be no confusion after the fact as to return to activity. 

The final thing that you must remember to do for the season is to have fun. 

For more information on our injury management seminars and other services offered check out our website at www.eliteinjury.com.  Please follow us on Twitter @EliteInjuryMgmt

Athletic Therapist Spotlight - Carrie Mussbacher

In our second National Athletic Therapy Month spotlight we feature Carrie Mussbacher. 

Name: Carrie Mussbacher

Job: Athletic Therapist, Fitness Centre Coordinator & Personal Trainer

Education Background: I completed my Bachelors of Physical Education at the U of A, and while there I became a Certified Personal Trainer through Canadian Society for Exercise Physiology (CSEP). Then I completed Advanced Certificate Athletic Therapy at Mount Royal University which prepared me for becoming a Certified Athletic Therapist with CATA.

What is a typical day for you: A typical day will involve supervising the fitness centre at Strathcona High Schoool, helping with Phys Ed or Sports Performance classes who use the facility. I will do a few clinical assessments every day, as well as injury treatment/rehabilitation sessions. I am on call for any injuries occurring in the school (sports teams, phys ed classes or sports performance classes mostly). Depending on the season, I provide on-field coverage for rugby and football games and any tournaments that we host. At the end of the day I often have one personal training session/group fitness class outside of my work at the school.

Favorite part of job: I love being apart of competitive sports, the adrenaline rush you get when you run onto the sports field to help an athlete, and the feeling you get when your injured athletes return to sport and are able to compete again after sustaining an injury. I love being challenged daily, and that no two days will ever be the same!

Why did you become an AT: I was once told as an athlete myself that I would have to quit sport in the middle of the season if I wanted my shoulder to get better. I wasn't given any other options. I don't want to put individuals in that position if they don't have to be. I want to promote the idea of returning to sport/activity in a healthy way. You don't have to play in pain but you also don't have to quit. There are options for every individual. 

Highlight of Career: 

-Winning 2006 CIS National Championship with U of A Bears Soccer

-Working with the Edmonton Rush Lacrosse Team (2011-12 & 2012-13 seasons

For more information on Athletic Therapy and Certified Athletic Therapists please visit www.athletictherapy.org or www.aata.ca

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

Ask the Therapist

We have joined YEG Fitness for their Ask the Therapist article. Here are our two most recent questions posed by readers and our answer.  

How important is stretching before exercising?

Stretching prior to training or exercise is important. What needs to be clarified is what type of stretching. Typically we see people doing static stretching both prior to and after training. Static stretching has a role but should be used at the end of a session as part of the cool down to increase flexibility. Prior to training incorporate dynamic stretching as part of your warm up. Dynamic stretching is controlled motion through the complete range. Do movements that mimic activities in your sport or training session. For more information check out our blog post Dynamic Stretching in Warm Up

What is the general time for Hamstring strain take to heal?

The average time for a hamstring strain to heal depends upon a five factors. Firstly the grade of the injury. Muscle strains are categorized into 3 grades. A grade 1 strain where there is not disability to a grade 3 which is a complete rupture, a grade 2 falls between these. Grade 1 strains typically resolve in around 1 week, grade 2 take 2-4 weeks and grade 3 beyond that. The second factor is if there is a prior hamstring strain. There is evidence showing that hamstring strains are a recurrent injury. Thirdly, the state of the body when the injury happened, fatigue and muscle imbalance can prolong the healing process. Fourth, the sport in which you participate. Any sport that involves running especially sprinting will take longer to get back to full competition. Finally, proper injury management. During the acute stage the principles of rest and ice are very important, followed by proper rehabilitation to increase range of motion, strength and functionality.

If you have a question about injury prevention, injury management or sport safety please email us at info@eliteinjury.com 

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

Athletic Therapist Spotlight - Chris Kucher

Throughout June we will be highlighting a local Athletic Therapist for National Athletic Therapy Month. Today we highlight Chris Kucher Certified Athletic Therapist and Owner of North Star Athletic Therapy 

 Name: Chris Kucher

Job: Athletic Therapist

Education Background: University of Alberta BPE, Mount Royal University Advanced Certificate in Athletic Therapy

What is a typical day for you: Depending on where I am it can be anything! Field events I am there early to ensure that all athletes are prepared as best they can be, whether it is pre-game taping, running a warm up, or a quick assessment and treatment. During performance I follow the action making sure that I can see any potential injuries, or am quick to respond to any on field emergency. Post-performance client care is the name of the game, assessments treatments and possibly referrals for all those in need. Clinical days are again all about the client without the distractions of on field care. Prior to the patient I ensure that my space is clean and tidy ready for the first patient. When he or she arrives the care starts and whether it is an assessment for a new injury, or an update to an existing treatment plan the patient is number one priority. Afterwards, a quick clean up and charting all the important information from the day's appointments.

Favourite part of job: Listening to past patients pass on the some of the information I had taught them. "Athlete 1: Wow you land really loud... Athlete 2: what do you mean? Athlete 1: I used to be like that too. You have to learn to land quieter, it shows you're in control and then you won't get hurt"

Why did you become an AT: The challenge of assessment, and the stress of emergencies. Every body is different, and while two people have the "same injury" they might need different strategies to rehabilitate back to performance levels. While on field situations stress a different aspect of the system, every time you watch an on field emergency you don't know what you'll encounter when you reach the athlete, so staying alert and current is a must!

Highlight of Career: Clinically- Opening our clinic space. Which gives me an opportunity to reach more people; and the greater the reach the greater the help! Field- On mat Athletic Therapist at the World Women's Wrestling Championships 2013.

For more information on Athletic Therapy please go to Canadian Athletic Therapist Association.

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

Lightning Safety in Sport

With warm weather comes, thunderstorms and of course lightning.  We all enjoy spending time outside either participating or watching outdoor activities and sports.  Many times when a storm approaches we all fail to proceed safely.  Many assume that only sports that involve metal implements, ie. golf, softball and some track events, need to have lightning safety policies.  In Canada there are an average of 10 deaths per year from lightning strikes and around 164 injuries. Most occur between June and August with a whopping 94% of deaths and 74% of injuries occurring this time. Those aged between 16 and 45 and male are the most prone to suffer a lightning related death or injury.  The activities that are most common are camping/hiking and work, golf and baseball rank third and fourth.  

We can not prevent thunderstorms from occurring, so to prevent lightning related injuries we must have a thorough lightning emergency action plan.  

1) Have a designated person who is responsible for suspending play. 

2) Have a designated weather watcher, who's job is to watch for incoming weather systems.

3) Have pre set safe zones for each venue in case severe weather does occur. 

4) Have a set of criteria as to when it is safe to resume activity. 

When deciding when to suspend play paying attention to the incoming weather is key.  As soon as there is a approximately 9.25 km from the edge of the storm and the area of activity, if you can hear thunder then there is lightning near by.  You must allow for everyone involved to be able to reach the safe area prior to the storm hitting.  The safe area must be indoors, places like shelters and picnic canopies are not sufficient.  When it is time to resume your activity the standard rule is 30 minutes after the last lightning strike and sound of thunder is heard.  

Having a well thought out EAP for lightning is important for all outdoor activities.  Being prepared to suspend play and stick by your actions is beneficial to all.  As with all safety initiatives lightning safety needs full team buy in to be successful.  Be proactive and set out your plan, do not rely on the officials or other team to make the call.  Research within your league as to who's responsibility it is to suspend play and if there is already a lightning policy in place.  Though lightning strikes are not as common as other injuries the damages from them are much more devastating and tragic.  

For more information on lighting safety in sports check out the NATA Position Statement on Lightning Safety for Athletics and Recreation and for general lightning information in Canada go to Environment Canada - Lightning Safety.

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

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 

A Cog on the Wheel

I spent the past weekend at a conference where the speakers and attendees ranged from coaches to sport medicine physicians.  I gained lots of things from the weekend in regards to lower body injuries, what I gained the most was how each profession in the world of sports medicine is just a cog on the wheel. 

Our speakers included a registered massage therapist, registered dietician, physical therapist, physical therapist with a PhD and an athletic therapist with a PhD in sports medicine and biomechanics.  They all pointed out how each profession plays a role in all aspects of sports. 

 Though many of our professions overlap in terms of scope, we need to work together to as part of a team to help our athletes and patients achieve their success.  

Everyone from coaches, parents, teachers, exercise therapists, kinesiologists, strength and conditioning coaches, chiropractors, massage therapists, athletic therapists, physical therapists, and sport medicine physicians all are part of the athletes support team.  Remember all of our goals are the same, to keep the athletes playing and achieving their goals. 

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

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

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