Monday, March 28, 2011

Who's in your corner?

Our clients expect the highest value during their time with us. Most of the people we work with are among the top athletes and physical performers in the our area. From evaluation to discharge our focus is on accelerating healing and improving function to progress toward maximum performance levels. This can only be accomplished if client, physical therapist and physician are on the same team!

There are professionals who refuse to work in this way. People who are no longer learning and claim to have all the expertise necessary to fix all problems all the time. This is not exclusive to physical therapy, sports medicine or coaching. 

The best physician in the world cannot fully heal a patient if the patient is does not comply with certain recommendations.

The most gifted athlete in the world will surely fail if the rely only on their abilities without learning from the lessons of a skilled coach.

The most skilled physical therapist will certainly see their interventions wasted if their client's physician is contradicting or undermining their care.

You see, it is only when all of the pieces of this puzzle fit together that each can acheive their highest potential. Ask yourself and others:
  • Does your physician speak with your physical therapist?
  • Is your physical therapist in contact with parents or coaches?
  • Has your any one part of your performance team given input to another?
  • Is there communication between athletes, parents, and trainers?
If you are among those who want to experience your greatest potential, you must first be able to truly answer 'yes' to all of the above.

Not all of us will have the opportunity to play professional sports. However, all of us DO have the potential. It is those of us who recognize that if they attempt to go it alone, the journey will be treacherous. We must see that there are people and professionals that can help to maximize all areas of sports performance.

Thursday, March 17, 2011

Baseball player with an elbow injury (UCL strain): A Case Study

I had a conversation with a patient's family recently and I thought it might be helpful to other athletes, parents, coaches and physical therapists (PTs).

The patient: A high school, high-level baseball player with an elbow injury (read: dominant arm Grade II UCL strain). He plays all phases of the game at an elite level (running, hitting, fielding, pitching/throwing).
The question: Will he be able to pitch or play the field within the next several weeks?
Parent's and athlete's thoughts: "Well, he should definitely be ok to play the field before he is back to pitch 100%, right?"

The answer: It's actually the reverse and it’s based on a lot of factors that might not be common knowledge.
The rationale: When a pitcher throws the ball, while it is a violent action in itself, it’s among the most “sterile” movements in sports. It’s a closed environment in that there is little in the way of distraction, barring a few situations, to interrupt the mechanics of throwing. The thrower’s lower body positioning, arm loading and acceleration, as well as the follow through are consistent and should be variation free.

When playing the field as a defender, the entire the upper extremity operates in a much more varied way. There is often lateral movement involved, momentum, obstacles, runners and not to mention situational strategy which all put the kinetic chain at risk.

This is the type situation that will ‘find’ the weak link in the chain. This is of greatest concern when coming back from a significant injury but it holds true in all athletes performing all kinds of movements.

Injury prevention is a main reason that athletes should be seeking PT evaluation on a regular basis. During such an eval we actively look for any less-than-optimal range of motion, strength and joint mechanics. We treat any issues we find and provide our athletes with the information they need to monitor any pain and take an active role in their prehab.

I'm happy to say that we have effectively lengthened seasons and increased performance in our practice. Using this approach we can have great confidence that our clients are prepared for the highest levels of competition. I'd recommend that all parents, coaches and PTs become more involved in preventing problems before they begin. There is no situation in which I'd rather see someone as a patient with an injury versus as a client for a prehab visit!

In the above patient case, the patient was advised to return to play along the originally established timeline after all manual techniques to rehab the elbow. The advanced timeline included hitting drills, THEN hitting practice, THEN pitching drills, THEN pitching and then finally back to playing defense. The athlete and family understood the rationale and the athlete is back on the field at this time.

Monday, March 7, 2011

Shakeology: The tough question answered.

Recently received a good question about a specific "meal-replacement" product and thought everyone would benefit from it.

The question:
I just bought "Insanity" - the Beachbody program - same company that produces P90X. I've been debating whether or not to purchase their nutritional shake - Shakeology. I was working out this afternoon, wearing my SPARK t-shirt, and took it as a sign from above that I should ask a knowledgeable fitness professional - Should I trust Shakeology? What are your thoughts on meal replacement shakes?

I did a little research on Shakeology but couldn't specifically find what was actually in this shake. Found a lot of sales speak, but not much in the way of real nutrition information. It looks mostly like a lot of other meal shakes. If what you can gleen from the internet is correct here is how it breaks down: 1 Serving: Calories: 299, Fat: 3g, Carbs: 50g, Protein: 22g

To answer what I think is the base question, I do like, use and endorse meal-replacement shakes and bars. As someone who is always on the go and having to eat while with or between clients these are a lifesaver. The main thing we want to be careful of is macronutrient make-up of the 'meal': the amount of sugar, fat, protein and total carbohydrates and the total calories.

I ask my clients, and really anyone who is looking to eat more healthily (is that a word?), to stick to a 60/30/10 or 50/30/20 split when it comes to calories from carbohydrates, protein and fat, respectively. This goes for all meals, not just meal replacements. IF a bar or shake does not conform to this metric, then it is not a meal replacement; i.e., if it has 80 grams of protein and 15 grams of cho (carbohydrates), then it is just a protein shake/bar. If the shake has 50 grams of cho, 25 grams of protein and 10 grams of fat, then it much more clearly is a meal replacement.

Using the limited info I found on 'Shakeology' I can tell you that it is a true meal-replacement and is probably fine if you want to be sure you're getting good calories in during the day. I almost always recommend that clients find ways to prepare their own meals. In this way, we can all be sure as to what is going into them.

The FDA is pretty good about regulating how much a nutrition company can fib about calories and macronutrients so you can trust the label. However, the rules for what a company can say is "proprietary" (in other words, what the manufacturer doesn't have to disclose to you) are very muddy. If the shake is said to "boost metabolism", curb your appetite or give you faster recovery there's not much you can do to know how they make those claims. Realize that many of the claims made usually apply to a regular meal as well so don't be fooled.

If you are versed in reading labels, be on the lookout for caffeine, certain herbals, and anything with an 'L' in front of it, i.e., L-carnitine, L-carnosine, etc. The effectiveness of these amino acids is rarely substantiated with evidence.

Hope this sheds some light. Let us know if you have other questions.

Sunday, March 6, 2011

The SPARK Stable: Stud throwers' corner

I've worked with a lot of overhead athletes so far in my career and I continue to see some recurring themes that concern me.

Here's a quick list of the issues I come across and what you can do to rehab recurring injuries, prevent more problems and maximize your performance for the long term.

#1. Almost every young thrower we see is lacking some significant range of motion in their dominant shoulder. The biggest problems usually show up in what we call 'internal rotation' especially with the arm in the late cocking and early acceleration phases. This lack of mobility asks the muscles of the rotator cuff to work harder than is normally needed to slow the entire arm. This leads to increased fatigue, decreased arm speed and shorter outtings. Over the course of a season, this will lead to less time on the mound, more time needed between appearances and ultimately increases overall risk for major injury.

#2. Invariably, we also find significant decreases in the strength of low and mid traps as well as the external rotator muscles. When operating normally these muscles keep the bones and ligaments of shoulder complex working in perfect harmony. Maximal performance with minimal risk for injury. Think about it: able to throw hard, often and with minimal pain. THAT is elite level performance.

#3. Not enough rest. Most of our clients are the best of the best. Our pitchers throw the hardest and with the best stuff at whatever their age. This is a great canvas for us to work on. The issue is that they are routinely trotted out to pitch with minimal rest and in some cases sooner than they should. Coaches are usually well-meaning in that they want to maximize their chances of competing but sometimes at the expense of long term health and performance of the pitcher.

In addition to all of the manual physical therapy techniques we use maximize pitcher performance, there are a few simple things we have all of our clients do that helps us get the optimal balance of stability and mobility we need to perform at peak levels: lots of stretching of the anterior muscles (like the pecs), stretching the posterior cuff and capsule and strengthening the external rotator muscles. In addition we teach our athletes to recognize the signs of fatigue to lookout for so they can best manage their pitch counts and become comfortable with communicating with coaches and parents about their pain or fatigue.

Our ultimate goal is to see pitchers before they have any major injury so that we can pick out small issues we can fix and train them to completely avoid the injuries that will sideline them for extended periods.