Just because something was on your MRI doesn’t mean that is YOUR PROBLEM.
Sometimes I've really thought about the name Victory Sports Rehab and if it does me a disservice or not. While my training is as a chiropractic practitioner and a sports medicine doctor, what we are able to do at Victory is so much more than just waiting till you have pain or an injury. But why would you come to a rehab facility if you weren't injured?
1. Injury Mitigation
This one is probably the most obvious. Many times, injuries can be mitigated through prevention programs, exercises, and stretches by going through an appropriate screening. Obviously there is no way to prevent all injuries, but compounded injuries through bad motions, muscles, joints, etc, can hopefully be at a minimum mitigated to not be as severe (or even subclinical).
The problem we find though is there are so many programs and people claim that they can prevent injuries, so which one is correct? If you've read my blog posts before, then you probably know my answer is about to be vague.
The answer? It depends.
I promise I'm not trying to cop out, but it really is case dependent. There are a lot of general things that we can do (ACL prevention programs have done a good job of that) due to knowledge of the most common mechanisms of injuries. I can run a baseball pitcher through an arm care program and probably make them better, but the only way to truly know if what we are doing is helping is by doing a complete assessment that includes active movements, passive range of motion, and coordinated movements. In fact, coordination is a big factor I see in athletic injuries in children and adolescents. I love what Eric Cressey has to say on this-
Don't take mechanics solutions to athleticism problems. Before tinkering with mechanics, make sure a pitcher can jog to the mound without tripping.
You have to be an athlete first before you can be a "sports player". Fundamental athleticism is extremely important to every single athlete, no matter the sport. In fact, the NFHS and University of Wisconsin conducted a study that showed athletes that played 1 sport were 70% more likely to suffer an injury than an athlete that plays more than 1 sport. Why is that the case? Single sport athletes tend to overuse the same joints by playing that sport 8, 9, 10 months out of the year (in some cases all year round), which causes compound damage to joints. If you are only playing one sport, then injury mitigation and joint health has to be a priority, regardless of "pain".
2. Strength and Conditioning
A proper strength and conditioning program is VITAL to every single athlete, no matter the sport. Once again, it's not a one-size-fits-all approach. How I would train a football player is different than a baseball player and is different than a soccer player. Even within that, how I would train a lineman is different than a defensive back, different than a quarterback, etc. Finding a qualified S&C trainer is one of the two most important off season investments you can make. While your school or team may have a good coach, taking the time and investment to have someone actually look at your own movements, exercises, and mobility cannot be overstated.
The other important investment is your joint health. I just talked about injury mitigation, and that goes hand in hand with the S&C. Reinforcing proper joint motion is crucial to joint health and coordination (the athleticism I mentioned earlier). The more good input you create in your joints, the better coordinated output you will create (garbage in, garbage out model). I love how Dewey Nielson, one of the master instructors for Functional Range Conditioning and Kinstretch, describes mobility training. He basically says that having optimal mobility is like having the cheat codes to movement, and let me tell you, he is spot on!
Personal story- I recently just started rock climbing again after 3 years. I had a membership in 2015, before I started my own mobility training, and had a hard time figuring out the moves to bouldering. When I picked it back up this summer, I can tell you that even without climbing for 3 years, it seemed so much easier with having good control over my range of motion.
It is imperative for everyone, but especially for athletes, to make sure your joints are functioning at their highest potential, and one of the best ways I have found is through Functional Range Conditioning. There's no fluff, it is just science and the application of proper stress.
Honestly, you don't want to wait to see me until you have an injury. As my patients' know, I am gonna make you work, and it's usually easier to work with me when you're healthy than on your injury. My love is helping athletes who are injured get back to playing, so don't let this post fool you into thinking I don't like injuries, but all of our goals, from the athlete to the coach to the parent to the practitioner, should be to create healthy athletes at all costs. And I promise, investing into your health is less expensive than treating injuries...
I'm back talking about baseball again... I would apologize, but it's definitely going to happen more!
Spring and summer baseball is in full swing. Now that the cold has finally left us, baseball tournaments are pretty much every weekend around here. It's pretty common for youth leagues to have 3-5 games in a weekend (which is crazy, in my opinion), and so with more baseball comes the risk of more injury, especially for the pitchers.
But what if I told you that arm fatigue may not be from the arm?
It's fairly well known and documented that player fatigue is correlated with a higher rate of injuries, and youth players are more likely to pitch in multiple games in a day and rest less. This is a big reason USA Baseball started the PitchSmart program, a guideline to how many pitches a player should throw dependent on their age.
So we know too much pitching can lead to injury, but it is arm fatigue that is leading to these injuries? Some studies may show otherwise...
A study done in 2016 by Chalmers et al showed that fatigue and a drop in velocity is normal within a game situation. What they found, however, that the loss of velocity is not due to arm speed, but actually to leg muscle fatigue first. This study demonstrates that velocity may be directly more correlated with leg strength than arm speed! But if you look up all these programs online, every coach promises you more arm speed or strength. Maintaining shoulder-hip separation, proper thoracic flexion and rotation, landing leg knee flexion, and total shoulder range of motion are also important factors into pitching injuries.
We talk a lot about arm injuries when speaking of pitchers because it is the most common injury to happen! If you look at our blog from March 28th, you can see what the chances of being injured and what that injury is. It's important to discuss because we are seeing a significant increase in youth and adolescent injuries and surgeries. While we may not know EXACTLY what's causing this rise, we have an educated guess as to multiple reasons why and try to hit all of the factors involved.
Remember when I said leg fatigue leads to lower velocity? To me, this is one of the EASIEST fixes in sports! Although it's not glorified like football, strength training is incredibly important for a baseball player. All of the power for a baseball player comes from the legs, whether it's pitching, throwing, running, or hitting. Without properly strengthening the body, you are losing out on power potential! Now I know that strength training isn't fun, nor does it make for good stats and Instagram posts. I get it, chicks dig the long ball. But in order to hit home runs, throw a nasty fastball or breaking ball, or throw out the runner at home, you have to prepare your body. And that preparation is a combination of skill work, strength training, mobility and body care, and just general maturity.
It's easy to focus on what hurts- it's much more difficult to focus on what is causing the pain to begin with.
Sometimes I wish I had the ability to just look at an athlete and tell them exactly when and how they will injure themselves, and then be able to prevent it (of course). Not only could I prevent a TON of injuries, but I could probably make a TON of money! Imagine getting hired by all the professional teams and just pointing and telling them who they need to work with, who they need to cut, or who needs to play more.
But unfortunately I can't tell the future. It's not as easy to look at someone and predict an injury. There is good news though- I do have statistics on my side! That sounded cooler in my head, but I'm also a huge nerd. What I mean by that was that I have data that people a lot smart than me have compiled over the years that can statistically show who is MORE LIKELY to be injured and how we can possibly prevent them. The big injury we are gonna talk about today is the big A- ACL tears. It is one of the most common injuries, especially in athletes, so let's break down what it is, how common it happens, and can we prevent it.
The ACL (anterior cruciate ligament) is an important ligament within the knee capsule. It begins on the posterior aspect of the intercondylar notch on the femur and attaches onto the anterior tibial plateau. There are actually two parts that arise from the femur and come together to attach into the anterior aspect of the knee capsule and medial meniscus. Like the image to the left shows, many texts and images will show the ACL is separate from the meniscus, but this is a fairly inaccurate representation, as there are very few structures within the musculoskeletal system that are completely isolated.
The primary function of the ACL is to provide stability within the sagittal plane (think front to back) and helps keep the tibia from sliding forward. It works with the PCL (posterior cruciate ligament) to provide complete stability of the knee joint within the sagittal plane. Without these ligaments, your knee would just slide forward and backward (see our Instagram post from March 22nd, 2018 to see what it looks like when your ACL is torn).
There are approximately 200,000 ACL injuries per year in the US, with 95,000 of those being complete tears. 100,000 ACL reconstruction surgeries are performed annually with an average cost of $5,000-$17,000 per patient (out of pocket cost), and some research actually puts the societal cost at $38,000 per ACL surgery.
I'm going to put those numbers together... the number of ACL surgeries within the US costs somewhere between $500 million to $1.7 billion, and that doesn't include what the insurance companies pay! Ok, so we've established there are a lot of ACL injuries and they're expensive... but who's at risk of getting them?
Allan et al performed an epidemiological study on high school ACL tears from the 07/08 year to 11/12. I could literally spend 2-3 hours breaking down this study (because that's what I did to write this blog... and enjoyed every minute of it), but I'm just going to throw out the highlights-
- ACL surgeries account for 60% of sports related surgeries among high school athletes
- ACL injuries account for more than 50% of all knee injuries
- Across 9 sports surveyed (Football, boy's and girl's soccer, volleyball, boy's and girl's basketball, wrestling, baseball, softball), girl's soccer accounted for 14.9% of all ACL injuries, with football coming in second and 11.5%
- The rate of ACL injuries in high school is 6.5 per 100,000 athletic exposures (this includes every practice and game)
- 42.8% of ACL injuries were during an athlete/athlete contact, 37.9% were non-contact
This is important information to digest. We can talk about each point of these, but the main thing to focus on is that if you play a sport, you have a higher chance of an ACL injury. I focus on high school athletics because roughly 50% of all high school aged adolescents play sports, but this does not include club sports, which probably increases that number fairly significantly.
One thing I observed during this study though was the ratio of contact vs. non-contact. I've read some studies where the ratio is 30/70 (contact vs. non-contact), and the definition of contact to me is not well defined. I don't believe the contact is defined as contact directly to the knee, just contact with another individual of any means, which I believe changes these numbers. Also, the numbers from football really skew the numbers in favor of contact, as 61.2% are contact related. Almost every other sport had a higher rate of non-contact ACL injuries than contact.
Why are we talking about this? Well, summer is approaching shortly, and despite the doom and gloom I just presented, there is hope! The National Athletic Training Association released a position paper on ACL prevention programs in January, showing some of the efficacy of these programs. While we are limited on the information of what actually causes ACL tears, programs that include strength, plyometrics, agility, balance, and flexibility seem to help reduce the risk of ACL tears, especially in females.
All that being said, Victory will be introducing it's first ACL Prevention program this summer! While most people know us for helping recover from injuries, we want to make sure we offer programs to help prevent injuries in the first place. This is important to help athletes stay on the field, but also reduce health costs, as a prevention program will be much cheaper than an ACL injury. We will be releasing the finalized program within the next week, so keep your eyes peeled on when, where, and how much. Don't let the summer fly by without making you or your athlete a better, healthier athlete.