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Keyword: sports medicine

Treat the Athlete, Not the Body Part

I recently attended a medical conference in New York, focusing on current sports medicine concepts in baseball.  The presenters were sports medicine providers including members of the sports medicine teams from both the New York Yankees and Chicago White Sox. The conference was outstanding, discussing some of the most current research and treatment techniques for injuries afflicting baseball players from the Major Leagues to collegiate and youth athletes.  There were over 20 different presenters from orthopaedic surgeons, physical therapists and athletic trainers; one of the biggest take home messages I learned was that there is little absolute consensus on treatments for different injuries.  There are a variety of different diagnostic and surgical approaches to a variety of shoulder and elbow injuries.  However, there was one consensus that ran through each section; the importance of core strengthening and stability as part of the athlete’s daily work-outs and rehabilitation process.

The idea of treating the entire athlete is not new; it is something that is discussed at almost every sport medicine conference and a topic that I have presented on a number of times in the past.  Unfortunately, players, coaches, and parents do not always have access to this information.  So there can be a lot of misconceptions out there amongst the non-medical population with regards to baseball players:

  • My shoulder hurts so I need to just rehab my rotator cuff
  • I want to throw harder so I need to hit the gym and get stronger
  • I lose my control the deeper into the game I throw, so I need to throw more in practice

For ideal results in performance, injury prevention and rehabilitation, the athlete’s entire body has to work in symmetry.  It is not about just one body part or one muscle group; it is about the entire body working in harmony to achieve a common goal.  So for the athletes that I work with, their programs focus on a variety of body parts from the rotator cuff to the peri-scapular musculature (latissimus dorsi, trapezius muscles, rhomboids, serratus anterior) to core and pelvic musculature, to the lower body.  The goal is to build strength, stability, and muscular endurance throughout the entire body to support the demands of their sport. 

You may now be thinking, how am I going to do this, my workout will take hours?  There is definitely a time and place for isolation, but the majority of the time, you can combine exercises to achieve the desired results.  There are still thousands of different exercises that you can do, but here are my top 6 exercises that I give to the majority of my throwing athletes to incorporate into their workouts:

  1. “Y’s” –  bilateral shoulder scaption prone on a stability ball
  2. “T’s” – bilateral shoulder horizontal abduction prone on a stability ball
  3. Bilateral scapular retraction to external rotation prone on a stability ball
  4. “I’s” – bilateral shoulder extension prone on stability ball
  5. Push-ups on stability ball or BOSU ball with holds
  6. Shoulder external rotation while in a side plank position

* Exercises should include high repetitions with little to no weight (zero to two pounds at most) focusing on slow controlled movements, body mechanics, and alignment. 

One of the athletic trainers at the conference said that “throwing programs should always be written in pencil, since they are constantly changing to meet the needs of the individual athlete.” I could not agree more, but I also take this philosophy to include all strengthening, rehabilitation, and maintenance programs. Every athlete is different and their program should be tailored to meet their specific needs, focusing on the entire athlete.
 

With the start of October comes the start of wrestling conditioning before the official season starts. The conditioning helps to get the wrestler ready for the season as well and is a time for an athlete to start cutting weight safely, if needed, to determine a healthy weight class for competition. High school wrestling programs should have a weight management program that includes urine testing with a specific gravity test that does not exceed 1.025, a body fat assessment no lower than 7 percent for males or 12 percent for females, and a monitored weekly weight loss program that does not allow for more than 1.5 percent per week of the alpha weight. Before competing, all wrestlers must go through a weight assessment to determine an alpha weight to include hydration and skin fold testing. The alpha weight will be used to help determine possible weight class as well as used for any weight loss during the season.

The alpha weight, hydration assessment, and skin fold testing are to be tested all at the same time and required to be completed no later than two weeks prior to the district certification deadline, this includes any appeals. This is all prior to the start of any competition with another school for any of the athletes.

A trained assessor will perform the testing protocols on each wrestler and will record results on the proper weight certification forms. There are three parts that are tested:

  1. Hydration Assessment: This is a pass/fail urine test based on the specific gravity levels of less than or equal to 1.025. If greater than 1.025, the test is a failure and can be re-assessed after a 24-hour wait period. Specific gravity determines how hydrated the athlete is at the time of test. This urine test can be judged using a color chart, but to get a better or more accurate reading, the use of a dipstick or specific gravity refractometer or other hydration testing methods is acceptable. If the hydration assessment is passed, the athlete will then weigh in to determine the alpha weight right then with no exercise or delays between the tests. 
  2. Alpha Weight Determination: The wrestler weighs in on a certified scale and that weight is the athlete’s alpha weight for the year. The alpha weight is the weight used to calculate a descent calendar using the 1.5 percent loss per week rule. After the weigh in is performed the athlete will move on to the skin fold testing.
  3. Skin Fold Measurements: Using the proper testing calipers, the skin fold measurements are performed on the bare skin. Each site is tested three times and each measurement recorded accurately. This is to allow an average overall percentage to be determined. Skin fold sites that are tested are the abdominal, tricep, and subscapular areas for males and tricep and subscapular areas for females. All testing is performed on the right side of the body.

Once all testing has finished and all the data collected, it’s then recorded properly in a computer system that will determine a minimum weight class at which the athlete can compete. The weight class is determined by a predicted body weight at 7 percent for males and 12 percent for females including a 2 percent variance made by the system. If the predicted weight including variance is a specific weight class, then that is the athlete’s minimum weight class. But if the athlete's weight is in between weight classes, the higher weight class is determined as the minimum weight class. If the athlete already has a body fat percentage below the allowed 7 percent or 12 percent, then their alpha weight including 2 percent variance is used to determine minimum weight class.

Although there is not much to be done for the testing and protocols, these are very important steps that must be done for the safety of the athlete. Making sure all testing protocols are done properly and accurately is key and can play a big part in the athlete’s season.

Guest Post by:
Michael Barr, PT, DPT, MSR
Sports Medicine Program Manager
MUSC Sports Medicine

Sitting on the sidelines I hear the sounds of hard hits, players grunting, and fans cheering … I bet most of you reading this think I am talking about covering a high school football game on Friday night, but I am not. Women’s roller derby … is one of the most dynamic, hard hitting, and exciting sports that I have been involved with, in my 10+ years as a medical professional.

One of our athletic trainers and I cover the Lowcountry Highrollers, women’s roller derby team; at the bouts this past Sunday we diagnosed and treated multiple ankle sprains, 2 concussions, a shoulder subluxation, countless number of contusions, dehydration and general fatigue. Overall this was a slow night for us; there were no fractures, tears, or lacerations.Roller Derby Action

Afrodite Superstar said to me, “I am in the best shape of my life, but I accept the fact that I am going to have daily pains” she also explained that the morning after a bout is always the worst, “just getting out of bed hurts”, but once she laces up her skates at the next practice, she is back to herself again.

This description by Afrodite Superstar sounds very similar to an article written by Elizabeth Merrill from EPSN about Matt Birk, former Baltimore Raven’s center, where she describes his Monday morning ritual:

Birk pops one elbow, then the other, and fans his legs until his pelvic bone makes a cracking noise. He takes a couple of deep breaths, and his feet hit the floor. The first few steps are similar to tiptoeing through hot coals. But it’ll get better; it always gets better once he makes it to the bottom of the staircase.
It’s Monday, and time to start another week in the NFL.

Roller Derby CompetitionUnlike the players in the NFL, the Lowcountry Highrollers are all professionals, in something other than their sport; they do not have the luxury of having a recovery day, they have to get up Monday morning and go to work, just like the rest of us.

As I am sitting in my office this morning, talking to Jungle Jane, president of the Lowcountry Highrollers, about a minor injury she sustained at the bout last night, and what she needs to do to expedite her recovery, I asked her why she plays? She answered, “I do enjoy the full contact part of the sport, but even more, it helps me build confidence not just on the court but in my everyday life.”

In the same article by Merrill, Matt Birk was asked a similar question; he answered, “You get so much from the game,” Birk says. “The camaraderie, the friends you make. You don’t mind having to pay that price because you get so much out of it.”

As this years’ season is coming to an end, we are starting to prepare for their off-season which includes a mandatory 2 month break from contact and reduced time on skates. During this time they have an off-season strengthening program designed for the specific needs of their sport. It includes 2-4 days/week of strengthening, muscular endurance and stability exercises, in addition to endurance, sprint, and skating specific skill training. Just like players in the NFL, they use the off-season to recover but also to get stronger, increase their fitness and improve their individual skills, so when they return to the rink in January they are ready for the next season.

The Lowcountry Highrollers’ season is coming to an end on November 9th, their home team championships; if you are interested in seeing a fast pace, high hitting sport, come to their next bout; for more information go to their Facebook page.

 

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