Back Clinic Physical Rehabilitation Team. Physical medicine and rehabilitation, which is also known as physiatry or rehabilitation medicine. Its goals are to enhance, restore functional ability and quality of life to those with physical impairments or disabilities affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. A physician that has completed training is referred to as a physiatrist.
Unlike other medical specialties that focus on a medical cure, the goals of the physiatrist are to maximize the patient’s independence in activities of daily living and improve quality of life. Rehabilitation can help with many body functions. Physiatrists are experts in creating a comprehensive, patient-centered treatment plan. Physiatrists are integral members of the team. They utilize modern, as well as, tried and true treatments to bring optimal function and quality of life to their patients. And patients can range from infants to octogenarians. For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
In order to comprehend how BFR, or blood flow restriction, functions, it is important to perform a quick debriefing on how your circulatory system, also called vascular or cardiovascular system, works. Your arteries are blood vessels that carry oxygenated blood away from your heart to your body. Your veins are blood vessels that carry blood from the body back to the heart.
The objective of blood flow restriction training would be to restrict venous return while still allowing arterial flow by strategically wrapping the lightest portion of your own limbs. Blood can keep pooling to a muscle by restricting the veins rather than the arteries and it remains trapped there. It is like filling a water balloon to max capacity (with no popping up, of course).
By gathering all of the blood to the working muscles without letting it leave, a couple key things happen:�One, you receive a crazy pump and your muscles become supersized. The concept is that this contributes to cellular swelling that shocks the muscles into growth. Second, it’s gonna burn tremendously. Your muscles become deprived of oxygen and can not eliminate accumulating waste materials and this creates a great deal of acidosis or strain. Metabolic stress is just one of the three major mechanisms of muscle development and shouldn’t be dismissed.
The Science of BFR
Dr. Brad Schoenfeld is a regular contributor on hypertrophy (the scientific term for muscle growth). In his book Science and maturation of Muscle Hypertrophy, ” he states: “The prevailing body of literature shows that BFR training stimulates anabolic signaling and muscle protein synthesis and markedly increases muscle development despite using loads frequently considered too low to encourage substantial hypertrophy.” Brad goes on further, saying that “it has been speculated that metabolic stress would be the driving force behind BFR-induced muscle hypertrophy.”
Another interesting matter that occurs with blood flow restriction training is since your oxygen-dependent slow-twitch fibers fatigue way quicker than normal, you have to quickly begin tapping into the fast-twitch muscle fibers, which have the biggest potential for growth.
Interestingly enough, your fast-twitch fibers typically don’t get hit unless you’re using heavy loads or pretty hefty loads performed explosively. But BFR lets you really go fast-twitch with loads less than 50 percent of your own one-rep max. Actually, one study from the Journal of Applied Physiology revealed increased muscle cross-sectional area with BFR training using loads as light as 20 percent of one-rep maximum.
What this means for you is that with BFR training you can utilize lighter loads to construct muscle while sparing your muscles from heavy loading and without fatiguing your central nervous system. Additionally, it is important to note that research has proven the gains are not just for legs and the arms but also for muscle groups over the wraps.
How to Wrap For BFR Training
There are some high-end pressure cuffs which may be used to wrap your limbs for BFR, however any wraps will get the job done. Some people utilize knee/elbow or ace bandages wraps. Others use hospital tourniquets that are run-of-the-mill.
For your upper body, wrap it only beneath the shoulder at the top of upper arm so that the wrapping is nestling into your armpit.
For the lower body, wrap only below the gluteal fold from the back and just below the hip flexor in the front.
For both the upper and lower body, you want to wrap at about a 7 out of 10 on the tightness scale (10 being as tight as you can).
You shouldn’t feel any numbness or tingling sensations. That usually means you wrapped it tight, if you do. Wrapping it too tight will limit flow and prevent blood from pooling in the gut, so it defeats the purpose. When in doubt, wrap at first, particularly around the back side of the spectrum.
How can you know whether you wrapped it right? In the event you get your life’s muscular pump. Recall, if it feels sketchy just take off the wraps and re-wrap a tiny bit looser. There is a bit of a learning curve and thus don’t place too much stress to nail it on the first try.
How BFR Training Builds Muscle
The secret to effective BFR training is using light loads (40 to 50 percent of your one-rep maxor less), high repetitions (10 to 15 repetitions or longer), and short rest periods (30 minutes or less). In addition, it is important to note that BFR does not replace your regular training–it just enhances it. Here are my three favorite ways to execute BFR training:
BFR Finishers
After performing your main work out, hit a BFR finisher. If you completed an upper-body workout, hit an upper-body BFR finisher. If you finished a lower-body workout, hit on a BFR finisher. Hit on one for the upper and lower body if you do total-body sessions.
Extra Training Volume and Frequency
BFR is a excellent way to increase training volume (how much work you do) and coaching frequency (how often you train) without impairing your recovery. As an example, to bump up your training volume, if you did 3 routine sets of an exercise with heavier loads, try adding in an additional couple sets of BFR training to the same movement pattern or muscle group using a lighter load for higher reps and shorter rest periods between sets.
Active Recovery and Deloading
Since BFR training requires having lighter loads, it is considerably easier to recover from deeper training. This makes it a process to employ but still want to train. It’s also great to use if you integrate regular deloads–or intervals of decreased loading or training volume–into your training schedule.
It is worth mentioning that BFR is being used with remarkable success in rehabilitation settings, especially with wounded athletes. Being able to operate and develop muscles after an injury or operation with loads is a joint-sparing feature unique to BFR training. As always, consult your physician or physical therapist to find out if BFR training is right for you in such circumstances.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sports Care
Athletes engage in a series of stretches and exercises on a daily basis in order to prevent damage or injury from their specific sports or physical activities as well as to promote and maintain strength, mobility and flexibility. However, when injuries or conditions occur as a result of an accident or due to repetitive degeneration, getting the proper care and treatment can change an athlete’s ability to return to play as soon as possible and restore their original health.
Athletes face extreme pressure to return to play when they are hurt however, the true challenge for physicians is to get them back in the game safely. Athletes should be tough and maintain a positive attitude whilst regularly going through pain. When they’re made to sit out due to an accident, they should be focused and motivated to return to play as quickly as possible. They rehabilitate and rest as they trust that their bodies will ready after a full treatment plan.
This is the idealistic perspective of injury associated with athletes in their specific sport or physical activity. However, the reality is that accidents are an unavoidable by product of being an athlete and the transition from “active athlete” to “injured athlete” and back to “active athlete” does not always happen without complications.
Injured athletes fight with anxiety, frustration, anger and sometimes depression during their time away from play, which might also keep them from following their rehabilitation program effectively. Additionally, the return to the sport itself yields a fresh pair of adversities as athletes should browse through personal fears and a desire to come back to their pre-injury condition with the support of their family and healthcare physician.
Importance of Support for Injured Athletes
Social support can come from various forms, ranging from emotional support to task challenge assistance. Some wounded athletes want a caring individual simply to listen to their anxieties while others might prefer a challenging drive to work harder during rehab. Studies looking at the supply of social support have found that athletes feel most satisfied with the support provided by professionals in comparison to support supplied by teammates or coaches.
It would appear obvious that athletes would need support to assist with the injury recovery process. Because teams have access to trainers in a school setting, this additional support is possible. However, injuries are not unique to the collegiate population, which makes it important to address that �and provide this service.
Researchers who immediately addressed athletes’ tastes from healthcare professionals found that the desire to learn more concerning the injury resulted in a clearer timeline for return to play along with an open environment where athletes felt comfortable asking questions. In respect to athletes not fully understanding their injuries, they noticed that they would have appreciated the use of models and more sophisticated explanations from their physicians. It’s essential for healthcare professionals to take the time to help these athletes that are injured throughout the rehabilitation and recovery process and return to play with expertise.
Even though a complete return to play could be potential in time, it won’t happen immediately and teammates, parents, the athletes and coaches need to understand this. Trainers who have missed those who have been inactive for any period of time or numerous practices will require a slow progression back to their previous degree. This is bothersome for coaches who may “need” that athlete and also for the athlete who wants to return so as not to let the team down, trainer or themselves. Additionally, while appeasing the team and coach, the athlete may want to listen to doctors to ensure a safe recovery.
Goal-Setting to Facilitate Confidence And Motivation
Throughout the rehabilitation process, athletes should set modest goals, adjust their mindset, surround themselves with supportive people and develop their patience. It is important for others such as doctors, parents and trainers to understand the process, and provide athletes with resources and support to help them construct in these areas. Like setting rehabilitation targets that are daily followed by exercise goals, simple strategies can help athletes experience modest successes and build their own confidence.
Every injured athlete would like to return to 100 percent but it is going to take some time to reach that degree. They’re very likely to eliminate the drive and motivation to continue, if they don’t see improvements over time. The athlete has to set goals based on their current status. The athlete will see little daily improvements leading them in the path of better performances in the future.
Building and/or maintaining confidence is vital, and it cannot be connected to results. Athletes need to realize that confidence keeps them trying even if scenarios aren’t going their way, and helps them push through failures. Confidence is a way of behaving and thinking that should be evident in everything one does regardless of the outcome.
In Conclusion
Given potential effects related to harm and the emotions, it’s clear that more education is essential to guarantee positive consequences for athletes who’ve experienced sports injuries. Injuries are unavoidable but they do not need to be devastating to well-being and one’s life if handled effectively. It’s apparent that athletes encounter adversity due to the injury and due to the change for their own lives and daily routines. The recovery is sometimes more easy than the yield to perform since the bone may heal and the tear could be mended, but the brain doesn’t change as easily.
It is necessary for everyone involved to understand that helping an athlete recovery in order to return to play as soon as possible demands attention to both the body and the brain. This can be accomplished by one with awareness, education and effort of coaches, doctors, athletes and parents alike.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sports Care
Athletes engage in a series of stretches and exercises on a daily basis in order to prevent damage or injury from their specific sports or physical activities as well as to promote and maintain strength, mobility and flexibility. However, when injuries or conditions occur as a result of an accident or due to repetitive degeneration, getting the proper care and treatment can change an athlete’s ability to return to play as soon as possible and restore their original health.
Injury is a common occurrence in sport participation. Ask any athlete and they’ll tell you that one of the drawbacks they can experience in their specific physical activity is injury.
Being hurt can mean a number of things to an athlete out of the pain they experience. Firstly, injury can bring a stop to training (i.e., coaching) and may indicate that what they’ve devoted lots of their time and energy and can too be removed quite suddenly (Crossman, 1997). Sport participation is a part of the identity of an athlete and so sports are a tremendous portion of their lives. When that is removed, albeit for a short time period, this can have a possible psychological effect on how an athlete views themselves.
Additionally, injury can take away the positive reinforcements sport provides where athletes undergo a feeling of mastery, autonomy and sense of control (Deutsch, 1985). Injury might be thought of as a setback because sport is used by athletes as a means of managing anxiety, stress and depression, among other things.
Psychological Effects on Injured Athletes
Understandably then, it may be anticipated that athletes can undergo a number of psychological reactions and stress upon becoming injured. Athletes’ psychological experiences differ as no one person experiences injury precisely in the same manner. Yet some emotions are more commonly reported than others and include stress, fear, anger, tension, fatigue, doubt, lack of motivation, and aggravation (Ahern & Lohr, 1997; American College of Sports Medicine, 2001; Klenk, 2006).
Of course it is normal for athletes to experience these emotions in reaction to trauma or injury and it is therefore necessary to be aware that not all athletes encounter an observable psychological disturbance to being hurt. They are athletes who seem to take being injured in their stride and their emotional reactions appear to resolve. On the flip side, other athletes appear to fight emotionally and their responses become problematic when symptoms do not resolve.
Though there’s no predictable sequence of an athlete’s psychological responses to injury, athletes often exhibit three classes of reaction to their injury. To help come to terms with their injury, athletes often attempt to get and interpret as much injury-relevant information they can (i.e., “How bad is it?” , “How long?” , “What can/can’t I do”, “Just how can I fix it?”) . As previously discussed, athletes may experience reactive behavior and psychological upheaval . Often athletes may ask questions or have thoughts that are like the following: “I can’t believe this has happened today”, “I’ll never return to 100%”, and “I’m no good to the group today”. Athletes with apparent psychological effects can frequently display a range of signs suggesting poor adjustment to the injuries, including:
Feelings of anger & confusion
Obsession with �when can I return to play?�
Trying to do too much too soon in terms of rehabilitation program (pushing the limits)
Denial (e.g., �The injury is no big deal�)
Repeatedly returning to play too soon & experiencing re-injury
Exaggerated bragging about accomplishments
Dwelling on minor physical complaints
Sleep disturbances
Alterations in diet
Guilt about letting the team down
Withdrawal from significant others
Rapid mood swings
Statements like �no matter what is done, it will never get better�
The final category indicates that athletes come to terms with the injury and engage in successful coping. If there is anything they could do at home or may help out in training athletes voice that the injury is starting to appear good or often think so, and ask their service network if their responses resolves than becomes debatable. But if an athlete is exhibiting problematic signs of adverse effect as a consequence of their injury, it is very important for them to find help from a sport psychologist who can assist them manage and cope more effectively with their injury thus assisting their injury recovery procedure.
Research has shown that negative emotions experienced by injured athletes may affect athletes’ attitudes toward and subsequent recovery from trauma (Ahern & Lohr, 1997; Crossman, 1997). Using psychological strategies have been found to improve injury recovery, mood through healing, coping, confidence restoration, pain control, and adherence to treatment protocols (Brewer et al., 2000).
Improving Athlete’s Psychological Skills
Psychological skills like goal setting, imagery and relaxation helps athletes cope better with stress, reducing likelihood of harm and stress of harm should it occur. In addition, even athletes that deal with injury can benefit from studying these strategies as they are sometimes utilized to boost performance on a basis that is constant.
Other psychological skills utilized to cope effectively with trauma but can also be used to enhance operation after experiencing injury include self-talk to help athletes have a positive attitude to rehabilitation and build confidence as well as problem solving to help deal with setbacks and search for opportunities. In addition to abilities, it is essential for athletes to be more educated in the recovery procedure and their injury to help reduce uncertainty and provide them with clear expectations and also to keep them informed.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sports Care
Athletes engage in a series of stretches and exercises on a daily basis in order to prevent damage or injury from their specific sports or physical activities as well as to promote and maintain strength, mobility and flexibility. However, when injuries or conditions occur as a result of an accident or due to repetitive degeneration, getting the proper care and treatment can change an athlete’s ability to return to play as soon as possible and restore their original health.
Exactly how effective are injury-prevention programs in soccer? El Paso, TX.s Scientific chiropractor Dr. Alexander Jimenez looks at the very latest evidence…
Football is the world’s most popular team sport. Injuries are a significant issue for both amateur and professional players. Indeed, previous research has estimated that soccer players are among the most injury-prone athletes having an estimated injury rate of 17-24 accidents per 1000 playing hours(1). Nineteen per cent of all sports injuries which exist in the Netherlands are because of soccer(two) and in Britain alone, the expense of therapy and time lost from work owing to football injuries is estimated to be approximately #1billion annually(1)!
In a landmark study, researchers followed two Champions League teams and gathered data on 2,229 players over seven seasons to examine the injury profile of muscular injuries in soccer players(3). They also analyzed the gamers’ training schedules and data out of their games to construct a detailed picture of the injury risks that were associated. The findings were as follows:
2,908 muscle injuries have been enrolled;
Normally, a player sustained 0.6 muscle injuries each season (equating to around 15 muscle injuries per season at a squad of 25 players);
Muscle injuries constituted 31 percent of all injuries and caused 27% of the total injury lack;
Ninety-two per cent of muscle injuries affected the four Big muscle groups of the lower limbs: hamstrings (37 percent), adductors (23 percent), quadriceps (19%), and calf muscles (13%);
Sixteen per cent of the muscular injuries were re-injuries; nonetheless, these re-injuries caused significantly longer absences than did the first injuries.
The prevalence of muscular injury increased with age.
The exact same group of researchers also carried out a follow-up study (published in 2013) in which they sought to establish the consequences of fixture congestion on injury rates among the gamers(4). Time-loss and exposure injuries were enrolled prospectively from 27 teams over 11 seasons. Matches were grouped based on the amount of recovery days before each match and the accident rates were compared between classes. The results showed that compared to a recovery interval of more or six days, muscular injury rates and overall injury rates were raised in league matches where players had had four or less recovery days.
Given the high levels of trauma among football players (a risk that is increased during periods of match congestion) and the financial pressure of the modern game, it’s perhaps unsurprising that medical team caring for players find that treatment of injuries in players is quite a frustrating and also a never-ending struggle. In addition, it clarifies why some players end up returning to contest prior to the injury has healed completely, setting the stage for injury recurrence, together with protracted absence of this participant from competition and training.
Injury Treatment
Treating injuries in football is both time- consuming and expensive, particularly at the elite level. And while there’s a large literature on the epidemiology of sports injuries, established protocols for treating muscular injuries and assessment criteria for imaging, and a number of clinical and functional tests that could assist the health staff in deciding the optimal point where an athlete can be safely returned to full participation(5,6), the current guidelines haven’t translated into a significant reduction in muscle injury levels in professional sports such as soccer.
To simplify things further, the evidence indicates a new injury often occurs within a couple of weeks after return to contest, and typically costs the player more lost playing time than the key injury(7). The most probable reasons for this observation are likely associated with bodily alterations following the first injury, such as muscle stiffness and/or fatigue, scar tissue formation, biomechanical alterations, neuromuscular inhibition, as well as inadequate treatment — for instance, overly aggressive or incomplete rehabilitation(8-10).
Injury-Prevention Programs
Even armed with knowledge that is up-to-date and the best technology is fraught with difficulty. Remembering the old adage that ‘an ounce of prevention is worth a pound of cure’, a alternative that is far better to attempt to prevent injuries from happening in the first place with an injury-prevention program. This is easier said than done. It is correct that there is an abundance of literature on the effectiveness of methods to avoid harm recurrence and muscle injury, such as enhancing flexibility eccentric and concentric exercises and drills. Despite this and apps like FIFA’s ‘The II’ (see Box 1), the incidence of muscle injuries generally, and the recurrence rate particularly, remains stubbornly high(11-16).
More recent studies indicate that in higher levels of functionality, there might not be much in the way of significant added benefits, while some early study appeared to give evidence for the efficacy of programs in football, as described in box 1. At a follow up to the study described above(18) and that was published this past year, the same group of investigators looked to see if an injury prevention program comprising 10 exercises designed to enhance stability, muscle strength, co-ordination, and versatility of the back, hip and leg muscles (FIFA’s ‘The II’) was effective concerning reducing injury levels and whether it offered any advantages in terms of reducing the related costs of following treatment for injuries that did occur(19).
From the analysis, 479 adult male amateur gamers aged 18-40 years have been split into two classes: the intervention group had been taught to do exercises focusing on core stability, bizarre training of thigh muscles, proprioceptive training, dynamic stabilization, and plyometrics with straight-leg orientation at every training session (2-3 sessions per week) through one season. The management team, meanwhile, continued their usual warm up.
As in the previous study, there were no significant differences in the percentage of players that are injured and injury rates between the two groups. What was intriguing was that in the intervention group, the price of injury treatment was 256 per participant. In the control group nonetheless treatment costs were twice at $606 per participant. The investigators commented that the cost savings in the intervention group may be the result of a rate of knee injuries, which have costs because of more lengthy rehabilitation periods and much more time lost at work compared to a number of different injuries.
Meanwhile, another study on an injury- prevention program (based on The II) in male amateur players had been printed in the end of last year(20). It discovered that (like the previous studies), an intervention program did not decrease the incidence of harm throughout the course of a season. However, such as the study, the players in the intervention group did incur less health care costs, although a justification for this finding wasn’t given. As if to validate the confusion surrounding the value of injury-prevention programs for football players, then a recently published systematic overview of all of the previous studies released thus far fought to achieve a definitive conclusion(21). Six studies involving a total of 6,099 participants met the inclusion criteria and the results of these were conflicting two of the six studies (among large and one of moderate quality) reported a decrease in injury rates that were actual. Four of the six research an ‘preventive effect’, even though the effect of a single study wasn’t statistically significant. Possible reasons for these contradictory findings might be subject choice (sex and level of ability), differences between the intervention programs implemented (content, training frequency and duration) and compliance with this application. What’s clear, however, is that studies investigating the type and seriousness of exercises within an injury-prevention program are still required to reduce the incidence of accidents in soccer efficiently.
Good News On Prevention
Since the review study cited previously(21) was printed, two quite newly published studies on injury-prevention apps in soccer seem to provide more encouraging news — for muscle injuries at least. In one, researchers studied elite players competing over two consecutive seasons, where the first (2008-2009) function as intervention period and the second, the management period (2009-2010)(22). In total, 26 (08/09) and 23 (09/10) elite male pro football players competing within the Scottish Premier League and European competition participated. The accident prevention training program was conducted twice weekly to the entirety of this season (58 avoidance sessions) and the results were compared with the control (no injury-prevention program) year.
On first inspection, the results were disappointing, showing an increase in the complete number of accidents within the intervention period (88 vs 72). But this was largely because of the greater quantity of contusion injuries sustained inside the intervention season (44) compared with control season (23). Assessing like for muscular injuries that were significantly fewer were observed during the intervention season, which had been even more impressive given the larger squad size at the intervention season.
Another newly published study by Italian scientists who researched the effect of a two-tiered injury-prevention program on initial injury and re-injury prevalence in 36 elite male football players also causes encouraging reading(23). During the season prior to that examined in the study, there had been 27 muscle injuries in the group, which accounted for 58.7 percent of the total injuries: 13 of these had occurred throughout practice and 14 during matches. The general incidence of muscular injuries was 5.6 injuries/1000 hours of training/playing exposure and the effect was 106.4 times absence/1000 hours exposure.
To try and decrease the speed of injury through the following season, the team doctor (also among the study’s authors) found an injury-prevention program, conducted 2-3 times per week. This consisted of two elements: a collection of core stability exercises conducted by the whole group prior to each practice session (see Box 2) along with an individualized injury prevention program, which has been started after assessment with kinesiologic and diagnostic tests. At the start of the year, every athlete underwent testing of leg flexibility using the Ober evaluation, Thomas evaluation and straight-leg-raising [SLR] test(24-26). The prone instability test(27) was completed to show spinal instability along with the stork test (28,29) to assess sacroiliac dysfunction. Quadriceps and hamstring strength were measured isokinetically and attention was directed in evaluation of immunity of gluteus medius’ power.
The injuries that happened based on MRI and clinical imaging findings were diagnosed by the medical team. An injury was defined as though it caused the participant to miss the next training session or match, and happened during a scheduled training session or match. An injured player was defined injured before the club medical staff cleared him for participation. Re-injuries were described as those that occurred as those that occurred at the same website no longer than three months following the player had returned to full involvement at early re-injuries and exactly the exact same site.
Results
Throughout the intervention season, a total of 64 injuries occurred — 36 (56 percent) during practice and 28 (44%) during matches. Of them, 20 were muscle injuries, accounting for 31.3 percent of the total injuries; 14 of which occurred during practice and 6 during games. In all, three re-injuries happened and (15 percent of overall muscle injuries) and there were not any premature re-injuries. In comparison with the preceding season with no intervention-program set up, there was a reduction in the number of times and muscle injuries . Specifically, whereas muscle injuries accounted for 31 percent of harms they accounted for 59% of all injuries. Significantly, the number of injuries per 1000 hours of training and playing time was reduced by over half of 5.6 to 2.5. Meanwhile, the number of days fell by nearly two-thirds 106 into 37. The investigators put the success of this intervention down to three key aspects:
An injury prevention program that comprised of core stability exercises similar to those in ‘The II’ program but which differed in its two-tiered arrangement (group and individual sessions), allowing for intense and special training. In contrast, the combined results in research into The II app are probably because of the non- special content and ineffective intensity.
The program’s continuity of commitment by the players to both the group and individual areas.
The addition of bizarre hamstring training in the group program (2 sets of 5 repetitions per week) combined with all the personalized application for players with a history of injury.
Using ice baths in the conclusion of every training session
The investigators cautioned that their study would have included a larger number of topics, but the data still showed a critical progress by the prior year over that. They also argued that by increasing the number of group and individual prevention training sessions, the outcomes could be enhanced.
Summary & Recommendations
Injury treatment in aggressive soccer is equally costly and time-consuming also given the pressures of the game, injury avoidance is more important than ever. But, despite extensive published literature on harm prevention strategies and initiatives such as FIFA’s ‘The II’, the injury rates in soccer remain high, especially in the higher levels.
The latest research indicates that while overall injury prevention programs such as The II might reduce the incidence of trauma in amateur gamers, especially by reducing the incidence of knee injury. However, they will probably not benefit professional players or level. Instead, combining a more individualized approach (using a far greater emphasis on particular exercises determined by kinesiologic and diagnostic testing) with team sessions seems to be desirable. Additionally, it is important that gamers are ‘on-board’ with almost any program and take part regularly (at least twice weekly) to achieve all the potential advantages.
References
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The previous rehab masterclass on Lisfrancs injuries highlighted the pathogenesis of injuries, the midfoot joint’s relevant factors, and typical injury mechanisms were presented along with diagnostic findings. In this masterclass scientific specialist Dr. Alexander Jimenez discusses the management of Lisfranc injuries…
Management
After the initial injury, it may not be clear exactly what harm the foot has been done to by the athlete. Both athlete and sports medicine staff may confuse. The athlete with subtle stage 1-type injuries will try to ‘run off’ the pain. As they continue and fail to reevaluate they will stop training/competition.
When an injury into the Lisfranc is suspected, the first MTP joint ought to be assessed to exclude a ‘toe’ injury and the ankle checked to exclude an ankle injury. They crutches till they could be properly analyzed and remain non-weightbearing ideally with an Aircast boot and need to ice the foot aggressively.
Non-operative�Treatment of Lisfranc Injuries
A stage 1 accident that’s functionally secure could be handled with a non-weight posture boot or cast for a first two weeks. They can be analyzed for tenderness on palpation over the TMT joint at this time and follow-up x-rays will be required to exclude any latent diastasis of the second and first metatarsal space. If pain-free on palpation and x ray is normal, they could have the weight bearing status assessed using complete weight bearing foot flat and position is raised by a toe. If that is normal they can stay out of the boot using a custom made orthotic and rehabilitation and return to conditioning may begin.
Then the boot is reapplied, if the foot stays painful to palpate or if they neglect raise test and they stay non weight bearing to partial weight bearing for a further four weeks.
For pain along with weightbearing status they’re reassessed in the stage. If these are uneventful then the rehabilitation and reconditioning stream is moved to by the athlete. If problematic they need to be assessed for postponed stabilisation.
The time period to get a injury that is secure could be a month recovery until return to play.
Operative Treatment Lisfranc Injuries
Stage 2 and stage 3 accidents need to have the midfoot surgically stabilized since they’re generally unstable injuries. Interestingly, Hummell et al (2010) recently clarified a successful result in a point 3 football player with non-operative treatment. The objective of surgery is to acquire a fantastic reduction to optimize functional results. Virtually all expert opinions relating to Lisfranc injuries emphasize the importance of gaining as to avoid long- term morbidity from the midfoot.
Myerson et al (1986) identified some things that result in poor outcome for example residual angulation between the metatarsals, diastasis greater than 2mm between the first and second metatarsals. Correcting these defects is essential to avoid long-term complications like chronic functional disability , post-injury arthritis and instability with walking.
To obtain reduction of the TMT joints reduction is usually necessary to remove any tissue for example little bone fragments or ligaments. Reduction is supported with fluoroscopy. Nevertheless, in instances percutaneous fixation can be accomplished if the dislocation can be reduced by the surgeon under fluoroscopy and stabilize the joints together with wires and screws. However, most will require an open reduction to properly visualize and access of the joints that are tarsometarsal.
The choice of hardware for surgery is debatable surgeons the choices are:
1. Cannulated screws;
2. Solid, Non-cannulated screws;
3. K wires;
4. Bridge plates for tarsometatarsal joints.
At a thorough literature review, Stavlas et al (2010) found that injuries to the first few metatarsals (lateral and middle column) react well with screw fixation, whereas harms to the fourth and fifth metatarsals (lateral column) may respond well with K wire fixation.
Post-Operative Rehabilitation
This will often involve a non-weight- bearing cast or boot to get the first 3 weeks with a CAM/Aircast boot used for the subsequent three to five weeks so that the athlete is complete weight. Weight is slowly built around the eight to twelve months post-operative interval so that in a custom-made orthotic the athlete can weight bear by 3 months that.
The hardware is often removed at 12-16 weeks post-op in lighter athletes and in heavier athletes (>200 lbs) it’s been suggested to take out the hardware in 24 weeks (Nunley and Verullo 2002).
Post-surgery the results are generally favourable. Nunley and Vertullo (2002) discovered that in stable stage 1 harms, great outcome was found with conservative treatment with athletes back to game at 11-18 weeks post-injury. Athletes with stage 2 injuries had good outcomes with ORIF and returned to play 12-20 weeks. Period 3 accidents were not described.
Physiotherapy
The athlete will see that the physiotherapist athletic coach weekly to regain mobility. Interventions will be necessary in addition to direct mobilizations to restore the accessory movements.
The therapist can also start intrinsic foot muscle exercises at approximately 8-10 weeks post-operative using the weight bearing exercises being postponed until week 12 post-operative. These exercises are designed to retrain the arch to be controlled by the foot muscles. Exercises that will satisfy this are towel scrunchies, cup drop, matt equilibrium and lunge exercises (see below).
The movement can be measured by the therapist regularly with knee.
1. Towel scrunchies. These have been used by therapists to strengthen the muscles that support the foot’s arch.
A. Place a towel onto a tiled or wooden floor (carpet will not work.
B. set the foot relaxed on the towel with all the foot in line with the knee and hip. The feet should be pointing directly ahead.
C. Initiate the movement by attempting to firstly raise the arch. Think about drawing the ball of the foot to the heel. You will see that the arch is going to lift.
D. Next use all the feet to loosen the towel under the foot.
E. Relax the foot and start again.
F. This exercise doesn’t cause any soreness the next day; the muscles should start to fatigue.
G. The development is seated, to standing on one leg and standing on two legs.
2. The cup drop. This can be an interesting and innovative way to integrate inherent arch muscle function and anti- pronator muscle function that is extrinsic using hip muscles that are hip, in particular the gluteus maximus and medius. During weight bearing, the hip is prevented by the gluteus medius muscle from rotating and adducting, and this action works well with the arch muscles preventing excess pronation.
A. Place a few small objects like marbles about one foot in front of your body.
B. Reach forward with the foot and also pick up the masonry with the feet. Of clawing at the masonry this activity will trigger the muscles.
C. Whilst holding the marble in the feet, circle the hip outwards into both sides of the body then behind the body and set the marble at a cup placed at 45 degrees to the cool.
D. It is necessary that the foot stays turned outwards as this retains the gluteus active.
3. The mat balance. This exercise incorporates these together with the arch muscles and adds contraction of the calf muscles both the gastrocnemius and soleus. The drill is done on a gentle matt, to create the exercise challenging. The mat surface generates an unstable situation, and there is mounting evidence that indicates that by incorporating a component of balance control to a rehab exercise may be necessary since the perturbations in movement excite all of the position feedback nerve endings which control proprioception. The nerve endings feedback to the muscle control system and also this potentiates the stimulation of their control muscles.
A.Place a soft mat in addition to a 6mm piece of timber or hard rubber mat. The thicker the mat that the harder the exercise.
B. Stand on the mat but just with the third, fourth and fifth feet connected with the matt. The first and second feet should be hanging unsupported from the mat.
C. This position of the foot makes a scenario whereby the foot wishes to turn in under gravity’s effect. The long pronation muscles in the shin and the muscles need to control the interior of the foot to keep it up and of the floor.
D. Attempting to keep equilibrium (and this will be hard when the matt is too soft), marginally boost the heel to participate the calf muscles.
E. Hold this position for 1-2 seconds and then slowly lower down to the beginning position.
F. Perform 3 sets of 10 repetitions.
4. Lunge with towel scrunchie. This workout is a high-level integration workout which combines gluteals and arch muscles whilst performing a exercise such as the lunge. This sort of exercise is done in late phase rehab prior to running as the muscle activation patterns more resemble what should happen in conducting concerning limb assistance — that is, the arch muscles control pronation, the quads control the knee and patella and the gluteus medius affirms the hip throughout foot strike.
A. Stand on a towel, very similar to Exercise 1 above.
B. Put some theratubing around a post and also wrapped round the upper tibia. The ring has to be guided to pull the tibia inwards, not outwards. This pulling in of the tibia can cause the top leg to follow along with this is imitating hip adduction and internal rotation. The goal of the exercise is to prevent it by maintaining the kneecap aligned with the next toes. The gluteals finally have to work to permit this to occur. Inwards and way would fall from the third toe, if they did not.
C. Gradually lower down into a lunge whilst keeping the monitoring of the kneecap over the next toe and also keeping the towel scrunched up under the foot.
D. Lift up to full knee extension. Rest. Start again.
Strength
The athlete will initially load throughout the foot with the foot impartial. Exercises such as split squat, high- foot leg press and posterior string movements such as deadlifts and stand pulls may start in the weight bearing phase. Exercises requiring more ankle dorsiflexion and so midfoot pronation will be delayed for a couple of weeks until strength and confidence improve (traditional one-leg squats, deadlifts and leg press).
Rehabilitation
The graded progressions for your athlete have been well summarized by Lorenz and Beauchamp (2013). The progression is a staged progression to gradually regain strength and confidence from landing and push-off positions. If the stage is pain free, the progressions could be made, the athlete could do selection and without compensations to the movement.
1. Bilateral heel raises
2. Heel raise,�single-leg eccentric lower
3. Single leg-heel raise from standing
4. Bilateral leaning heel raises
5.�Bilateral leaning heel raises, single leg�eccentric lower
6. Single-leg leaning heel raises
7. Single-leg triple extension heel raises
8. Mini-tramp low Impact exercises
A. Bilateral jumps in position
B. turns in place (two legs).
C. turns in place (two legs).
D. Jog in place
E. Three hops uninvolved, one hop involved
F. Two hops uninvolved, two hops involved
G. One hop uninvolved three hops involved
9. Agility ladder
A. Different frontal transverse plane designs
B. Hopscotch to involved negative (two to one)
10. Single-leg A/P jumps in place
11. Single leg M/L jumps in place
12. Single leg transverse jumps in position
13. Single leg hops in agility ladder
Return To Running
The choice as to when to remove the hardware will influences the choice. As a general rule, when the screws and wires are eliminated, the athlete will be permitted to attend and walk gym sessions to the elimination but running will probably be delayed.
The athlete is encouraged to walk a treadmill using a incline to promote the push. This can start at 12 weeks . The athlete may quickly advance into backward and forward running on grass and it’s expected they are doing so by week 14 depending on when the hardware was taken away. As they progress through running they could slowly begin to construct speed they reach sprint speed.
Gentle off-line running drills such as weaving, easy bypassing, stepping and caricoca drills would normally be started in around 16 weeks post-op and progressed into tougher single-leg and hard-cutting plyometrics as pain allowed. It would be expected that by 20 weeks post-op, the foot has sufficient strength, range of movement and confidence to start team- based ability function. Prior to this, the athlete can experience some frequent field hop tests like tests and single-leg triple jump to assess differences in abilities.
Functional Tests
A evaluation that is practical sports-specific is a test or field test that aims to mimic the movements. The use of practical tests aims to recognize imbalances and will boost confidence in both patient and the clinician the injured patient can return to play. It is effectively a way of reducing the hazard. The evaluation ought to be an objective, measurable and quantifiable test that includes a component of:
Strength
Agility
Power
Balance Neuromuscular status.
The aspects can be incorporated into practical tests such as agility and jumps/ movement evaluations.
The hop tests comprise:
1. Single jump
2. Triple hops
3. Crossover jump
4. 6m timed jump.
Single limb evaluations are necessary as study proves that dual limb and modified double limb tests don’t demonstrate any differences between groups since the uninvolved limb can mask deficits of the thoracic (Myer et al 2011). Single-leg hopping evaluations are sensitive enough to discover asymmetry, and specifically the crossover hop test at six months post-op is the most sensitive of these tests at predicting future function of the knee along with the 6m timed test is the most vulnerable and sensitive of under normal function at six months . (Logerstedt et al 2012).
Therefore isolated single-limb performance tests may provide a critical element to field-based operational performance testing to identify deficits in reduced limb performance, including deficits in force attenuation functional power and postural stability. The capability to maintain isolated single limb electricity is significant in sports that require significant control in stepping edge and cutting manoeuvres. This may require and ability to regenerate and divert and then to absorb force on one limb the motion.
Conclusion
Injuries are uncommon in athletes on account of the severe consequences they could have on athletic role, the sports medicine specialist has to be well versed in evaluation and initial management. They can be challenging injuries manage and to diagnose for the clinician.
Stable Lisfranc injuries with no instability can be handled conservatively stage 2 and 3 accidents involving diastasis of their second and first metatarsals requires consideration. This can be done usually using the open reduction and fixation with screws, K cables and/or plates
Rehabilitation after surgery will take no less than 12-16 weeks it’s typical for the return to sport to take in contact sport athletes. Successful return to competition time frames extend to the 20-24 week stage post-surgery and rehab will involve reduction of the entire limb kinetic chain but also not only the foot muscles.
References
1. Castro et al (2010) Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. AJR. 195; W447-455.
2. Chiodo CP and Myerson MS (2001) Developments and advances in the diagnosis and treatment of injuries to the
tarsometatarsal joint. Orthop Clin North America. 32(11); 11-20.
3. Garrick JG and Requa RK (1988) The epidemiology of foot and ankle injuries in sports. Clinical Sports Medicine. 7: 29-36.
4. Hummell et al (2010) Management of a stage 3 Lisfranc ligament injury in a collegiate football player. Athletic Training and Sports Health Care. 10(10); 1-5.
5. Logerstedt et al (2012) Single-legged hop tests as predictors of self reported knee function after ACL reconstruction. The Delaware-Oslo ACL cohort study. American Journal of Sports Med. 40(10); 2348-2356.
6. Lorenz and Beauchamp (2013) Case report. The functional progression and return to sport criteria for a high school football player following surgery for a Lisfranc injury. The International Journal of Sports Physical Therapy. 8(2); 162-171.
7. Myer GD, Schmitt LC, Brent JL, Ford KR, Barber KD, Scherer BJ, Heidt RS, Divine JG and Hewett TE (2011) Utilization of modified NFL combine testing to identify functional deficits in athletes following ACL reconstruction.
Journal of Sports Physical Therapy. 41(6); 377- 387.
8. Myers et al (1994) Midfoot sprains in collegiate football. American Journal of Sports Medicine. 21; 392-401.
9. Myerson et al (1986) Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot and Ankle. 6(5); 225-242.
10. Nunley JA and Vertullo CJ (2002) Classification, investigation and management of midfoot sprains: Lisfranc injuries in the athlete. American Journal of Sports Medicine. 30(6); 871-878.
11. Ouzounian TJ and Sheriff MJ (1989) In vitro determination of midfoot motion. Foot and Ankle. 10; 140-146.
12. Rankine et al (2012) The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection. AJR. 198; W365-369.
13. Shapiro et al (1994) Rupture of the LisFranc�s ligament in athletes. American Journal of Sports Medicine. 22(5); 687-691.
14. Stavlas et al (2010) The role of reduction and internal fixation of Lisfranc fracturedislocation: a systematic review. International Orthopaedics. 34; 1083-1091.
Chiropractor, Dr. Alexander Jimenez looks at the way this common injury shows itself.
Introduction
Iliotibial band syndrome (ITBS) between the knee is frequently diagnosed in sport injury clinics. ITBS presents having an incidence rate of around 22% in most lower extremity running-related injuries (1) also has been said to be the second most common complaint amongst distance runners (2). ITBS has been given the expression ‘runner’s knee’.
Trainers like endurance runners who perform flexion and extension combined with loading are subjected to this illness. ITBS presents during the first two or three miles in running with no mechanism of injury, which can make identifying the cause more interesting. With plenty of factors having been considered within the literature, changes are often purported to be a cause of ITBS. But some biomechanical factors have been researched and have been found to have little or no effect in the start of ITBS. Therefore this text’s point would be to examine the biomechanical changes which may induce an individual to the beginning of ITBS. The research published reviewed is largely based on a current systematic review that was published in Physical Therapy in Sport in 2014 (3).
Anatomy & Function
The iliotibial band (ITB) encapsulates the tensor fascia latae (TFL) presenting with both deep and superficial fibre attachments at the pelvis (4). In addition to attaching to the TFL, approximately three-quarters of the gluteus maximus tendon also conjoins with the ITB (4). The ITB courses along the lateral aspect of the hip and passes the greater trochanter. The ITB maintains an attachment on the posterior ridge of the femur whilst attaching itself to the fascia. The ITB has a fixed attachment at the lateral femoral condyle where it then divides into three segments with the first being the lateral patella (3). The remaining two segments cross the knee joint to insert at the head of fibula and most distally at the infrapatellar tubercle also known as Gerdy’s tubercle on the tibia (3). Figure 1 illustrates the location of the ITB.
The ITB passively functions to resist hip adduction, hip internal rotation and internal rotation of the knee in accordance with its attachments at the pelvis, femur and tibia(3). The gluteus maximus functions, through its attachment, to increase stability through the hip and knee complex by increasing the tension of the ITB(4). It is possible to see, based on its attachments at both the knee and hip, how changes could bring about the onset of ITBS.
Studies have proposed that as the knee flexes and extends the ITB ‘slides or flicks’ over the lateral femoral condyle of the knee causing an irritation beneath. This notion was debated by Falvey and colleagues (5), who stated that it was highly unlikely that the ITB would flick or slide over the bone during knee flexion due to it not being a loose structure. But the authors did agree that the impact of compression on the richly innervated fat pad was pain’s cause but by strain of the ITB where pain presents crossing the lateral femoral condyle. Strain rate and strain magnitude were measured in a prospective study involving female runners (6). The results indicated that frequency of strain of the ITB at the lateral femoral condyle was greater that the strain magnitude. This implies that a runner might have the ability to run for a short period but then incur lateral knee pain because of the strain to the ITB.
MRI scans have ascertained the knee flexion angle of 30� elicited the greatest compression of the ITB at the point of heel strike, whereas others have said that maximal compression occurs between 20-30�(2,6). A knee flexion angle at the point of heel strike has been found to be significantly different with 20.6� in ITBS patients compared to 15.3� in the control(7). Downhill running produces a greater knee flexion angle at the point of heel strike eliciting a larger strain load to the ITB and therefore this is often a main precursor to ITBS (6). Although an elevated knee flexion angle at the point of heel strike has been considered to contribute to ITBS, it is essential to examine the lower extremity from the frontal and transverse planes too and not solely from the sagittal plane (2).
Rearfoot Eversion
It’s possible to envisage how rear foot eversion could contribute to ITBS causing internal rotation of the tibia resulting at the distal attachment in greater strain of the ITB. In contrast Ferber and colleagues (2) indicated that there was no significant difference in the peak eversion angle of the female subjects, who were previously diagnosed with ITBS but were now symptom free, compared to controls. In a similar study non-significant differences were found between the currently symptomatic ITBS patients and controls for rear foot eversion (8).
Louw & Deary(3) found that ITBS patients sometimes demonstrated decreased eversion angles, accompanied by decreased internal rotation of the knee, at the point of heel strike. Ferber and colleagues (2) noted an increased inversion moment in the ITBS group which was suggested to control and limit the eversion moment. By comparison, currently symptomatic ITBS patients demonstrated a substantial difference compared to a control group with twice the rear foot motion during running (9).
Knee Internal Rotation
Peak internal rotation angle of the knee was found to be significantly greater in the ITBS patients when compared with controls at the point of heel strike (2). This research was supported by other studies who also found a significant effect for increased internal rotation of the knee following a run of moderate intensity to physical exhaustion(7). With excessive rotation comes compression due to increased strain of the ITB at the attachment.
An explanation of increased internal rotation of the knee was attributed to excessive external rotation of the femur perhaps due to shortening of the piriformis, gemellus inferior and superior and the obutrator externus (8). The authors added that excessive rotation at the hip might result from muscular activity of the rotators that were hip being the medius, minimus and the tensor fascia latae. These studies(2,7) were retrospective in design in that they tested healthy runners with a history of ITB pain, whereas(8) was a prospective study of patients with ITBS at the point of testing.
Hip Adduction Angle & Hip Abductor Strength
The hip adduction angle during the stance phase has been suggested to be greater. Ferber and colleagues(2) found that the peak hip adduction angle was significantly greater in the ITBS cohort and stated that with 95% confidence. Increased angle results in increased stress to the ITB and consequently increased compression at the lateral femoral condyle when combined with increased internal rotation of the tibia.
Figure 2 illustrates, when peak hip adduction and internal rotation combine, how this may result in increased the compression of the ITB at the lateral femoral condyle. Louw and Deary(3), however, stated that it remained inconclusive whether the peak hip adduction angle was a substantial element. Additional research is therefore required to support Ferber and colleagues'(2) initial findings as this study was a retrospective study carried out on healthy female runners with a history of ITBS.
Hip Abductor Strength
It’s been proposed that an increased peak hip adduction angle may coincide with hip abductor activity involving the gluteus medius in this group. During the stance phase of gait the gluteus medius functions to keep stability. Research has indicated that during stance the adduction forces can exceed three times an individual’s body weight(3). What’s more, it was stated that these forces were beyond the metabolic capacity of the gluteus medius to main pelvic stability during the stance phase using just this muscle alone(3).
Louw and Deary (3) were not able to identify a heightened hip abductor moment in the ITBS patients with increased peak hip adductor angles and suggested that it was more of an issue of timing as opposed to the size of the hip abductors. Louw and Deary (3) stated that the research is yet to examine trunk and pelvic movements in ITBS patients and it is plausible to suggest that biomechanical changes from higher up the kinetic chain has the potential to be a contributing element in ITBS etiology.
A research study of 24 (14 female, 10 male) patients with ITBS undertook a six-week rehabilitation programme to increase the strength of the hip abductors(10). Following six weeks of hip abductor strengthening to running 22 patients reported being pain-free and had returned. The female patients reported an average hip abductor torque increase of 34.9% and the male patients found 51.4% increase. However this study used a hand held dynamometer to measure isometric strength and therefore Fedricson (10) findings should be viewed with caution.
A more recent study assessed the hip abductor strength of currently symptomatic patients with healthy controls in a fixed position(11). The results indicated that no substantial differences occurred for static and dynamic hip abductor strength between the groups. Further research should look into the EMG and strength of the hip abductors in the role of managing ITBS. Table 1 shows of significance in the some of the variables of the studies used in this text.
Rehabilitation programs, following periods of immobilization and during, should include gluteal exercises to provide stability to the leg that is involved. If active exercises for the gluteal muscles are provided in a manner that is secure and effective then this can influence the period of transition from non weight. It’s prudent based on the research provided to date to develop function although research is lacking in terms of quality and volume as to the biomechanical influences on the etiology of ITBS. This guarantees that once load bearing commences that the leg that is involved has the stability and control that is active to keep the beginning of load of the ITB.
Summary
The recent review published by Louw and Deary(3) indicates that much of the research published within the literature depending on the etiology of ITBS is inconclusive. The level of research is relatively low and is based on retrospective trials. The research does indicate that knee biomechanics and abnormal hip is involved in the occurrence of ITBS. The authors ascertain that muscle strength is involved as is foot biomechanics that are abnormal. It is recommended that future research should measure kinematic movements of the hip and knee during downhill running as this is a complaint of ITBS onset.
References
1.Clini J of Sports Med, May 2006,16, (3), 261-268
2.J of Sports Phys Therap, Feb, 2010, 40, 2, 52-58.
3.Phys Therap in Sport, 2014, 15, 64 e75.
4.Surgic and Radiologic Anatomy (Dec) 2004; 26, (6), 433 – 446
5.Scand J of Med & Sci in Sports, Aug 2010, 20 (4), 580-587.
6.Clini Biomech, 2008, 23, 1018-1025.
7.Gait Posture. 2007 Sep, 26 (3), 407-13
8.Clini Biomech, Nov 2007, 22 (9), 951-956.
9.Med Sci in Sport & Ex, 1995, 27, 951-960.
10.Clini J of Sports Med, 2000, 10:169�175.
11. Int J of Sports Med, Jul, 2008, 29 (7), 579-583.
Spinal cord injury (SCI) can have many causes. The way a person’s injury affects them can differ depending on the origin of SCI. SCI can generally be described as being ‘traumatic’ or due to a trauma, or ‘non-traumatic’ being due to other causes.
Spinal cord injuries occur in an assortment of ways. In adults, damage to the spinal column is usually involved and the cord is affected, bruised, stretched or compacted due to movement or an external force. Wear and tear on the spinal column, can lead to narrowing of the canal called stenosis. This results in pressure on the spinal nerves and the spinal cord, causing loss of function. In children, a spinal cord injury occurs by an over-stretching of the spinal cord.
Automobile accidents involving pedestrians or occupants, falls, sport-related accidents and diving into shallow water are considered to be the most common cause of traumatic SCI.
Spinal cord damage can be caused by the following kinds of injuries:
Flexion Injuries
Flexion injuries occur when there is a forcible forward movement of the head. This results in injury to the vertebrae in the neck (cervical) area of the spinal column. The vertebrae then impact on the spinal cord, causing damage. Spinal ligaments are often torn. These types of injuries occur in auto accidents.
Rotation Injuries
Rotation injuries occur alongside an injury, often where there is rotation of the spinal column. This leads to an associated injury of the spinal cord. Ligaments are often torn where the side rotation injuries happen in automobile accidents. They can also occur with people in motorcycle accidents, and wearing lap seat belts.
Compression Injuries
Compression injuries occur in diving accidents, where the force is transmitted through the head; or falls from a height, where the force is transmitted through the base of the spine or limbs. Impact causes the vertebrae commonly in the cervical or lower thoracic and lumbar region, to fracture into pieces and protrude into the spinal canal, damaging the spinal cord. The discs may be displaced and protrude into the spinal canal.
Hyperextension Injuries
Hyperextension injuries occur during an incident, such as a fall, where the neck is extended in a backward direction, stretching the cord. The spinal cord is damaged by the opening up of the discs and stretching of the ligaments if there’s minimal damage to the spinal column. This injury is often seen in people, and those injured in assaults and auto accidents. Hyperextension of the neck is the way children damage their spinal cords. The force of the trauma causes stretching of the spinal cord, although there’s often no or little damage to the spinal column.
Penetrating Injuries
Penetrating injuries occur when the spinal cord is penetrated by an object such as a knife or bullet. This type of injury can occur at any level of the spinal column and is often not associated with column damage.
Whether an injury is caused by events that are traumatic or non-traumatic, a person with a SCI has the ability to benefit from a variety of treatment options and rehabilitation, performed by a qualified and experienced healthcare professional. Research has indicated that the outcomes for people with a SCI are better if they have rehabilitation in a specialist unit as opposed to a general rehabilitation unit.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Automobile Accident Injuries
Whiplash, among other automobile accident injuries, are frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. The sheer force of an impact can cause damage or injury to the cervical spine, as well as to the rest of the spine. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. Fortunately, a variety of treatments are available to treat automobile accident injuries.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
