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
Two surgeons discuss the diagnosis and treatment of acromioclavicular injuries in athletes. El Paso, TX. Chiropractor, Dr. Alexander Jimenez follows the discussion.
Acromioclavicular (AC) joint injuries most often occur in athletic young adults involved in collision sports, throwing sports, along with overhead activities like upper-extremity strength training. They account for 3% of all shoulder injuries and 40% of shoulder sports injuries. Athletes in their second and third decade of life are more often affected(1), and men are injured more commonly than women (5:1 to 10:1)(1,2).
Acromioclavicular dislocation was known as early as 400 BC by Hippocrates(3). He cautioned against mistaking it for glenohumeral (shoulder joint) dislocation and advocated treating with a compressive bandage in an attempt to hold the distal (outer) end of the clavicle in a diminished position. Almost 600 decades later Galen (129 AD) recognized his own acromioclavicular dislocation, which he sustained while wrestling(3). He left the tight bandage holding the clavicle down as it was too uneasy. In today’s era this injury is better known, but its treatment remains a source of fantastic controversy.
Anatomy
The acromioclavicular joint combines the collarbone to the shoulder blade and therefore links the arm to the axial skeleton. The articular surfaces are originally hyaline cartilage, which affects to fibrocartilage toward the end of adolescence. The average joint size is 9mm by 19mm(4). The acromioclavicular joint contains an intra-articular, fibrocartilaginous disc which may be complete or partial (meniscoid). This helps absorb forces in compression. There is marked variability in the plane of the joint.
Stabilizers
There is little inherent bony stability in the AC joint. Stability is provided by the dynamic stabilizers — namely, the anterior deltoid muscle arising from the clavicle and the trapezius muscle arising from the acromion.
Additionally, there are ligamentous stabilizers. The AC ligaments are divided into four — superior, inferior, anterior and posterior. The superior is most powerful and blends with muscles. The acromioclavicular ligaments contribute around two- thirds of the constraining force to superior and posterior displacement; however, with greater displacement the coracoclavicular ligaments contribute the major share of the resistance. The coracoclavicular ligament consists of the conoid and trapezoid. The conoid ligament is fan-shaped and resists forwards motion of the scapula, while the more powerful trapezoid ligament is level and resists backward movement. The coracoclavicular ligament helps bunch scapular and glenohumeral (shoulder joint) motion and the interspace averages 1.3 cm.
Mechanism Of Injury
The athlete who sustains an acromioclavicular injury commonly reports either one of two mechanisms of harm: direct or indirect.
Direct force: This is when the athlete falls onto the point of the shoulder, with the arm usually at the side and adducted. The force drives the acromion downwards and medially. Nielsen(5) found that 70 percent of acromioclavicular joint injuries are caused by an direct injury.
Indirect force: This is when the athlete falls onto an outstretched arm. The pressure is transmitted via the humeral head into the acromion, therefore the acromioclavicular ligament is disrupted and the coracoclavicular ligament is stretched.
On Examination
The athlete presents soon after the severe injury with his arm splinted to his side. The patient may state that the arm feels better using superiorly directed support on the arm. Most motions are limited secondary to pain near the top of the shoulder; the degree varies with the grade of sprain. The hallmark finding is localized swelling and tenderness over the acromioclavicular joint.
In dislocations, the outer part of the collarbone will appear superiorly displaced using a noticeable step deformity (in fact, it is the shoulder which sags beneath the clavicle). Occasionally, the deformity may only be apparent later, if first muscle spasm reduces acromioclavicular separation. Forced cross-body adduction (yanking the affected arm across the opposite shoulder) provokes discomfort. The clavicle can frequently be moved relative to the acromion.
Acromioclavicular Visualisation
The typical joint width measures 1-3mm. It’s regarded as abnormal if it is more than 7mm in men, and 6mm in women. Routine anteroposterior views of the shoulder reveal the glenohumeral jointnonetheless, that the acromioclavicular joint is over penetrated and so dark to interpret. Reduced exposure enhances visualization. The individual stands with both arms hanging unsupported, both acromioclavicular joints on one film. Weighted viewpoints (stress X-rays) are obtained with 10-15 lb weights not held but suspended from the individual’s wrists. They help differentiate type II-III injuries, but are of little clinical significance and therefore are no longer recommended in our practice.
Classification Of AC Separation
The importance of identifying the injury kind can’t be over emphasized because the treatment and prognosis hinge on an accurate diagnosis. The injuries are graded on the basis of that ligaments are injured and how badly they’re torn.
Allman (6) classified acromioclavicular sprains as grades I, II and III, representing respectively, no involvement, partial tearing, and total disruption of the coracoclavicular ligaments. More recently, Rockwood (1) has further classified the more severe injuries as standard III-VI.
The injuries are classified into six categories:
Type I This is the most common injury encountered. Only a mild force is needed to sustain such an injury. The acromioclavicular ligament is sprained with an intact coracoclavicular ligament. The acromioclavicular joint remains stable and symptoms resolve in seven to 10 days. This injury has an excellent prognosis.
Type II The coracoclavicular ligaments are sprained; however, the acromioclavicular ligaments are ruptured. Most players can return to their sport within three weeks. There is anecdotal evidence to suggest that steroid injections into the acromioclavicular joint speed up the resolution of symptoms, but this practice is not universal.
Type III The acromioclavicular joint capsule and coracoclavicular ligaments are completely disrupted. The coracoclavicular interspace is 25-100% greater than the normal shoulder.
Type IV This is a type III injury with avulsion of the coracoclavicular ligament from the clavicle, with the distal clavicle displaced posteriorly into or through the trapezius.
Type V This is type III but with exaggeration of the vertical displacement of the clavicle from the scapula-coracoclavicular interspace 100-300% greater than the normal side, with the clavicle in a subcutaneous position.
Type VI This is a rare injury. This is type III with inferior dislocation of the lateral end of the clavicle below the coracoid
Treatment
The treatment of acromioclavicular joint injuries varies based on the seriousness or grade of the injury.
Initial treatment: These can be quite painful injuries. Ice packs, anti-inflammatories plus a sling are utilized to immobilize the shoulder and then take the weight of the arm. As pain starts to subside, it is important to start moving the fingers, wrist and elbow to prevent shoulder stiffness. Next, it’s important to begin shoulder motion in order to stop shoulder stiffness.
Un-displaced injuries only require rest, ice, and then a slow return to activity over two to six weeks. Major dislocations require surgical stabilization in athletes if their dominant arm is involved, and if they participate in upper-limb sports
Type I & II: Ice pack, anti-inflammatory agents and a sling are used. Early motion based on symptoms is introduced. Pain usually subsides in about 10 days. Range-of-motion exercises and strength training to restore normal motion and strength are instituted as the patient�s symptoms permit. Some symptoms may be relieved by taping (taking stress off acromioclavicular joint). The length of time needed to regain full motion and function depends upon the severity or grade of the injury. The sport and the position played determine when a player can return to a sporting activity. A football player, who does not have to elevate his arm, can return sooner than a tennis or rugby player. When a patient returns to practice and competition in collision sports, protection of the acromioclavicular joint with special padding is important. A simple �doughnut� cut from foam or felt padding can provide effective protection. Special shoulder- injury pads, or off-the-shelf shoulder orthoses, can be used to protect the acromioclavicular joint after injury.
Some Type II injuries may develop late degenerative joint changes and will need a resection of the distal end of the clavicle for pain relief. It is important to note that after a resection of the distal end of the clavicle, particularly in a throwing athlete, there may be formation of heterotopic bone on the under surface of the clavicle which can cause a painful syndrome which presents like shoulder impingement.
Type III: The treatment of type III injury is less controversial than in past years. In the 1970s, most orthopaedic surgeons recommended surgery for type III acromioclavicular sprains(7). By 1991, most type III injuries were treated conservatively(8). This change in treatment philosophy was prompted by a series of retrospective studies(9). These showed no outcome differences between operative and nonoperative groups.
What’s more, the patients treated non-operatively returned to full activity (work or athletics) earlier than surgically treated groups(10, 11). The exceptions to this recommendation include people who perform repetitive, heavy lifting, people who operate with their arms above 90 degrees, and thin patients who have prominent lateral ends of the clavicles. These patients may benefit from surgical repair(12).
Any discussion about the management of acute injuries to the AC joint must deal with which of the many methods of surgical therapy described is the best for their situation, but whether surgery should be considered at all. Surgery is generally avoided in athletes participating in contact sports since they will often re-injure the shoulder later on.
Type IV-VI: Account for more than 10-15% of total acromioclavicular dislocations and should be managed surgically. Failure to reduce and fix these will lead to chronic pain and dysfunction.
Surgery
Surgical repair can be divided into anatomical or non- anatomical, or historically into four types:
? Coracoclavicular repairs (Bosworth screws(13), cerclage, Copeland and Kessel repair).
? Distal clavicular excision.
? Dynamic muscle transfers.
? Disadvantages of surgery are that there are risks of infection, a longer time to return to full function and continued pain in some cases.
For the individual with a chronic AC joint dislocation or subluxation that remains painful after three to six months of closed treatment and rehabilitation, surgery is indicated to improve functioning and comfort.
For sequelae of untreated type IV-VI, or painful type II and III injuries, the Weaver Dunn technique is advocated. This�entails removing the lateral 2cm of the clavicle and reattaching the acromial end of the coracoacromial ligament to the cut end of the clavicle, thus reducing the clavicle to a more anatomical position.
Postoperatively, the arm is supported in a sling for up to six weeks. Following the first two weeks, the patient is permitted to use the arm for daily activities at waist level. After six weeks, the sling or orthosis is discontinued, overhead actions are allowed, formal passive stretching is instituted, and light stretching using elastic straps is initiated. Stretching and strengthening are begun slowly and gradually. The athlete shouldn’t return to their sport without restriction until full strength and range of motion has been recovered. This usually occurs four to six months following operation.
Conclusion
AC joint injuries are an important source of pain at the shoulder area and have to be assessed carefully. The management of these injuries is nonoperative in the majority of cases. Type I and II injuries are treated symptomatically. The present trend in uncomplicated type III injuries are a non operative strategy. In the event the athlete develops following problems, a delayed reconstruction might be undertaken. In athletes involved in heavy lifting or prolonged overhead activities, surgery may be considered acutely. Type IV-VI injuries are generally treated operatively.
No matter what kind of treatment is chosen, the ultimate purpose is to restore painless function to the wounded AC joint so as to reunite the athlete safely and as quickly as possible back to their sport. It is possible in the vast majority of acromioclavicular joint injuries.
References
Reza Jenabzadeh and Fares Haddad
1. Rockwood CA Jr, Williams GR, Young CD. Injuries of the Acromioclavicular Joint. In CA Rockwood Jr, et al (eds), Fractures in Adults. Philadelphia: Lippincott-Raven, 1996; 1341-1431.
2. Dias JJ, Greg PJ. Acromioclavicular Joint Injuries in Sport: Recommendations for Treatment. Sports Medicine 1991; 11: 125-32.
3. Adams FL. The Genuine Works of Hippocrates (Vols 1,2). New York, William Wood 1886.
4. Bosworth BM. Complete Acromioclavicular Dislocation. N Eng J Med 2 41: 221-225,1949.
5. Nielsen WB. Injury to the Acromioclavicular Joint. J Bone Joint Surg 1963; 45B:434-9.
6. Allman FL Jr. Fractures and Ligamentous Injuries of the Clavicle and its Articulation. J Bone Joint Surg Am 1967;
49:774- 784.
7. Powers JA, Bach PJ: Acromioclavicular Separations: Closed or Open Treatment? Clin Orthop 1974; 104 (Oct): 213-223
8. Cox JS: Current Methods of Treatment of Acromioclavicular Joint Dislocations. Orthopaedics 1992; 15(9): 1041-1044
9. Clarke HD, Mc Cann PD: Acromioclavicular Joint Injuries. Orthop Clin North Am 2000; 31(2): 177-187
10. Press J, Zuckerman JD, Gallagher M, et al: Treatment of Grade III Acromioclavicular Separations: Operative versus
Nonoperative Management. Bull Hosp Jt Dis 1997;56(2):77-83
11. Galpin RD, Hawkins RJ, Grainger RW: A Comparative Analysis of Operative versus Nonoperative Treatment of Grade III Acromioclavicular Separations. Clin Orthop 1985; 193 (Mar): 150-155
12. Larsen E, Bjerg-Nielsen A, Christensen P: Conservative or Surgical Treatment of AC Dislocation: A Prospective, Controlled, Randomized Study. J Bone Joint Surg Am 1986;68(4):552-555
13. Bosworth BM. Complete Acromioclavicular Dislocation. N Engl. J. Med. 241: 221-225,1949.
Return to play describes the stage in recovery from a sports injury when an athlete is able to go back to playing sports or participate in their specific physical activity at a pre-injury level.
Nobody likes to be sidelined with an undesired injury. Among the goals of sports medicine professionals and specialists is to try to restore an athlete back to action. Returning too soon, however before restoration or healing has taken place, can put an athlete at an increased risk for re-injury and down time.
With the ideal treatment and care plan for sport accidents and injury, from early identification and proper treatment to full functional rehabilitation, you can often safely accelerate your return to perform.
Lessons from Professional Athletes
Why does it seem that professional athletes come back to play so much quicker than the normal person or athlete? Professional athletes are often, at the time of injury, in tremendously good physical conditioning. This fitness level helps them in various ways. Various studies have demonstrated that conditioning the body properly can not only prevent injuries, it may also lessen the severity of an injury and speed up recovery.
Professional athletes also get prompt treatment once an injury happens, and this lessens the acute phase of the injury. Treatment and care is required as soon as an injury followed by symptoms such as, stiffness, swelling, and loss of muscle tone manifest. In addition, professional athletes work hard with a physical therapist or certified athletic trainer.
Many professional athletes contribute their healing to exactly what they bring to their game,a positive attitude. You are able to harness the power of a positive mindset to your own benefit, even though you may not have access to the tools that professional athletes possess.
Advice from the Pros to Boost Your Recovery
Maintain balanced physical conditioning
Make Sure injuries are recognized early and treated promptly
Participate in a complete functional rehabilitation program
Stay healthy while injured
Keep a positive, upbeat mental attitude
Proper Athletic Treatment Recovery Plan
Phases of Care
Recovery from an injury involves a set of logical steps from the time of the injury until you are able to return on the field or court. Every step should be summarized and monitored by your physician and therapist.
During the acute phase of injury, the focus should be on minimizing swelling. This entails the RICE formula (Rest, Ice, Compression, and Elevation), Together with a limitation of actions. Based on the type and severity of your injury, treatment may involve casting, or bracing and surgery in more serious cases.
During the acute period, it’s extremely important to keep overall conditioning while the injury heals. Creative techniques may be used to safely work around the injury. As an example, a runner with a leg injury may often run in plain water or use a bicycle to keep conditioning. By doing exercises if one leg is in a cast, the remainder of the human body can be exercised. Don’t wait till your injury is treated to get back into shape.
In another phase of recovery, you should focus on regaining full motion and strength of the injured limb or joint. Your doctor, physical therapist or certified athletic trainer will help outline an exact treatment plan. For injuries, gentle protective exercises can be started almost immediately. Muscle tone may be preserved by means of strengthening exercises or electric stimulation.
When strength returns to normal, functional drills could be started. For lower extremity injuries, this may include brisk walking, jumping rope, hopping, or light jogging. For upper extremity injuries, effortless ground strokes or light throwing could be carried out. The coordination that might have been lost in the injury can be brought back by specific exercises for agility and balance.
Once you have progressed with mobility, endurance, strength, and agility, and are tolerating functional exercises, you can try higher levels of sport-specific movement routines. Your physical therapist or certified athletic trainer monitors this. You could find that tape, braces, or supports help in this transition time.
Only when you are practicing hard without significant problem, and the healing has progressed to the point at which the probability of injury or harm is reduced, are you ready to return to play. During these phases of recovery, you ought to be carefully monitored. Special attention ought to be given to sufficient warm up following the activity prior to the activity and icing after engaging in the specific sport or physical activity.
Note Of Caution
The rational progression of recovery not only reduces the chance of re-injury but also assures that you will be able to perform at your best when you return to play. Frequently, athletes believe they are all set to return as soon as the limp or even the swelling subsides. They might feel good, but they are probably just 70 to 75% recovered. This invites re-injury.
Sports medicine experts are working on approaches to assist athletes to achieve near 100% healing as fast as the proper cautionary measures allows. The athlete’s health and safety has to be put over all other concerns, although there is enormous pressure to get the athlete back whenever possible.
A systematic recovery program has been successfully utilized every day, at all levels of play, from the recreational athlete to the elite professional or Olympic athlete, by a variety of specialized healthcare professionals. As with any type of sports injury, seek immediate medical attention from a qualified specialist to begin the rehabilitation process.
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.
BFR or blood flow restriction therapy has been around for a long time, but recently, the evidence for its use in the world that is rehabilitation has begun to emerge. The principle is very simple: that the circulation of blood flow is confined to the area of the human body that’s being trained or undergoing rehabilitation in a certain manner to boost the impacts of the training via lower load (less stress).
Is Blood Flow Restriction Effective?
According to the American College of Sports Medicine, to achieve an increase in muscle size and strength, you want to do 8 to 10 repetitions of an exercise. A moderate to high intensity is deemed to be 65 to 80 percent of their patient’s one rep maximum (the maximum amount of weight a person can lift 1 time). However, the majority of patients that are injured can’t deal with this kind of load, consequently restricting their capacity.
So again we’re faced with the question: Just how can we achieve hypertrophy and gain muscle strength without using heavy loads? The solution involves using a tourniquet to restrict blood flow into a muscle. This technique is known as blood flow restriction training (BFR).
According to the most recent research in the event the appropriate blood flow restriction therapy protocols are utilized, the benefits of the training are equal to those found when using 70 percent of an individual’s maximal load, while using as little as 20 to 30 percent of somebody’s maximum load. The secret is that restricted blood flow training allows healthcare professionals, such as physical therapists, to make a localized region of exercise that is anaerobic.
BFR is a tool that uses a doppler and tourniquet system placed on either thigh or the upper arm to limit blood circulation. After this, it begins to create lactate and hydrogen ions and denies the muscle oxygen. This is what causes the “burning” feeling when we lift heavy weights. The burn is simply the response to being in an active environment of the body. During heavy lifting (65-85%), we create small microtraumas in the muscle that the body then repairs by building more muscle. Together with BFR, we are not generating microtraumas at the muscle, so our body does not have to devote the energy to repair the muscle; rather our bodies just focus on creating the muscle.
Second, soreness is not experienced by us as we would when we were lifting weights. This means we can now lift at low loads (15-30%) and basically gain more muscle strength and size, at a quicker manner, as if we were lifting a more heavier load.
As soon as we create lactate, we activate growth hormone release. The release of IGF-1 subsequently stimulates once growth hormone is released. Such enables your muscles ability to activate; this in turn increases muscle protein synthesis, or our stem cells to the muscle. As previously mentioned, if we were to have muscle breakdown, these stem cells could have to concentrate on repairing muscles building. With blood flow restriction therapy or training, we skip the muscle repair and focus on muscle building. This result is not concentrated throughout the exercise, but impacts the tissues and muscles to create the greater benefit of BFR. BFR has shown to have the ability to help in endurance training and coaching, tendon healing and bone recovery.
All of our muscles are produced from other kinds of fibers, including type 1 which are slow to twitch and rely on oxygen and type 2, which are those we’re currently attempting to build with BFR training and fast-twitch fibers. By limiting the blood flow, we create an environment at the muscle group that compels the increase of more fibers that are type 2. Higher strength gains are the outcome because these type 2 fibers normally can produce more force. Another effect of blood flow restriction is that is allows for a synthesis of proteins needed to build and repair muscles and tissues.
In a treatment setting, this helps us achieve the outcomes for patients faster, and in sports it enables the gains to be attained with less strength and less damage to the muscle. That is why pro and college teams are currently turning to BFR as a training principle. In sports, athletes are attempting to come back to the field quicker after suffering trauma or injury from an accident. Some athletes re-injure themselves by lifting. That is really where BFR can come by lifting loads that are lower and receiving the same, or even much better profits. Healthcare specialists will tend to eliminate strength immediately following a sports injury, but they can not exercise at elevated levels. In this manner, they can not only keep the power but build strength in the process although together with blood flow restriction training.
Is Blood Flow Restriction Safe?
You might be thinking that its effects sounds fantastic, but is it safe? The brief answer is yes, but as with any rehab technique, there are precautions which should be taken and it’s recommended to first seek medical attention from a healthcare professional to discuss the option of BFR therapy for you. We certainly don’t recommend that individuals do this by themselves and tie bands around their limbs. In the practice, specialists can track it as you train and use special devices to know exactly how much you need to train to experience its benefits.
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.
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.
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