Please watch this short video on Workload Management:

---

Simon Jiries
Ivy Rehab Physical Therapy, Head of Athletic Training
sportsmedicine@ivyrehab.com

Please watch this short video on Knee Injuries:

---

Simon Jiries
Ivy Rehab Physical Therapy, Head of Athletic Training
sportsmedicine@ivyrehab.com

Please watch this short video on ACL Tears:

---

Simon Jiries
Ivy Rehab Physical Therapy, Head of Athletic Training
sportsmedicine@ivyrehab.com

Please watch this short video on Shin Splints.

---

Simon Jiries
Ivy Rehab Physical Therapy, Head of Athletic Training
sportsmedicine@ivyrehab.com

Exercise has many proven health benefits and helps most bodily systems. But as with anything, moderation is crucial to avoid burnout, injury, or overtaxing the body. Many people find themselves in physical therapy for an overuse injury – and overtraining can be detrimental to your overall health and wellbeing. After months of running, passing, and shooting, the body, if not trained and rested properly, starts to wear out. In the world of competitive sports, there is a delicate balance between achieving optimal conditioning and overdoing it. 

Two common ways athletes burn themselves out is by training too much without allowing for proper rest, or by chronically under-fueling. The former also has to do with sleep deprivation. Many student-athletes have very poor sleeping habits, which has been linked to an increased risk of injury. School age children should aim for 9-12 hours of sleep, while teenagers should aim for 8-10 hours. As far as rest days, a general rule of thumb is to try for 1-2 a week, depending on intensity of competition. When it comes to training, more is not always better. Those rest days are crucial in allowing your body to heal and getting ready for the next practice/gameday. 

Finally, it’s important to make sure that you’re taking the time to eat well-balanced, fulfilling meals. Sometimes in a hurry, athletes will skip a meal or eat something small just to satisfy their hunger. Without proper nutrition, your body will not be able to recover correctly following intense workouts. Everyone’s recovery is different, but meeting these requirements is a great start to investing in your health and preventing overuse injuries.

For additional information please review THIS article on IvyRehab.com. 

Simon Jiries

Ivy Rehab Physical Therapy, Head of Athletic Training

sportsmedicine@ivyrehab.com

Sources:
Milewski MD, Skaggs DL, Bishop GA, Pace JL, Ibrahim DA, Wren TA, Barzdukas A. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014 Mar;34(2):129-33. doi: 10.1097/BPO.0000000000000151. PMID: 25028798.

Ankle sprains can be painful and debilitating, taking you out of the game or off the job for a few days or a few weeks. According to a review done by Ekstrand and Tropp, ankle sprains occur 1.7-2 times per 1,000 hours of soccer. This means that repetitive ankle sprains can be a big problem for soccer players. After spraining your ankle for the first time, it increases the likelihood of it happening again.

A sprain is an injury to ligaments. That initial ankle sprain causes micro-damage to the small ligaments in your foot and ankle whose jobs are to help provide stability to the joint. This micro-damage results in your ligaments getting stretched out or torn. Sprains range from mild to severe and can take days to several weeks to heal, depending on the extent of the injury to ligaments. Unfortunately, your ligaments are not elastic and do not shorten back to their original size after being damaged. They stay stretched out and loose. Walking off a step or curb or even an awkward landing playing soccer can lead to another sprain due to a weak or unstable ankle. In addition, many athletes return to their sport before the ankle is properly healed and rehabilitated.

So, what do you need to do if you sprain an ankle? The good news is that they are very treatable. A physical therapist or athletic trainer would take an athlete through an individualized program in which they focus on range of motion, strengthening, and neuromuscular balance. Additionally, getting the ankle taped or purchasing a brace may also help the athlete return to soccer activities. Most importantly, don’t wait to see if the pain goes away. Make sure to get it checked out so it can be treated properly.

Simon Jiries

Ivy Rehab Physical Therapy, Head of Athletic Training

sportsmedicine@ivyrehab.com

Sources: 
Ekstrand J, Tropp H. The incidence of ankle sprains in soccer. Foot Ankle. 1990 Aug;11(1):41-4. doi: 10.1177/107110079001100108. PMID: 2210532.
Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Brüggemann GP, Best R. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg. 2013 Aug;133(8):1129-41. doi: 10.1007/s00402-013-1742-5. Epub 2013 May 28. PMID: 23712708; PMCID: PMC3718986

The period in time after getting injured can be confusing and scary for athletes. When you have an issue with your bones, tendons, ligaments, or muscles, your doctor may have you get an imaging test to help diagnose your injury. There are several different tools that we use to do this including X-rays, MRIs, CT scans, and high-resolution ultrasound. Here’s what you need to know about them:

X-rays use a burst of radiation that get absorbed by certain structures in your body. This creates a glowing image that can show your doctor whether you have any fractures or bony defects. X-rays are a very quick and comfortable test. 

Magnetic resonance imaging, or MRIs, use magnetic fields to create a 3D image of your affected joint. This is one of the most commonly ordered tests to look for cartilage or other musculoskeletal damage. It gives us a more detailed picture than an X-ray. It is also preferred because the scan can get deeper and larger images than an ultrasound. MRIs typically involve you laying down in a tubular machine for 45min-1hour. 

Diagnostic ultrasound uses high-frequency sound waves to create images of your tissue. The ultrasound can also be used to help guide injections. Typically, this takes anywhere from 30 minutes to an hour and is harmless due to the lack of radiation. Ultrasound is less commonly ordered because it can’t penetrate as deep as an MRI and is not able to take as large of an image. For joint injuries, MRI is still the scan of choice.

Computed Tomography, or CT scans, has the patient laying in a tube, similar to the MRI, which then uses a series of X-rays to create cross-section images. CT scans are more expensive and use more radiation than a simple X-ray so they are only ordered when necessary. Often used to see fractures, severe head/other traumatic injuries.

Simon Jiries

Ivy Rehab Physical Therapy, Head of Athletic Training

sportsmedicine@ivyrehab.com

As a soccer player, I’m sure you’ve been lectured over and over again about how important warm-ups (WU) are. But what makes a good WU? This can be challenging to answer because no two WUs are the same. The goal of a soccer WU is to prepare you for the movements necessary during practice/games. Just doing static stretches (ex: toe touches or calf stretch) or running a couple of laps is not sufficient enough for athletes to prevent injury or prepare for their sport. Ideally, it should be a mix of dynamic stretches, agility, light exercises, and soccer movements essential to your position. It is also important to keep these WUs short and sweet. A good rule of thumb for warming up pre-practice is to keep it between 10-20 minutes. This will prevent fatigue as well as ensure that you are receiving the proper benefits of that WU. It is also a good idea to start practicing as soon as possible because waiting longer than 15 minutes can hamper any benefit you might receive from a WU. 

How effective are WUs at preventing injury? A proper neuromuscular WU is much more advantageous than a low-effort one. One study from Al Attar et al claims that the WU developed by FIFA reduces injury rates by anywhere from 20-50%. Another study from Grooms et al followed a collegiate soccer team for two seasons and found that they had a 72% injury reduction with the FIFA 11+ program. Studies have also shown that WUs are important prior to practices/games for movement performance. Silva et al found increased performance with WUs before various activities such as running, jumping, and kicking. 

Investing in a quality warmup program can save you time and money on potential injuries. Take the time to learn the movements, perform them well, and you will feel more prepared during practices/games. 

Simon Jiries

Ivy Rehab Physical Therapy, Head of Athletic Training

sportsmedicine@ivyrehab.com

References: 

1. Al Attar WS, Soomro N, Pappas E, Sinclair PJ, Sanders RH. How Effective are F-MARC Injury Prevention Programs for Soccer Players? A Systematic Review and Meta-Analysis. Sports Med. 2016 Feb;46(2):205-17. doi: 10.1007/s40279-015-0404-x. PMID: 26403470.

2. Grooms DR, Palmer T, Onate JA, Myer GD, Grindstaff T. Soccer-specific warm-up and lower extremity injury rates in collegiate male soccer players. J Athl Train. 2013 Nov-Dec;48(6):782-9. doi: 10.4085/1062-6050-48.4.08. Epub 2013 Jul 12. PMID: 23848519; PMCID: PMC3867089.

3. Silva LM, Neiva HP, Marques MC, Izquierdo M, Marinho DA. Effects of Warm-Up, Post-Warm-Up, and Re-Warm-Up Strategies on Explosive Efforts in Team Sports: A Systematic Review. Sports Med. 2018 Oct;48(10):2285-2299. doi: 10.1007/s40279-018-0958-5. PMID: 29968230. 

One of the most common injury areas in sport is the knee complex. With growing awareness of knee injury due to social media, professional sports, and increased sport participation more research has been provided to identify potential risk factors. In recent years proximal hip strength has been shown to correlate with potential knee injury.

A theory that hip abductor weakness and hip external rotator weakness relating to knee pain has been described in multiple articles. According to Powers, C., excessive hip internal rotation and adduction can create a distal knee valgus force. This valgus force collapses the knee inwards thus creating excess medial shearing at the knee. (1) Proximal strengthening at the hip has been theorized to potentially decrease distal forces at the knee.

A systematic review by Peters and Tyson in 2013 identified eight studies discussing patellafemoral pain syndrome and hip strengthening. All eight studies utilizing hip strengthening were found to be effective in reducing pain and improving function, while only 80% of knee strengthening programs were found to reduce pain. (2) This systematic review provides evidence that hip strengthening may reduce pain and improve function in patients suffering from knee pain.

A second systematic review conducted by Santos, Oliveira, Ocarino, Holt, and Fonseca in 2015 discussed the effectiveness of hip strengthening in patellafemoral pain syndrome. Seven studies were included. (3) All studies demonstrated pain reduction with hip strengthening, and five studies were shown to improve function.

Although a complex diagnosis, knee pain may benefit from interventions utilizing hip and core strengthening. A complete “lower-extremity chain” approach should be taken when treating knee pain in formal physical therapy. 
 

Eriks Zusevics

Ivy Rehab Physical Therapy, Physical Therapist

sportsmedicine@ivyrehab.com

References:
1. Powers, C. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. Journal of Orthopaedic & Sports Physical Therapy. 2010; 40(2): 42–51

2. Peters, J. and Tyson, N. Proximal exercises are effective in treating patellafemoral pain syndrome: a systematic review. Int J Sports Phys Ther. 2013 Oct; 8(5): 689–700.

3. Santos, T., Oliveria, B., Ocarino, J., Holt, K., and Fonseca, S. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review. Braz J Phys Ther. 2015 May-Jun; 19(3): 167–176.

When I think of recovery, I consider it as getting over something or getting back to my normal self. According to Dictornary.com, recovery means, “The regaining of or the possibility of regaining something lost or taken away, restoration or return to health from sickness or to any former and better state or condition.” With this definition in mind, how does recovery play into post-exercise? An athlete's post-exercise routine may consist of stretching, as stretching can be helpful in our recovery process. According to Harvard Health “stretching keeps the muscles flexible, strong, and healthy, and we need that flexibility to maintain a range of motion in the joints. Without it, the muscles shorten and become tight. Then, when you call on the muscles for activity, they are weak and unable to extend all the way. That puts you at risk for joint pain, strains, and muscle damage.” Stretching is not only beneficial for our muscles but it is helpful in our overall well-being. According to the American Council on Exercise, stretching can “decrease stress, reduce pain and stiffness, improve health, enhance range of motion, improve function, may reduce risk of injury, enhance performance, improve blood flow and circulation, minimize wear and tear on joints, and improve quality of life.”

In a recent systematic review article from Frontiers in Physiology, a study was conducted on evaluating the impact of recovery techniques on delayed onset muscle soreness (DOMS), which is perceived fatigue, muscle damage, and inflammatory markers after physical activity. They examined massage, compressive garments, water immersion, electrostimulation, stretching, anti-inflammatory interventions relying on cold exposure such as cryotherapy, and active recovery such as a low impact form of exercise like riding a stationary bike or swimming. At the conclusion of the study it was found that massage seemed to be most effective for both DOMS and perceived fatigue while massage and cold exposure such as water immersion and cryotherapy helped with inflammation. I would suggest an athlete devote time to stretching post-exercise as well as using a foam roller, assuming they are unable to get a massage, in order to maximize recovery and relieve soreness in their muscles. If cold water immersion or cryotherapy is not available, considering following the stretches and foam rolling with icing using a cold pack.

Ultimately, we know stretching can help with muscle soreness and flexibility, but it should not be painful, and it will not prevent against injuries on its own. Some other topics to keep in mind beside stretching for post-exercise recovery are hydration, diet/nutrition, and sleep. Drinking half of your body weight in ounces is recommended in staying hydrated which can aid with muscle soreness. Making sure you have a balanced diet that consist of complex carbs, good fats, and protein will not only help get you through a practice or game, but can aid in muscle recovery and overall brain function. Getting 6-8 hours of sleep will help in mental and physiological recovery which assists with complete full body recovery. If you have any questions regarding the information presented here, please reach out to me through our email listed below.

April Locke, ATC

Ivy Rehab Physical Therapy, Head of Athletic Training

sportsmedicine@ivyrehab.com

References:

Dictionary.Com. 2020 January. https://www.dictionary.com/browse/recovery?s=t

The Importance of Stretching. Harvard Health Publishing. 2019 September 25. https://www.health.harvard.edu/staying-healthy/the-importance-of-stretching

Matthews, Jessica. 10 Reasons Why You Should Be Stretching. American Council on Exercise. 2017 April 19. https://www.acefitness.org/education-and-resources/professional/expert-articles/6387/10-reasons-why-you-should-be-stretching

Dupuy O., Duzi W., Theurot D., Bosquet L., and Dugue B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Frontiers in Physiology. 2018 April 26. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931?pg=2&reDate=21012020

Youth concussion awareness has gained considerable interest in the past 10+ years due to an increase in youth sport participation and media presence.  According to a study by Tsushima, Siu, Ahn, Chang, and Murata in February 2019, the overall incidence of concussion was 12.1% in a sample of over 10,000 youth athletes participating in five different sports.1  Furthermore, researchers determined that females were at a one and a half times higher risk than males.1 Tsushima et.al. also stated that athletes with a previous history of a concussion were three to five times more likely to receive a second concussion versus those without a history.1

Concussions result as a direct or indirect blow to one’s head causing the mildest form of a traumatic brain injury.2,3  Rapid acceleration and deceleration of the brain causes a cascade of neurochemical changes that alters one’s mental status.2,3  Although most concussions within youth sports resolve within three to five days, a minority of cases can last for multiple weeks or months.  

A study performed by Colven, Mullen, and Lovell in 2009 described differences in groups between youth males and females having a history of one or more concussions.  141 females and 93 males ranging from eight to 24 years old recently diagnosed with a concussion were included in this study.4  ImPACT testing consisting of reaction time, memory, and visual motor-speed exams were utilized and compared.4  Significant differences were noted as females scored worse on neurocognitive testing and reported increased negative subjective symptoms versus males.4  Furthermore, females with a history of a prior concussion performed significantly worse on ImPACT testing that those who did not.4

This research supports evidence that high-school-aged females may require a longer period of time to return to baseline function, especially those with a previous history of a concussion.  Return to school functions, physical activity, and return to sport should be adjusted accordingly to accommodate these factors.  Initial treatment should consist of rest followed by a gradual return to physical and cognitive activity.    

1. William T Tsushima, Andrea M Siu, Hyeong Jun Ahn, Bolin L Chang, and Nathan M Murata.  Incidence and Risk of Concussions in Youth Athletes: Comparisons of Age, Sex, Concussion History, Sport, and Football Position.  Arch Clin Neuropsychol. 2019 Feb; 34(1): 60–69.

2. Christopher C. Gizacorresponding author and David A. Hovda.  The Neurometabolic Cascade of Concussion.  J Athl Train. 2001 Jul-Sep; 36(3): 228–235.

3. William J. Mullally.  Concussion.  The American Journal of Medicine.  2017 August; 130(8): 885-892

4. Colvin AC1, Mullen J, Lovell MR, West RV, Collins MW, Groh M.  The role of concussion history and gender in recovery from soccer-related concussion.  Am J Sports Med. 2009 Sep;37(9):1699-704