The Importance of Accelerated’s Concussion Return to Play Program

 

Paul Schroeder

You may have heard about the recent uproar concerning University of Michigan coach Brady Hoke sending his quarterback Shane Morris back into a game after suffering a concussion. If you haven’t, check out the gif below:

Shane Morris hit under the chin

Within seconds of being hit, Morris exhibited symptoms of a concussion; he was unsteady on his feet and leaned on another player for support. Due to miscommunications on the parts of coaches, trainers and refs, Morris returned to the game. In the aftermath of this event, students and fans protested in front of University of Michigan president Mark Schlissel’s house demanding changes to the university’s athletic department. In response, Schlissel demanded a reevaluation of the athletic department and a review of safety procedures.

University of Michigan fans and students were right to be concerned for their quarterback’s—and all players’— safety. When an athlete sustains a concussion, it is imperative to provide for cognitive rest to allow for full resolution of symptoms. After the athlete remains symptom-free for 24 hours, it is not only the best evidence-based practice, but also state law to undergo exposure to various challenges before it is safe to obtain medical clearance for safe return to full sport participation. Just because symptoms disappear for 24 hours does not mean that they will not reoccur over the course of the Return to Play (RTP) protocol. The challenges included in the protocol are incremental and daily exposure to the cardiovascular, vestibular/balance, oculomotor, and cognitive systems over the course of several days.

The RTP protocol contains 7 phases:

Phase 1 includes cognitive rest. Phase 1 lasts as long as it takes for symptoms to completely disappear.  85% of concussion cases become symptom-free within 2 weeks; most symptoms subside within 2-3 days. Upon being totally free of any post-concussive symptoms, phases 2 through 7 are intended to occur on 6 successive days. Over the course of these 6 days, the degree of exertion of all above listed body systems is increased and challenged simultaneously.

Phase 2, corresponds to Clinic Day One, which includes light aerobic activity.

Phase 3, or Clinic Day Two, increases cardiovascular loading and adds body weight resistance.

Phase 4, or Clinic Day Three, incorporates dynamic movement, circuit training, head and body position changes, and initiates sports-specific movements, as well as concomitant cognitive loading.

Phase 5, or Clinic Day Four, advances dynamic sport movements and drills, cognitive loading, balance and vestibular challenges, and multiple-task activities.

Phase 6 takes place outside the PT clinic with a Certified Athletic Trainer (ATC) and the team during full-contact practice.

Phase 7 is return to game play.

It is important to understand that in order to safely progress to each successive stage, the athlete needs to be completely SYMPTOM-FREE.

The primary advantage of going through an RTP program in the clinic is the ability for the physical therapist (PT) to closely monitor the patient in a one-on-one, real-time environment. The PT is ideally suited with training in neurological, vestibular, cardiovascular, orthopedic, and balance systems to design and monitor progression through the various phases. Though RTP protocols administered by ATCs, coaches, or parents do occur, they are less than ideal from a perspective of both resources and training. In my opinion, the goal of a thorough RTP program is to sift through the “false positives” that would otherwise indicate a clearing for return to play. This is especially important in a program carried out by someone who has +30 athletes to monitor or by someone who lacks the necessary medical training in coaxing out latent symptoms.

__________________________

Accelerated Rehabilitation Centers offers full-spectrum concussion management services, which includes the RTP Program.

Paul Schroeder is an MPT, CSCS at Accelerated Rehab—Lincoln Park, IL. While owning and operating his own clinic six years ago, Paul developed the RTP Concussion Management Program. He has received training from some of the nation’s top concussion institutions including University of Pittsburgh Medical Center (UPMC), UCLA, Children’s Hospital of Philadelphia (CHOP), and Princeton University. As Accelerated Rehab’s RTP Coordinator, he has appeared on ESPN Sports Medicine Weekly Radio with Dr. Brian Cole, SCORE Values Radio with Dr. Jeffrey Mjaanes, and in the Chicago Sun Times discussing detection, education, and management of concussion injuries. Paul is celebrating three years at Accelerated Rehab. For more information about Paul’s RTP Program, visit our website.

Accelerated Staffers take Marathons, Half Marathons, and Triathlons in Stride This Fall

Accelerated staffers take marathons, half marathons and triathlons in stride this fall

When you’re in the business of taking care of injured athletes, finding time for your own fitness can be challenging…especially when you’re training for a marathon, half marathon or triathlon of your own.

We’re not sure when these Accelerated staffers sleep, but we’d like to give a shout-out to our athletes who are running in various events this fall.

Ansel Wachter, Physical Therapy Technician, Peoria, IL center

Ansel will be running the Indianapolis Monumental Marathon on November 1. He is an elite runner (2:40 finish or below) who has been running for quite some time but started running marathons this past year. His first marathon was in Peoria – the first one in that city – where he placed first overall. At the 2013 Run River City Peoria Marathon, Ansel represented the Easter Seals as part of their Team Believe, where he helped raise over $70,000. He also competed in the New York City Marathon where he placed 89th with a time of 2:40. Unfortunately, he injured himself two weeks before the 2014 Boston Marathon and was unable to complete it. Now, he has healed and says he is stronger and faster than ever and is looking forward to Indianapolis!

What motivates Ansel to run marathons is his competitive nature. He loves the constant endeavor to better himself as a person and as an athlete. With running, he feels that there is always room to get better and there is always a constant challenge. Ansel also loves the strategic element of marathon running and the unique challenges marathons present. For Ansel, running is something that has gotten him through hard times and will always remain an important part of his life.

Jessica Stanish, Physical Therapist, Naperville North, IL Center

Jessica has been running half marathons for years but will be running her first marathon – the 2014 Bank of America Chicago Marathon — this year. The leap from half to whole marathon feels like a natural progression to her. As a running specialist, she treats many patients who run and has drawn inspiration from them. Nonetheless, Jessica thinks she’ll be better able to relate to her elite athlete patients after having completed a marathon herself.

Jessica is running with her friends from her undergraduate program at Purdue University and is looking forward to seeing her boyfriend at the finish line.

 

Jessica Stanish trainning for her race

Salena Garland, Physical Therapist, East Peoria, IL

Salena is running her fourth half marathon on Oct 18^th. This year, she is participating in the 2^nd Annual Susan G. Komen Memorial Promise Run and Relay.  Salena has been running since fifth grade and continued on to run track and cross country in high school. Now, she mostly runs to stay in shape and to burn off stress.  She finds that signing up for races motivates her to stay on track with her workouts and training.

Salena Garland running in a race

Eric Glow, Physical Therapist/Director of Operations for Central Illinois

On November 1, Eric will be competing in his 12^th Ironman Triathlon. He has completed the previous eleven over the past eight years. He was initially attracted to Ironman Triathlons because of the endurance challenges over the 140.6 mile course. Eric was a collegiate swimmer and has been working hard on learning how to cycle and run efficiently.

Eric also enjoys the mental challenge of battling the emotional highs and lows while racing. He believes setting both small and large goals is the key to success. He thinks the first goal is getting to the starting line healthy. From there, he looks forward to achieving the other goals he has set for the remainder of each race.

 

Parul Shah Bester, Physical Therapist and Facility Manager, Morton Grove, IL Center

Parul is an experienced runner who has been competing in races since 2005. This year’s Bank of America Chicago Marathon will be her sixth. While most moms with three children aged six and under would hang up their running shoes, Parul has continued going strong.

Parul keeps her training in good shape by participating in the Niles Chicago Area Runners Association (CARA) and her goal this year is to finish the marathon in under 3 hours and 50 minutes.

Parul’s older sister, who was diagnosed with cancer this past year, is her inspiration for running this year. Her sister’s strength and fight have motivated Parul to keep strong and moving. Parul will be fundraising for the American Cancer Society.

 

Liz Wolfe, Physical Therapist, Kenilworth and West Lakeview, IL Centers 

Liz will be running her seventh Chicago marathon this year. Initially, she was motivated to run a marathon by her father. He has run close to 20 marathons and Liz says he is still faster than she is! She also finds motivation from her patients. When running, Liz finds herself getting through the mental grind by focusing on a different patient or person who inspires her for every mile. Running the marathon is her way of celebrating and appreciating her own good health.

 

Tim D’Onofrio, Athletic Trainer and Facility Manager, Naperville, IL Centers

Tim is an experienced marathoner and actually ran his first one at age 21, which stands as his fastest time yet. He has run 15 marathons in total, averaging 2-3 per year. Today, he is a ‘pacer’ and will be setting the pace for the 9-minute mile group in the Naperville Marathon. He wears two watches to make sure he stays on pace so that he can bring his group to the finish line with a time of 3:55.

Tim recently suffered a lower extremity injury so he will not be running the Chicago Marathon, and is instead giving himself a little extra time to heal and be with his friends in Naperville. He loves to encourage other runners on both training runs and during races. Tim likens the exchange of ideas and support to “running counseling.”

 

Mike Stevenson, Physical Therapist, Oak Township, MI Center

Mike is running in the Detroit Free Press Marathon. This is his first marathon and he is very excited about it. He is hoping to complete it in four hours, but it being his first marathon, it is merely a hope! Mike is looking forward to the great mental and physical challenge and to crossing it off his bucket list. He’ll wait to see how the first marathon goes before planning on running a second one

 

________________________

Congratulations and good luck to all our Accelerated runners, as well as the rest of you gearing up for fall races. We’ll meet you at the finish line!

The Accelerated Physical Therapy team includes running specialists trained to treat a wide variety of running injuries, prevent running injuries from occurring, and enhance runners’ speed and endurance. Call to schedule an appointment at 877-97-REHAB.

 

 

National Physical Theraphy Month

October is National Physical Therapy Month!

Curious as to what that is or why we celebrate it? We’re here to fill you in.

National Physical Therapy Month is organized by the American Physical Therapy Association (APTA), to recognize how physical therapists and physical therapist assistants help restore and improve motion in people’s lives.

APTA is an organization that represents over 88,000 physical therapists, physical therapist assistants, and students of physical therapy in the United States.

Throughout the month, Accelerated will be committed to bring you information on the importance of physical therapy in your daily life by providing tips, blog posts, and interactive social media posts.

How can you participate? Great question! Ask your healthcare provider how PT can possibly improve your motion and mobility. Visit one of our clinics for a free injury screen by calling 877-97-REHAB or visiting our website acceleratedrehab.com.

We’re so excited to have you celebrate this month with us!

 

Two-Time Olympic Running Coach and Creator of The Pose Method® Visits Chicago and Signs New Book

Running is one of a few sports that typically doesn’t require lessons, a teacher or coach. For most runners, it just happens naturally. A good pair of shoes, lots of water, a sidewalk — and they’re off. That’s one of the reasons it’s so popular among fitness-minded men and women.

However, a recent study by Harvard University showed that up to 75 percent of middle and long distance runners suffer at least one injury in a year.

What if there was a way of running that allowed you to run faster, longer and without pain?

Dr. Nicolas Romanov, a two-time Olympic running coach, sports scientist and creator of The Pose Method, will be at Accelerated Physical Therapy, 1640 N. Wells Street, Chicago, on October 9, from 7 to 9 pm, to speak to runners about a technique he has created called The Pose Method and to sign copies of his new book “The Running Revolution.” This event is free and open to the public. His visit coincides with the Bank of America Chicago Marathon on Sunday, October 12.

The Pose Method of running teaches the use of gravity as the primary force for forward movement, instead of muscular energy. Accelerated Physical Therapy Pose Method specialists are among a few in the Chicago area trained to teach this new technique.

In “The Running Revolution,” Dr. Romanov addresses many questions about running method and technique, such as: Have we been running the wrong way? Have we been running in the wrong kind of shoe? What is the safest type of foot strike? How many types are there? He goes on to provide both beginning and experienced runners with the knowledge they need to develop a more efficient stride that will improve performance and significantly decrease running-related injuries.

No existing running guide has clearly addressed these concerns—until now. The book also argues that the modern running shoe, with its built-up heel and motion control support, has taught us to run incorrectly and inefficiently. Dr. Romanov explains how our bodies were meant to run and provides the new rules for running faster, longer and stronger.

Books will be available for purchase at the event. Please send any question to: run@acceleratedrehab.com.

Hip Labral Tears: What Effect Does Specialized Rehab Have?

With the NFL season in full swing now the prevalence of injuries during games and practice unfortunately become almost a daily occurrence with teams and players. The constant grind along with excessive impact that these players put on their bodies put them at more of a risk for potential injuries. Hip injuries in the past few seasons have come into the limelight with players like Brandon Marshall, Percy Harvin, Corey Wooten, and Ed Reed having to undergo surgical procedures to repair a torn hip labrum. So how does something like this happen and how do these athletes return to a high level of play?

 

The labrum in the hip is a strong piece of cartilage that sits on the outside rim of the hip socket. It acts as a sort of gasket for the hip joint and helps the hip to form a suction seal for stability. With a tear in the labrum the hip joint loses stability and in turn causes increased pain especially with rotational movements and during higher impact activities. Many times arthroscopic surgery, which involves sewing together and re-attaching the labrum to the acetabulum (socket) of the hip joint. This provides the athlete with the ability to perform higher-level activities like jumping and cutting with proper stability, and without pain.

 

Structured rehab and return to sport programs are imperative for athletes such as these to return to a high level of sport. In the case of Brandon Marshall after undergoing his arthroscopic procedure, in the 2010 season he caught 86 passes for 1,014 yards and followed that up in 2011 with 81 catches for 1,214 yards and six TDs. After undergoing another arthroscopic procedure on the hip in January of 2013 he put up tremendous numbers including setting single season Bears receiving records for 2013. Other players such as Percy Harvin were also involved in specialized rehab and return to sport programs to combat the years of wear and tear they have put on their bodies. As a rehab professional it would be irresponsible to return a worker back to work before making sure that they could do their full job duties, so why is it different for returning to high level sport? It is necessary for us to provide this high level of return to sport rehab so that the athlete returns to sport safely and efficiently.

 

Imagine driving a car that can only run in first and second gear. You are able to start, but if you want any power and speed you can’t have it. A torn labrum inhibits that athlete from switching into third and fourth gear. Involvement in a structured rehab and return to sport program tunes the athlete’s engine so that it performs at its maximum ability. At Accelerated Physical Therapy we have a team of trained hip specialists that are able to screen athletes for potential hip problems, and provide that primary rehab and return to sport rehab in order for them to return to their high level of sport.

 

Please provide your thoughts on hip labral injuries, and how you feel a structured return to sport program is essential for these athletes.

Preventing and treating ACL injuries in young athletes

Accelerated Physical Therapy is tackling the growing rate of ACL injuries among youth athletes. A team of more than 50 physical therapists throughout Illinois and Indiana is specially-trained to both prevent and treat ACL injuries.

This team is part of a program called 3P: Prevention, Progression and Performance. Here’s what it offers to athletes involved in ACL injury-prone sports, such as football, basketball and soccer:

Prevention

To help prevent an athlete from sustaining an ACL injury, Accelerated’s specially-trained ACL physical therapists use proven research to help a patient strengthen muscles surrounding the knee, core, hip and lower leg. This, in turn, supports the knee’s ligaments, including the ACL. Some of the prevention program elements include:

• Basic ACL education
• Stretching muscles which surround the knee, hip, core and lower leg
• Strengthening of the core, gluteus medius and hamstring muscles
• Agility drills
• Identification of biomechanical flaws
• Jumping and cutting-specific exercises

Progression (Rehabilitation)

Following ACL surgery, it is extremely important to work with a physical therapist trained in ACL rehabilitation. Typically, a physician will recommend that a patient undergo rehab for 12 weeks, with functional assessments at 14 weeks, six months and one year post-op. The specially-trained Accelerated physical therapists have developed an expertise in ACL rehab over many years.

Performance (Return to Play)

Each patient and each injury is unique. So, when an athlete has finished post-surgical rehabilitation, it is important to assess if he/she is ready to participate in sports with a limited risk of re-injuring the ACL. (Re-injury can be as high as 20-30 percent.)

The Accelerated return to play program is a collaboration of several research-based programs and is a comprehensive assessment of an athlete’s readiness to return to his/her sport. Customized for each patient’s sport, the program includes a fatigue component, which determines an athlete’s readiness after a work-out or practice.

A physician or physical therapist typically recommends a return to play program (functional evaluation) at 12-14 weeks and then periodically thereafter at six and 12 months to make sure things are progressing well.

Accelerated’s return to play specialists use a combination of assessment tools, including video analysis, to evaluate the patient performing these movements:

–       Single leg squat test

–       Drop-box Jump

–       Tuck jump

–       Land within footprint

–       Lateral hop (ice skate hop)

–       Double leg squat, single leg hop, lateral hop, cut 90° right, cut 90° left, ladder “Z” cutting

If deficits are identified, and the patient may be at-risk for re-injury, the physical therapist will discuss an individualized program with the patient and his/her physician.

For more information or to speak with an ACL specialist in your area, visit www.acceleratedrehab.com or call 877-97-REHAB.

Is your youth athlete at risk for an ACL injury?

Fall sports have begun and, for many young athletes, painful anterior cruciate ligament (ACL) injuries will follow. The ACL is one of the four main ligaments of the knee that connect the femur (thigh bone) to the tibia (shin bone). When injured, this ligament can tear, causing instability, pain and, often, a “popping” sound.

According to a recent study published by the American Academy of Pediatrics, ACL injuries in athletes under age 18 have increased over the past two decades, especially among those who play football, soccer and basketball. The American Academy of Orthopedic Surgeons estimates that 200,000 athletes will sustain an ACL injury this year alone. Furthermore, research shows that nearly 30 percent of those who have had an ACL repaired will re-injure it in the 24 months following surgery.

Accelerated physical therapists and athletic trainers agree that ACL injuries are on the rise among both male and female athletes. They point to young athletes specializing in one sport too early, playing a single sport year-round and the increasing pressure to compete at higher levels.

Yet, there is good news. The American Academy of Pediatrics study reported that athletes can reduce their risk of injury as much as 72 percent by engaging in a comprehensive knee strengthening and conditioning program.

The first step in a good prevention program is a screening (or evaluation) to determine if an athlete is at risk for an ACL injury. This should be conducted by a qualified healthcare provider.

This fall and winter, Accelerated athletic trainers and physical therapists trained in treating ACL injuries are performing ACL injury screens at many area high schools and club team locations. They are evaluating soccer, football, basketball and volleyball players to identify biomechanical deficits in the athletes’ movements. After a one-on-one evaluation, the athletes are given a low, medium or high risk score. If an athlete is considered medium or high risk, he/she may be referred to a local sports medicine physician who will determine if a prevention program will be beneficial. (Note: in Indiana, patients may schedule a physical therapy appointment without a doctor’s prescription.)

Accelerated is also offering free ACL injury screens* to youth athletes throughout Illinois and Indiana. This can be scheduled by calling 877-97-REHAB.

 

*Not for federally funded payers.

The hip bones connected to the, shoulder bone?

Do you remember the song, “Dem Bones” by James Weldon Johnson? Well in case you don’t have the patience to sit through a child’s song with a dancing skeleton, the gist is the human body is connected in more ways than we may ever realize. The interdependence of our body’s joints, muscles and bones may not be a prevailing thought in a healthy person because when everything is working, we tend to not ask questions. But for Josh Beckett, a three-time MLB All-Star, who has been on the disabled list since August 3, 2014 and diagnosed with a torn labrum in his left hip. Beckett is wondering if this injury has currently ended his season… and possibly his career.

You may be scratching your head on Beckett’s injury, wondering how on earth a pitcher hurt his hip. “I thought pitchers injure their elbow or shoulder. Those are the injuries I read in the headlines”. Well, if we look further down the kinetic chain and into the mechanics of a pitcher it all makes sense.

A Pitcher generates power from his legs, throughout his entire pitching motion. That power is produced from his legs and core and transferred to his shoulder, elbow and eventually hand. The more work your legs and core do, the less stress that is placed on the shoulder and elbow.

As a pitcher plants his front side (for a right handed pitcher, his left foot), his trunk is flexing over his hip and due to the pelvic rotation, there is internal rotation and flexion stress on his hip, leading to hip impingement. Doing the pitching motion 100+ times a game for over 15 years at a professional level (not counting his youth, high school and college ball) and you can understand how Beckett has a pretty serious overuse injury on our hands.

Even though Josh’s injury made the headlines, overuse injuries in pitchers has become more common in overhead throwers as we become better at diagnosing hip injuries. It is important as sports medicine professionals that we have a firm understanding of both pitchers mechanics and risk factors for hip impingement.

At Accelerated Physical Therapy we have a ‘Hip Preservation Team’ as well as an ‘Overhead Throwing Team’ where we specialize in identifying, preventing and treating these conditions.

Do you think Josh will return from this? Have you seen an increase of hip injuries in overhead throwers?

 

Will Tanaka’s Elbow Survive Without Surgery?

Have you ever tweaked a muscle and you knew right away something wasn’t right? That’s exactly what happened on July 8,2014 while playing the Indians, Masahiro Tanaka, the NY Yankees huge offseason pitching acquisition left the game knowing something wasn’t right. An MRI on his elbow revealed a partial tear of his UCL and a faced a tough decision as to how to treat it.

Surgery or no surgery, that is the question.

The UCL or better knows as “Tommy John Ligament” is a relatively small ligament on the inside of your elbow that resists the tremendous forces created by pitching. Studies have revealed that every pitch thrown has enough force to tear your UCL if there was no help from the secondary stabilizers such as bones and other surrounding soft tissue structures. If this ligament is compromised and does not do its job, the surrounding soft tissue structures, flexor-pronator muscles will have to work harder to support the medial elbow. Additional work will have to be done along the kinetic chain, especially the shoulder to make up for the loss of velocity. It is no surprise that Tanaka recently started to have general arm soreness after mound progression and simulated game throwing.

In my opinion, he will most likely wind up going under the knife to repair this torn ligament and could very well return next year as the dominant thrower he left as. I do understand and respect the Yankees decision to try non-op rehabilitation as current literature has shown that the return to play rates for UCL reconstruction are not as high as once thought. That discussion will be for another post.

As sports medicine professionals, it’s our job to identify those at risk of UCL injuries. At Accelerated Physical Therapy we have video analysis systems that can identify flaws in mechanics and help correct them before the body breaks down. We film youth baseball pitchers throughout the Midwest to help put the brakes on this injury that continues to plague America’s pastime.

I would like to open up this forum to any comments on UCL injury and your thoughts on Tanaka’s future.

 

Hot tips for summer running

As the weather heats up this summer, so does marathon training. Be sure to use caution when running in the heat. High temperatures can lead to overheating and dehydration—two problems known to harm health and performance.

According to a recent study in the Journal of Athletic Training, runners who began a 12K race on an 80-degree day already dehydrated completed the race about two and a half minutes slower than when they ran fully hydrated.

Dehydration occurs when too many fluids are lost through sweat and/or not drinking enough. In the process of sweating, water and electrolytes are lost and, after prolonged periods of time, body functions are compromised. Common signs of dehydration include thirst, headache, confusion and abnormal fatigue.

Overheating occurs when your body is unable to cool itself due to the amount of water evaporating from your skin. The most common symptoms of overheating are headaches, fainting, dizziness, and after long periods of time, heat stroke.

According to Denise Smith, Accelerated Physical Therapy running specialist, dehydration and overheating can cause serious symptoms, but simple adjustments to your training schedule can help you avoid these conditions altogether.

She suggests these five tips for hot weather running:

• Run at the right time–Even at the hottest time of the year, temperatures are coolest in the morning and at night when the sun’s rays aren’t as strong.

• Wear appropriate clothing–Running gear that is a light color, lightweight and is breathable will help cool you down significantly. Light colors absorb less heat and clothes with vents or mesh will allow for air-flow and breezes to decrease your body temperature.
• Consume sports drinks–In high temperatures, electrolytes are so crucial and just drinking water isn’t enough. Many sports drinks increase your water-absorption rate and replace the electrolytes lost through sweat. Drink a sports drink about one hour before your run to fill your body’s electrolyte stores. Always drink again after you run.
• Be smart–It can take some time for bodies to fully acclimate to the high temperatures and humidity. Instead of starting your training with high intensity runs, take your time and gradually increase the length and speed of your runs.
• Embrace the breeze–If possible, begin your run going with the breeze and finish your run against it. The wind will cool you down when you are running into it, so use that to your advantage when you are at your hardest part of the run… the end.

If you would like to discuss your summer training program or are experiencing pain that concerns you, call Accelerated Physical Therapy at 877-97-REHAB and ask for a running specialist. We can schedule you for an appointment within 48 hours at your nearest Accelerated location.