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Is an Ounce of Prevention Worth a Pound of Cure?

Winter run seriesThe 2016 athletic season has officially begun with the kickoff of the Winter Run Series and the annual favorite Brewery Run. Many of my patients past and present had a terrific 2015 season. I am personally proud to see that many of them performed consistently well, a good percentage finding their way to the podium while others achieved PR’s and/or challenging lofty goals. The names are too numerous to list, but you all know who you are. A sincere and well-deserved congratulation to all of you. I am happy to have contributed in a small part to your success. Thank you for your patronage.

With the advent of a new season, it is an opportune time to address the nagging injuries and conditions that perhaps hindered your training and/or performance last season. Many believe that simple rest in the offseason is the antidote for your ailments; this is not always the case and a common misconception. Recuperation time is an important component but may not be enough to ultimately resolve the condition.

Many of these nagging, reoccurring injuries are the result of repetitive stress and strain that occur from lack of adequate recuperation time and winter run seriesinadequate preventative activities, such as proper stretching, yoga, pilates, plyometric and the like. These repetitive stress and strain injuries will cause adhesion to develop in soft tissue including muscles, tendons, ligament and/or fascia. Adhesions are simply fibers that have become stuck together. As the adhesion recruits more fibers, increased tension is taken up in the structure which causes a restriction in range of motion and freedom of movement. A good example is a paintbrush that is not cleaned thoroughly. Once this brush dries the bristles become stuck together. The brush is not going to perform properly in this condition and neither are soft tissue fibers that are adhered.

 

 

injury cycle

The adhesions form in various ways, such as a simple strain, perhaps a sprain, the accumulation of micro-tears that occur over time or perhaps there was a muscle pull or a sprain of some kind that has not completely resolved. In many cases, the athlete is not aware that any damage occurred until over time, due to the repetitive nature of training, it becomes cumulative and soreness, discomfort or pain develops, also referred to a Cumulative Injury Disorder (CID).

Rest and recuperation alone in many cases will not be sufficient to resolve these types of conditions. The intervention of ancillary modalities often proves to be beneficial. Specifically, manual Active Release Techniquesmanipulation therapy, such as Active Release Techniques (ART), provides an effective success rate at resolving many of these related conditions. The goal of ART treatment is simple, identify the tissue that is compromised, palpate the location of the adhesion and through specifically designed movement based massage protocols break up the adhesions which ultimately allow the fibers to move independently once again restoring normal function and integrity to the tissue.

The beginning of the season is the perfect time to address these types of conditions for a few reasons. First, training frequency normally follows a light schedule and second, the intensity of training tends to be low to moderate. Therefore, recuperation time is adequate, allowing muscles and other soft tissue structures to effectively recover between training sessions. Including injury treatment at this stage of training allows the athlete the ability to effectively test, assess and evaluate the progress of treatment under normal training conditions. This process of treating and testing normally results in complete resolution of the condition and is typically accomplished within 3-5 treatments, on average.

With the 2016 season upon us, it’s a good time to personally assess any injuries or conditions that may have negatively affected your training or performance last season, minor or otherwise. Do you still feel that twinge in the calf, does the hamstring still not feel quite right, does the quad still feel a bit tight, is the shoulder still stiff, does neck movement continue to feel restricted? If your aspirations for 2016 include building upon your personal performance achievements of last season, it is best to address the issue(s) now before training begins to ramp up.

Best of luck to all this season. Train hard, train smart, be safe, have fun and above all, enjoy the journey.

winter run seriesYES, an ounce of prevention is undoubtedly worth a pound of cure!

by Terry Stein, LMT, ART

Athletes Performance Care is an alternative medicine practice specifically dedicated to assessing, evaluating and resolving conditions associated with soft tissue injuries. We accomplish this by utilizing a specialized modality known as Active Release Techniques®, ART. ART is an advanced movement based medical massage technique that restores normal function to compromised tissue. The conditions that we treat are all related to muscles, tendons, ligaments, myofascia and peripheral nerve impingements. ART resolves repetitive stress/strain injuries and cumulative injury disorders resulting from overtraining, overuse, athletics, occupational activity or injuries occurring from activities of daily living (housework, yard work, gardening, snow shoveling, etc…).

Alternative Stretching Method for Compromised Tissue

Many times patients come in for treatment for strained muscles they have attempted to remedy their selves but continue to be hindered by the problem. These are noble efforts and include a variety of methods. The one method that is a common denominator is stretching. Intuitively, this is proper treatment but the manner in which we need to stretch compromised tissue differs from the manner used to stretch healthy/noncompromised tissue. This brief article will provide a basis for the reasons behind this and the methodology to perform a more beneficial stretch when tissue has been strained or sprained.

Typically when we perform a stretch, regardless of the structure being stretched, we tend to hold the stretch for 10, 20, 30 seconds or more, this is how we have all been taught. For healthy/noncompromised tissue this is completely acceptable and effective. However, for compromised tissue, this method literally adds insult to injury and the physiology behind this follows.

When we perform a typical stretch and hold it for 10 seconds or longer we begin to feel burning, and perhaps mild pain/discomfort the longer we hold it. This is due to the firing of the stretch receptor in the muscle spindle. This stretch receptor sends a somatic signal to the brain, the brain interprets this signal and sends a motor response back to the muscle to contract, but we are not allowing the muscle to contract because we are holding the stretch. This is what causes the burning, discomfort and perhaps mild pain. Ultimately, when the stretch is released the muscle contract or shortens, there is no cramping or Charlie horses that occurs and we don’t necessarily feel this occur, but physiologically the tissue is shortening. Now, for healthy tissue, this is completely fine and effective, but for compromised tissue, it has the opposite effect.

When soft tissue; muscles, tendons, ligaments, and fascia, are compromised the response is for the structure to tighten, thus shorten, in order to protect itself, this is an automatic defense mechanism. So, if we stretch as in the previously described manner, the muscle will tighten/contract further, literally adding insult to injury.

So, how do we avoid this since stretching is an effective remedy? The answer is a method known as Active Isolated Stretching (AIS).

AIS is a specialized stretching method developed by Aaron Mates that isolates and stretches specific structures either passively or actively. For the purposes of this brief article, we will focus specifically on the AIS method and not the isolation. In this manner, you will perform the stretch you would normally use to stretch the structure that is sprained or strained, for example, a quad, hamstring, calf, adductors, hip rotators, forearm, chest, back, etc.

Regardless of the stretch used, we are going to lean into the stretch just to the point where we begin to feel the stretch, NO FURTHER. We are not straining to get the most out of the stretch, just to the point where we begin to feel it. Hold that for 2-3 seconds and release the stretch. Follow this procedure for 15-20 repetitions. By the time the 15th to 20th repetition is reached you will notice a relative improvement in the range of motion. It’s that simple.

Here is what we have accomplished with this method. Since we are not holding the stretch for a great length of time, the stretch receptor does not fire. Therefore, the stretch receptor does not send the somatic signal and no motor response is triggered. Hence, we have eliminated the contraction response. We have therefore accomplished effective tissue elongation without excessive tissue contraction.

Try this stretching method the next time you suspect a sprain or strain. If the sprain or strain does not show signs of relief or improvement then manual manipulation is probably warranted. In which case, Active Release Technique is a highly suggested treatment for repetitive stress and strain injuries discussed in this article.

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