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Is an Ounce of Prevention Worth a Pound of Cure?

The 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 w ay 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 off season 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 inadequate preventative activities, such as proper stretching, yoga, palates, 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 restriction in range of motion and freedom of movement. A good example is a paint brush 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.

 

 

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 manipulation 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 breakup 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 perfect time to address these types of conditions for a few reasons. First, training frequency normally follows a light schedule and second, 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.

YES, 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/stain injuries and cumulative injury disorders resulting from over training, over use, athletics, occupational activity or injuries occurring from activities of daily living (house work, 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 there 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/non compromised 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/ non compromised 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 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.

Heat Or Cold?

Frequently when patients come in for treatment they are often confused regarding whether to apply ice or heat to their injury. In many cases they have chosen the wrong application. This brief article will provide a few simple guidelines and a better understanding of which application would be appropriate based on your injury and symptoms.

ICING and COLD APPLICATION  (Cryotherapy)

Application of ice or cold is referred to as cryotherapy. Cryotherapy will initiate a sympathetic nervous system response. This is the fright, flight or fight response.

Cryotherapy will decrease the sensory nerve input and creates an anesthesia effect thus decreasing pain. It also decreases muscle spasm and cramping which is simply an involuntary muscle contraction. Since the sensory nerve input is being interrupted, the motor response causing muscle contraction is decreased creating temporary relaxation.

Ice or cold packs should be applied immediately after initial injury during acute injury phase and is continued for 48 to 72 hour after initial injury depending on severity. Cryotherapy causes vascular contraction also known as vasoconstriction. This constriction prevents swelling by forcing interstitial fluid out of the vasculature in the affected area through the lymphatic vessels. This reduces inflammation and acts as an analgesic, temporarily reducing pain by decreasing the sensory input.

Proper application of ice or cold packs is important. Gel packs and ice packs stored in a freezer can be utilized. A baggie filled with ice and two to three finger widths of water may also be used. Adding water will actually provide a colder application and allow the low temperature to be distributed evenly over the affected area. Always have a barrier between the ice and your skin. This can be a thintowel, cloth/clothing or a plastic baggie. DO NOT APPLY ICE DIRECTLY TO SKIN. Keep ice on affected area for 15 to 20 minutes. DO NOT EXCEED 20 MINUTES. Keep ice in place through these 4 phases: cold, burning, achy, numb (remember CBAN). Initially the application will feel cold, then a burning sensation will develop followed by an achy feeling and then numbness will occur.

It is best to apply cryotherapy on top of injured area while in a neutral, relaxed position. This will assure minimal tissue tonicity (tension) and no compression allowing the cold to penetrate as deep as possible. Cold application will be complete upon a numbing feeling or 20 minutes of application, whichever occurs first. Rule of thumb: 20 minutes on, 40 minutes off. For successive application apply ice for durations of 20 minutes, once per hour as needed.

Another form of cryotherapy is ice massage. Ice massage is best suited for localized areas and superficial soft tissue structures such as tendons and ligaments. For example: Achilles tendonitis, tennis elbow, golfers elbow, patellar tendonitis, ankle or wrist sprains and similar conditions.

Ice massage is best applied using an ice cube, frozen bathroom Dixie cup filled with water or a cryocup. Ice is applied directly to the skin in the affected area and is massaged in the local area where pain and inflammation has occurred. Do not hold ice in one spot, keep the ice moving. Again, follow CBAN (cold, burning, achy then numb). Continue treatment until ice cube melts, when numbness occurs, when skin becomes rosy in color or after 5-10 minutes, whichever occurs first.

Other forms of cryotherapy include ice baths and contrast bathing. 

HEAT THERAPY APPLICATION

Application of heat will initiate a parasympathetic nervous system response. This is the relaxation response. 

Heat application is typically applied after the acute injury phase (48 to 72 hours after injury occurred). Applying heat causes vascular dilation also known as vasodilation. This dilation opens blood and lymphatic vessels, increasing circulation and relaxing connective tissue which fosters increased blood supply and nutrition to the injured area. With the increased blood supply will be increased oxygen which is carried in red blood cells. Oxygen is essential for tissue repair and stimulates the healing process.

Heat will produce an anesthesia effect by decreasing pain and muscle spasm. In addition, heat provides prolonged relaxation of hypertonic (tight) tissue leading to early mobilization.

Heat may be applied in many forms, gel packs specifically design for microwave ovens, hot packs, hot water bottles, electric heating pads and wet towels heated in a microwave. There are products sold that can be used as both a hot or cold pack. We sell one of these products from Nature Creation. Use moist heat whenever possible. Moist heat will tend to penetrate better than dry heat.  Apply heat on top of relaxed, non-compressed tissue for optimum benefit.

Always take CAUTION not to cause burns. An affective practice to avoid burning is to wrap the heat device in a terry cloth towel and determine how many layers allow for comfortable and adequate heat penetration.

Keep heat on effected area for 15 to 20 minutes. DO NOT EXCEED 20 MINUTESRule of thumb: 20 minutes on, 40 minutes off.  Exceeding 20 minutes may cause plasma to permeate into the interstitial space between cells causing inflammation, a condition we want to avoid.

Heat applications may be repeated as often as needed. Again, successive treatments should be applied for 20 minutes once per hour. DO NOT USE HEAT ON ACUTE INFLAMMATION OR INJURY.

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/stain injuries and cumulative injury disorders resulting from over training, over use, athletics, occupational activity or injuries occurring from activities of daily living (house work, yard work, gardening, snow shoveling, etc…).

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