The boat...there it goes again.

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A little while back I posted a little shortie entitled “Injured? Take a Break!” The message behind this post was simply for endurance athletes to step out of their “comfort zone” and make wise…ahem, *common sense…choices when suffering from an injury.

Please consider this current post its sequel.

Often we, as clinicians, frown upon the volume of training some coaches espouse upon their athletes, criticizing the high mileage their athletes spend on the road and in the pool.

Our argument? “They are fatigued, they need to rest and recover.” The coaches’ argument? “I’ve sent many athletes to world championships and this is how we’ve always done it.”

Both may perhaps be valid points. Perhaps. So where is the disconnect?

Is high volume training really that bad?

Without question, high volume training may increase the severity of musculoskeletal injuries sustained (Brooks et al, 2008), especially in contact sports where the variables that influence the risk factors of injury are greater than that of non-contact sports. And absolutely, ultra and extreme endurance training regimens may result in acquired training intolerances of which high volume training may lead to unwanted skeletal muscle pathologies in those with such intolerances (Grobler et al., 2004). But in an appropriately individualized and periodized program for a given athlete, I really cannot place 100% blame on high volume training as the cause of injury for non-contact sports.

So let’s shift our focus just a little bit here. Where could we place some of the blame?

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The blame game.

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I recently listened to a podcast interview between Mike Robertson and Tim Vagen where they discussed this very topic. You are more than welcome to listen to this podcast here. I think Tim and I share similar sentiments in that perhaps some of this blame should be placed on the complementary training, or more specifically the lack thereof, that such athletes perform. Specifically when it pertains to addressing muscle imbalances.

You see, in 2010 we are working with athletes who live in a different generation. A generation that includes facebook, drive-thrus and escalators. And a generation where perhaps not everyone in western society are fit to wear vibrams, let alone run a marathon in them.

But let’s get back to muscle imbalances. Very often I use the analogy of a car with a slight alignment issue (I’m sure many of you do as well). Driving from home to work on any given day will not likely result in a malfunction or breakdown. But driving across the country?

I hope you get my point.

The problem I see quite often is in the lack of complementary training non-contact athletes perform. Swimmers and runners alike, these athletes (and often their coaches) seem to be pre-occupied with getting their mileage in.

“My knee hurts but I need to run 12 miles tomorrow“, or

“My elbow hurts halfway through training and I know I need to come see you but coach won’t let me miss practice”

Do you see what I’m getting at?

I am all for adhering to one’s training regimen and by no means do I have the right to question the amount of volume a specific coach programs into their…well…program. In fact, this IS their program and who am I to question it. But, the point I am trying to convey is that we must complement this training with the addition of exercise means that address those imbalances that may present themselves as a result of the lifestyle that we live. Especially in novice, intermediate, recreational, and student athletes. We simply cannot apply programs meant for professionals in such populations. This just opens up the possibility for “repetitive strain” injuries.

So if you consider yourself a non-contact athlete, be it a runner, a swimmer or the like, and are either self coached or coached by a professional, then I encourage you to take the time to start employing complementary strategies to your program. Even if it does mean cutting your training short.

And if you are a coach, trainer or rehab professional looking for a program for your athlete that encourages and devotes time to such strategies, then may I kindly suggest that you look into those programs put forth by ironguides and core performance. Your athlete will thank you for it!

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“Just because they can move well, doesn’t mean they will.”

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But does that mean you shouldn't?

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In the last 4 months, I have had the privilege of seeing Dr. Stuart McGill speak twice on low back health and performance. On both occasions he stated the above quote with respect to screening movement. My interpretation on said quote is that:

• Screening movement may show you what they CAN do (i.e. deep squat) but it does not necessarily show you what they WILL do….

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...with the various tasks athletes perform on an everyday basis.

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And I agree.

But if an athlete has requisite mobility and stability yet still does not move well, I believe that is more of a coaching problem rather than a “screening” problem. You simply cannot expect the screening system to do the work for you.

For example, if an athlete is showing approximately 45 degrees when actively lifting his or her leg off a table, would it not be prudent to improve this finding? It is naive to think that inadequate ranges of motion do not correlate with possible risk of injury.

This is why we have goniometers in orthopaedics in the first place.

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Just ask fellow Edmontonian, Dr. David Magee

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Now I am not suggesting that you must only strive for full mobility and flexibility. Because once we achieve our desired range, we must lock it in. We must lock it in with the most challenging and relevant exercise the athlete can do well. Use whichever progression along the exercise continuum for that particular joint complex and respective movement plane you wish. Just make sure you create meaningful changes for the individual. And call it whatever you want: Motor learning. Neuroplasticity. Whatever,

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Screening systems are not be-alls, end-alls. They simply provide baseline measures. We must not forget that there are many other aspects of fitness to consider. It is known that fatigue, both aerobic and neuromuscular, plays a role in injury risk and therefore should be at the top of our list of priorities. Without question, an athlete who screens well but posseses poor aerobic capacity will be at more risk of injury in the third period. Of course the screen will not be sensitive to this. But we must not fault the screening system. We must look at our testing protocols…or lack thereof.

Perhaps it might be wise to perform the screen under fatigued states?

Perhaps.

But if an athlete screens well yet continues to perform athletic movements with suboptimal form, perhaps the finger should be pointed elsewhere.

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Even if you are in close vicinity to a mirror.

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What a fascinating joint complex. But complex it is, and hats off to Mike Reinold, Eric Cressey, Dale Buchberger, Michael Chivers, and others who really have a true appreciation for understanding the role of this region in human movement and athletic performance.

Another one of those individuals who truly understands the shoulder is Eric Beard. A corrective exercise specialist and manual therapist, Eric was one of Rick Kaselj’s team of experts in Muscle Imbalances Revealed.

Muscle Imbalances Revealed

I recently provided a summary of Bill Hartman’s lecture on Mobility and Muscle Imbalances which can be found here. This post, however, will focus on Eric’s lecture. So sit back and enjoy!

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Secrets and Staples of Training the Athletic Shoulder with Eric Beard

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• If you have yet to listen to one of Eric talks, you are missing out on such an entertaining and engaging speaker. It was really my pleasure to “sit in on his presentation”. Often times you will encounter boring, monotone speakers that have you constantly asking yourself (or the computer) “when do we get to the good stuff”? With Eric, this doesn’t happen. He provides relevant and important information that ultimately results in seamless transitions from one slide to the next. His passion for the shoulder certainly does not go unnoticed.

• Eric begins the lecture with a brief epidemiological literature review to provide the rationale for corrective exercise (CEx) for the shoulder. That is, the importance of using prudent strategies to minimize or prevent unwanted sequelae (i.e. secondary to impingement). He goes on to outline some everyday causes of shoulder impairment and states,

"Our bodies are NOT designed to wear man-satchels!"

• He also provides a thorough review of the anatomical structures of the shoulder, the implications of abnormal biomechanics to specific tissues, as well as some typical mechanisms of injury and tissue failure of this complex joint complex.

The shoulder is a complex joint complex!

• He then proceeds to cover some important assessments and tests for the shoulder that fitness professionals can utilize in “healthy” populations to direct one’s corrective exercise strategies. *note: I’ve been known to frown upon shotgun approaches to corrective strategies since corrective exercise should be…well…CORRECTIVE. In my opinion, giving everyone the same thing is not only lazy, but also time-wasting.

• As a health care practitioner (LMT), Eric also shares some important precautions and clinical tidbits that many fitness professionals may not be aware of when prescribing self-care strategies such as self-myofascial release. Some important information that everyone should know!

• All in all, Eric does an excellent job with this lecture. If I may suggest: when watching this presentation it is important to not focus on the slides but on his dialogue as he provides a wealth of information. This is not dissimilar to sitting in on a Gray Cook or Stu McGill lecture…you need to put the pen down and JUST LISTEN. You’ll likely have to watch this presentation multiple times, first with the eyes closed to just listen to the wealth of information he provides and second with the eyes open to appreciate the beauty of the slide show that he complements his dialogue with.

For more information on this educational resource, please visit Muscle Imbalances Revealed.

Because even the fist pump deserves optimal mechanics!

*Please note that the above link is an affiliate link but one that I highly recommend.

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One such risk factor may be the presence of muscle imbalances.

In a nutshell, muscle imbalances develop between muscles that have a tendency to develop tightness and other muscles which are prone to inhibition (according to Janda). However, there is more to simply stretching out your hip flexors and strengthening your hip extensors.

Fortunately, Rick Kaselj put together an awesome line up to create an educational resource for athletes, fitness professionals, and clinicians that details some of the specific and practical information that individuals should be aware of when addressing these muscle imbalances.

Muscle Imbalances Revealed

I had the privilege of studying these presentations in video format and wanted to share some of my thoughts with you. Normally I would “review” such educational resources but rather than doing so, I figured it would be more practical to pass on some of the things I learned. Since this resource was quite comprehensive, rather than outlining the entire set in one post, I thought I would provide my thoughts in a series.

First up:

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Mobility & Muscle Imbalances with Bill Hartman

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With all the hubbub surrounding corrective exercise these days, it is important that we obtain our knowledge from credible sources. Bill Hartman is one of those individuals and I am thankful to have had the opportunity to learn from his presentation. Here are some of the things I took away:

• Everyone should be doing mobility exercises. We simply should use different methods and intensities depending on the individual we are working with. Bill reminds us that we should not use a cookie cutter approach when programming. We must be specific. This might be “training 101″ but laziness is quite rampant in the fields.

• Often you will utilize seated and quadruped exercises to improve thoracic extension in your clients. Unfortunately, some of these exercises may cause or irritate shoulder impingement (see Chi’s comment this post). Thankfully, Bill provided a nice modification for placing the shoulders in external rotation to minimize subacromial impingement when performing these exercises.

• Bill also provided a short little piece looking at hip immobility versus lumbopelvic-hip dysfunction. He suggests the importance of performing a modified ober’s test together with the modified thomas test when assessing one’s lumbopelvic-hip complex.

• Money moves. We’re all looking for money moves. Bill provides a couple of techniques for active hip mobilization (i.e. coupled adduction and active hip internal rotation). If you’ve seen Assess and Correct, you may be familiar with these.

• Bill also reminds us that the position of the acetabulum position may block hip mobility. Therefore, it would be wise to first assess this position not dissimilar to how Stu McGill scours the hip prior to squatting.

• Bill suggests the importance of simultaneous anterior compartment strengthening when performing dorsiflexion mobilization exercises of the ankle.

• The “key point” of his presentation was that we must adapt to the client. That, for example, some individuals may require active mobilization techniques while others require passive techniques such as manual therapy.

Adapt baby, adapt!

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*FYI, Rick Kaselj has just updated this educational resource to include new presentations on the lower extremity, fascia and barefoot running:

• Muscle Imbalance Exercises for the Lower Extremity
• Fascia, Exercise & Muscle Imbalances
• Naked Running

For more information on this educational resource, please visit Muscle Imbalances Revealed.

*Please note that the above link is an affiliate link but one that I highly recommend.

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Here’s a brief summary of the study:

Study Purpose:

• To determine the presence of a relationship between hamstring length and PFJ stress at 3 specific knee joint angles of flexion.

Study Population:

• 16 recreationally active males divided into two groups based on knee joint angle-measured hamstring length.

Methodology:

• A biomechanical model incorporating knee joint angle, knee extensor moment, and PFJ contact area was used to quantify PFJ stress.
• MRI and 3D motion analyses were also utilized in this study.
• A one-way ANOVA to determine the variations in PFJ stress between the 2 groups (with and without reduced hamstring length) was used.

Main Findings:

• Patellofemoral Joint stresses differed significantly between the two groups at specific angles of knee flexion.
• No significant differences in hip angles between the two groups.

Clinical Application:

• This study demonstrated that subjects with reduced hamstring lengths have increased PFJ stress during various positions of the squatting movement.  As a result, such a decrease in length MAY contribute to the pathogenesis of various conditions relating to the knee.
• These results enable us to consider another factor when managing those with knee pathology.

For a complete and “evidence-informed” understanding of the study, check out my review. I have obviously left out specifics from this study in this post as Research Review Service is a paid membership site. However, if you would like more information, please do not hesitate to ask.

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*note: the above link for RRS is an affiliate link

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Have you missed the boat?

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I understand that you may not be a new graduate and therefore, may not have been exposed to the latest research but even those magazines that you’re getting your training programs from have published articles on this issue.

So in the event that you have unwillingly missed the boat, here are a series of articles from Mike Robertson that should help you understand the implications of what you are prescribing.

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UNDERSTANDING YOUR ABS

UNDERSTANDING YOUR ABS, PART II

.(click on the above links)

Mike will be lecturing in Vancouver in December so if the above articles tickled your fancy, you may want to attend. I’m sure it will be a great presentation. Click here for more information.

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“At what age should you start developing movement patterns for the purposes of injury prevention?”

In my opinion, this was a significant question in light of the fact that there as been ongoing discussion on several forums as to what minimum age would be most appropriate for the application of the Functional Movement Screen.

Since many of the athletes I work with fall within the 12 to 21 year old age range, it seems only appropriate that I address this question. Here are some tidbits of information that may assist in clarification:

Childhood ranges from 6 to 9 years of age and is marked by significant physical changes that in general, exhibit a linear growth. Development is typically somewhat predictable.

Adolescence, in contrast, ranges from 10 to 16 years of age and is marked by dramatic and rapid physical changes.

When considering the appropriate minimum age, it is also important to understand the differences between growth and maturation.

• Growth: actual changes in size occurring over a period of time
• Maturation: progress towards biological maturity (timing and rate of maturation generally varies between and within individuals).

Adolescent growth spurts generally occur between 13 and 15 years of age in males and between 11 and 13 years of age in females, while the age of maximal rate of growth (aka peak height velocity) generally occurs approximately 1 to 2 years following the commencement of sexual maturation. These variables may indeed influence motor learning and control.

In general, young children lack the motor skills required to adequately run, jump, and throw. With growth and maturation of the neurological and musculoskeletal systems, so do the development of these skills. The adult forms of these skills are generally acquired between 6 and 10 years of age and while the nervous system reaches 90% of its adult size by the age of 6 and full maturation by puberty, ultimate skill development depends highly on practice and training.

Gender differences do occur with motor performance with boys generally outperforming girls in run, jump, and throw performance. Further, males generally demonstrate continual improvement until early adulthood while improvement in females often slow by age 14…likely a result of proven decreases in levels of physical activity. It should be noted however, that in general, females tend to perform better than males on fine motor tasks.

Through an examination of the Long Term Athletic Development stages from the Canadian Sport for Life resource, it is apparent that the Learn to Train stage (Boys 9 – 12, Girls 8 – 11) is the stage at which adolescents should be developing and refining all movement skills, since the brain is capable of highly refined skill performance.

Interestingly, those who may be classified as “late developers” actually have an advantage since this learn to train stage is actually lengthened in this population.

During my graduate education experience, I had the privilege of working closely with Joe Baker, Phd of York University who’s primary focus and interests lie in optimal human development. When asking his opinion of this topic, his response was:

“…‘lack of consensus’ is a good way to describe most of the recommendations regarding training and rehab issues with youth and adolescent athletes. It’s clear that there are significant and persistent problems with this population but no real consistency in the recommended approach to deal with them. The immature motor system is part of the explanation but it also relates to the motor system’s interaction with the still developing cognitive and physiological systems. Adolescent athletes are at a stage of development that is almost constantly in flux making a ‘one size fits all’ approach very difficult…Unfortunately, I’m not sure of any rehab recommendations for this population.”

So in consideration of the above information, my recommendations would be as follows:

• Movement pattern development for the purpose of injury prevention may be implemented at the ages corresponding to early adolescence

• Functional Movement Screening for the purpose of identification of injury risk may be implemented at a similar age, HOWEVER, it is my opinion that the development and refinement of general movement skills take priority over the screen itself.

• Focus should be on the fundamental of motor development until mid to late adolescents – at least that’s what our research would suggest for most late maturation sports. (a recommendation from Dr. Baker)

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The following information was derived primarily from the text, “Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation” by Magee et al as well as the Canadian Sport for Life website.

For more information on youth development please visit the International Youth Fitness Association and Canadian Sport for Life.

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Please be aware that the following information is based on my interpretation of each lecture and therefore, may be subject to “lost in translation”.

Note: Please click here for Part 1

It must be stated that each of the two esteemed researchers prefaced their talks with addressing the fact that misconceptions often occur when one is asked to speak about a specific facet of their research. Both of them stated that the oft-requested material is simply a part of the big picture and as a result, labeling and misinterpretation typically occurs.

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‘Motor control changes in spinal pain: effects, mechanisms and efficacy of interventions’ ~ Paul Hodges

Adaptation & Rehabilitation: How does motor control change in the presence of pain?

Some common myths explained (in red):

The Transversus Abdominis and Multifidus are NOT the most important muscles for spine control

• However, he states that they do make a contribution and that this is often modified in the presence of low back pain.
• His rationale for addressing the importance of specific musculature is compromised control (of the system) in the presence of weakness or inhibition.
• Note: he was adamant in stating that rehabilitation does not stop here…that training these muscles should not be the sole target of lumbar rehabilitation

With respect to the debate surrounding the delay of motor activity with arm movement:

• He states that this delay is not necessarily a dysfunction in and of itself -> but simply is a “window” to look into the system.

Motor control training is NOT just about training the Transversus Abdominis

• The aim should be placed on addressing postures, movement patterns and muscle activation patterns
• A consideration of the deep musculature is simply one aspect of motor control

People should NOT be encouraged to isolate the Transversus Abdominis and Multifidus in function

• The aim should be to change their activation patterns while introducing them into function…in addition to the correction of posture, movement, and muscle activation (if necessary).

The need to isolate deep muscle activity in rehabilitation

• Some of the reasons presented pertained to organizational changes within the brain, the relationship between motor activity improvement and clinical improvement, and the applicability for the identification of individuals who may respond to motor control rehabilitation
• This was one area where he stood his ground

Some explanations as to why motor activity decreases during pain:

• Reflex inhibition
  • Change in excitability of the motor neuron (descending motor pathway) secondary to injury
• Change in organization of the motor cortex
  • In the presence of low back pain, he reported that the cortical area of TrA representation is shifted posterolaterally
  • Interestingly, individuals with the biggest temporal delays in motor activity have the largest shift in displacement (note: this does not necessarily imply causation).

Motor control isn’t always about giving people more…it may also be about taking things away

• Some people have OVERactivity!!!!
• That often individuals with low back pain have increased muscle stiffness and subsequently, poor control.

So does an increase in muscle activity during pain allow us to adapt? Yes!

Is this adaptation about protection of the injured part? Yes – the high threshold strategy

• But is this a good thing or a bad thing? Does that alter motor control?

Hmm…

Adaptation ALSO occurs in the presence of a “threat” of pain

• The “threat” of nociception caused alterations in motor activity
• Therefore nociception is actually not necessary

Adaptation may be good in the short term…but it may be detrimental in the long term

• In the short term, adaptation facilitates alteration in stresses and loads placed on the body. i.e increased trunk stiffness for spine stability
• BUT…too much secondary stiffness may perpetuate back pain due to increased compression forces
• Thus, variability is necessary to adapt to change in conditions/environment…

We have to match the system to the demands of the task!

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"...and in this corner"

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“Opinions on the links between back pain and motor control: The disconnect between clinical practice and research” ~ Stuart McGill

A WHOLE BUNCH OF OPINIONS (in red)

As mentioned earlier, Stu prefaced his lecture by stating that clinical groups develop preconceived notions of different researchers due to the requests they receive to speak about a specific component about their research.

• He is always asked to talk about stabilization strategies and therefore never gets a chance to talk about anything more than what they ask for
• He hazards a guess that there is actually about 95% convergence between himself, Hodges, and the various researchers within the field!

Notice the space in between…its actually larger than each of these two think!

• Lately he asks questions not on what causes pain but what takes pain away

“Its at the concentrations of stress where the tissues break down.”

“It is extremely important to ask if your patients have good days and bad days.”

• If so, you know you’re going to be successful – so find out what creates the good days!

“People get painful backs because of the way they move”

• We must assess Postures, Motions, and Loads to find out (within each variable) what
  • Causes pain
  • Takes pain away
  • Prevention and treatment therefore, can be summed up as “don’t do what hurts you!”

Postural dominance:

• Flexion (cyclists), extension (gymnasts), lateral flexion/rotation (cricket bowlers), etc
• Neutral spine is imperative to minimize shear loads
  • At spine neutral, the longissimus muscle is at 45 deg and therefore,  able to buttresses this shear
  • With spinal flexion, the longissimus is at 10 deg and therefore, unable to buttress this shear

Movement screening:

“Just because they can (perform an ideal movement upon screening), it doesn’t mean they will!”

• Movement screening may show you what they can do (i.e. deep squat) but it doesn’t necessarily show you what they will do….with the various tasks they have to perform throughout the day.
• Therefore, provocative testing must also be performed!

On using the term  chronic non-specific low back pain:

“Wouldn’t it be funny if we lumped all leg pain into “leg pain” and did a research study to determine the efficacy of various treatment approaches for “leg pain” (chiropractic care vs physical therapy vs massage therapy)”

• Note: In general, I, myself think researchers may be missing the boat on this argument altogether. That is, researching the efficacy of various treatment modalities on CNSLBP…especially since more evidence is pointing toward a weaker relationship between pain and tissue disruption/dysfunction the greater the chronicity of pain

“Muscles of the torso are fundamentally different than those of the limbs”

• Limb/extremity muscles – generate motion
• Torso muscles – stop motion
  • No such thing as agonist and antagonist in the spine. They all work together.

“The rectus abdominis, with its transverse tendons, is designed to create short range stiffness – otherwise God would have given us a hamstring!”

Quadratus Lumborum vs Gluteus Medius for lumbopelvic stability in the frontal plane:

• During the unilateral suitcase carry – McGill argues that the QL eccentrically contracts to hold the pelvis up during the swing phase as opposed to the current widespread belief that the gluteus medius is the primary stabilizer of femoral adduction during the stance phase

On the problem with performing a physical exam/assessment on a patient in jeans:

• Whether you ask them to perform a quadruped rock or straight leg raise, jeans tend to lock the hips and force the spine to move in greater ranges of motion than normal

Internal vs External Focus for Skill Transfer:

• Gabrielle Wulf: suggests that external focus in motor learning more effectively facilitates performance
• E.g. Pelvic Floor control
  • Rather than asking a patient to contract and relax their pelvic floor, he suggests one should focus on farting and preventing a fart

Insert random quote here:

“Pavel will kick you in the feet randomly and put you on your back before you even know it.”

On the Transversus Abdominis:

“Most clinicians would be more successful ignoring this muscle”

• His rationale was that stiffness and stability in the spine comes from a corset action – synergistic action between all core musculature
• That the TrA can simply be “tuned” up by raising ones voice

“I would be so bold to argue that Gluteal problems are much more dominant as a whole than the TVA”

• Karel Lewitt – push navel down and out to facilitate intraabdominal pressure. Stop drawing navel in!

On creating deep oblique training:

• Lay on one’s back with hips and knees flexed
• Breath with normal tidal volume – go to full tidal expiration – then KEEP FORCING AIR OUT

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There you have it. A recap of the lectures presented by arguably the two most prominent leading researchers in the field of spine control. I apologize for withholding personal opinion from this summary, but I felt that doing so would provide everyone with an unbiased narrative of their lectures. Tune in tomorrow for Part 3 of the 2010 Spine Control Symposium Recap as Professors McGill and Hodges “join forces” to provide a clinical update on the emerging trends in exercise management of spinal pain.

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Doctors group to seek ban of MMA prizefighting in Canada.

Utilizing evidence-informed responses, I would like to hear your opinion.

So kindly contribute to the poll below and add your thoughts.

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• In a study of Div III collegiate athletes by Cichanowski et al, 13 females who were diagnosed with unilateral “patello-femoral pain” were found to have significantly weaker hip abductor and external rotator muscle groups of the injured lower extremity.

• In a study of 15 females with “patellofemoral pain” by Ireland et al, hip abduction strength and hip external rotation strength were found to be significantly less than age-matched controls.

• Robinson and Nee’s study of 10 females who sought physical therapy for unilateral knee pain demonstrated significantly less hip extension, abduction, and external rotation strength than the same number of control subjects with no known knee pathology.

• Average hip abductor (glute medius) torque in 24 distance runners with ITBS was found by Fredericson et al to be significantly weaker than that of the uninjured limb and controls.

• Hewitt et al’s review of ACL injuries in Females reported a number of studies that demonstrated decreased gluteal muscle activity and/or ability to absorb ground reaction forces by the hip musculature during landing in females who sustained ACL injuries than in uninjured athletes.

• Hewitt et al’s prospective study on predictors of ACL injury risk in females demonstrated significant hip and knee neuromuscular control differences than their controls.

So although “the glutes may not be firing” may indeed be an incorrect way of approaching such musculature, in my opinion ignoring their importance in injury prevention, rehabilitation, and sport performance may not be entirely accurate.

…but that’s just my opinion!

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Joe Przytula recently posted some highlights from the Athletic Trainers’ Society of New Jersey’s (ATSNJ) concussion summit of which Dr. Robert Cantu was the keynote speaker. Here are his notes (as taken directly from his blog):

• VERY important the athlete is permitted appropriate time for healing to take place.
• There is no set number of concussions that is a disqualification for further participation in contact sports.
• 2 man wedge tackling, blindside hits rule changes in American football are in order.
• No way to predict CTE in a live person; lawyers should not be driving decision making.
• Concussion accounts for 6-10% of all athletic injuries. The reported ones are just the tip of the iceberg. Subconcussive blows and their effect is an unknown factor.
• Loss of consciousness is not a good indicator of degree of brain injury.
• You don’t need to grade a concussion to manage them efficiently.
• Time to recovery is a good indicator for risk in subsequent concussions.
• When a player shows any symptoms of concussion, they should discontinue participation at least for that day.
• The cornerstone of concussion management is physical and cognitive rest until symptoms resolve.
• Prolonged post concussion syndrome (1m+) is usually associated with playing with a pevious head injury prior to the concussion.
• Concussion Research- Journal of Neural Trauma: http://www.liebertonline.com/toc/neu/27/7
• Many concussions occur at lower force, 60G’s and below. The new NFL helmet recommendations are suspect because they involved testing at higher G’s. Head and spine biomechanist specialists were not used in the study.
• Since every concussion is different, is legislating concussion guidelines a good idea?

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For those of you who are unaware, there has been quite a stir recently regarding the role various types of sneakers play in injury prevention. Alex Hutchinson of Sweat Science wrote an excellent post on this topic last week so if you have yet to read it, click here.

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