Got FOMO? Review of Conference Season So Far.
This month's newsletter is going to sum up some of my favorite presentations this season. So far, I attended the SF Giants Sports Medicine Conference and also the NSCA Southwestern Regional Conference. These are main points that I jotted down. Please don't hesitate to contact me for the actual literature and powerpoints if you want to take a look at them. I do not take credit for any information or content; those materials were put together by the hardworking presenters.
SF Giants 3rd Annual Sports Medicine Conference
- Throwing is not a good thing; it's not natural and is actually very bad for the shoulder and elbow. With that said, athletes have to do it so we have to work to preserve the tissue and athlete.
- Athletes who play baseball more than 8 months in a year are 5x more likely to injure their shoulder or elbow. Athletes need to have off-season or play different sports. Playing multiple sports has actually been shown to increase athletic performance while preventing overuse injury, especially for developing youth athletes.
- As throwing velocity has increased over the years, so has Tommy John surgery. Trauma and damage are common, and not because of a certain throwing style or pitch; it's simply due to overuse. Not only do we have to manage this through pitch count, but assess training methods to dose both volume and intensity correctly.
- Don't tell the youth athletes to keep throwing hard, and don't use all the special velocity programs being sold. Each year a youth athlete ages, they throw 1.5 mph faster. Each inch they grow, they also throw 1.2 mph faster. Increase in throwing velocity is not the training that may be increasing speed, it's just a part of the body maturing. It can also be due to proper strength and conditioning of the entire body.
- There are salesman out there claiming their amazing patented weighted-ball programs increase speed. They are having kids throw upwards of 7 pound balls for training. Research has only studied programs with 4-17 ounce balls, and even at these weights, athletes have high injury risks. Athletes are 27% more likely to injure themselves using weighted balls. There was no significant difference in velocity, yet in 6 weeks there was a 10 degree increase in range of motion (external rotation of the shoulder). Although that sounds good, 10 degrees is an insane amount for a youth athlete to gain within 6 weeks. This means tissue is nearly at failure and being stretched too aggressively due to these programs.
- Tubing and light dumbell programs have shown to safely and significantly increase ball velocity without the risk of weighted-ball programs.
He presented a few studies showing the results of increased velocity through select programs as an alternative and safer way for athletes to increase velocity in conjunction with proper strength and conditioning.
- When throwing a ball lighter than a baseball, a huge amount of stress occurs. Imagine how painful it is to throw a wiffleball as fast as you can. Although studies show less stress is caused by heavier balls, that stress still occurs over a long period of time which still equates to risk of injury. Meanwhile, lighter balls should not be thrown as a means of training.
- Weighted-ball programs can be used conservatively and carefully to return an injured athlete back to normal throwing speed, but should not be used to increase velocity past normal. There is currently no protocol or proper dosing. Coaches need to get guidance from a physical therapist or qualified strength coach for advice. Better yet, if the athlete is injured, they should be managed by a physical therapist.
- Long toss is very intense on the shoulder. It is okay to perform it, but within a well-capable range; not as far as they can.
- The best program is to play catch rather than throw the ball as fast as they can. An arm care program and strength and conditioning program must be implemented however the rotator cuffs should never be worked until failure.
Rafael Escamillo, PT, Ph.D.
- Rafael has so much amazing research on everything movement that I couldn't even begin to sum it up. If you are interested, just send me an email asking for some content. Most of his current presentations and research has been on overhead athletes. If you are getting into sports PT, they are definitely materials you'll want to read. Definitely an amazing researcher.
Geoffrey Head, RSCC - Managing Fatigue and Team Culture
- The body needs to take care of basic needs before it can focus on other aspects such as performance. Geoff talked about trophic changes in ecosystems and related it to how humans can't expect their body to be ready for high performance, when it is trying so hard to survive. Essentially recovery is just that, givng you body what it needs in order to perform other functions at it's best. These are all prioritized, For example, want great sleep? Hydrate. You can't expect to sleep well if the body is trying to stay awake for you too look for water since it is dehydrated.
- Data is king, but it has to be actionable. Great, you invested in nutrition monitoring and measurements. Now what? Athletes are busy, may not understand what you understand, and need things given to them in a clean format. If you plan to present someone what's wrong with them, simplify it and tell them exactly how to fix it. Additionally, don't present everything at once; prioritize it.
- Athlete's are busy, keep everything accessible. Athletes are busy and have many things going on. If you want them to take the actions you tell them, you have to make things as accessible as possible. Want them to take multi-vitamins? Leave a packet and bottle of water at each of their lockers. Need them to eat a particular condiment? Have it next to their food station, and not around the corner at some designated area.
- Culture is king. Some people will not buy-in, so you may need an extra effort. Remember, no matter what you do you can't affect everyone. Just continue to have things available, and they may give in sooner or later when they have performance problems, they see their teammates buy-in, or they just want to make a change. Geoff collects urine regularly to check hydration levels. He implemented a trophy of a urinal for the person who was most hydrated each week, and for the month they received a "I piss excellence" shirt. This added a component of fun for his team.
2017 NSCA Southwestern Regional Conference
Nick Tumminello, CPT and Nick Clayton, MBA, RSCC - Movement Assessment Testing: Evidence vs. Claims
- There is a lot of evidence that popular movement screens are not valid, and people need to read the evidence rather than listen to "gurus". Many reasons for this exist including low-load and slow testing does not relate to fast-paced sports contexts. Movement Screens can still be useful as a means of interdisciplinary communication, and screening of red flags, which I also talked about in a previous newsletter here (link).
- Personal Trainers are not qualified to treat pain, as they may be missing many red flags. It is best to refer out to a physical therapist and get clearance. Personal trainers need to let their egos go and stop pretending to be psuedo-physical therapists. Inversely, physical therapists should know when to refer out to a personal trainer for general fitness and behavior change. Although PT's like to think they can do it all, personal trainers may be better in weight loss, strengthening, and lifestyle change; PT's may not have time since they're treating patients in pain. Disciplines need to drop their egos and work together to give the patient the best care possible. Referring, picky networking, and trust will build a strong community and career for both sides.
- "Poor" posture does not equal pain. Many in the physical therapy world have adapted this concept, and trainers are now being taught this. Acute and neurological symptoms can be due to posture, however there is substantial evidence that "improving" posture does not decrease pain. People need to get away from analyzing and working posture claiming their "system" is the best and previous trainers suck. Instead, trainers need to focus on what they do best...getting people to move. The point was not to say trainers are useless, but it's to say exercise is medicine. What they do works to relieve pain at times, however not for the reasons they think; so stop the bogus guru claims. Additionally as mentioned, back pain could be cancer so they need to be sure to refer their clients out before exercising if any pains exist.
- Don't spend so much time on "special" correctives. People claim their special correctives can fix lives, yet the problem usually isn't stretch this or strengthen that. Nowadays in the general population, it is more of a motor control problem. It's not the correctives that are effective, it's the movement in general compared with proper motor learning structuring.
Brandon Beamer, MD - Orthobiologics: Surgical Alternatives for Sports Injuries
- Stem cells (specifically BMAC) are being used to promote growth of tissue in areas and individuals with poor tissue restoration potential. Stem cells are new cells that are produced by the body that have yet to specialize, therefore they can adapt and turn into any cell around the body. Stem cells can be drawn from red bone marrow, often from the pelvis. once marrow is extracted by a needle, it is then put into a machine (centrifuge) to extract multipotent cells. Multipotent cells are the 3rd of 4 stages of stem cell development. They are still able to specialize, but are not as adaptive as the stage one types. Unfortunately stage 1 cells can not be used because they must be harvested from infants.
- It is most often used for bone marrow lesions and restoration of bone. Bone marrow becomes fatty, and therefore yellow, as we age. This can happen faster in some regions of the body. If there is damage on a bone that reaches the marrow, stem cells from a healthier region of the body can be injected into the more fatty yellow marrow. The injected marrow can adapt to the "good" type of marrow and repair the bone and stimulate new marrow.
- Studies show the new bone growth within joints is hyaline cartilage rather than scar tissue. This is a good thing for joints as hyaline cartilage is more resilient and forgiving to joints.
- There is still hesitation to use it on patients with osteoarthritis. Osteoarthritis is the presence of certain cells and chemicals that break down cartilage and bone tissue. Doctors fear that by using stem cells, the stem cells will adapt the features of the damaging cells and actually make the problem worse. There is no guarantee or control of which cells the stem cells will adapt too.
- There is 1 unit of stem cell to 100,000 units of blood. A fair amount is drawn from the pelvis.
- Stem cells can also be harvested from abdominal fat and the fat pad of the knee. Some surgeons may be cleaning the knee and take some stem cells from the fat pad for re-injection since they are already inside the joint for surgery.
- PRP is being injected into sites for faster healing, using a person's own biological material. PRP stands for platelet rich plasma. Doctors draw blood from one area of the body, use a machine (centrifuge) to concentrate certain materials, then inject it into a damaged part of a body.
- All PRP is not made up of the same material. Some are filled with white blood cells, white some are filled with red blood cells. White blood cells attract and promote inflammation and healing. This mixture is often used for tendinopathy and tendonitis. Specific studies on lateral epicondylitis and patellar tendinopathy have been done showing decent results. For osteoarthritis, inflammation actually causes pain, so red blood cell PRP is injected. This acts as a anti-inflammatory. The high concentraion of red blood cells (lacking the fluid volume) enters the site and that signals the body to stop the inflammation process since there are enough chemicals there.
- From over 8,000 studies, the success rate of pain relief is 50%. There were no studies comparing it to corticosteroids. Corticosteroids can damage tendons, and is not biologically produced so if people want to try a more natural option, PRP is suggested.
- PRP is more expensive than corticosteroids, but it is getting cheaper.
- PRP does not restore tissue, it either promotes or stops inflammation to decrease pain and encourage normal tissue healing the body potentially has.
- Pain may be decreased, but rehab and healing time may not differ. There is not documented change of pace in rehab and return to sport after PRP. Protocol and progression is all based on the patient's symptoms.
- Decision to use PRP is dependent on many factors. The doctor takes into account lifestyle, age, goals, and more into account over joint replacements and corticosteroids.
Vien is Doctor of Physical Therapy Student and also a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. He has 6 years of experience training youth, college, and pro athletes in 1-on-1 and team settings. He has shadowed several Strength and Conditioning Programs in a addition to having clinical rotations in sports settings.