Understanding Stroke

There wasn’t anything unique about that day; it had started like any other. I had just begun my warm up on the bike as the rest of the class went through the beginning phases of their programing. After being there no more then 5 minutes, one of our coaches calmly walked up and said something I had hoped I would never hear, “Josh, I need you to come take a look at one of our athletes, I think she is having a stroke.” As we quickly made our way through the gym I scanned the room looking to find someone on the floor or in some level of distress. Instead I saw another one of our coaches standing beside one of our members who was sitting and leaning heavily to the left. What caught me off guard when I first saw her was the fact that she was young, less then 30 in fact. Everyone around her was incredibly comforting and attentive to her. I took one look at the situation, asked her to smile, and upon seeing her response I quickly called 911. The fire department was there shortly after I hung up and began to walk through the necessary steps of checking her vitals, obtaining medical history, and preparing her to be transported to the hospital.

After the scene had cleared and she was in good hands on her way to the hospital, several of us started to talk about what had happened. I was very curious as to how a young, healthy individual like her could have something like this happen. How did all of this unfold? Where there signs and symptoms that she was experiencing prior? As it turns out she had noticed a mild headache throughout the day and had been feeling “forgetful.” During that particular workout the athletes were breaking up a slow tempo exercise with a mobility movement, arm raises. One of the coaches noticed that she was having difficulty raising her left arm during the exercise and asked her if everything was OK. It was at that time he recognized that things were in fact not OK and helped get her to a comfortable place to sit.  Her situation demonstrates a classic presentation of how stroke signs and symptoms manifest and highlights how to effectively recognize and manage this unfortunate situation.

Closeup of a CT scan with brain and skull on it

The term stoke refers to an event in which the blood supply to the brain is significantly reduce or obstructed, depriving the brain of oxygen, which can lead to brain cell death. There are three different types of strokes, ischemic, hemorrhagic, and transient ischemic attack.

Ischemic Stroke: The vast majority of strokes will fall into the category of ischemic stroke. This type of stroke occurs when the arteries supplying the brain become narrowed or occluded, reducing blood flow. Thrombotic and embolic are subcategories of an ischemic stroke and refers to the different forms of blockage to the arteries that can occur.

Hemorrhagic Stroke: A hemorrhagic stroke occurs when a blood vessel in the brain ruptures. Based upon the location of the rupture the stroke can be referred to as an intracerebral hemorrhage, a rupture of a blood vessel in the brain, or a subarachnoid hemorrhage, occurring in the space between the skull and the surface of the brain.

Transient Ischemic Attack (TIA): This type of stroke tends to be temporary and is the result of a blockage of a blood vessel that resolves in a relatively short amount of time. Since the occlusion of the blood supply is temporary the effects are usually temporary as well and people often don’t have any residual limitations with a TIA.

In the situation I was involved in, we were fortunate to have several very attentive coaches that quickly recognized that something was not right. She exhibited sings of facial droop, arm and leg weakness, as well as difficulty speaking, In addition to these common signs, trouble walking, difficulty understanding, headache and difficulty with vision might also be other common signs. The best thing that can be done if you suspect a stroke is to recognize the signs and symptoms and get immediate help. The acronym F.A.S.T. is an easy way to quickly identify if the individual is having a stroke.

stop watchFace. Ask the individual to smile and look for facial droop

Arms. Ask the individual to raise their arms and look to see if both arms rise to same height

Speech. Ask the individual to speak their name and look for slurred speech

Time. If you notice any of these signs, call 911 immediately

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There are many identified risk factors for a stroke, some of which are modifiable/treatable and some that are not. Modifiable risk factors would include things such as diabetes, smoking, drug use, binge drinking, physical inactivity, and certain types of cardio vascular diseases. Other variables such as gender, men are at a higher risk then women, over 55 years of age, and a family history of stroke may also put someone at a greater risk. This particular situation falls well outside of the “norm” as she is a fit, active, and young female.

Recovery from a stroke can be just as complex as the stroke itself. Multiple variables need to be taken into consideration with regards to the potential residual effects. The length of time it takes to start treatment, severity of the bleed, health of the individual, and location of the stroke all have an impact on the recovery process. The greater the size of the brain that is impacted, longer duration until treatment, and poorer general health tend to have worse outcomes then those that have smaller bleeds, quicker treatment time, and are in better health. This is not always the case though and time, in conjunction with therapy directed at restoring normal function, are two very important aspects of the recovery process.

In the moment your focus is on doing whatever is possible to help, there really isn’t any time for reflection of the gravity of the situation. A stoke is a very serious situation regardless of the individual. However, this particular situation pulls a little harder at my heartstrings given how young she is and that she was someone I would workout side by side with on a weekly basis. I know she is receiving the best possible medial attention. I commend all of those at the gym that day that were incredibly calm and collected as they dealt with a very serious situation and did everything right to get her the care she needed. Our thoughts and prayers are with her and her family during their time of need.

The PT Weighs In: How to Tackle Concussions

From professional football to pee wee hockey, there is probably no other health concern in athletics that has exploded on a national level like concussions. The American Journal of Sports Medicine says up to 300,000 high school athletes will experience a concussion this year. We want to take a moment to explain what concussions are, how they are diagnosed, and what role physical therapy can play in recovery.

Concussions Defined

A concussion is defined as “a brain injury and a complex pathophysiological process affecting the brain, induced by biomechanical forces.” Several common features occur with a concussion to include an “impulsive” force transmitted to the head, rapid onset of neurological impairments, and may or may not involve loss of consciousness. It has been stated that 80-90% of concussions resolve in a 7-10 day period but may be prolonged in children or adolescents.

Concussion Diagnosis

Diagnosing an acute concussion takes into account a wide range of clinical symptoms, cognitive impairment, neurobehavioral features, and sleep disturbances. When an athlete is suspected of sustaining a concussion the immediate injuries are assessed using the emergency medical response and continued assessment is performed by a licensed health care provider or removed from the field if one is not present. This rapid medical assessment includes physical injury (i.e. fracture or lacerations), cranial nerve assessment, and balance. After the first aid issues are addressed the athlete is assessed for a concussive injury using the widely accepted multi-modal sideline assessment tool known the Sport Concussion Assessment Tool (SCAT 3) and (Child SCAT 3) or other sideline assessment tool. The SCAT 3 consists of memory tests, orientation tests, and balance testing. Rapid assessment on the field has its challenges and when a concussion is suspected erring on the side of caution is paramount. A concussion could include one or several clinical domains such as somatic (i.e. headaches), cognitive (i.e. feeling “in a fog”), or physical (i.e. loss of consciousness). Following the initial “on field” SCAT 3 performed by a licensed health care professional such as a Physical Therapist, neurologist, or the team physician, a series of SCAT 3’s are performed for several hours following the event in serial testing due to the known fact that symptoms of a concussion may evolve and deterioration of function can occur. Following the on-field assessment the athlete may be evaluated in the ER or doctors office with a through medical evaluation. It has been shown that imaging studies such as a CT’s or MRI contribute very little to the diagnosis of concussion and are typically are normal but the determination for more accurate neuroimaging will be made by the physician to exclude structural abnormality resulting from a severe brain injury.

Injured Player Youth Football

Return to Play

It was unanimously agreed upon that the athlete should not return to play on the day of concussion. The agreed upon protocol is treatment that includes physical and cognitive rest until the acute symptoms resolve. Following medical clearance a progressive graded activity program is implemented with a stepwise return to play program (RTP). This RTP consists of functional exercise stages and corresponding objectives lasting approximately 24 hours each for a full rehabilitation program of 1 week. The athlete needs to remain asymptomatic at rest and with provocative exercise for each stage and if not they are returned to the prior asymptomatic level of the RTP protocol. Stage 5 of 6 includes return to full-contact practice following medical clearance and stage 6 is return to play at normal “game speed”. The go ahead for RTP ultimately remains in “the realm of clinical judgment on a individual basis.”

Risk Reduction

According to the Consensus Statement on Concussion in Sport: there is “no significant valid evidence” that headgear in rugby, mouth guards in American football, and neck strength increases reduce concussion risk. There was evidence stated that eliminating body-checking in Pee Wee hockey and “fair-play” rules in ice hockey were effective injury prevention strategies. The greatest risk reduction cited by this study would be helmets that “reduce head-resultant linear acceleration and angular acceleration” below certain parameters, rule changes and their enforcement, and “sporting organizations should be encouraged to address violence”.

The Role of Physical Therapy

The available evidence for the effects of rest and treatment following sports concussion is small and further research is needed to evaluate length of rest, type of rest, and timing of low-level exercise. Physical Therapy can benefit the athlete with multimodal treatment for cervical spine and/or vestibular dysfunction and with supervision and guidance of a graded exercise program. Once an athlete has been medically cleared for RTP, a Physical Therapist plays a vital and important role in development of a program to ensure adequate strength, flexibility, and joint mobility to help off-set injury risk factors brought upon by poor conditioning. Poor conditioning for instance, can place the athlete in a less than advantageous mechanical position as they compensate for physical limitations, detract from performing their sport at a high skill level, and thus leave them more susceptible to injury.

The science of concussion is evolving and this discussion was based upon the findings and agreement published in the “Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.

1. McCroy P, Meeuwisse WH, Aubry M, et al. Br J Sports Med 2013;47:250-258.

Return to Sport part 2

Now are they ready?

Time has passed, rest has been given and things are feeling better, but how are we sure the athlete is ready to go? Honestly we aren’t, at least not with 100% certainty. However, we can work through a specific recovery framework that will allow for the best possible outcome to be achieved. Moving through these various training elements will be a very individualized process and should not be skipped because “things are feeling good.” Use the tissue healing times as a general guideline but also take into consideration form and function. How well does the athlete move during a given skill or task? Do they demonstrating adequate joint mobility and stability? What are their endurance, strength and power levels like? Once some of those questions have been answered it is time to move into skill training and sport specific drills, which will bring them to the threshold of returning to sport.

Corrective and therapeutic exercise

The initial phase of the recovery process typically starts with corrective and therapeutic exercise. This can be initiated moments after an injury has occurred. Once it is determined that the area is stable, not getting worse or in need of secondary medical treatment, we can start to work on movements and techniques that help to keep the body for further injury but facilitate recovery. Simple things like compression, elevation and gentle pain-free movements can help with swelling and keeping the nutritional flow moving in and around the injured tissue. Strengthening and mobility work can be implemented to address near by areas that may be affecting the recovery rate or causing part of the problem such as working on hip and core strengthening for an ankle injury.

Chiropractor massaging a woman's knee

Stability and Mobility

As healing continues training for stability and mobility becomes a priority. It would make sense that both would need to be addressed simultaneously as working through specific exercises can improve mobility but yet we haven’t done anything to retrain our bodies on how to manage this new found range or stabilize the joint through the range. Mobility also references the tissue in and around the area that has been injured. Scarring and other disorganized tissue can drastically impact movement and recovery and can be addressed with soft tissue mobilization like stretching, massage, using a foam roller or a lacrosse ball. Take note of healing times though, you wouldn’t want to start mobilizing or stretching tissue that is in an active healing process which can potentially prolong healing as the stretching may be disrupting the tissue growth. It is never to late or to early to look at core stability, as this is a vital element for proper movement. Remember we need proximal stability to have proper distal mobility.

Endurance, strength and power

Research has shown us that once an injury occurs we see a decrease in muscle activity and atrophy in a given area. Moving through the recovery process will require time focused on endurance training, which will segue into strength and power development. These concepts can be both general and specific regarding the systems being trained. You can train a recovering sprained ankle for endurance and strength with single leg squats but also put in some time on the bike or the pool to work on general endurance and conditioning. As the necessary strength, stability and control is restored power will be one of the final areas to be addressed. Along with power should be sport specific drills and skill development. Almost every event or sport that we do is scalable so we can take advantage of working certain tasks from part to whole movements or reducing the load and demand as we work our way back into that task. Here is where we make our greatest strides towards understanding where we are in terms of returning to sport. If we progressively scale our loads and training demands without any significant issues, demonstrate proper movement patterns with solid motor control and have given the body adequate time to recover, our confidence in returning should be high. Remember mobility ensures movement competency but training ensures movement capacity!

The concept of power and determination of a man lifting a weight

It’s really that simple

Tongue in cheek comment to say the least. It’s fair to say that some people heal faster then others, they are “genetic freaks”, and should be considered the outliers on an average recovery bell curve. But even with genetic superstardom there are multiple variables that we can use daily to recover better, train smarter and get our athletes back out on the field faster. Things like sleep, high quality nutrition and general health can all influence healing rates. It goes without saying but the road to recovery can be an intimidating one, so getting in touch with a qualified clinician or coach can make the process less daunting.  But ultimately it is up to how the athlete feels and how they are responding to treatment and progressive return to sport. Confidence needs to be there as well, otherwise the mental blocks that can develop prior to returning can be just as limiting as any physical one. So train hard, train smart and be respectful of what the body is saying, it’s the only one we’ve got!

Returning to Sport part 1

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Working with athletes for the past ten years I have come across a wide variety of injuries and set backs that have all required time off from training. Everything from sprained ankles to an ACL repair will require the patient to step away from certain activities and focus on the rehab process. Depending on the type of injury and location this may be weeks or months with hours of recovery training and various types of therapy. Progressively things will start to come together; there will be less pain, better range of motion and improved strength. Inevitably though, the question that always comes up is “how do I know when I am ready to return?” The questions is much simpler then the answer but by examining several aspects of injury, rate of tissue healing, training and loading strategies we will be able develop a more systematic approach to determining when we might be ready to return.

**Please note that individual healing and training specifics are unique to every situation. If you are working with a surgeon, physician or other health care provider regarding your injury and care it is very important that you communicate with them regarding your post-operative/post-injury protocol**

Type of injury

When it comes to real estate we always here “location, location, location.” We can think of injuries in the same way. But don’t just think of location as where on the body we hurt but more in reference to what structures were involved and to what extent the tissue has been damaged. Muscle, ligament, tendon, bone and everything in between all have the potential to sideline you or significantly limit performance and each one will carry a slightly different rate of recovery.

Ligaments, tendons and muscles

When referencing injuries to structures like ligaments, muscles and tendons a grading system is often used. A grade I strain or sprain (F.Y.I. we strain muscles/tendons and we sprain ligaments) indicates that some level of trauma has been experience with possible minor tearing.  Grade II is more severe with trauma and tearing to the structure but the ligament or muscle/tendon is still intact. A grade III is the most severe with complete rupture of the ligament or muscle/tendon and often significant loss of function. Surgical repair is a separate type of trauma category for ligaments that is common with the grafting procedure that is done for ACLs and with severe joint instabilities. Ligaments and tendons don’t have the blood supply that muscles have so recovery time is typically longer for those structures or may require surgical intervention if severe damage has occurred.

Bones

Bones don’t carry a grading system like ligaments or muscles but can be classified by the type of fracture. Compound, spiral and stress fractures might all be terms you will hear to describe what is seen on an x-ray. The more traumatized or displaced the bone the more likely some type of significant intervention will be needed including surgical fixation (pins, plates and/or screws) of the fracture bone.

Phases of Tissue Healing

For all types of tissue, the initial phases of an injury usually start out the same, an event results in trauma to the tissue, the body initiates a specific series of physical responses to reduce further injury and the healing process begins. Tissue will go through a cascade of events as it moves from acutely injured to a more stable healed state.  The bleeding stage is typically short in duration, 6-8 hours on average, and dictated by the level of trauma sustained and the location of the injury. Muscles, rich with blood vessels, will tend to bleed more where tendons and ligaments have a limited vascular supply and don’t tend to bleed as much. Keep in mind we are referencing internal bleeding here and usually swelling, bruising and discoloration is present. The inflammation phase is a necessary component of the healing process and will immediately follow the bleeding phase. Within this phase a series of events take place that help remove some of the traumatized cells and tissue and allow the body to prepare for healing to start. The healing phase, or proliferative phase, occurs next and is when the tissue starts the restorative process. The final phase, the remodeling phase, occurs as scar tissue is formed and becomes a more dynamic part of the tissue again. The tissue will continue to change during this time becoming progressively more like the original tissue as it matures over time.

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Healing rates for each specific type of tissue is somewhat generalized and should be used as a guideline not a hard and fast rule.

Typical rates of recovery are as follows:

Muscle Strains

Grade I 0-3 weeks

Grade II 4 days -3 months

Grade III 3 weeks-6 months

Ligament sprains     

Grade I: 0-14 days

Grade II: 3 weeks to 6 months

Grade III: 4 weeks to 2 years

Bone

5 weeks-3-4 months

Tendon

Tendonitis: 3 weeks-2-3 months

Laceration: 4 weeks-6-12 months

Ligament graft

2 months-2 years (example: ACL)

As you’re healing

Often time injuries occur as a result of something that is preventable and avoidable. Even in the presence of a traumatic event most of our injuries occur due to inadequately prepared tissue, under recovered systems and poorly organized movement patterns. With injuries like a sprained ankle or strained quadriceps muscle, there are likely multiple variables that can lead down the path of mechanical failure, pain and ultimately limited sport participation. During the time that the injury is healing is a perfect opportunity for the athlete to address certain areas that have left them vulnerable. Tendonitis of the shoulder limits overhead activity? Fine, spend the time looking above and below the shoulder at other areas that could be contributing to the problem like a stiff thoracic spine, a weak rotator cuff system or poor hip/core control. Calf strain from soccer camp? Use that relative rest period as a time to look at the ankle, knee, hip and core to see if the strain is a result of other poorly moving joints. When the tires wear bad on your car you certainly don’t blame the tires. You step back and say, “Huh, tires are wearing funny, better check the alignment.” The human body is no different. When we find ourselves hurt or injured it is important that we take the time to recognize that the issue is likely not just about that structure, but a combination of factors that leave us vulnerable at our weakest point.

Eyes wide (CrossFit) Open

2014-open

 

Well it came and went in a FLASH! The 2014 CrossFit Open closed out on Monday at 5 PM and ended a five-week anxiety filled max effort attempt at my first ever Open. Being relatively new to CrossFit (late April will mark one year) I had never had to opportunity to go through an Open nor experience the weekly excitement around each new workout announcement. Besides being tired and a little sore, the 2014 CrossFit Open taught me several invaluable life lessons.

First, a little about the CrossFit Open format. Every year since 2011, CrossFit headquarters has organized a five week long process at determining the best athletes from each region. The world, yes the world, is broken up into different regions. There is the Northwest, Northern California, Southern California, Mid Atlantic, Australia and Europe to name a few. Each week a new workout is posted for five consecutive weeks. The workout is announced on a Thursday and every athlete that has singed up to participate in the Open will have to complete the workout and submit a score by the following Monday at 5 PM PST.

The workouts consist of everything that embodies CrossFit. Cardiovascular and respiratory endurance, stamina, strength, flexibility, power, speed, coordination, agility, balance, and accuracy are all in play. Some workouts will place more emphasis on those skills then others but you will need to be a well-rounded athlete to excel in the Open and hopefully make it on to Regionals.

My well roundedness is a bit lopsided right now and that became very apparent during the Open, but we wont dwell on that. I didn’t have any aspirations of being a Regional level athlete but I was very curious as to how my performances would compare to others in the world. And while my initial intensions were slightly more egotistical, I’ve come to respect and view the open, CrossFit, my community, and myself in a whole new light.

With the anticipation of each announcement I felt a stronger and stronger bond with the CrossFit community as a whole. It was awesome to think that collectively as a world community we would be performing the same workouts over the same period of time; all sharing in the same agony, excitement, relief, and joy that each passing workout would bring. To me this brought a sense of togetherness with the entire CrossFit community, something that had been previously reserved for just those that I trained with or I knew personally.

Physically I found that I was pushed to try new movements that I had never tried before and work at a level I didn’t think would be possible. I had to learn to “Be comfortable with being uncomfortable.” Even though I dined on humble pie with every workout, I found strength in my weakness and pride in my strengths. I have the ability now to step back and look at my future training in a whole new light but most importantly look at myself with a new sense of accomplishment and excitement.

I don’t have any grand ideas of standing on the podium being crowned the Fittest Man Alive at a future CrossFit Games, but I have come to realize that everyone carries a different podium in their heart and so many of us have stepped up and accomplished more then we ever thought possible. To us we stand on our own podiums and that is exactly why I feel so strongly about CrossFit. It gives us all a chance to win individually even if we never make it past the CrossFit Open!

Marc Who?

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The fundamental nature of sport pushes athletes, both professional and recreational, to exceedingly greater levels of physical and mental performance. World and personal records quickly become the “norm” in performance as individuals perfect their craft and discover better ways to train, recover, and compete. I once asked a very well respected colleague and conditioning coach, “What tactics can we implement to help our athletes recover more efficiently, especially during multi-event competitions?” His response, “Build better athletes!” Short, sweet, to the point, and so true. This building process relates to athletes capitalizing on elements of their recovery that will allow them to train as efficiently as possible while providing their bodies the necessary means to adapt to their training program. Nutrition, sleep, manual therapy, ice baths and compression clothing are all commonly used tools to assist in the recovery process. One additional element that I have recently become more familiar with is the use of the Marc Pro device.

I was first introduced to the Marc Pro (Marc is an acronym for Muscle Activated Recovery Cascade, by the way) during a weekend long CrossFit event in central Oregon. I had heard of the device only through a few YouTube clips and brief conversations with local athletes. The concept of using additional modalities to potentially assist and accelerate the recovery process was very intriguing. After a great conversation with Troy Willis, one of the founders of the Resiliency Project and my Marc Pro guru, I was ready to introduce the product to my patients and athletes. Immediately I was getting great feedback from athletes about how much better they were feeling between events. Those athletes that had them at home were also sending me comments about their recovery between training sessions and how they were having less soreness, quicker recovery time and continued gains with their training.

The concepts behind the effects of the Marc Pro can get a little nerdy with terms like angiogenesis, vasodilation, and nitric oxide production, being the major physiological effects of it’s use. To simplify it I will barrow a quote from Kelly Starrett in which he describes the devices ability to “take out the garbage and bring in the groceries.” The non-painful, involuntary muscle stimulation we see with the device helps to create greater fluid movement in and around the area being stimulated in an attempt to “flush” out the byproducts of cellular breakdown and physical activity.

The Marc Pro has quickly become a resource that I use with both the high level athletes and the recreational “weekend warrior” that may have over done it a little.  The Marc Pro is a component of the recovery process, but not a stand-alone feature. It is important that people recognize it’s benefit while still focusing on other areas of recovery such as nutrition, sleep, stress and one of the biggest, their training schedule.

Bringing Your A Game to Sporting Events

Red Cross flag

Earlier this month I had the privilege to attend a first responder course that was targeted for physical therapists and other clinicians who work or volunteer at various sporting events.  As I have been spending more time at CrossFit events and sport venues, I felt it was important for me to be as well prepared as possible. Fortunately, there haven’t been any serious situations during my time at these events (knock on wood) but now I feel as though I am able to manage and assist in the triage process should something occur.

Evidence in Motion (EIM) and the American Red Cross have teamed up to create a comprehensive course that provides the student with the knowledge and confidence to enter into a variety of scenes and be able to effectively start the treatment process. The course itself was very well put together and the majority of it was self-paced online. The course is completed after a two-day lab intensive weekend that puts the clinician into a variety of unique situations with various levels of trauma. Everything from a simple ankle splinting to an eight man team working on a spine board transfer of a football player with a neck injury is played out. But this course is more then just how to wrap a suspected fracture or how to remove a facemask.

Being in a group of 30+ peers, where all eyes are fixed on you, can be a very intimidating situation, even for the most seasoned clinician. The sweaty palms and the feeling of butterflies in the stomach took me back to my practical exams in school. While no one really likes to be put into an uncomfortable situation, the group work and exam process help you grow not only from a knowledge standpoint but also as a person. Having the ability to manage a team and execute a rapid response to a potentially life threating situation is incredibly empowering.

Although this particular course was created more for physical therapists, I think that coaches, parents, and other clinicians would benefit tremendously from taking a first responder course. The course itself doesn’t have to be sport specific but if more people have the ability to respond to various types of emergencies not only will the field of play benefit but also so will our community. While I hope that everyone stays safe during the events that I attend, I know that my new found knowledge will help me provide the best possible care should the need arise.

Clinic Director Josh Zavertnik Keynote Speaker at Oregon Physical Therapy Association Conference

Therapydia Portland Clinic Director, Josh Zavertnik, will be a keynote speaker at this year’s Oregon Physical Therapy Association’s Annual Conference. His talk is titled “CrossFit & the PT: Improving Awareness of CrossFit Concepts and Its Application”. The purpose of this session is to present a more clear understanding of the history of CrossFit, the core tenants of its application, define common terminology used by the CrossFit community and help improve the clinicians understanding of the movements and musculoskeletal problems seen in CrossFit. The concepts presented in the session will focus on improving the clinician’s ability to communicate with local athletes and coaches so that we can collectively help improve our patients and support them in their health and wellness goals.

Download the full OPTA C14 Brochure.

Omega Wave, Physical Therapy and Human Performance

When it comes to movement, performance or anyone of our biological systems the nervous system is front and center. Elements of respiration, digestion and muscle activity all rely on our nervous system and the better the nervous system is functioning the better the other systems of our body will function too. The Omega Wave is a tool that can help coaches, athletes and non-athletes alike to better understand their bodies and the effects that training and daily life can have. I am super excited to have this system as a part of our assessment and treatment/training process. I want to introduce Mark McLaughlin and let him talk more about the Omega Wave and his role with us here at Therapydia Portland.

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Hello I would like to introduce myself, my name is Mark McLaughlin and I am a sport fitness coach and health and wellness consultant. Over the past 13 years, I have trained over 700 athletes from every competitive level, ranging from Olympic, professional (NFL, MLB, CFL), college, high school athletes, and adults looking to improve their fitness, along with health and well being. I now work as a private Physical Preparation Coach, in addition to consulting with numerous professional organizations and lecturing across the United States. I have been using the Omegawave since 2003 and consider it to be an essential tool for optimizing the training of all the athletes and adult fitness clientsIn 2003, I was set to open my own private training facility for athletes and I knew I needed technology that would allow me to test and monitor my athletes to make sure the training was effective, in terms of resulting in the specific biological adaptations desired. During my research at that time I learned about a company out of Omegawave (www.omegawave.com).

To give one a very brief overview on how the Omegawave actually works, here is what takes place in as little as two and a half minutes. While the athlete is at rest, the Omegawave collects ECG and DC potential through a series of electrodes that are placed on specific points of the body. The information is then processed through the following three methods to complete the assessment. The Heart Rate Variability (HRV) method is used to assess the state of the cardiac and autonomic nervous systems. The differential ECG method is used to assess the state of aerobic and anaerobic systems as well as Heart Rate at Anaerobic Threshold. Finally, the Omega method measures the DC potential and is used to assess the state of the Central Nervous System. Once the process is complete, an athlete readiness screen comes up to display the readiness of the multiple biological systems, identifying the ones that are ready to proceed with training and others that might require additional rest and recovery.

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The key point that one must understand is that performance enhancement can come in many ways and it is not simply about “hard work”, not even simply the right kinds of hard work for a particular sport, event, or position. To maximize performance improvements in both sport and life, and minimize the potential for injury and over-training, an athlete needs the right KIND of work at the right TIME and also needs to adjust their recovery methods and nutrition based on their current physical condition.

Based on multiple physiological markers, it might be appropriate to reduce an athlete’s workload or increase the volume of specific training, but unless you know what an athlete’s limiting factors are on a daily or weekly basis you are really just guessing at what type of workout would be optimal at any given time. This means you are not maximizing the results of the athlete’s time and effort and in a lot of cases limiting or wasting their potential (through injury, over-training, etc).

I am very excited with the opportunity to begin working the clients at Therapydia Portland. Joshua has a very pro-active approach to both physical therapy and the after care. I am really looking forward to this collaboration.

 

Evolution, not resolution

With the dawn of the New Year comes the rush of excitement at the opportunity to “start anew” in the coming months. Resolutions, goals and hard-core commitments are often laid out in front of us as the road map for the next 365 days. But for some this excitement leads to a crash like a child after all the presents have been opened. Our resolution battle cries for change slowly fade away and we are left with our list that becomes more of a reminder of what we didn’t do versus what we did. The idea of New Year’s resolutions are nothing new with historical accounts dating back to pre-Christian times (fun little history lesson for you here). With resolutions being around for so long, why do so many of us reach that critical drop off point after roughly 90 days? Haven’t we come up with the secret formula to allow us to sustain and endure throughout the entire year? Simply put, no, until now! I have worked tirelessly with countless physicists, math mathematicians and psychologists to come up with a foolproof algorithm for achieving all of your 2014 goals. Ready? Here is it is…(intentionally blank).

Yeah, a let down I know, but the fact of the matter is goal setting and resolutions are very individualized and therefore need an individualized approach. With that being said I think it is important to redefine what it is you are trying to do and understand more about the underlying variables related to the changes you want to make.

I find the term resolution to be a part of why we see less follow through. It doesn’t get to the essence of what is taking place. By definition a resolution is a course of action determined or decided on. So, this simply states that by developing a resolution you have decided to do something. Which is great and I commend you, but what if you set out on a New Year’s EVOLUTION? Evolution is defined as a gradual process in which something changes into a different and usually more complex or better form. This is the essence of what we are trying to accomplish is it not? We set each year to be more organized, to lose weight, save more, spend less, and be with our families more. All of these goals require a change, a change for the better and thus an evolution of you! When I treat patients there often is a spot or region of pain that has brought them into see me. Whether it is their shoulder, knee, low back or neck, most patients can clearly identify where they are feeling their symptoms. The interesting part though is that where they hurt may not be the true source of their pain. As complex as the body is, pain can emanate from remote structures and areas of our body and be felt somewhere completely different. It is because of this that as clinicians we need to do a thorough evaluation and try to understand the source of the condition not just where things are being felt.

As you set out on your evolution I encourage you to look at your plan in much the same way. Let’s take losing weight as an example. The physical change we are hoping to create has many variables to it. Nutrition, sleep, hydration, exercise, stress etc can all contribute to our current physical states. So for us to make blanket statements like “I want to lose 25 pounds this year” we are only discussing the “signs and symptoms” not the cause. So the next logical step is to outline what it is going to take to lose 25 pounds. Changes to nutritional habits and exercising more will likely need to be a part of the equation. But go one step further. What drives your eating habits? Do you eat when you are stressed, depressed, bored? Does the lack of exercise stem from a lack of energy due to depression or poor sleep habits due to work related stress? My point here is that much like the physical conditions I see in the clinic, going into greater detail about the individual situation helps to understand more about why things are the way they are. For goal setting and true evolution it will be vital to have a deeper level of knowledge about the why so you can do what is necessary to truly evolve and not just resolve. bond-motivation I support everyone that talks to me about the plans for the New Year and hope that they all are successful in making the changes they are looking to make. If you are interested in an additional point of view regarding goal setting take a look at this 2013 article from Peter Bergman.