Therapy's Starting Lineup
How therapists are getting athletes back in the game
By Bob Stott
Article available online at: http://www.therapytimes.com/0617Olympics
It only takes one shoulder sprain, one snapped tendon or one broken bone to kill a dream. As Olympic athletes gradually become larger-than-life media superheroes, it is easy to forget how fragile all the fame and glory is – and how one simple injury can easily bring a tower of ambitions crumbling down.
For world-class athletes aspiring for the grandeur of the Olympic games, everything hinges on their success, both in qualifying rounds and in the actual competition.
While Olympic trainers may remember the promising young athlete who would have won gold medals if not for an unfortunate muscle tear, the general public, however, does not place much stake in “what could have been.” For an athlete who has trained in one particular sport for much of their young life, an untimely injury can undo years of training in one fell swoop.
With this specific demographic in mind, many therapists have become specialized in sports medicine, joining forces with physicians, surgeons, and coaches, to provide injured athletes with the fastest recovery possible.
Encompassing a wide array of specialties, sports medicine is expanding to focus not only on the curative and rehabilitative aspects of therapy, but also collaborating with sports physicians to diagnose and take preventive action against the most debilitating injuries in the field.
Knowing the Ropes
When discussion of what it takes to be a world-class Olympic athlete arises, the physical risk to life and limb might not be the first thing that springs to mind. However, nearly every Olympian takes certain chances in their exercises and pushes their physical limits in the course of training – a pattern of overexertion that runs the risk of permanent disability.
In a competition driven by excellence, it is often the athletes who shoulder the brunt of the stress in achieving these goals. If not properly regulated by an athletic trainer or coach, athletes can succumb to overtraining, in which the athlete’s exercise frequency exceeds their recovery capacity.
By overexerting their bodies, muscle growth is stunted, and their physical condition can actually begin to deteriorate.
Since increases in strength and overall fitness only occur during rest periods following rigorous training, athletes who do not allow sufficient rest periods will strain their already sensitive musculature, causing long-term damage and extended periods of pain.
While athletes of the old school of thought may still hold to the adage “no pain, no gain,” more often than not, chronic pain can undermine athletic ability. Physical pain can cause hormones to spike, which, in turn, puts strain on the heart and lungs. Mild overtraining may only need a few days of reduced activity to restore physical fitness, but continued overexertion accumulates bodily stresses, leading to multiple smaller injuries and depleted stamina.
Battling the minor aches and pains that inhibit athletic performance, therapists often employ a wide range of techniques from multiple specialties.
To promote athlete recovery, “we usually stop the offending activity, using anti-inflammatory methods such as ice, elevation, compression, and anti-inflammatory medication,” says Bruce J. Thomas, MD, medical director of Mima Orthopedics and Sports Medicine in Broward County, Fla.
With past experience as one of the team physicians for the U.S. Olympic team, Thomas is no stranger to the various injuries that come with competitive sports. This summer, Thomas will be traveling to Beijing to serve as the physician for the People’s Republic of China’s Olympic baseball team. And he plans to add another another instrument to his therapeutic tool belt.
“Recently, I’ve added the Flector Patch® to my treatment plan,” he says. “This is applied twice daily directly over the injured area and provides great relief. I recently treated a patient with tennis elbow (who had tried many other forms of treatment) with the Flector Patch and was pleased to see it mostly resolved within four days.”
Unlike oral medications, the Flector Patch, from Bridgewater, N.J.-based Alpharma Inc., is a topical treatment patch, which is absorbed through the skin and goes directly to the site of pain, rather than traveling through the stomach and digestive tract. Applied at the site of a minor strain, sprain or deep bruise, the Patch releases 180 milligrams of diclofenac epolamine, a widely used nonsteroidal anti-inflammatory drug.
Available by prescription, the Flector Patch can be found in drugstores across the United States, and strictly meant for short-term use. Forgoing side effects such as upset stomach and nausea, it can be reapplied to the acute injury every 12 hours as needed, a short-term salve for the innumerous injuries suffered by Olympic athletes.
“Once the patient’s immediate pain has improved, we begin restoring motion and then strength – in that order. Once those have been brought back to pre-injury levels, we begin ramping up the sports activity again. The treatment team will actually map out a schedule for the patient to follow to allow gradual resumption of activities without the injury recurring. It’s a dynamic calendar, and the patient is followed frequently. If plateaus or setbacks occur, we modify the activity schedule.”
Rebuilding from Scratch
Easing muscle aches and strained ligaments is one thing, but getting an Olympian on the fast-track to recovery after a severe injury is quite another. Sustaining an injury or surgery so close to competitions is a problem for any athlete, and such inopportune injuries for Olympians require heightened attention from their therapists and trainers.
When an athlete develops leg pain during peak training near the Olympic Games, a stress fracture is often suspected. Sudden overexertion quickly leads to muscle fatigue and decreased shock absorption, which places strain on the bones. In a stress fracture, the bone is cracked only partly through, remaining stable and able to safely bear weight.
A mild aching, often confused with a muscle strain, may persist for weeks or months as the condition worsens. Athletes who are already sustaining an injury to an opposite extremity are highly susceptible to stress fractures.
Treatment for the majority of stress fractures, sprains, and muscle strains involve discontinuing high-impact running; instead, athletes are often advised to take up swimming, rowing or weight training until the injury subsides.
However, athletes who have undergone arthroscopic surgery for orthopedic conditions, such as torn floating, surface cartilage or ACL reconstruction may have a rockier road to recovery. Although arthroscopy has been primarily used for professional athletes, as the smaller incisions require less healing time, irrigation fluid can sometimes leak into the surrounding soft tissue, causing inflammation and swelling.
“I incorporate a myofascial technique called the ‘graston technique’ that helps to resolve acute and chronic soft-tissue injury. It separates and breaks down collagen cross-links, and splays and stretches connective tissue and muscle fibers,” says Steven Shoshany, DC, CCEP, a New York City-based chiropractic healthcare specialist focusing on both spine and sports-related injuries.
“[The graston technique] also increases skin temperature, facilitates reflex changes in the chronic muscle-holding pattern, and alters spinal reflux activity. It works by increasing the rate and amount of bloodflow to and from the area of injury, and increases cellular activity in the region, including fibroblasts and mast cells. It also increases histamine response secondary to mast-cell activity. This helps break down scar tissue as [it] limits range of motion and, in many instances, causes pain, which prevents the patient from functioning as he or she did before the injury,” Shoshany says.
Unable to utilize the same alternative modes of intensive weight-bearing exercise as athletes with sprains or muscle strains, many post-surgical athletes tend to use a number of core strengthening techniques in the interim: sit ups, crunches, Swiss balls, elastic bands, and weight machines.
However, as these exercises typically work on only one plane of motion, they can aggravate muscles, and cause spinal joints and discs to scrape against one another and wear away cartilage. To combat this, European physicians, physical therapists, and strength-training coaches have developed a training system to strengthen deep spinal muscles and improve strength – the SpineForce® 3-D Rehab Trainer from Miami-based Techno-Derm LLC.
“The SpineForce acts on the recruitment of deep muscles of the vertebral column, but also in the improvement of sports movements by developing the proprioception of the subject,” says Shoshany, who has recently added SpineForce technology to his practice.
“[It] provides a whole-body, closed-kinetic chain exercise that integrate the soles of the feet to the top of the spine. SpineForce improves posture and body contour through reinforcement of the abdominal muscles, and enhanced sheathing of the trunk muscles; conditions treated include low back pain, neck pain, [and] post-operative rehabilitation for knee and ankle surgery.”
Using ergonomic handles and an oscillating platform, SpineForce creates an unstable environment in which internal bodily resistance exercises the spinal musculature.
Designed for patients at various levels of mental and physical rehabilitation, SpineForce is equipped with sensors that isolate specific muscle groups in order to strengthen areas of weakness or overall instability. The accompanying interactive screen provides real-time progress reports and feedback displays as built-in programs go through a series of varying postural adjustments.
SpineForce can be used to relieve chronic pain common in competitive sports, such as lower back, neck, and shoulder pain. It has also been shown to be effective for rehabilitation of stroke victims, those with neuromuscular disorders, as well as patients recovering from back surgery or spinal decompression therapy.
A Breath Away from the Finish Line
While recovering from surgery in time for the Olympics is the top priority for some competitors, even physically capable athletes are scouring for the extra boost to achieve their peak performance. With the 2008 summer Olympic in Beijing, respiratory therapists are currently assisting aspiring Olympic sprinters, as well as endurance athletes, such as cyclists.
Numerous breathing treatments, as well as expanded trials with hyperbaric oxygen therapy, have been developed by several countries in attempts to give Olympians the additional edge in upcoming competitions.
Located in an inland basin surrounded by mountains on three sides, the city of Beijing often bears the brunt of sandstorms sweeping in from the Gobi Desert. In addition to dust clouds, smoke and carbon emissions from the booming capital’s factories also become trapped in the lower atmosphere, creating a city-wide haze that can last for days. While striking a blow to the city’s aesthetic beauty, the smog has also generated concern among athletes and trainers about the effects of air pollution on their performance.
Of prime concern to the athletes is the presence of respirable suspended particulates (RSPs) – pollution particles with a diameter of only 10 micrometers or less – with the ability to penetrate deep into the lungs. Among the most noticeable effects of RSPs are shortness of breath, coughing, wheezing, damage to lung tissues, and deteriorating respiratory condition.
Although the elderly or children with influenza and asthma are observed to be the most sensitive to RSPs, athletes – due to the above-average efficiency of their lungs and high air-intake during exercise – are also highly susceptible to this condition.
While some U.S. Olympic teams have invested in facemasks as a precaution against RSPs, several British teams are instead relying on a special diet of antioxidants to overcome the effects of pollution.
Other teams are exploring the ways in which certain versions of oxygen therapy can, not only help nullify pollution poisoning, but also improve an athlete’s overall performance before the Games.
For years, long-distance runners and cyclists from across the world have traveled to locations, such as Albuquerque, N.M., to train for their events.
According to sports-therapy experts, runners who train at high altitudes and compete at sea level have “extra” oxygen in their blood that prevents the build-up of lactic acid and lowers their heart rate for longer durations.
However, to avoid the expense of traveling between high and low-altitude locales, some athletes – such as Australian Olympic swimmer, Kenrick Monk – utilize hypoxic chambers and hypobaric training facilities, where, under the supervision of a respiratory expert, the athletes can lower the level of oxygen in the room and gradually acclimate to it.
On the other end of the spectrum, Olympic sprinters have been using increased levels of oxygen as a way to counteract muscle fatigue after training sessions, and assist in the recovery of injuries during major competitions.
Athletes – such as Irish Olympian Karen Shinkins, who runs the 400-meter race – have used hyperbaric oxygen therapy to reduce post-injury swelling and accelerate the recovery time for muscles and ligaments. Similar to the oxygen tanks used on the sidelines of football games, some sprinters rely on hyperbaric oxygen to grant them a slight boost for their short-term exertions.
According to Jackie Joyner-Kersee, an Olympic champion in the heptathlon and long jump, world-class athletes often push their bodies to the extreme. “Ask any athlete: We all hurt at times. I’m asking my body to go through seven different tasks. To ask it not to ache would be too much,” Joyner-Kersee says.
While shouldering the ambitions of an entire country, it’s easy to lose sight of the fact that Olympians are – first and foremost – athletes, who struggle with the same stresses and pains as any other athlete.
As these athletes are risking it all for the chance to prove their mettle, therapists and physicians are working together to combat the varied injuries, and ensure that a minor injury suffered in training does not deprive an aspiring athlete of their chance for the gold.