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Wednesday, January 31, 2018

Study Spotlight: Contrast Therapy Does NOT Cause Fluctuations in Human Gastrocnemius Instramuscular Temperature

By: Joel Luedke

Contrast therapy can be a very useful modality both for the treatment of injury and also for the recovery of athletes from workouts or competition.  It can be used in the subacute phase of injury as a
transition from traditional cold therapy (if you choose to use it) or it can be an nice change up from just using the cold tub to help recover.  Find out  more about what it does with temperature below.

What They Did: 

The researchers in this study looked at how a contrast therapy consisting of 4 minutes in hot and 1 minute in cold (4:1) for 31 minutes compared to a 'control group' of doing 31 minutes of hot water and how that affected tissue temperature in the gastric at 4cm deep.  The study consisted of 20 participants and the warm was at 37deg-43deg C while the cold baths ranged in temperature from 12deg (53.6degF) to 15deg C.


What They Found:
Researchers found that the mean overall temperature change in the control (warm whirlpool) group to be significantly greater than that of the experimental (contrast therapy) group.  The did not find that the contrast group had significant changes in the tissue temperature through the 31 minutes and that at 11 minute mark there was very little change in tissue temperature.  This was in contrast to the control group that saw a gradual increase in temperature throughout the duration.

What It All Means:
As mentioned above contrast therapy is a modality that is commonly used in the subacute phase after the control of inflammation and pain has been achieved.  The thought of physiologically "flushing" the treated area has been relatively dispelled and shown to not truly occur.  There is thought that the tissue change could help in the healing process and the alternating of it can be something that works.  While this study shows that there wasn't enough change in tissue temperature to make a significant change it is only one protocol (4:1).  This is something that could be addressed and edited to see if using different lengths of time and/or temperatures could get a more desired effect.

In changing tissue temperatures you have to be careful to make sure there is no risk to the patient.  Lehmann reported that tissue temperature must reach at least 40degC (104degF)in order to produce significant physiologic response to heat, below this is typically placebo effects.  You would want to be very careful of getting temperatures to high or low as to make sure there is no risk to the patient but in most cases of young and healthy individuals you could go lower and higher.

While this research did not show specific significant results there is also nothing wrong with the placebo effect in that if this treatment helps aid an athlete in recovering from their injury or in prepping their body for the next activity then I think it is well worth utilizing.  It is a fairly inexpensive and could be helpful.  That always works for me.

Resource: Higgins, D.  Contrast Therapy Does Not Cause Fluctuations in Human Gastrocnemius Instramuscular Temperature.  Journal of Athletic Training.

Monday, January 29, 2018

Lessons From Half Way Around the World (Literally)

By: Joel Luedke

The more I've progressed in my career the more I seem to find you can't stick to just one ideal.  While  I have found it beneficial to have some ground principles from which to operate on and using those principles to help build a system it has become very clear that you can't latch on to just one or two things*.


After having taken a trip back to India and for the first time for Sri Lanka I wanted to pay very close attention to how things are done half way around the world.  I had the opportunity to meet some physiotherapists from iPhysio and discuss with them on how they treated their athletes/patients and what I found was that it is so similar both in the problems that they encounter and also their approach to treating them.  What was the common thread, basic principles.


From there I had the great fortune to speak to a group of sports medicine physicians in Sri Lanka about taping techniques for athletic injury.  You may wonder why physicians wanted to know taping and how it could help out athletes, isn't that a job for someone else?  Well it turns out sports medicine in Sri Lanka has only been around for 5-10 years.  These professionals are at the front line of developing so many great things in that country and on how they asked questions you could tell it was all routed in principles that they could build off of.

Basic principles.  What am I talking about?  Well lets go over a couple of them that seem to hold true, even after a 14 hour flight.

  • Patient Centered: It seems obvious but it is so easy to lose sight of this.  In the run around of many things that happen at the gym or clinic we can get frustrated or stray away.  Don't let it go too far.
  • It Must Start with the Evaluation: It's happened to me when I've jumped immediately to "the fix".  Don't get too far ahead of yourself as if you set yourself up with a great evaluation and knowing what you're trying to help/fix you will be better off in the long run.
  • Set the Body Up to Heal: It's hard to make the body heal and it isn't something that we can do for someone.  All we can do is set up the person's body to heal itself.  Make sure you are provide the best care and information you can to aid in that.
  • Never Stop Learning: This was a common theme that I experienced.  All egos were checked at the door (I did my best to check mine).  I wanted to be open to questions and ideas that made sense even if it wasn't in direct agreement with mine.  That was reciprocated in how physicians (many way smarter than me) were open to trying something new and different.
It was an amazing experience and I can't wait to go back and learn more.  Don't stray too far away from what you feel to be correct and when all else fails, return back to the basics.




*Check out the CP Short released on Tuesday January 30th called "Why Do We Go to Extremes?"

Sunday, January 28, 2018

Mobility Monday: Partner Heel Cords. Safe word?


Heel cords (calves) can get extremely tight and it doesn't take too long for it to happen.  When you

are working on your mobility and motion it can be hard to get yourself to go hard enough to make sure you are getting all the tightness out.  Sometimes it just hurts too much to get there.  

Having been at a trigger point workshop this past weekend and feeling the pain of having someone really work on a point that is tender I can testify.  Sometimes you need a partner to get into that tissue and get after it and that is where this can be really beneficial.  You might want that word just in case.

Things It Helps: 
-Tight Calves
-Lower Leg Pain
-Potentially Foot Pain

Thursday, January 18, 2018

Friday Food: Scrambled Egg Curry

In honor of Joel taking a trip back over to India we wanted to search for more Indian inspired food.  This one would work well for either a breakfast option or a lunch option.  The prep work takes a little while but we think in the end you'll very much enjoy this recipe.

Ingredients: 

  • 4 gloves garlic, finely grated or minced
  • 1 1/2" piece fresh ginger, peeled and finely grated or minced
  • 2 tbsp safflower oil or grasped oil
  • 1 medium onion, thinly sliced
  • 1/2 tsp ground turmeric
  • 2 tsp ground coriander
  • 1 tsp Kashmiri chili powder
  • 3/4 tsp kosher salt
  • 6 tbsp water
  • 8 large eggs, beaten
  • 4 warm paratha breads or whole-wheat tortillas
  • Fish cilantro for garnish

The Game Plan:

  1. Combine garlic and ginger in a bowl; press with spoon to make a paste.
  2. Heat oil in a large nonstick skillet over medium-high heat.  Add onion, reduce heat to medium and cook , stirring, until softened, 3 to 4 minutes.  Stir in turmeric; cook, stirring occasionally, until the onion is light brown, 5 to 7 minutes more. Stir in garlic-ginger paste, coriander, chill powder and salt.  Stir in water, partially cover and cook until the water evaporates, about 5 minutes.
  3. Add eggs and cook, stirring constantly, until almost set, 4 to 6 minutes.  Serve rolled in paratha (or tortillas) with cilantro, if desired.

Recipe Courtesy of: Eating Well

Wednesday, January 17, 2018

Study Spotlight: Predictors of Clinical Recovery from Concussion

By: Joel Luedke

Concussions have become one of the, if not the, biggest topics when it comes to sports related injury. Research continues to advance and look at many possible factors for how to predict them, diagnose them, predict recovery length and also predict recovery outcomes.  While things have come a long way when it comes to evaluation and management of a concussion there is still a lot of work to be done.

This study tries to take a look at what has been previously done and get a sense of the broad strokes of where we are with concessions and what factors specifically predict clinical recovery from concussion.

What They Did:
Researchers identified 7617 articles utilizing their search strategy.  After review, 101 articles were included in the review based on the established criteria.  The researchers identified 'clinical recovery' as the functional return to normal actives, including school and sport, following injury.

What They Found: 
The researchers did a very good job in this review stating how difficult it was to compare studies due to wide ranging variables in methodologies and how the statistics were run.  They also did a good job looking at the broadest strokes they could while making it very clear that they were not finding direct relationships but general trends as they were going through the data.  A summary of those points follows: 

  • For the majority of predictors, the literature is mixed with positive and negative findings.
  • Pre injury mental health problems and prior concussions appear to be risk factors for persistent symptoms.
  • Greater acute and subacute symptoms are a consistent predictor of worse clinical outcomes.
  • The teenage years might be a particularly vulnerable time for having persistent symptoms-with great risk for girls and boys.


What It All Means:
From the bullet points above it may not seem like much ground breaking information came out of this study.  While there wasn't a specific list of factors that seemed to directly predict concussion the information they did provide can help reinforce what we might be already doing as well give a reminder that we might need to adapt what we are looking at.

It was interesting that researchers noted that ADHD and other (non-specified) mental health problems can play a role in pre concussion symptoms but have not seem across the board to influence the recovery from a concussion.

The main finding of the review is that greater acute and subacute symptoms are a consistent predictor of worse clinical outcomes.  This does not seem like a surprising finding but it reinforces the importance of quick and accurate diagnosis and immediate management of concussion symptoms.  This is something that is within the control of athletic trainers, physicians, coaches and parents and must be taken seriously as it can have a profound effect not only on the athletes return to play but also their long term health.

Resource: Iverson, G. Predictors of clinical recovery from concussion: a systematic review. British Journal of Sports Medicine.

Thursday, January 11, 2018

Friday Food: Buddha Bowls

Don't let the ingredients list overwhelm you.  If you're like me you'll see what you have in the cabinet and maybe get a few things but not necessarily all of them just due to the fact that there are so many.  And as always we mention that you can customize to your taste.  We like to find recipes that seem to be a great base for doing things how you will enjoy them.  

This recipe combines a lot of really good things and should make for an extremely tasty meal.

Ingredients:

  • 1 large sweet potato, peeled and cut into 1/2" cubes
  • 1 large red onion, diced
  • 4 tbsp. olive oil, divided
  • Kosher salt
  • Black pepper
  • 2 cup baby spinach
  • 1 lb. boneless skinless chicken breast
  • 1/2 tsp ground ginger
  • 1/2 tsp garlic powder
  • 1 small garlic clove, minced
  • 1 tbsp. soy sauce
  • 2 tbsp. smooth peanut butter
  • 1 tbsp. honey
  • 1/4 cup lime juice
  • 1 tbsp sesame oil
  • 1 tbsp. chopped cilantro
  • 1 tsp. toasted sesame seed
  • 1 avocado, thinly sliced
  • 4 cups cooked brown rice
The Game Plan
  1. Preheat oven to 425degF.  Spread sweet potatoes and red onions onto a large baking sheet.  Drizzle with about 1 tbsp of olive oil.  Season with salt and pepper and toss to coat.  Back for 20-25 minutes, until the sweet potatoes are tender.
  2. Meanwhile, make chicken.  Heat 1 tbsp of olive oil in a large skillet.  Season chicken all over with salt, pepper, garlic powder and ground ginger.  Add chicken to skillet and cook for 6-8 minutes per side, or until cooked through.  Let rest for 10 minutes, then cut each breast into 1" pieces.
  3. Make dressing.  Whisk together garlic, soy sauce, peanut butter, honey and lime juice until evenly combined.  Whisk in sesame oil and 1 tbsp of olive oil until smooth.
  4. Divide rice between bowls.  Top with sweet potatoes, chicken, avocado and baby spinach.  Sprinkle with cilantro and sesame seeds for drizzle dressing on top.
Recipe from www.delish.com

Tuesday, January 9, 2018

All The Small Things

By: Joel Luedke

In the time of the New Year and the corresponding resolutions that can lead to overwhelming senses of if things are going to work and how you're going to maintain the expectations that you have set for yourself.   This appears to be why these resolutions rarely ever workout for people.  You have the excitement to get started but the expectations to hold them becomes overwhelming.


This post is meant to try and relieve that stress and let you know that you're able to get so many thing accomplished in health, nutrition, fitness and performance without having to focus on to many things and that simple and small changes can make a huge difference in your life. Find a few examples below:


  • Diet changes: simply removing one 'unhealthy' item from your diet (i.e. sugar beverages) can have a profound impact on your body and how it responds.  Often times this can be the start to a big roll in getting the diet you want started.
  • With your squat form if you break at your knees prior to loading your hips you set your body up for a lot of stress through the quads and knees that doesn't need to be there.  By adjust this subtle change in movement you can relieve knee pain and also increase your squat ability.
  • In my daily life we deal with a lot of athletes that have injuries on and off.  It seems like a vast majority of them are more chronic in nature and in my eyes, often preventable.  When I watch them perform their mobility exercises in the SPC there is often a lack of attention to detail.  Really focusing on these subtle movements can make significant improvements in how your body moves and therefore reduce your injury risk and also get you healthy faster.
  • Not every workout has to leave you shuffling out of the gym and not wanting to get out of bed the next morning.  You don't need to spend hours upon hours in the gym in order to get the results you are looking for when it comes to body composition and appearance.  Focus on things that work and that have stood the test of time.  Experiment but go at what what feels good and works for you.  Watch out for fads.

Back to our original point, you don't have to make huge sweeping changes in your life in order to get results that you are looking for.  Simply focusing on the 'keystone' change that can have the most dynamic effect on your health and fitness.  Don't let yourself get overwhelmed with all the information that is out there.  Start with the basics and look to add as you see fit or as you get going and seek help from professionals when the time comes.

And for your listening enjoyment, a little Blink 182.




Monday, January 8, 2018

Mobility Monday: Low Back Ache Test


Low back pain is unfortunately one of the most common aches and pains people deal with on a regular basis.  It can often be overwhelming to try and figure out what is causing that pain because there are so many structures that have influence on the low back.


In this video Dr. Starrett takes a closer look at the anterior musculature around the hip and how it can play a role in low back pain.  He also discusses a very simple "test" to see what might be contributing  to that low back pain.

For ideas to help fix the mobility check out some of his other videos on Mobility WOD or send us a message on Facebook or email at joel.luedke@totalathletictherapy.com.

Things It Helps:
-Assessing Low Back Pain Root Causes
-Anterior Hip Issues and Tightness



Thursday, January 4, 2018

Friday Food: Chicken Stir Fry

So think of this recipe as more of a guideline when it comes to the quantities and the ingredients.  You really can mix this one up to make it what you want it to be and what you'll enjoy but with that enjoy plenty of food and not a lot of guilt.

For the Marinade:


  • 1/4 cup soy sauce
  • 1 tbsp lemon juice
  • 1 tbsp honey
  • 1 tbsp sesame oil
  • 1 tbsp rice wine vinegar
  • 1/2 tsp red pepper flakes
  • 1 pound chicken breast, cut into bite-sized pieces


For the Stir Fry

  • 2 tbsp olive oil, divided
  • 3 cloves garlic, minced
  • 3 large carrots, peeled and julienned
  • 1 large red bell pepper, julienned
  • 1 large yellow pepper, julieneed
  • 1 cup snow peas
  • 8 oz. button mushrooms, thinly sliced
  • 2 cups frozen broccoli, defrosted
  • 1 tbsp cornstarch
  • 4 cups minute white rice
The Game Plan
  1. In a medium-sized bowl, whisk together the soy sauce, lemon juice, honey, sesame oil, rice wine vinegar, and red pepper flakes.  Add in the chicken, and toss to coat.  Let marinate in the fridge while you chop your veggies.
  2. When you have all your veggies ready to go, heat a large wok over high heat.  Add one tbsp of the olive oil.
  3. Drain the chicken from the marinade, reserving it.  Add the chicken to the wok and cook until the chicken is cooked through, about five minutes.  Remove the chicken to a plate.
  4. Add the remaining olive oil to the wok, and then add in the garlic.  Cook for a minute or until fragrant.  Add in the carrots, bell peppers, snow peas, and mushrooms.  Cook until bright in color and just crisp cooked, about three minutes.
  5. Add in the broccoli and cooked chicken.  Reduce heat to low.
  6. Whisk the cornstarch into the reserved marinade, and then pour into the wok.  Bring to a simmer and cook until thick, about five minutes.  Serve on top of white rice.

Wednesday, January 3, 2018

Study Spotlight: Influence of Body Comp and Using Cold Water Immersion


By: Joel Luedke

We have talked about cold water immersion (CWI) before and how it has been shown to be a good recovery tool in many different ways (predominantly with nervous system regulation).  The question still hasn't been answered about how long you need to stay in the cold water in order to get the recovery response.  This study starts taking a look at that question by see how different body types respond to CWI, hot water immersion (HWI) vs. control.


What They Did:
27 male participants were split into three testing groups: 1) low mass and low fat 2) high mass and low fat 3) high mass and high fat.  Each participant did a standardized cycling workout and did so until core temp reached 38.5degC.  The participants then completed 15 minutes in one of the above mentioned interventions.  Core, skin, and muscle temperature along with limb blood flow were recored at baseline, post-exercise, and every 30 min following for recovery for 240 minutes.

What They Found:
Taken right from the study itself-Main Findings: 

  1. CWI caused significant reductions in core and muscle temp and limb blood flow whereas there was no significant change in HWI and CON.
  2. Muscle temp remained lowest during post CWI period in individuals with high mass and low fat compared to those with high mass and high fat and those with low mass and low fat.
  3. Core temp after drop and muscle temp peak drop in response to post exercise CWI were correlated with the body surface area to mass ratio and all measures of adiposity.
  4. Blood flow responses were not different between body composition groups in any recovery condition.


What It All Means:
What appears to be the result of this study is that the lower your body fat they more that the cold water affects you in the given 15 minutes.  While the authors of the study did not look at what would be 'optimal' times for given body types they did show that a difference did occur when using 15 minutes.  This can help guide your practice in potentially requiring larger individuals and those with varying body compositions to stay in the CWI longer to get a more desirable effect for recovery.

This will take some experimentation on your own as the study has not been out yet (we will keep looking) but perception can be a powerful tool to utilize and could make a small difference that could be big changes down the line.


Resource: Stephens, J. Influence of body composition on physiological responses to post-exercise hydrotherapy.  Journal of Sports Sciences.