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Tuesday, August 28, 2018

Inflammation and Swelling: More to the Story

By: Joel Luedke

Inflammation has gotten a bad rap lately when it comes to certain things and most of it is justified when it comes to chronic illness and disease.  Does it deserve the bad classification when it comes to working out and injury though?  We are going to investigate that here.


Whenever we work out we are causing some level of damage to the muscles that are doing the work.  This is a good thing as long as it is contained.  It can get out of hand and things can go really wrong (ARTICLE: Death By Burpee) and that is too far but when we have a controlled amount of 'damage' we are able to let our bodies adapt and improve due to the stress.  In this case of damage the inflammation associated with it is a good thing as it makes our body more resilient.


This general idea also transfers over to injury.  The inflammatory process is the bodies natural response to injury so why would we want to shut it down in some capacity?  To be clear we are going to try and differentiate the inflammatory response and inflammation from 'swelling'.  Inflammation is part of the healing process, when it gets slowed down or out of hand that can lead to EXCESSIVE inflammation and left over swelling, this is where the problem occurs.

Excessive swelling slows down and causes problems with the inflammatory response and this leads to problems in the treatment and rehab process.  What are we supposed to do then?  Well for most it is rest and throw a bag of ice on it and see how it feels tomorrow.  There has to be a better way... (ARTICLE: Can I get a bag of ice?)


When you start taking a look at the specifics of inflammation and how the body handles it you can start asking a lot of questions, such as, have we been too slow to move and reliant on rest in the past.  Inflammation/swelling/waste is moved out of your body through the lymphatic system (some venous) and then your body figures out how to get it out.  The interesting thing about the lymphatic system is that it is a passive system meaning that something has to stimulate it for it to work as it can't pump swelling out on its own.


There are many options for this such as mechanically moving the swelling (massage, graduated compression) or getting muscle activation.  By contracting the muscles your body creates a pumping action that helps the waste products make their way back to the systems that can then excrete them out.  With muscle activation after injury you do have to be careful, you don't want to do more damage. Gary Reinl sums this up best "Use your brain, no pain."  (Clinically Pressed Episode) Find movements that cause no pain but get the muscles around the injured site to fire and then fire them as much as possible to keep everything moving and the inflammatory process running at optimal.

You have a lot of control over the outcome of your workouts or injury when it comes to inflammation but it does take work, not just rest and ice.

Sunday, August 26, 2018

Mobility Monday: Heel Cords of a Cheetah


We made it through football camps with soccer, volleyball, tennis and cross country getting into full swing. With that being said with the increase in activity and intensity we have a lot of people with lower leg pain and tightness that presents itself in many different ways.  The great thing about having these types of issues is that they are very easy to take care of on your own to make sure that you don't miss time or suffer a worse injury.


What It Helps: 
-Tight Calves
-Medial Tibial Stress Syndrome (MTSS/Shin Splints)
-Plantar Fascia Issues

Friday, August 24, 2018

Friday Food: Pasta w/ Sautéed Peppers, Zucchini & Smoked Mozzarella

We can't get enough of our carbs and when it comes to our favorite types of carbs it is usually pasta.  so with that we try and find anything we can to make that meal as healthy as possible and make sure that it doesn't set our nutrition back completely.

Ingredients:


  • 2 tbsp. unsalted butter
  • 1 tbsp extra virgin olive oil
  • 3 small bell peppers, thinly sliced
  • 1 small onion, thinly sliced
  • Kosher salt
  • Fresh ground pepper
  • 2 medium zucchini cut into 1/2" thick slices
  • 12 oz/ fettuccine or tagliatelle pasta
  • 4 oz. smoked mozzarella, grated (about 1 cup)
  • 1/4 cup fresh basil, torn

The Game Plan:

  1. Heat butter and oil in a large skillet over medium-high heat.  Add peppers and onion, season with salt and pepper.  cook, stirring often, until almost tender, 10 to 12 minutes.  Add zucchini and cook until peppers are tender and zucchini is crisp-tender, 4 to 6 minutes.
  2. Meanwhile, cook pasta according to package directions.  Reserve 1 cup pasta water; drain.
  3. Add pasta, mozzarella, basil, and 1/2 cup of reserved pasta water to pepper mixture and toss to coat. (Add more pasta water if needed to create a sauce.)  Season with salt and pepper.
  4. Serve topped with mozzarella and basil.


Via: Country Living

Sunday, August 19, 2018

Mobility Monday: Fixing an Acute Ankle Sprain


Ankle sprain are no fun to deal with and can put you out of commission for quite a long time.  The good news is there really isn't a reason for you not to start with rehab immediately.  To some this video seems will seem really simple and you'll wonder why we even shared it but there is a big lesson in it we want people to understand, movement fixes things (when there isn't a lot of pain with it).  Give these principles a try the next time you have an acute injury.


Things It Helps: 
-Ankle Sprain
-Swelling Reduction
-Increase Movement/Motion


Friday, August 17, 2018

Mental Health Series Part II: Anxiety

This is Part II of a brief synopsis of the impact health professionals, other than mental health specialists, can have on athletes and other patients alike who struggle. Anxiety, itself, is normal from time to time. But uncontrollable, physical, and constant anxiety which hinders one's performance, mental well being, or life in general is not and should be addressed medically. The following contains some warning signs and facts about anxiety and exercises and methods you can provide someone who is struggling with anxiety. Let's stop the stigma and create conversations about mental health.

Disclaimer: I am in no way, shape, or form a mental health specialist. I am student physical therapist  relaying on knowledge garnered from experience, research journals, and professors during my undergrad and graduate career. I do, however, care about the well-being of others and feel mental health is an overlooked aspect in many aspects. If a case is encountered that you may presume to include a mental health disorder it is important to speak to the client/athlete/patient about this and consider including mental health professionals in the treatment plan.

The NCAA reports that 18% of those over 18 had a mental disorder diagnosed in 2011, with 9 million of those people having it affect their day to day living greatly. 75% of those diagnosed have their first onset by 24 y.o.. That brings us to college students (see image below). This data from the ACHA, indicates a slight decreased level of student athlete mental health involvement compared to non-student athletes. However, it was also discovered that student athletes are more reluctant to report mental health history and a decreased willingness to seek help of mental health professionals in the future. This is where it becomes important for those surrounding athletes (especially student-athletes) to be aware of mental health struggles of those athletes.


Part II: Anxiety 

Types & Definitions: 
  • Generalized Anxiety Disorder: often described as 'free floating' due to no particular cause. Those affected often find it difficult to sit still or relax. Constant worrying interferes with concentration and daily activities. 
  • Performance Anxiety/Athletic Performance Anxiety: worry and fear about an upcoming practice, game, etc. 
  • Social Anxiety Disorder (SAD): a fearful, sinking, etc. feeling when performing or interacting in public (ex: public speaking, interacting at a party, encounters with those you feel are more 'powerful' than you)
  • Panic Attack/Disorder: a feeling of terror that may occur without warning and is usually accompanied by a racing heart and/or shortness of breath
  • Obsessive Compulsive Disorder (OCD): recurrent irrational thoughts or behaviors that those affected feel compelled to perform; an inability to perform the behavior can worsen the anxiety
  • Phobias: irrational fear of a specific object or situation
  • Post-Traumatic Stress Disorder: reliving a traumatic event or threat of injury, especially during the night. This can also cause emotional withdrawals and emotional outbursts. 
Prevalence: 31.9% of adolescents in the US; college students (see chart above)
Cause: Not totally understood but thought to be an altering of brain chemistry due to trauma, stress, medications, and/or drugs/alcohol.
Signs and Symptoms (Emotions): 
  • Apprehension 
  • Feeling Powerless
  • Having a sense of impending danger, panic, or doom
  • Increased Heart Rate
  • Having the urge to avoid things that trigger anxiety symptom
  • Trouble concentrating or thinking about anything than the present worry
  • Unable to control worrying
Signs and Symptoms (Physical):
  • Breathing Rapidly 
  • Sweating
  • Trembling
  • Feeling Weak/Tired
  • Sleeping Trouble
  • Gastrointestinal Problems
Our Role:
We as healthcare professionals need to be aware of the stress level and what is going on that may cause the symptoms of our patient's distress; i.e. their 'emotional construct'. Dr. Scott Goldman breaks anxiety into two categories: performance anxiety and general anxiety disorder; but, the emotional constructs between the two remain similar. He states that the anxious thoughts and behaviors are often about the future which may be perceived as a threat or danger. Further breaking down anxiety, he describes two threats: a threat to safety (that person is going to hurt me) and a threat to ego (if I don't perform well, I am a loser).

In today's world, there is an utmost pressure to succeed and the fear of failure is instilled early in life. It is not uncommon to find someone struggling with depression and anxiety, together. The NCAA reports that nearly 85% of athletic trainers believe anxiety is currently an issue with athletes on their campus.As a diagnosis of anxiety is difficult to pin-point from observation, it is important if you suspect a mental health disorder to take the patient/athlete into private and have a meaningful conversation with them.  Let them talk about their feelings, be an outlet for them, LISTEN. This is a time for you to figure out their emotional construct. This step is often the hardest as it is difficult to get others to open up, especially if you are not particularly close. Furthermore, it is important to ask them if they would like resources to pursue mental health providers whether you work in a hospital or a campus, there should be a card you can hand them that has information for them to pursue. You need to understand your department's mental health referral protocols as everyone is different.

Those who suffer from OCD or PTSD should be encouraged to entertain the idea of a mental health professional as the disorders are often very complex. SAD and Performance Anxieties are the more common situation that we as regular health professionals will encounter and will therefore these self-help strategies will be focused on those diagnoses. Since everyone is different and not one technique, or even set of techniques, will be perfect for everyone. Below are several links that I thought provided really sound self-help strategies you can provide to your struggling athlete/patient or even yourself.

What does exercise do for Anxiety?
Besides exercise being a way to enhance mood, energy levels, and sleep quality; it can be a way for those suffering from anxiety to release tension, feelings of fear/worry, and help ease symptoms of other co-existing conditions such as depression. Exercise also releases endorphins (the feel good chemical in the body) and reduces the production of stress hormones which both help fight pain and stress. It has also been discovered that exercising regularly can help decrease a person's sensitivity to stress/anxiety. Remember, it is important to start small, develop a routine, and be consistent with that routine. Even if it is performing a breathing technique upon waking up or running 10 miles, doing something consistently is the most important.

Again, I have posted links to various help-lines, links, etc. that one may find useful if they are struggling with tough times. 

For everyone: be an active listener to your friends, family, teammates, etc. and be true to yourself and don't try to 'tough it out', help is only one call away and it is NOT something to be ashamed about. 

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Depression Clinics Help Line: 1-888-771-5166
UW-L Counseling Center608-785-8073

Note from Mayo Clinic: "If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, see your doctor or mental health professional. Exercise and physical activity are great ways to ease symptoms of depression or anxiety, but they aren't a substitute for talk therapy (psychotherapy) or medications.

Monday, August 13, 2018

Mobility Monday: Improving the Squat


The squat can be considered one of the most fundamental movements we have and is part of our everyday life.  Along with that it is a foundation for athletic performance and we use it as a base of strength and athletic performance.  Performing this movement "properly" is very important and having the proper mobility to do so plays into that significantly.  Find more ideas in this video.


What It Helps:
-Squat Mechanics
-Hip Mobility
-General athletic improvements

Sunday, August 5, 2018

Mobility Monday: Swollen Knee Strategy


Inflammation and swollen joints can be caused by all kinds of different reasons.  It could be a result of an injury or just build up over the past couple weeks due to a movement flaw that has finally caused your body to break.  This 11 minute video starts to break down what you can do with a swollen joint and how to manage that while you are still moving through your working day. Check it out.


Things It Helps:
-Fighting Inflammation
-Apply General Principles to Different Body Parts
-General Recovery


Thursday, August 2, 2018

Mental Health Series Part I: Depression

I'm going to really open up a can-of-worms right now and talk about probably the most brushed aside, or ignored, topic in today's society. No, not "sex", but mental health; the various diagnoses (or lack-there-of) and versions that exist that need not to be ignored but treated. There is a stigma we, as a society, need to conquer when discussing mental health. But for where we are now, guess what, most people ignore this topic because 1) we (coaches, therapists, doctors, etc.) don't know how to talk about it or don't like to talk about it, and 2) we don't know what to do about it if we do talk about it. I'm going to discuss some options for coaches, athletic trainers, and other medical professionals to both interpret, understand, and help provide treatment to those in need. This will focus more on an exercise based approach due to my field of study's inability to prescribe drugs and overall mantra of exercise and human happiness.

Disclaimer: I am in no way, shape, or form a mental health specialist. I am student physical therapist  relaying on knowledge garnered from experience, research journals, and professors during my undergrad and graduate career. I do, however, care about the well-being of others and feel mental health is an overlooked aspect in many aspec. If a case is encountered that you may presume to include a mental health disorder it is important to speak to the client/athlete/patient about this and consider including mental health professionals in the treatment plan.

The stress of sports, work, and life in general can heavily influence the quality of life of an athlete/individual. Among the many mental health disorders today, I'm going to focus on those that have had the largest impact on me, whether I've seen teammates, friends, classmates, or family struggle with or I think are the most occurring in today's world that we as health professions can help the most. These will include depression (mood disorders) and anxiety disorder broken up into 2 different posts.

The NCAA reports that 18% of those over 18 had a mental disorder diagnosed in 2011, with 9 million of those people having it affect their day to day living greatly. 75% of those diagnosed have their first onset by 24 y.o.. That brings us to college students (see image below). This data from the ACHA, indicates a slight decreased level of student athlete mental health involvement compared to non-student athletes. However, it was also discovered that student athletes are more reluctant to report mental health history and a decreased willingness to seek help of mental health professionals in the future. This is where it becomes important for those surrounding athletes (especially student-athletes) to be aware of mental health struggles of those athletes.


Part I: Depression 

Definition: A lump-sum, blanket term for disorders that cause an "experience prolonged times of sadness that interfere with the ability to function in daily life", "pervasive sadness causing difficulty for the individual suffering to imagine not feeling depressed", or "a sad, empty, or irritable mood that affects the individual's capacity to function".
Prevalence: 6.7% of US adults experience major depressive disorders in a calendar year; 18% of college-aged students
Cause: Interrelated, biopsychosocial factors such as genetic make up of the individual in combination with mindset and social factors. The direct cause can be linked to an imbalance in chemicals in the brain.
Signs and Symptoms (Normal Population): 
  • Low/sad moods
  • Irritability or anger
  • Feeling worthless, helpless, and hopeless
  • Eating/sleeping disturbances
  • Decreased energy, fatigue or tiredness
  • Decrease in concentration, interest, and motivation
  • Social withdrawal or avoidance
  • Negative thinking
  • Thoughts of death/suicide
  • Severe cases: suicide intent with plan
Signs and Symptoms (Athletes), above and possibly the following
  • Psychological response to injury
    • Being out for an extended period of time may result in a sense of failure for the athlete or loneliness from lack of participation 
  • Psychological response to the end of athletic career injury
    • It is important to keep the athlete involved with the team in any way as they may feel disconnected from their selves 
  • Over-training  
    • May induce depressive symptoms due to lack of rest/insomnia, recovery, and over-worked CNS
Our Role:
As a whole we need to be able to recognize and tell the difference between when an athlete, client, friend, family member, etc. is tired versus feeling depressed. It is important to have a meaningful conversation with the athlete and also those closest to them. Insert soap box. This is something that is I find really bothersome for me when I see healthcare personnel, coaches, etc. brushing through mental health history during paperwork, exam, or the "two questions to rule out depression" (insert link) like it is expected that they will be clean of mental health disorders. 43% of Division I college head athletic trainers admit they did not screen for mental health disorders at all. We can not assume just because the person is a high level athlete, a successful business person, or even just a 'normal' person, etc. that they are in the clear. Have a personal conversation about life, their stresses...be a people person. Too many professionals think they know everything by the book but can't recognize it when it shows up in their face because they forgot how to be a person first. End Soap Box. 

Now, to switch gears, let's say we do have a presumed or clinically diagnosed depressed patient/athlete on our hands. What can we do? It depends! I bet you hate that answer. Each approach will be different, the hardest things to do are 1) have the subject open up to you about their struggles, and 2) get started on a routine. If we have someone that is in a rut and can't seem to get a normal physical activity schedule going we need to start small...

The Orange Theory: 
One of my favorite coaches in the world told me this story the very first time we met and it's stuck with me all this time, it goes something like this (synopsis): A doctor told an overweight man who wanted to lose weight to eat an orange a day for the next month and then come back to see him.  A month passes and the man comes back with numbers better than ever. The doctor asks what happened (fully knowing the response) and the man says, "I started eating an orange a day, then I began exercising, then I began eating healthier". Moral of the story: establish a routine with this person!!! 

What does exercise do for depression?
According to Mayo Clinic, exercise can release the endogenous opioids (feel good hormones) from the brain which can enhance the sense of well-being. Establishing an exercise routine can give them a place in their life to get away from the worries and negative thoughts. Realistic goals and small, incremental challenges can boost self-confidence and self-worth. Be aware of lofty goals as the failure to achieve can lose all progress the person had gained up to that point. 

A simple task can lead to a habit which can lead to more habits = a routine. Therefore, Step 1, help the person establish a simple routine. Start with relaxation techniques every morning such as diaphragmatic breathing, visualization, meditation, morning reading/journaling, or walking for simple cardiovascular exercise. Here's an example routine from Tim Ferriss (great author, internet guru, and just an overall overly-smart guy). I would not recommend throwing all of this at someone at one time, this is an end goal if they are up to it. Eventually help the person establish what they like to do, whether it's group exercise, strength training, or recreational sports, etc. Just be sure to provide the person with any knowledge and support they need. Harvard (yes, the world renowned Harvard) suggests that this is not a one-time fix (i.e. going for a 20 minute walk will not automatically cure one of depression), rather a long term lifestyle adjustment that should expect to see results in about a month. This further solidifies the effects of establishing a routine.

For athletes, it may not always be beneficial to withhold the person from a team sport or other events, as these may give the person a sense of identity or a self-esteem boost. This decision should be made along with other healthcare professionals involved. 

Overall, the athlete/client/patient NEEDS to be involved in the conversation at all times. Find out what works, what doesn't work, and what they think may work. If they think it would work, it doesn't need to be 100% evidence based, people. There's a thing called the placebo effect that makes healthcare more of an art than a science sometimes. This is an ongoing process, be patient!

To review, the prevalence of depression disorder is on the rise and affects all populations. It is a debilitating disease that 1) needs to be more scientifically researched and 2) needs to be more of a topic of conversation so healthcare professionals are more comfortable with treatment approaches. There are a multitude of symptoms that can be teased out with a conversation with the person and other close peers/teammates and it's not uncommon for athletes to try and hide it due to the social stigma. Treatment wise, start small, find out what works or doesn't work but don't take away from who the person is, especially athletes. Being essentially quarantined may be the worst thing for a person. I have posted links to various help-lines, links, etc. that one may find useful if they are struggling with tough times. 

For everyone: be an active listener to your friends, family, teammates, etc. and be true to yourself and don't try to 'tough it out', help is only one call away and it is NOT something to be ashamed about. 

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Depression Clinics Help Line: 1-888-771-5166
UW-L Counseling Center608-785-8073

Note from Mayo Clinic: "If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, see your doctor or mental health professional. Exercise and physical activity are great ways to ease symptoms of depression or anxiety, but they aren't a substitute for talk therapy (psychotherapy) or medications.