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Cold Truth About Ice Therapy

To convince my patients, fellow #SpartanRace athletes and friend that ice therapy works, I simply tell them: “Ice is your best friend”!

Ice is cheap, easy to use, mobile, effective and, most importantly, ice therapy works!  Its time we all stop complaining how “ice hurts” and “it makes me stiff”.  Sure it hurts and it requires some warmup after the 10-15 minutes of ice treatment.  But if ice therapy works, isn’t 4 minutes of discomfort (that’s how long it usually takes for the area of treatment to go numb) a mild sacrifice to feel better?

Smart athletes put pain medicine down and pick up ice to manage their pain.  Follow their lead.

As a Sports Medicine Expert for Spartan Race, I write posts for fellow Spartan racers and SGX coaches related to important sports medicine topics.  Recent posts include topics such as wrist injuries, injury prevention, rehabbing an ankle injury, injury management, and resolving low back pain.

Here’s a link to a recent post I wrote on Spartan.com to keep you “In the Game”!

Click Here For:  THE COLD TRUTH ABOUT ICE THERAPY

Keeping you healthy, happy and a helluva lot easier to live with, Mike

Measuring Your Fitness Program With Gratitude

iPhone 2010 312How does an athlete measure his/her success?

High profile athletes have coaches, fans and ESPN to judge their performance.  Runners and bikers have the clock to gauge the results of their hard work.  The athletes determined to lose weight have the dynamic-duo of the mirror and the weight scale to determine if their efforts were successful.

I recommend a different measuring tool: Gratitude, defined as “a feeling of thankfulness and appreciation”.

The Busy Life Dilemma

Today’s typical lifestyle is crazy hectic.  Personally, I work seven (7) days per week from mid-July until the end of the season in early January or February.  If I’m real lucky, I will get two (2) days off during the Bye Weekend if the injuries are low and I can properly stagger the off days with my amazing assistant athletic trainers.  That sounds insane to most people but that’s the way it is in the NFL as a certified athletic trainer and physical therapist.  This is my 26th full-time season in the NFL, 521 games, and I’m very comfortable with that schedule.

With that being said, it would be very easy to say “I’m too busy to workout”.  That is an absurd thing to say because it’s the crazy schedule that makes the need for a workout extremely important to me.  I need some “me time” to workout away from everyone asking for my help.  Be it just 45 minutes at 4:30 AM, that workout time is exactly what I need to strengthen my body and my mind to handle my daily duties.

Happy Heart, Great Start

Stress management isn’t too high on most people’s priority list these days and that’s a problem.  Taking care of your body, your mind, your attitude and your heart will change your life….and it may ultimately save your life in the process.

Reality Check

Have you ever had an injury that kept you out of your favorite sport?  Standing on the sidelines sucks.  Soon you found yourself saying: “Man if I could only (fill in the activities) again, I’d be thrilled!”

It was about 1:00 AM, January of 1984 and I was laying on my back in a dark parking lot in Hartford, CT with a dislocated ankle and fractured leg.  I was a 3:58 1500 meter runner getting ready to start my indoor track season at Central Connecticut State University but now I was in serious trouble and I was scared.  In an instant I knew my life had changed when I heard the loud crack and I realized that both my right knee and the back of my right heel were both facing in the same direction.  I remember looking down at my mangled leg and wondering if I’d ever run again.

I have to admit, I was burnt out from running at the time.  I was often running over 100 miles per week as I trained and raced on the collegiate cross country, indoor track and outdoor track teams while working in the CCSU Athletic Training Room at least 20 hours per week along with a full class room schedule so I could graduate in 4 years.

Two surgeries later and with a very aggressive rehab plan, I was ready to try to run again.  It was exactly 10 weeks to the day of my accident.  I put my books down, limped down the bleachers where I was studying and walked onto the track.  I ran 1 lap, 400 meters, with a huge smile on my face.  It was March 13, 1984 and I was a runner again!

That accident was what I needed to truly feel grateful to be the athlete that I was then and what I am today.  It shouldn’t take a devastating loss of a physical ability or a blessing or a life to make us appreciate what we have.  Being grateful is my measuring tool and my “reality meter” for everything in my life.  I get on my knees every night to give thanks to God for what I have because I’m very grateful for what I have today and I know that tomorrow is never guaranteed.

Being Grateful…Now

NOW is the best time to appreciate your health.  Like everything else in your life, investing time and effort into your body and will reward you richly.  Stop taking your health for granted before you find yourself with an injury or ailment that puts you on the sideline watching others doing what you love to do.

The time to enhance your fitness is NOW.  It will test your patience so focus on getting better every day and celebrate your accomplishments along the way with passion.  There’s a new YOU out there and it all starts with you being grateful today while you work on being better tomorrow.

Foot Orthotics – Are They Worth the $?

I’m often asked about orthotics and the questions usually involve two basic issues:

     1.  Do orthotics really work?

     2. Why are orthotics so expensive?

I find it ironic that most people asking these questions own orthotics.  If they are wearing orthotics and they have to ask if they work, it must mean the orthotics are not doing their job.  No one seems to ask such questions about contact lenses or glasses.  If they’re wearing contacts and they question their effectiveness, the contacts probably aren’t the right lenses for that person.

Orthotics are no different.

As for the price, in many cases I think orthotics are grossly over-priced.  Sure there is tons of science and detail installed into a properly fitted pair of orthotics but there is little reason why someone needs to charged $600 for any shoe insert that isn’t covered in gold and diamonds!

I’m a fan of orthotics if fitted properly….for the right reasons and for the right price.  Approximately 40% of my athletes presently wear orthotics.  I owe a great deal of my knowledge about the lower kinetic chain and orthotics to David Tiberio, professor and friend from one of my alma maters, the University of Connecticut.  He’s a brilliant physical therapist and I appreciate him sharing his amazing insight with me over the past 25+ years.

What is an orthotic?

An orthotic is a specifically designed shoe insert which is custom-made to correct a biomechanical abnormality by correcting the poor alignment and enhancing the body’s ability to move.

How Do Orthotics Work?

As I tell my pro football players: “Orthotics bring the ground up to the foot.”  The foot is the base of support of the entire body and it starts the movement pattern when the foot is in contact with the ground during standing, walking or running.

If you were to put a smaller wheel on the front left side of your car, the car will still be driveable and get you to where you want to go.  It will be slower, it will be harder to drive, other parts of the car will be stressed more, the other tires will wear-out faster and the appearance of your car will change.  Poor foot alignment is no different.

To get that car alignment corrected without changing the tire, it can be done two ways.  1.  The car can be driven without the front left tire ever touching the road – not likely to happen or  2. The road can be brought up to the tire as if that tire was now riding on the curb.  This is a simple example of how an orthotic functions.

The Benefits of Orthotics

There are many reasons why orthotics are used.  Those reasons include leg length discrepancy, plantar fasciitis, heel pain, ankle sprains, tendonitis, arch pain, shin splints, foot pain, stress fractures, low back pain, muscle pain/injury, neuromas, bursitis, and sciatica. The influence of an orthotic, as with the base of support of any structure, can reach from the bottom to the top of that structure.

There is much discussion related to the best manner to create the orthotic and it goes well beyond the scope of this sports medicine blog posting.  Weight bearing status, casting, laser, standing, sitting, laying prone, hard orthotics, half-length, orthotic material, where to stabilize the arch,…etc. are just some of the factors related to orthotics.

The Truth About “Perfect Alignment”

The mechanics of the human body are amazing and a big reason why I love doing what I do as an athletic trainer and physical therapist in the NFL.  Every joint in the body has a three-dimensional movement pattern.  Unlike the hinges on your door that moves in only one plane of motion, the human body joints have what is called accessory movements.  These are subtle movements of a joint are necessary for full range of motions to occur.

I like to restore “proper alignment” because there is no such thing as “perfect alignment”.  This normal three-dimensional movement means that an orthotic must bring the ground up to the foot to allow for this normal movement pattern to happen naturally.  In other words, orthotics allow the body to do its job by moving naturally without pain.

I tell my players that the only time they will have bilateral symmetry on the football field is during the National Anthem.  It’s true.  Think about it: the field is never level and they are always changing direction throughout the game.

The A Factor

As for the athletes (A) themselves, one leg is usually longer than the other, injuries change joint motions over the years, flexibilities vary from side to side, the wear pattern of the shoe alters the mechanics of the foot, muscle weakness alters the running sequence and their joint laxity/arthritis changes how that athlete moves.

In other words, the athlete himself isn’t moving the same on both sides of the body.  With this being said, the theory of an orthotic is to help balance the manner in which an athlete moves on both sides of their body.

Back to Orthotics….

Now that we got all the kinesiology and body mechanics out-of-the-way, let’s get back to the orthotics themselves.  I emphasize to my athletes that a properly fitted pair of orthotics should fit like your favorite pair of blue jeans.  They “just fit right”.  No two pair of favorite jeans are the same.  The same is true for orthotics.  A well-fitted orthotic should have no hot spots, no pressure points, no uneasy feeling when they are worn and the athlete should almost forget that they are there.

Think about it this way:  if your orthotics are doing their job properly, the foot and the entire body above it is positioned to do its job.  Those previously noted movements can now happen with ease.  It’s like tucking that napkin under the leg of the wobbly table.  Now the table is both level and stable to do its job of being a table.

Getting the proper orthotic to meet your needs is the key.  The most important factor related to the orthotic is what YOU, the athlete, feel and think.  Speak up and give your medical team the necessary feedback to adjust your orthotics so they “just fit right”.  Don’t forget that it’s your feet and your money!

 

What I Learned in (Training) Camp This Summer

How Ending the NFL Lockout Changed My Perspective on Sports Medicine

Tonight is the first pre-season game of the awoken 2011 NFL season and no one is more excited than yours truly.  The 120+ day NFL lockout stressed the fans, the players, the team owners and the team support staff members like me.

Unable to treat and care for our Jaguars’ players was a strange position for me as I enter my 24th season employed as an athletic trainer and physical therapist in the NFL.

The players have returned to work approximately 3 weeks ago and resumed their sports medicine treatments with my staff and me.  During these two weeks of training camp I’ve learned many valuable lessons.  These lessons have made me a better therapist and will help me improve the quality of the care that I provide for my followers of MikeRyanFitness.com.

My Learning Points:

#1 – Preventative Care Does More Than Prevent Injuries

Most players will tell you that this lockout made it much more difficult to take care of their injuries.  Typically NFL medical staffs address almost all of their rehabilitation needs twelve month a year.  Peyton Manning stressed that point by saying: “…you can’t use your athletic training room and can’t use your athletic trainer” during the lockout and it slowed his recovery from his neck injury.

Elite sports medicine care enhances performance while significantly reducing injuries in athletes, young and old.

#2 – Knee Pain Doesn’t Care How Old You Are

Knee injuries are a big deal in the NFL.  When our players returned and I was able to assess their medical status after 4 months away, it was interesting to see the changes in knee symptoms.

It showed me knee pain in athletes at any age can be controlled effectively when it is addressed on a consistent basis.  Improving joint range of motion, enhancing lower extremity soft tissue mobility and utilizing the proper combination of ice/heat can reduce knee pain for any and all athletes.

#3 – Roller Are Here to Stay

The players that used rollers had better flexibility and less pain then those that didn’t use them.  It was that simple.

Rollers can be used on any part of the body.  It is an easy way to improve the body’s ability to reduce pain and allow muscles to do their job.  I use them on a daily basis with my athletes and myself.  Today’s smart athletes include soft tissue rollers as a valuable tool to stay healthy.

#4 – Fitness is Not a Passive Process

Some players came back in great shape while others didn’t make fitness a high priority.  A normal off-season program provides a well-structured and organized fitness plan for our players.  There is great value in having such a plan for an athlete.

Fitness, even for a young professional football player, just doesn’t “happen”.  In other words, fitness needs to be an active process and the more time spent working on it the greater the yield.

#5 – Flexibility Never Comes Easy

One key point consistently echoed by my players since they returned after the lockout is that they missed having certified athletic trainers available to keep them loose and flexible.  Specific massages, soft tissue treatments and stretching techniques, normally provided to our the players every day, helps to keep their joints loose and flexible.  Without access to these treatments, most of the players returned with worse flexibility than normal.

This point became obvious to me when I looked at my body.  To improve flexibility it takes a consistent effort.  Not necessarily a large amount of time but consistency is the important element to increase the painfree motion of an athlete’s joints and muscles at any age.

Back Where it All Began

Football gets started tonight for me and the Jacksonville Jaguars tonight right where my dream of becoming a NFL athletic trainer and physical therapist began: Foxboro, Massachusetts. Born 30 minutes north of the stadium, I was the wide-eyed kid in the bleacher seat of Schaefer Stadium with my Red Sox hat on screaming for the Patriots.

These past 4 months have made me realize how important the NFL is to me and how blessed I am to be living my childhood dream.  As for that Sox hat, I still have it.  As for my NFL alliance, it’s no longer the Pats.  Nothing personal….

How to Get a Massage with a Happy Ending Every Time!

Come on, who doesn’t love a great massage with a happy ending?!

I can see you smiling now just thinking of that satisfied feeling at the end of a massage with all the worries of the world and the aches and pains of a long week gone. Whether it’s a caring shoulder rub after a hard day at work or a therapeutic sports massage before a big game, the results are almost always positive.

Have you ever wondered why massage is so beneficial to the body and mind?  I have and my “research” on the benefits of sports massage continues to this very day. In other words, I receive massages on a regular basis. As a physical therapist and athletic trainer who works with elite athletes, I almost always incorporate some type of massage therapy into my athlete’s rehabilitation protocols.

Think of the different types of massages you’ve received. Have you ever been given a massage that was so rough that it made you feel sore and achy for days? Or maybe you’ve been the recipient of a massage that so light and easy that you found it to be a waste of time? I have been through both of these scenarios and it taught me a very valuable lesson.

In order to optimize the benefits and positive results of my sports medicine massage, I suggest that you clearly determine the objectives of your massage beforehand.

Determine the objectives of your massage

Here are the four simple questions you and your massage therapist need to answer before your treatment.

  1. What areas of my body am I interested in treating?
  2. What are my symptoms and limitations in these areas?
  3. What is my desired outcome of this massage and how do I want it to improve my symptoms?
  4. What types of massage techniques will be used and what can I expect to feel during this massage?

Identifying the answers to these questions will help get you and your health care professional to be on the same page and significantly enhance the positive results of your massage.

Types of Massage

Here are some of the most popular types of massage used in the field of sports medicine:

  • Sports Massage
  • Swedish Massage
  • Deep Friction Massage
  • Trigger Point Therapy
  • Neuromuscular Therapy
  • Hot Stone Massage
  • Reflexology

Benefits of Massage

Massage has been around for thousands of years and has become an important healing tool in many cultures for good reason.

The benefits of massage and its ability to heal various ailments are well documented. Human touch is a natural healer. It offers support and conveys compassion as it soothes away aching muscles, eases pain and relieves stress. In fact, medical experts estimate that up to 90% percent of all disease is stress-related, regardless of your age.

Healers from all around the world have created and applied countless types of therapeutic techniques utilizing touch. Today, modern medicine has scientifically proven and continues to support the many benefits of massage, which include but are not limited to:

  • Increased muscle and join flexibility immune system
  • Improved immune system
  • Reduced emotional stress
  • Relaxing muscular and spine tension
  • Improved circulation
  • Increased endorphin production to reduce pain
  • Enhancing a general sense of well-being
  • Decreased blood pressure
  • Reduced depression and anxiety

The Happy Ending?

Massage therapy does more than just relax your body and mind. It can actually affect your physiological (body chemistry) and psychological (mind related) state of being.

By utilizing massage therapy in both your injury prevention and rehabilitation plans, you’ll get the best “happy ending” by accelerating your return to being active and enjoy a healthy lifestyle!

 

Knee Therapy: Sports’ Best Kept Secret

One of the most common questions that I’m asked is:  “With a sports-related injury, when do I use ice and when should I apply heat?”

ICE THERAPY the best kept secret in sports medicine, period!

All the fancy machines and cool rehab techniques may get all the hype.  But if you ask the elite athletes with a knee injury what helps them maintain their body and assist their recovery the most, they will tell you that some form of ice therapy is vital.

Personally, my best training partners when it comes to athletic injuries is ice therapy.  I often use ice to help me control soft tissue pain and supercharge my recovery.

Knee Surgery Recovery is Enhanced With Ice

Recovering from any type of knee surgery is not easy.  Unless you have the unique skill of a gymnast, you won’t be able to walk around on your hands all day.  With the painful and lengthy rehab work that needs to be done with most knee injuries, you’re creating additional swelling and pain in the joint on a daily basis.  Knee surgery recovery starts with pain control to allow you to increase your range of motion (ROM), increase your strength and to restore your function.  Ice therapy is the trick to making that happen as soon as you wake up from your surgery.

It’s not a coincidence most successful knee orthopedic surgeons apply a cold therapy device to their patient’s knees before they even leave the operating room!  What does that tell you?

Injury prevention is an important motivator for me as the founder of this website and I’m sure it is the same for you.  Ice therapy should become a part of your injury prevention plan.

There are many myths and questions in the battle of ice versus heat…so today I am going to shed some light on the truth about ice.  I’ll discuss the benefits of heat therapy in upcoming blog writings.

How to Use Ice in Knee Therapy

Three Benefits of Ice

  1. It’s a lot easier to keep a joint from swelling than it is to reduce the swelling of an inflamed injury.
  2. Icing will quickly relieve knee pain by blocking pain receptors’ feedback to the brain.
  3. Ice will significantly minimize the likelihood that the injury will swell which can actually reduce your recovery time by 50%!

How Does Your Knee Respond to Ice?

  • It decreases inflammation.
  • It moderately reduces circulation to an area which will drastically decrease the rate of tissue swelling. (In contrast, applying heat to an acute injury is like turning on a drippy faucet.  It speeds up blood flow which can quickly INCREASE tissue swelling.)
  • It slows down the metabolism of the injury site which will reduce the body’s normal inflammatory process.
  • It decreases pain.

How Should I Include Ice in my Knee Therapy?

  • Ice the injury and the surrounding tissue, not just at the site of the injury.  For example, if your injury is on the right side of your knee, ice all the way around the knee instead of just on the injured side.
  • Try to ice the knee injury while elevating the body part.
  • Ideally ice with compression.

Methods of icing:

  • Submerge in ice water – the most aggressive and effective way to ice.
  • Ice Bags
  • Ice Massage
  • Frozen Vegetables

How Long Should I Ice My Knee?

  • Ice Massage – 10 minutes
  • Ice Bath, Ice Bag/Veggies – 15 minutes

Ice Massage Made Easy:

Fill a paper cup almost to the top with water and place in the freezer.  Once frozen, peel away most of the cup and massage with the exposed ice.

Common myths about icing

  • “Ice hurts.” Toughen up!  It’s not going to kill you.  Besides, you’ll get used to it.  To minimize your pain when icing the entire leg, keep the distal extremity being iced warm.  One way to do this is to put a rubber glove or bag over the toes when submerging the body part in ice.
  • “I might get frostbite.” The likelihood of frostbite is pretty rare–especially when you are only icing for 15 minutes or less.  However, if you have a circulatory pathology like diabetes or are being medically treated for chronically swollen extremities, consult your doctor before implementing this type of ice therapy.
  • “It’s been more than 72 hours since my injury, so it’s time to switch to heat?” If the injured area feels warm, it needs ice, regardless of the time frame.  So if the injury site feels warm and inflamed, apply ice, even if it’s been more than 72 hours.

The bottom line is simple:  If you want to stay active and continue to challenge yourself as an athlete, ICE THERAPY needs be included in your knee therapy plan.  If you’re pondering the eternal question: “To use ice or heat?”  ICE is always the safe selection.

How To Recognize And Treat Achilles Tendon Ruptures

Achilles Rupture

Your Achilles tendon is a strong tendon in your body.  It connects the calf muscles (made up of the gastrocnemius and soleus) located in the back of the lower leg to the back of the heel. The Achilles tendon can partially tear or completely rupture. It is more common for individuals over the age of 35 to suffer a complete rupture of their Achilles tendon than a younger athlete.

Achilles tendon ruptures are frequently associated with a previous history of a prolonged inflammatory condition.  Significant Achilles tendon injuries are commonly the result of an aggressive acceleration movement using the lower leg and/or rapid change of direction activities.

Signs & Symptoms of an Achilles Tendon Rupture

  • A sudden sharp pain as if something hit you in the back of the leg.
  • A sudden snapping sound accompanied by an intense but short-lived pain.
  • The inability to push your foot downward or raise yourself up on your toes while walking.
  • The presence of a divot or gap felt along the usual location of the tendon.
  • A significant amount of swelling and surprisingly, minimal pain, in the back of the lower leg.
  • A positive result for Thompson’s test.

How to Treat a Torn Achilles Tendon

  • Apply ice to the area with an ice bag, ice massage or, ideally, an ice bucket.
  • Avoid walking on the ankle.  Until the severity of the injury is determined, walking on this injury may result in additional damage which can significantly prolong the recovery time.
  • Elevation of the ankle and lower leg will limit the swelling and decrease the pain.
  • Seek sports medicine consultation immediately. Confirming the diagnosis early is very important.

Questions to Ask About Your Torn Achilles Tendon

Even if you’re not a professional athlete, your goal should be to treat your torn Achilles tendon both safely and efficiently. To emulate the smart professional athlete with an Achilles tendon injury who wants to safely return to his/her sport, ask your sports medicine specialist the following questions:

  1. Are you certain of the diagnosis and do we need to do an MRI to determine the extent of the injury?
  2. What are my options with a conservative (without surgery) rehab plan and with a surgical approach?
  3. With both options, what can I expect for the next 3, 6 and 9 months?
  4. If your son or daughter where in my situation and had the exact same injury as I do, what would you recommend them to do?
  5. If surgery is my best option, how many of these types of surgeries do you do per year?  Who do you consider to be the expert Achilles surgeon in this area?
  6. Who do you consider to be the expert Achilles rehab specialist in this area?
  7. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Elite Sports Medicine Tips You Can Apply to Recover More Quickly

  • Know what you’re dealing with – To quickly get a clear diagnosis and plan, it’s better to have this type of an injury evaluated by an orthopedically-oriented medical specialist compared to a general medical professional.
  • Start treating it early – There are many factors such as walking boots, surgery and early weight bearing plans that must be addressed within the first couple of days after an injury if a full recovery is expected.
  • Know Your Plan for Today & Tomorrow – Be realistic about your activity plans for both your short term and the long term.  Being on crutches for a month or two is never ideal for anyone but if in doing so it considerably improves the likelihood that you will be a happy and active athlete for the rest of your life, DO IT!
  • Think like a Pro – Most high-level athletes with a complete Achilles tendon rupture decide to have their tendon surgically repaired.  The outcome is usually better than the conservative approach, which usually takes longer to heal along with a slower rehabilitation schedule.
  • Expect a Marathon Recuperation Period– The recovery time is considerable for this type of an injury.  Generally speaking, with a surgical repair the recovery time is approximately 6 months.  With the conservative or non-surgical approach, the recovery time is usually closer to 9 months.