Welcome to Advance Physical Therapy, Inc. Newsletter

Welcome to our April newsletter! Spring is already upon us and the sunny weather invites us to spend more time outdoors. With an increase in outdoor activities, we've seen a proportionate increase in the number of hip, knee, ankle and foot injuries related to activities such as hiking, cycling, soccer, running, cross-fit, baseball and football.

It's very frustrating when an injury sidelines an individual from returning back to an activity they love. There are several key factors that can minimize an athlete's exposure and risk to injury.

In this newsletter, we'll address the importance of movement screenings that helps athletes get back to the playing field more quickly and prevent further injury. We'll also highlight ACL injury prevention programs and the role of taping in rehabilitation.

To Your Health,

Advance Physical Therapy, Inc.

Movement Screenings for Athletes
Simple tests can get them back in the game.

Toe, ankle, knee, hamstring -- every week it seemed like there was another NFL player on the injured list. In October 2015, it was the Arizona Cardinals' Alex Okafor with a strained calf, and a season-ending blow to Baltimore Ravens wide receiver Steven Smith's knee. More recently, it was a combination of thumb and wrist injuries for Andy Dalton and A.J. McCarron, leaving the Cincinnati Bengals hurting for a quarterback.

Workouts and training continue year-round for serious athletes who want to maintain muscle, improve their performance, or make a full recovery after an injury. Physical therapists help get them there.

And it's not just the pros. An estimated 4.2 million men, women and youth played football in either a professional or amateur capacity as of 2012, according to the National Center for Catastrophic Sport Injury Research. Nearly one-tenth of them are treated in emergency departments every year nationwide, according to the U.S. Department of Health and Human Services.

Movement screenings help get these players and other athletes back on the field in time for the next fantasy football draft, or even the annual company flag football game. Typical football injuries include lower back and knee pain typically caused by overtraining, but often more serious are traumatic knee injuries, especially ones to the anterior or posterior cruciate ligament and to the menisci. 

These athletes are also more prone to ankle sprains as a result of field surfaces and the cutting motions used in defensive and offensive play.

In order to best treat a patient's persistent pain, a thorough movement analysis is required to determine the etiology of the symptoms. Included in the movement examination is the passive and active mobility of spinal segments, body mechanics, neural structures, and non-contractile tissues.

Teenage athletes are injured at about the same rate as professional athletes, but injuries that affect high school athletes are often different from those that affect adult athletes, according to the American Academy of Orthopedic Surgeons.movement screenings in athletes

Certain strength-building exercises aren't appropriate for young athletes because we need to take care not to stress their growth plate. As a result, teens can be more susceptible to muscle and tendon injuries.

A minor league baseball player with zero experience in weightlifting may be placed on the same movement and base-building program as a middle-school baseball player. Movement analysis is individual specific and understanding the integration of the whole musculoskeletal system, neural system and mechanical system is imperative to preventing injury and optimizing performance.

Physical therapists screen athletes by observing them while they perform a set of functional movements such as squats and leg raises, as well as walking and running.

Rating can be based on a zero-to-3 score. Each movement screen has scoring criteria and in general, zero = pain, unable to perform; 1 = unable to perform correctly with compensation; 2 = able to perform correctly with compensation; and 3 = able to perform correctly without compensation."

These scores help create a personalized fitness plan and can identify dangerous weaknesses a patient may have before injury occurs. Movement screenings can also establish a starting point for people who are not traditional athletes.

We had an adult who never mastered the motion of kicking a ball. In fact, he was always picked last in gym class early in life, and always wanted to excel at soccer, albeit never played once. In our movement analysis session, he was able to learn the coordination and the ability to step up, time it, balance, and kick a ball athletically. He then became the striker, or forward, on his volunteer league and scored the most goals all season.

This individual's progress was made possible by detecting underlying balance issues that would have gone unnoticed if it weren't for continual assessments.

Re-testing is done every 6-12 weeks. Through the proper, constant feedback and a home exercise program (HEP), the athlete hears the repetition required for learning and is able to integrate the new skill into the fabric of their own technique with constant coaching.

While the athlete is undergoing rehab, it's extremely important for them, their family, the team, and coaches to realize that they may not be able to return to the game at the same level, despite time and hard work put into recovery.

As physical therapists, we must continue to engage the patient in order for greatest efficacy, determining best practices and those that have not worked for the patient in the past. Educating the patient is also of the utmost importance, because that empowers the patient to become more independent and more importantly, prevent future re-injury.

As a result, the work of a physical therapist is a heavy weight to bear year-round. When it comes to working with athletes, we work very hard to manage their expectations. But they are, of course, incredibly eager to get back to their sport.

Most high-school players aspire to play on the collegiate level, and strive to earn scholarships in the process. Collegiate players are also trying to get back into the game so NFL scouts can see them and make steps to advance their career. Once the athletes go pro, physical therapists face pressures working with patients who rely on their physical ability to make money in a competitive industry.

Physical therapists must remain objective despite these stressors, and ultimately leave it to the screenings to determine whether an injured athlete should get back into the game.

So whether you are a professional athlete or a weekend warrior, we all strive to perform well and stay on the road of healthy living. If you have questions about movement screenings or experience impairments that hav affected your function, don't delay on getting a physical therapy assessment completed today.

Therapeutic Taping Is on a Roll 

Evidence-based modality becomes a sports medicine mainstay.

Elastic therapeutic tape is being employed on a variety of populations for a range of diagnoses, from correcting movement among children with developmental disabilities, to addressing gait mechanics post-stroke, to chronic pain relief through novel cutaneous input.

But the core patient population for rehabilitative taping remains the active population recovering from sports-related injuries. Post-surgery, joint instability, swelling and acute pain in the elbows, shoulders and back are common reasons that clinicians will reach for the tape.

Taping can assist to decrease pain and add stabilization to a joint while still allowing for  normal range of motion to occur.


Taping can be effectively used for ACL injury and post-surgical rehab, foot and ankle, rotator cuff injury and shoulder dislocations, chronic elbow pain and painful back syndromes. A typical patient might wear it for 3-5 days, and because we prioritize manual therapy in our treatment approach, we'll usually remove the tape for the therapy session and re-apply it at the end. As patients progress in rehab, the frequency of taping might decrease to one time per week as symptoms dictate.

therapeutic taping for sports medicine As clinicians, we take into consideration the patient's skin resistance, fear avoidance, and whether they might become reliant on it. While the research remains mixed on whether taping alters muscle function, there is stronger support for its role in joint support and pain resolution.



Sidestepping ACL Injuries
Evidence-based prevention techniques help keep athletes on their feet.

We've all seen it happen: The quarterback fades back for a pass, is tackled, and falls to the ground grasping at his knee. The soccer player extends her right leg, in full motion kicks the ball toward the goal, and quickly goes down on the field. The basketball forward reaches up and around the opposing team's players, stretching with ball in hand toward the net, is propelled forward, and lands on the court writhing in pain.

Alarming Numbers

Anterior cruciate ligament (ACL) injuries are common in athletes, costly, and potentially debilitating. It's estimated that 1 in every 3,000 persons injure their ACL and approximately 95,000 new ACL injuries occur each year.

Individuals who suffer an ACL injury and undergo surgical intervention face a lengthy rehabilitation process, ranging from 6 to 36 months. Unfortunately, surgical intervention does not ensure a return to previous activity, as roughly 75% of these individuals return to their previous activity levels.

Moderate-to-severe disability is also reported in individuals suffering from ACL injury during walking activities (31%), routine activities of daily living (44%), and sport activities (77%). Perhaps most alarming is that individuals suffering acute knee injury, such as ACL injury, are 7.4 times more likely to develop knee osteoarthritis as those individuals with no history of knee injury.

Ultimately, the disability associated with ACL injury may lead to reduced physical activity levels and loss of independence. In addition to disability, ACL injury places a large financial burden on the healthcare system, with healthcare costs reported to be as high at $2.5 billion annually. The frequency, disability and excessive cost associated with ACL injury make it a significant health concern.

The rate of ACL injury is greater in females than males, especially in younger individuals. Research indicates that females involved in recreational as well as organized physical activities injure their ACL at a rate of 2-5 times greater than males.

Some studies have reported an increased rate in females over 10 times greater than the male rate, but these are based on small numbers and should be regarded as tentative. The risk of ACL injury is greater in younger individuals (high school-age and college-age). Given the frequency, disability, cost, and higher rate of injury, it is necessary to develop interventions to reduce ACL injury rates, especially in younger females.

Preventive Training

Preventive training programs are effective at reducing ACL injury and overall knee injury risks. A recent systematic review with meta-analysis demonstrated an overall 62% reduction (males and females combined) in ACL injury risk when regularly performing a preventive training. When stratifying by sex, the reduction in ACL injury risk was 85% for males and 52% for females, thus indicating that both males and females benefit from preventive training programs.

Two more recent, high-quality studies demonstrate large reductions in ACL injury risk after implementing a preventive training program. Labella et al. reported a 73% reduction in ACL injury risk in female basketball and soccer athletes in the urban public high school setting.

Walden et al. observed a 64% overall reduction of ACL injuries across all athletes performing the program. The protective effect was even greater among those who were highly compliant with the program, as the risk of ACL injury was reduced by 83% in these individuals. These Level 1 studies indicate that the risk of ACL injury can be substantially reduced by 64-85% in young females participating in higher-risk sports (soccer, basketball, etc.).

Athletic trainers and other sports medicine team members, along with coaches, can be trained to successfully implement these programs that require approximately 15 minutes to complete during regular training sessions. The previously described studies provide education on how to properly perform the preventive training program during a single educational session. These sessions help with exercise selection, proper technique and execution, and the importance of consistently performing the program.

In this case, the coaches were then responsible for teaching their athletes the preventive training program and implementing on a regular basis. These findings suggest that individuals can be educated and trained to effectively implement a preventive training program in a single session, and ultimately largely reduce ACL injuries (64-85%).

There are several successful preventive training programs with regard to exercise selection as well as training intensity and frequency. Successful preventive training programs use an integrated approach to exercise selection by incorporating balance, plyometrics and agility, flexibility, strength, and technique training.


The following considerations should be taken when designing and implementing a preventive training program. Preventive training programs should take no more than 15 minutes in order to maximize compliance of athletes and coaches. Perform 2-3 times per week prior to training sessions over the course of the entire season.

Select exercises that are of appropriate intensity for those performing the preventive training program. Exercises should be challenging, but proper technique and movement quality should be maintained.

Research suggests that ACL tears and other traumatic knee injuries can be reduced by more than 50% by following these basic recommendations and regularly performing a preventive training program.

It's important to consult with a physical therapist for a thorough assessment in order to prescribe an appropriate preventive training program to minimize ACL injuries.

If we can answer any questions or field any topics of interest regarding  physical therapy, health and wellness or about our programs, please contact us. We'd love to hear from you.
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Research on the Role of Taping

Knee pain is one pathology cited by physical therapists as particularly responsive to this intervention. A 2014 study led by Scott Freedman, PT, PhD, assistant professor at Mount Saint Mary's College, published in the June 2015 issue of Sports Health, tracked 49 subjects with patellofemoral pain syndrome (PFPS), a condition contributing to an estimated 30% to 40% of all sports medicine visits, according to the authors.

In this non-randomized controlled trial, each subject underwent patellar kinesiology taping with both experimental and sham applications while completing four functional tasks and the single-leg triple jump test (STJT). Separate paired tests found step-up, step-down, and STJT pain improvement statistically significant between taping conditions. The analysis showed there was little change in STJT distance between repeated measures performed on the untaped, noninvolved leg. However, subjects' STJT distances were significantly greater for the experimental tape application than the sham application for the involved side.

Authors concluded that patellar kinesiology taping provided an immediate and statistically significant improvement in pain and single-leg hop function in patients with PFPS when compared with a sham application. However, improvement in STJT scores did not surpass the minimally detectable change value, and therefore, the clinical effectiveness of the modality for improving single-leg hop function was not established in this study.

Kinesiology tape thus provides a viable, short-term method to control pain, the authors found.

Meeting Demand

In the marketing and referral realms, offering therapeutic taping allows practices to separate themselves. Informed consumers taking an active role in their treatment, including those of the younger generation, will seek out practices that offer the latest in evidence-based interventions. Sports physicians seeking rapid resolution for their patients will prioritize practices that have several modalities at their disposal.

The therapists who spoke with ADVANCE point out that although the novelty of the method has somewhat subsided, physical therapists across specialties are continuing to research and employ it. And that could be the best endorsement for the evidence-based efficacy of therapeutic taping.

Things come and go in physical therapy and sports performance. Taping intervention is being adapted from its original uses to incorporate new populations and theories. As  clinicians, we have to look past the hype and examine the evidence, keep an open mind, use sound clinical reasoning and learn something new with each patient.

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